SOUTHEASTERN, N.C. — Coronavirus is disproportionately impacting southeastern North Carolina’s Hispanic and black communities, highlighting disparities that were present even before the pandemic arrived.
Statewide, the disparity is stark for those who identify as Hispanic, comprising 41% of all positive cases while making up just 9.6% of the population.
In other words, Hispanic individuals are more than four times as likely to test positive for the virus in North Carolina compared to the general population; in Brunswick County, Hispanic individuals are 6.1 times more likely; in New Hanover, 3.8 times more likely; in Pender County, 1.9 times more likely.
With 348 deaths statewide, black North Carolinians are disproportionately dying from the virus, at 34% of the state’s deaths while making up 22% of the population.
Covid-19 case data including ethnicity only recently became available, with fewer than 20 of the state’s 100 counties publicly reporting this information. North Carolina is missing race data for 11,400 Covid-19 positive cases and ethnicity data for 12,425 cases, representing about one-third of all cases as of June 11.
When it comes to Covid-19 deaths, race and ethnicity data is nearly completely reported by the state, with respectively 3% and 4.3% of data missing. This difference is likely due to requirements in death certificates versus varying county-by-county health department protocols when collecting positive case information.
Tracking the data
Early on, data showed that positive cases among different ethnicities was relatively proportionate, according to New Hanover Regional Medical Center Director of Health Equity, Human Experience, & Interpreter Services Joseph Conway. From late May to early June, the Hispanic disparity became more pronounced.
“Then all of a sudden, the tide started turning,” Conway said in an interview Tuesday.
Hispanic communities are more vulnerable to contracting Covid-19 for several reasons. “Where does the Hispanic community predominantly work? They are in a lot of our frontline positions. They are your servers, they are your housekeeping, or in our world, environmental services technicians,” Conway said. “They are in the face of this pandemic daily. Perhaps in ways that we haven’t even begun to quantify. So now your data is showing you there’s a huge disparity.”
In addition to where Hispanic individuals tend to work, Conway also points to common living arrangements and religious practices that present a challenge for containing the virus’ spread. “Their communities are set up very differently. They’re in congregate housing. So when you’re asking for social distancing, for physical distancing, you’re going to struggle there,” he said.
Despite the best efforts of medical and Latinx advocacy groups to share Spanish inclusive Covid-19 messaging, a language barrier makes it more difficult to get important information across. “Once all of us were on board and rowing the boat in the same direction, it took off. But we’re seeing the impact of that delayed communication,” Conway said.
NHRMC Vice President Dr. Phillip Brown said his team is still working out its strengths and weaknesses with bilingual messaging. “We were very inclusive of the Latinx community. We’re still sorting out — did we under-communicate? Or is it more of the deeper social determinants that we know are a challenge in certain populations that have to do with where people live, work, learn, play, worship, and age?” he asked.
Black and Hispanic adults are disproportionately affected by cardiorespiratory failure, hypertension, and other metabolic disorders. People with underlying health disorders have an increased risk of having an adverse outcome after contracting the novel coronavirus, which helps explains why the pandemic is hitting minority populations harder.
“When you start before a pandemic like this happens with a disparity that already exists around these types of diseases, you’re already starting behind,” Conway said. “It’s like a triple whammy.”
Had medical systems put into place policies and procedures aimed at dismantling racial and ethnic disparities before the pandemic arrived, Conway said the outcomes wouldn’t be as bad.
“It really would have helped out now had we done our homework. Unfortunately, what’s happening now is just the same story, just a different disease, just a different pandemic.
“We cannot miss this opportunity again. This has got to stop. We’ve got to get some structural things in place that start to dismantle the structural and institutional racism that’s built into and baked into, not just the healthcare system, but the justice system, the education system, the housing system,” Conway said.
Conway has a four-part recommendation to begin dismantling institutional racism in the healthcare system: 1) track and stratify patient data based on race, ethnicity, preferred language, and gender while protecting identifiable information 2) reassess leadership and governing positions to prevent homogenous teams that lack racial, ethnic, and gender diversity and diversity of thought 3) partner with community groups already connected to the marginalized communities 4) enhance and encourage cultural sensitivity and humility training for all healthcare employees.
