A piece at the Associated Press underscores a point I have been making for some time:
As many as 215,000 more people than usual died in the U.S. during the first seven months of 2020, suggesting that the number of lives lost to the coronavirus is significantly higher than the official toll. And half the dead were people of color — Blacks, Hispanics, Native Americans and, to a marked degree unrecognized until now, Asian Americans.
The new figures from the Centers for Disease Control and Prevention highlight a stark disparity: Deaths among minorities during the crisis have risen far more than they have among whites.
There is conflicting evidence as to whether the disparity is due to access to health care or some other factor that could broadly be described as racism. A recent JAMA study suggests that’s entirely the explanation; a study from NBER suggests that the disparity is robust even when you control for age, education, income, and occupation.
In the past I have offered one hypothesis: could it be due to Vitamin D deficiency? Here’s another. According to the Census Bureau the prevalence of multi-generational households among Asians, Native Americans, blacks, and Hispanics is nearly twice that among whites:
The percentage of family households that were multigenerational ranged from 3.7 percent for non-Hispanic White alone households to 13.0 percent for Native Hawaiian and Pacific Islanders. Over 10 percent of Hispanic and American Indian and Alaska Native (AIAN) households were multigenerational, while over 9 percent of Black and Asian households were multigenerational. About 8 percent of households with a multiracial householder were multigenerational.
That could potentially account for the disparity. I would not rejoice if my hypothesis proved true because it’s less susceptible to mitigation than other possibilities (like Vitamin D) might be.
Regardless of the reasons for the discrepancy you deal with a pandemic with the population you have. It may be no coincidence that the prevalence and mortality due to COVID-19 in the U. S. is increasingly coming to resemble that in Brazil or Mexico, countries we are increasingly coming to resemble, than it is that in Germany. As I have noted in the past, outside of New York and New Jersey and a few other Northeastern states, prevalence and mortality among whites in the United States is not unlike that in Germany.
To be very clear I’m trying to make multiple points here. First, the vacuity of present policy and practice. Even the esteemed Dr. Fauci was recently photographed wearing a mask in the outdoors on the pitchers mound but not wearing one in the stands with friends. It should have been the opposite. Other than in a few crowded downtown areas the risk of contracting COVID-19 outdoors is slight; you’re much more likely to catch it at home. Nonetheless decrees are being issued for wearing masks outside while the greater risk is being ignored. And young people demonstrating (or rioting) in the streets create higher risks when they live in multi-generational households. That needs to be called out rather than wrapping ourselves in the flag, boldly proclaiming free speech rights.
The other point is this. We need to devote resources where they’re needed most and it’s increasingly clear that more resources need to be devoted to black, Hispanic, and Native American communities. Why aren’t the states addressing this? That isn’t all or even mostly the responsibility of the federal government.
All those points are worthy of consideration. However, one attribute not mentioned is how diabetes and obesity fit into those stats of people who appear more vulnerable to dying from COVID. Do black and brown demographics have larger percentages of diabetes and obesity than whites do? Are the diets of different ethnicities significantly different from each other to account for such physical health disparities?
Again, obesity is always in the mix when discussing lethal co-morbidities involved with this virus. Ironically, though, when you combine our shelter-in-place policing policies, closing of gyms and work-out centers producing what is being called “COVID 15†– packing on an extra 15 pounds because of couch-lounging – with mandates to gather for months indoors together, aren’t we actually being counterproductive in our pressing desire to curb this virus?
Obesity among Mexican-Americans is closely correlated with obesity among Mexicans in Mexico. Attributing it to the racism of American whites would be a stretch.
I’m only attributing obesity as seemingly more prevalent among Mexican/Americans and AAs, which, in turn, is a factor that comes up repeatedly as a relevant co-morbidity when discussing COVID deaths. Racism? I don’t know where that linkage came from.
