Racism and Covid-19 threaten our health – we can't fight them as separate battles

Right now, the United States is reckoning with centuries of systemic racism at the same time as it battles a pandemic. These fights are not as separate as they appear.

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While most other wealthy nations have seen a peak and abatement in Covid-19 cases, the US, despite some states’ concerted efforts at lockdown, saw just a brief ebb in cases. The daily case rate is now surging, higher than it has ever been. This can be attributed to many comparably unique factors: a large and mobile population, a lag in testing of already present cases, and the politicization of the virus and response. Yet, a keystone of the Covid-19 problem in the United States is systemic racism; health, housing and employment disparities are the propellant of this fire.

The US is not a healthy country, making the national impact of Covid-19 unsurprising. Hypertension, obesity, diabetes and other risk factors for severe viral complications, are generally more prevalent in the US than other developed countries. Due to structural and environmental racism in the US, these diseases are also more prevalent in minority populations. Food deserts, worse air and water quality, and poor access to preventative care, set minorities up for chronic diseases. Beyond these risk factors, racism profoundly affects our biology. Race-related stress can worsen sleep quality and increase stress hormones like cortisol, leading to worse immune function (a phenomenon called “allostatic load”).

These disparities in health are only worsened by an extraordinarily unequal healthcare system. Despite occupying nearly half the healthcare support occupations, people of color often have unequal access to care, and when received, it is often poorer quality.

Beyond the risk to individuals, racism affects transmission through housing and employment: Household spread is the most common form of transmission, with crowded homes – urban and rural, being a major contributor for the new upswing in Covid-19 cases. With more people per home and per room, overcrowding is an even higher risk for people of color. Put simply, they often do not have the luxury of social distancing within their homes.

There is little reprieve outside of the home either. There are fewer publicly provided resources, such as parks and bike lanes, for minority-dense neighborhoods. Additionally, they are often treated as though they are not welcome in parks, as evidenced by the incident with Amy Cooper. Such outdoor spaces are known to have a positive impact on health, resulting in yet another Covid-19 disparity.

While the global public health advice is to stay at home, essential workers lack this option. Not only are fewer Black and Latino adults able to work from home, but they are also overrepresented in essential jobs. Almost half of all transportation, warehouse, and postal workers are Black and Latino. These are services all Americans directly engage. During a viral pandemic, we place ourselves at risk by dismissing the wellbeing of our workforce.

While we agree that this work is essential, we do not compensate people accordingly. Reduced paid leave, combined with systemic racial inequity in wages and wealth, make taking off from work when symptomatic or exposed to the virus nearly impossible. By not investing in the protection of these marginalized employees, the US hinders its ability to lessen the impact of this pandemic.

These racial and ethnic issues are not unique to the US. Europe has rampant racism with disproportionately high Covid-19 death rates among racial minorities. However, many European countries, like the UK, have less diversity – as well as universal healthcare and superior social support. Ethnic and racial diversity should be a source of strength in the United States, but instead, systemic racism and oppression weaken the moral and physical health of the country.

The racial and ethnic inequalities that we uphold in our countries will not only harm black and brown communities, but they increase the risk of the entire population. While it is easy to view such inequalities and racism as intractable, the urgency is on par with that of Covid-19, and fighting inequality is an imperative part of quelling this epidemic.

If we want to succeed in mitigating the harm of the virus, the United States must view the problems of Covid-19 and racism not as separate battles, but as linked and overlapping.

• Renee C Wurth is a PhD population health scientist who trained at Northeastern and the TH Chan School of Public Health at Harvard University

• Marcelius L Braxton, JD, is the assistant dean of students at Capital University Law School and serves as a diversity, equity, and inclusion consultant

• C Lee Cohen MD MBA is a frontline pulmonary and critical care doctor at Brigham and Women’s Hospital and co-founder and editor of covidprotocols.org