Each week, there are endless stories about people of color being disproportionately infected with COVID-19. Far too many African Americans, Hispanics, and Native Americans of all ages and backgrounds have succumbed to the virus—deaths that, in many instances, could have been avoided had these patients been treated earlier, or treated at all.
The reasons why communities of color are most at-risk from COVID-19 are varied, ranging from deep-seated structural inequities in access to health care, to racism and bias in the health care industry itself. It’s true that the virus doesn’t discriminate. But we, its host, do. Our policies and practices, in effect, steer the virus toward our most vulnerable communities, and we then fail to protect and treat those communities before it’s too late.
As we begin to flatten the curve and gradually ease physical distancing restrictions, there is near universal agreement among experts that the only way to safely re-open is through both robust testing (upwards of 20 million tests a day, by some estimates) and a mass mobilization of contact tracing (performed by perhaps as many as 250,000 new workers). Our testing and tracing regime must prioritize vulnerable populations, lest we risk repeating the same mistakes that have allowed communities of color to become infected with and die from COVID-19 at alarmingly high rates.
First, we need to dramatically increase the number of tests available. The Trump administration continues to falsely claim that testing practices have been adequate. The truth is that we need tens of millions of more tests—especially for frontline workers who are already putting their lives on the line, often without sufficient safety protections in place.
Second, we must recognize that the populations most vulnerable to COVID-19 also experience significant barriers to testing. Data show that African Americans are less likely than white Americans to receive a COVID-19 test, even when both present with the same symptoms. Native American tribes face shortages in tests, or no tests at all, which is compounded by inadequate access to basic necessities such as running water. The inaccessibility of testing is also a major problem for Hispanics. And, once people in these communities are diagnosed, they are more likely to become seriously ill from COVID-19.
Behind each statistic is a story, a human face with a family and loved ones. Rana Zoe Mungin, a beloved African-American teacher from Brooklyn, was denied COVID-19 testing three times, despite showing symptoms. Zoe succumbed to the virus on April 27. Sergio Rodriguez, an employee of a JBS meatpacking plant in Denver, showed up seriously ill to his health care provider with likely COVID-19 symptoms, but was told he couldn’t get tested. He ended up in an emergency room after his condition worsened and was only then admitted for a COVID-19 infection.
The barriers that Rana Zoe and Sergio—and countless others—faced are likely to remain even as we increase the availability of tests. Research shows that where a person lives has important implications for the quality of health care that they receive. Geographic access to primary care physicians is lower for majority African-American zip codes. Lower-quality health facilities tend to be concentrated in neighborhoods where the majority of people of color live, and rural populations still experience major challenges with accessing health care.
Residential segregation, combined with discrimination based on race and ethnicity, means that whiter, richer communities have easy access to tests, while people of color go without them. Without addressing these barriers as we ramp up testing, we’ll end up with “testing deserts” across the country.
How do we overcome these barriers? In the short term, it starts with ensuring equitable access to both testing and treatment. As I outline in a recent report for The Century Foundation, this includes steps like eliminating cost-sharing for COVID-19 services and providing free treatment for uninsured individuals through the National Medical Disaster System or Medicaid. We should also prohibit balance billing for COVID-19 treatment, implement an ACA special enrollment period, incentivize Medicaid expansion in the states, and require the CDC to collect and report demographic data on testing practices.
The House-passed HEROES Act accomplishes many of these goals. The bill allocates $75 billion for testing, contact tracing, and other activities, and it requires the Department of Health and Human Services to implement a national strategic testing plan with specific guidelines to ensure the availability of tests for at-risk populations and underserved communities, as well as mechanisms for reporting testing demographic data. But more will need to be done, including greater financial support to hospitals and providers in high-need areas.
Longer term, policymakers should implement concrete solutions for universal health care coverage. With millions of people losing their employer-sponsored insurance due to the pandemic, the need for public health insurance, whether through Medicare-for-All or a public option, has never been clearer or more urgent.
We can’t bring back all those that have needlessly and tragically died in recent months from COVID-19. But we can ensure that those deaths are minimized and avoided going forward. We can listen to people of color, and take them seriously when they express pain or discomfort to health care providers. We can make it so that money is never a barrier to seeking care. And we can make testing not only widely available, but accessible to all communities, equally.
header photo: Sevonna Brown of Black Women’s Blueprint , a mutual aid group, looks at her son, Panther Herd, 2, in the Bedford-Stuyvesant neighborhood in the Brooklyn borough in New York City.