As the coronavirus spread across the United States, sweeping through low-income, densely populated communities, black and Hispanic patients have been dying at higher rates than white patients.
Crowded living conditions, poorer overall health and limited access to care have been blamed, among other factors. But a new study suggests that the disparity is particularly acute for black patients.
Among those seeking medical care for Covid-19, the illness caused by the coronavirus, black patients were hospitalized at nearly three times the rate of white and Hispanic patients, according to an analysis of patient records from a large health care system in Northern California.
The disparity remained even after researchers took into account differences in age, sex, income and the prevalence of chronic health problems that exacerbate Covid-19, like hypertension and Type 2 diabetes.
The finding suggests that black patients may have had limited access to medical care or that they postponed seeking help until later in the course of their illness, when the disease was more advanced.
Black patients were also far less likely than white, Hispanic or Asian patients to have been tested for the virus before going to the emergency room for care.
Black patients “are coming to us later and sicker, and they’re accessing our care through the emergency department and acute care environment,” said Dr. Stephen H. Lockhart, the chief medical officer at Sutter Health in Sacramento and one of the authors of the new study.
The study, which was peer reviewed, was published in Health Affairs.
Delayed care may give the virus more time to spread through households and neighborhoods, Dr. Lockhart and his colleagues concluded. The delays also suggest that minority patients continue to face barriers despite California’s broad expansion of health insurance under the Affordable Care Act.
“How soon you access care, even supportive care, affects how you experience illness and how much pain and suffering you have,” said Kristen M.J. Azar, a research scientist at Sutter Health who was the study’s lead author.
She added, “While we don’t necessarily have treatments at this point, there are therapies being developed, and identifying people early on as these treatments become available will be important in order to prevent poor outcomes, like death and being put on ventilators.”
Dr. Clyde W. Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine, said the granular study of patient records bolstered cruder public health reports of higher Covid-19 death rates among black Americans.
The data confirm that socioeconomic factors play an outsize role in influencing health status and vulnerability to infection, he added.
“Where and how we live contributes greatly to our health,” said Dr. Yancy, who has written about health disparities and the pandemic.
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The new study analyzed the electronic health records of 1,052 confirmed Covid-19 patients who sought care between Jan. 1 and April 8 at Sutter Health, a health system serving 3.5 million patients in Northern California.
The Coronavirus Outbreak
Frequently Asked Questions and Advice
Updated May 20, 2020
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How many people have lost their jobs due to coronavirus in the U.S.?
Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Is ‘Covid toe’ a symptom of the disease?
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
More than half of the 61 black patients who tested positive for the coronavirus were admitted to hospitals, compared with about one-quarter or fewer of the Hispanic, white and Asian patients who tested positive.
Black patients were also more likely than the others to be so sick that they required treatment in an intensive care unit.
Even after the investigators factored out a number of differences between patient groups, black patients were still 2.7 times more likely than others to require hospitalization when they sought care.
“The important thing we found in this study is that even when we were accounting for all those things, race mattered,” Dr. Lockhart said. “That’s a message that’s incredibly important as we think about going forward.”
The study was too small to detect differences in death rates among the patient groups, the authors said. In California as a whole, however, black residents are bearing a disproportionate burden of Covid-19 deaths.
Black residents make up 6 percent of the state’s population and roughly the same percentage of the state’s Covid-19 cases. But black patients represented 10.3 percent of Covid-19-related deaths as of May 13, according to the California Department of Public Health.
One limitation of the study was that researchers did not make adjustments for obesity. Rates of obesity are somewhat higher among black people, and obesity has emerged as a risk factor in patients with more severe complications from Covid-19.