“All four of those are happening right now,” Conway said of NHRMC’s ongoing efforts. “It may not be our fault that we inherited this type of structure. But it for dadgum sure will be our responsibility to undo it and build something better for all citizens,” Conway said.
Brown pointed to research that shows black babies are more than twice as likely to die before the age of one compared to non-Hispanic white babies. “The health disparities that we’re seeing that lead to acute deaths from Covid-19 fit into a pattern of healthcare that has been longstanding,” he said. “Our organization has dedicated itself to changing that.”
“We know we have such a racial disparity in care across the board that an African American mother with a college education has a higher [risk of dying during childbirth] than a white mother that didn’t even complete high school. So these are longstanding systemic structures that we simply have to dismantle and change. And Covid-19 just happens to put an acute exclamation point on it,” Brown explained.
“But these things are not new. And they were totally predictable. And it would really be a shame on us if we don’t figure out how to have a brighter future the next time we have a crisis,” he said.
View the U.S. Census’ 2019 population estimate compared to the proportion of Covid-19 positive cases in each region:
In Pender County, the disparity is greatest in black individuals who tested positive for Covid-19. At 15% of the county population, black individuals make up 33% of its total positive Covid-19 cases. But Pender County Health and Human Services Director Carolyn Moser said if black Pender Correction Facility inmates are discounted from the data set, the disparity is weakened. With that adjustment, the numbers are in line with the state’s average, with the black community accounting for 4.8% more cases than its share of the total population.
“If you do not count the 11 black offenders from the prison, Pender County has 27 black community members out of 104 cases, which equates to 26 percent. The state average is at 27 percent. Of those 27 black community members who tested positive, 16 are comprised of families who were impacted by COVID-19,” Moser wrote in an email Tuesday.
Of the 19 inmates that contracted the virus in Pender County’s state prison, 11 are black, at 57%. That’s likely because the prison presents a disparity of its own — with a disproportionately higher number of black inmates compared to the state’s black population. The reasons for that are complicated, and beyond the scope of most health studies, but it is worth noting that, nationwide, black men and women are more likely to be stopped, charged, and convicted of crimes.
“Pender County is unique, as compared to a non-agricultural county such as New Hanover County,” Moser wrote in an email. The county’s Hispanic numbers are high because of migrant farm workers, she said. “Pender County Health Department has 19 sites, including the health department, who are testing. There is access for any Pender County resident to be tested.”
Brunswick County began tracking ethnicity around May 8 when the ratio of Hispanic positive cases increased to 8% (5/64), according to Brunswick County Health and Human Services Director Cris Harrelson. The ratio has since ballooned to 30% with 60 positive cases in Hispanic individuals out of 190 as of June 12.
The trend was not a surprise to the county, according to Harrelson.
“Some of the reasons this disparity might be occurring include the proximity of housing, challenges to practicing social distancing, occupational exposure and barriers in transportation, as well as historical obstacles in access health care, a concentration of unmet health needs and chronic disease burden,” Harrelson wrote in an email. He pointed to the state’s new Andrea Harris Social, Economic, Environmental, and Health Equity Task Force created June 4 which has been directed to address health disparities among marginalized and underserved communities.
“Well-established patterns of COVID-19 infection continue to demonstrate that LatinX/Hispanic populations are disparately impacted by the pandemic,” Harrelson said. “Additionally, front line and essential workers, by nature of their jobs, experience higher rates of infection and ongoing exposure. In Brunswick County, uninsured rates are highest among those working in construction, retail, and food service. These fields rarely offer health insurance as a benefit. In Brunswick, 37.6% of residents worked in these industries in 2018.”
Brunswick County has worked with community partners to create fliers and social media messaging and also to expand testing availability to uninsured people, according to Harrelson. To improve the disparity, Harrelson said outreach efforts could be improved. Harrelson added outreach should include education for frontline essential workers, including following the three Ws: wear a mask; wait 6 feet apart; wash hands frequently.
Four locations in Brunswick County currently provide Covid-19 testing to the uninsured: Brunswick County Health Services in Bolivia (for children only), CommWell Health in Bolivia, Goshen Medical in Southport, and CVS Pharmacy in Leland. Three Brunswick County locations provide clinical services to the uninsured: New Hope Clinic in Southport, CommWell Health in Southport and Bolivia, and Goshen in Southport.
Send tips and comments to Johanna Ferebee Still at firstname.lastname@example.org