Excess deaths attributed to COVID are about the same in Europe and the U.S. Looking at the COVID-19 Projections: Western Europe: 174,861 deaths per 320M people vs. U.S.: 175,360 deaths per 330M people. (Western Europe defined as Italy, Austria, Germany, Sweden and Europe to their west)
There is a possibility by my defining an entity called Western Europe, what it really looks like is that Europe has very similar outcomes to the United States, with more internal differences within each than they differ from each other (i.e., Belgium vs. Norway: New York vs. West Virginia). But I don’t think there many Native Americans in Amsterdam, so I’m not sure whether a lot of the racial issues that stand-out are simply about New York, and not about the U.S.
This should answer your question, PD.
Deaths of blacks per 100K population due to COVID-19 in Michigan are five times higher than those for whites, in Louisiana three times higher, in Illinois, Pennsylvania, Iowa, and Missouri four times higher. the white population-adjusted deaths in Missouri due to COVID-19 are about the same as in Germany.
France would be an interesting comparison (it has a substantial black population) but the law prohibits France from keeping statistics by race.
As has been commented upon here numerous times, the reasons will be many, and some unknow right now. I’ll wager that obesity/diabetes and multi-generational living circumstances will be two of the top three in the analyses to come down the road.
BTW – given the well publicized biased and error rate in reporting COVID deaths I discount any figures by a third.
I agree with Drew in being skeptical about the accuracy of COVID’s death count. People coming into the hospital for anything, who die of anything, but test positive for COVID are counted in those COVID death stats. So, IMO, there is a high over-counting in those stats, an observation made by Dr. Birx months ago, claiming she did not trust the CDC’s numbers, thinking they could by off by “over 25%.â€
As for the 215,000 higher death number than normal, I would attribute that more to the deferral of health care treatment ( a million plus surgeries put on hold, along with health screenings and procedures), and a general amplification of stress from loneliness and negative emotional side effects from this unnaturally long lockdown – not related to a COVID undercount.
After this is all over the COVID- related death count will truly be shocking!
Over 10 percent of Hispanic and American Indian and Alaska Native (AIAN) households were multigenerational,
That surprises me. My experience is that housing is always in short supply among NA’s as are living parents. Children are everywhere and Elderly NA’s are rare, and none are without a house full, unless they are in nursing homes.
“BTW – given the well publicized biased and error rate in reporting COVID deaths I discount any figures by a third.”
In right wing conspiracy world this is true. Not in reality.
It is difficult to know exactly to what ascribe the extra excess deaths. We do have some other experiences to draw from. When California had a strike by physicians there was actually a drop in deaths. Both then and now emergency services remained available, but there was a big drop off in elective procedures and a delay in some urgent procedures. There is morbidity and mortality associated with essentially all elective and urgent procedures, though generally not as high as with emergencies. So you could expect deaths to decrease with the cessation of elective procedures.
Absent a study it will be hard to know the balance of people who didnt come for emergency care who should have vs the expected decrease from not doing elective and urgent procedures. The other part to remember is that Covid attacks more than the respiratory syndrome. One of the major additions to treatment which has decreased mortality and morbidity many of us think was the addition of anticoagulants. Our rate of emergency cases in the IR suite has greatly increased since Covid. I dont think that death from stroke, PE or MI would have been thought of as related to Covid for quite a while.
In qualified support of steve’s position, I’m ready to attribute a large part of the actuarial “excess deaths” to COVID-19, especially when they’re associated with symptoms of the disease. Doing otherwise runs against Occam’s Razor. I wouldn’t attribute the increased homicide and suicide rate since February 2020 to COVID-19.
I forgot to respond to a staterment of jan’s that a lot of people ignorant of health care would not understand.
” ( a million plus surgeries put on hold, along with health screenings and procedures),”
There is a mortality rate associated with every surgery and some procedures. So take colon cancer as an example. If your goal in life was to make sure you lived one more week and you had colon cancer you would avoid surgery. If your goal was to live as long as possible you would probably want to have the surgery. Every year people forget to follow their npo guidelines for their colonoscopies and upper endoscopies then aspirate and die. (Yes, people really do lie about it.)
Steve