As the Trump administration pushes aggressively for states to end shutdowns—and as states like Georgia, Florida and Texas ignore White House recommendations for safely reopening their economies—experts continue to call on the federal government to put robust testing protocols in place.
As they made clear in testimony before Congress, testing is not merely important to diagnose those who might spread the coronavirus or develop COVID-19, but when deployed more broadly, it can save lives. Yet, at least three months after the pandemic reached the shores of the United States, widespread testing is still not in place. And the resources that have been allocated appear not to benefit people of color equitably, which raises an important question: will Black and Latinx people be steamrolled in the name of economic progress yet again?
A Man-Made Medical Crisis
Since the earliest days of the pandemic, experts advised the Trump administration, states and local governments to quickly implement public health strategies, including population-based surveillance, that would identify how many people in a community are infected, symptomatic or not. Also called widespread, mass or robust testing, surveying a representative sample of the population would facilitate governors, mayors and other leaders’ ability to make science-based decisions about how and when to ease or contract social-distancing and open economies more safely.
“Ideally, we would have tested enough of a local population to ascertain how common the virus is, asking people who were newly diagnosed whom they have been in contact with and might have spread the disease to, and then testing those people and asking them to quarantine themselves for 14 days so they don’t spread the virus to anyone else,” says epidemiologist and family physician Camara Phyllis Jones, MD, MPH, PhD, a past president of the American Public Health Association. “If we had done that, we would have interrupted the exponential spread very early on and would not have overwhelmed our hospitals and intensive care units.”
Though the White House deploys public health measures like daily testing and contact tracing to manage its internal epidemic, President Trump has resisted using the power of the federal government to coordinate similar efforts nationwide. Instead, he dumped that responsibility on state and local governments that lacked the budgets and capacity, causing them to scramble. “We have not been applying public health strategies to this public health crisis,” says Dr. Jones. “The result is that we have made it a medical care crisis.” Public health impacts populations; medicine focuses on individuals.
The administration’s early and continuing missteps resulted in insufficient testing availability, seemingly caused by ongoing supply chain problems. The resulting rationing strategy seemed race-neutral, but it has played out along predictable lines of structural racism and socioeconomic class division, invisibly advantaging many White Americans while shoving Black and Brown people, and low-income White folks to the back of the line.
Immediately, the rich and famous jumped to the front. Additionally, White Americans are more likely than people of color to have both health insurance and the physician gatekeeper who is initially required to access a coronavirus test. As people lost jobs, they also lost health insurance. Large numbers of Blacks and Latinos have been laid off or furloughed during the coronavirus shutdowns. And Black and Brown people disproportionately live in the Southern states that refused to expand Medicaid. Compounding matters? The digital divide between online health information and testing sites; the appointment required to access a test; drive-through sites being virtually inaccessible without a car; locations inconvenient to Black and Brown communities and public transportation; and the inability to take time off. Historic distrust undermines Black Americans’ belief in the health care system and many immigrants fear being deported. Stories of people denied testing, some of whom died, have raised additional concerns about racial bias in health care.
In early March, antiracist historian Ibram X. Kendi, Ph.D., founder of the Antiracist Research and Policy Center at American University, sounded the alarm that racial demographic data identifying who was being tested for, infected with, hospitalized or killed by COVID-19 weren’t being reported. The conversation challenged experts’ assertions that the disease would affect society with “blind egalitarianism.” And as data trickled in—from Milwaukee; Chicago; Los Angeles; Charlotte; Albany, Georgia.; Orleans Parrish, Louisiana; and beyond—it revealed racial disparities, sickness and death.
Around that time, a small community of volunteers, currently led by The Atlantic staff writer Alexis Madrigal, launched The COVID Tracking Project in an effort to aggregate and make sense of the numerous and confusing data sources. It then partnered with the Antiracist Center to found The COVID Racial Data Tracker. “This outbreak will not affect everyone equally,” says Madrigal. “It is moving through American institutional structures and socioeconomic realities. The COVID Racial Data Tracker is really to track racism, not to track race.”
Though maddeningly incomplete, the data on race are providing visibility to the wildly disparate rates of Black and Brown infection and death—evidence of the nation’s structurally racist policies.
Indeed, predominately Black counties have experienced three times the infection rate and six times the deaths as predominately White counties during the virus’s initial wave, which hit big cities hard. In Los Angeles, for example, Latinx people made up 44 percent of the population, but 65 percent of the deaths.
Many states are not reporting infections among Native Americans—whose history already includes being ravaged by infections, such as smallpox and tuberculosis, carried by Europeans. But what we do know looks grim. Though Native Americans make up just 6 percent of Arizona’s population, they account for 16 percent of the state’s deaths. In New Mexico, they comprise 11 percent of the population, but 31 percent of deaths.
It’s Like a False Negative
In mid-April, an analysis by the New York Post found that although 3.8 out of every 100 residents of Staten Island borough had been tested, as compared to 2.9 per 100 in the Bronx and 2.5 per 100 in Queens. Staten Island is 75 percent White; the Bronx and Queens boroughs consist primarily of people of color. A separate analysis found that 22 of the 30 ZIP codes where the greatest numbers of COVID tests were conducted were either Whiter or wealthier than the city as a whole.
In Philadelphia, residents of high-income neighborhoods were six times as likely to be tested as those in low-income communities of color. In Nashville, screening centers managed by Vanderbilt University Medical Center in a predominately White community were open, while sites near Meharry Medical College, in the Black neighborhood, were unable to obtain supplies for weeks. In Chicago, though Blacks comprised 37 percent of COVID-19 deaths, they received only 13 percent of the tests.
In San Francisco, researchers mass tested 2,959 residents of the Mission District, whose population includes a mix of affluent tech workers and low-income and recent Latinx immigrants—many, essential workers. Not one White person tested positive. Latinos comprise 58 percent of the district, but 95 percent of positive tests; 75 percent were men.
Testing conducted in the Navajo Nation—which spans Arizona, New Mexico and Utah—has uncovered what could be the highest infection rate per-capita in the United States, even higher than that of New York City. However, these data should be viewed with some caution since the Navajo Nation has been testing a higher proportion of its population than most other locations. In many locations, the demographic data for indigenous populations is not necessarily broken out. Instead, many Native Americans get lumped under “other.”
Even in early May, in Akron, Ohio, zip codes where the largest numbers of Black people live had the lowest number of confirmed cases in the county. “The numbers are so low because we aren’t testing people,” says Akron Councilwoman Tara Samples, whose district had zero diagnoses—the only such district in the county except one that’s home to an uninhabited national park. “It’s almost like a false negative,” says County Councilwoman Veronica Sims of how the missing data creates the misperception that no disease exists.
The Way Out
Tragically, only three states—Illinois, Kansas and Delaware—report testing statistics, and those data are incomplete.
In Illinois, only 8 percent of tests performed by May 13, 2020, were administered to Latinx patients; 55 percent returned positive for coronavirus. Though they received less than 2 percent of tests, 38 percent of American Indian and Alaska Natives tested positive. Despite taking just 10 percent of tests, 32 percent of Blacks came back positive. And while Asian Americans accounted for less than 8 percent of tests, they represented 30 percent of the positives. Data from Kansas and Delaware reveal similar gaps.
As many big cities flatten their curves, the epidemic is exploding in rural areas in the nation’s heartland and South. Indeed, many coronavirus hot spots are smaller locales that serve as home to correctional facilities and meatpacking or poultry plants, which employ large numbers of people of color and the poor, including immigrants and refugees.
“We need to go into areas that we already know are highly impacted and know to be hot spots and do universal testing—test everyone—not just symptomatic individuals,” says Dr. Jones, citing Black, Brown and poor communities; nursing homes; prisons and detention centers; meatpacking plants; and big warehouses, such as Amazon. “We need to do as much testing in those places as possible because we need to know how widespread the virus is.”
Furthermore, she advises that we be more like Singapore and South Korea, which have more successfully controlled the pandemic, and do not send people back home once they’re known to be infected. “We know that close proximity over time causes the infection to spread,” Jones says. “If you send them back, the people in their home are more likely to become infected, especially if it’s crowded, which makes it harder to isolate.” Instead, nations like these have created centralized isolation centers to care for people who test positive for COVID-19.
“We need to set up, in culturally acceptable ways, places where people who are infected can isolate,” Jones says. “Nurses can keep an eye on people and take their temperature and evaluate their oxygen saturation twice a day. When they see people about to ‘crash,’ they call the ambulance so the person can be transferred to the hospital in a timely manner. Instead, people are going home, infecting their family, and not realizing until they turn blue that they’re very sick.” She notes that trusted organizations such as HBCUs and YM/YWCAs could serve in this role.
“If the way out of this pandemic is to test everybody and take public health steps, then we need to make sure that everyone has this kind of access to health care,” says Madrigal.
Dr. Jones also underscores the need for population-based testing, including approaches that allow us to identify how much virus exists in any given city or county and where it is located. Performed on an ongoing basis, such as weekly, this type of testing would additionally allow experts to understand the impact of various policy decisions, such as whether it’s safe to open, reopen or stay open.
Though the backlog is easing, as of May 13, only about 9.7 million tests had been performed. That’s approximately 325,000 of the 900,000 per day the Harvard Global Health Institute estimates should be conducted by May 15, 2020. (Go here to see where your state falls.)
Advocates from Congressmembers Ayanna Presley and Senator Elizabeth Warren, to the Congressional Black Caucus, to newspaper editorial boards are demanding that the Department of Health and Human Services require all testing entities—including private labs—to report demographics. That hasn’t yet happened.
New York State now offers testing in churches in Black, Latinx and low-income communities, which supplements the increased testing aimed at New York City’s low-income residents, the elderly and essential workers. Wisconsin is offering free testing to African Americans, Latinxs, and Native Americans. In Chicago, testing sites have opened in previously overlooked low-income neighborhoods like Auburn Gresham and Austin.
Tragically, it’s all too late to protect thousands of Black and Brown people who have already lost their lives to COVID-19.
Hilary Beard is a Philadelphia based writer and the author of “Health First!: The Black Woman’s Wellness Guide” and “Promises Kept: Raising Black Boys to Succeed in School and in Life.”