The deck was already stacked against families where English is a second language, those who live in crowded conditions, and single-parent families before the coronavirus pandemic struck.
But when the virus arrived on U.S. shores, it infected and killed more people in counties with higher populations of those vulnerable people, according to new research from the University of Michigan’s Institute for Healthcare Policy and Innovation that was published Friday in JAMA Network Open.
“The big-picture finding was … that the more socially vulnerable or socially disadvantaged the county is, the higher the likelihood of COVID cases and deaths,” said Dr. Renuka Tipirneni, an assistant professor at the University of Michigan and an internal medicine doctor at Michigan Medicine who is senior author of the study.
The U.S. Centers for Disease Control and Prevention has recognized the health outcomes associated with living in disadvantaged communities, using 15 factors to create what it calls a Social Vulnerability Index to rank them.
U-M researchers used that index to compare COVID-19 infections and deaths per capita in the first six months of the pandemic in each county in the nation. It revealed a map of the U.S. that shows areas with the most at-risk people in urban centers like New York, Chicago, Detroit, and Los Angeles as well as some high-poverty rural areas correlate to higher numbers of coronavirus infections and deaths.
“This pandemic has exacerbated longstanding racial/ethnic, social, political, and economic inequities in the U.S. to once again ensure that the most marginalized and under-resourced communities experience the worst outcomes,” the study authors wrote. “The difficult but crucial task for local, regional, and national policy makers will be to address, in addition to downstream health care issues, the numerous upstream and midstream social factors associated with health and health care disparities.”
It showed rural areas like Lake County, Tennesee and Lee County, Arkansas, had high rates of coronavirus infections and deaths along with high social vulnerability scores.
The county with the highest death rate, Hancock County, Georgia, also had a high overall social vulnerability index score and reported a large number of nursing home deaths early in the pandemic.
In Michigan, the three counties with the highest COVID-19 infection rates from March to July were Oceana, Wayne, and Oakland, Tipirneni said. Two of those counties — Oceana and Wayne — have high levels of social vulnerability. And the three counties with the highest death rates in the state during that timeframe were Wayne, Macomb and Oakland.
Among the social factors that most heavily impacted COVID-19 infections and deaths, Tipirneni said, “were crowded housing, places where there were more people than rooms in a specific housing unit; limited English proficiency, and then households that are single-parent households.
What is it about these factors, specifically that put people at higher risk?
“You can imagine the more people there are in a dwelling, it’s harder to socially isolate,” Tipirneni hypothesized. “And so if one member of a family or household gets COVID, it’s really hard to isolate and prevent everybody else in the household from getting COVID.
“If you think about more crowded apartment complexes or other types of housing, there’s going to be a lot more interactions between residents, simply because they’re more closely spaced than separate, detached homes.”
With English proficiency, Tipirneni said, a couple of factors could converge to explain why people who don’t speak English well are at higher risk of poor coronavirus outcomes.
“It could be simply not getting as much of the information about ways to mitigate risk, like mask wearing and social distancing,” she said. In addition, some immigrant communities are wary of government authorities and nervous about engaging in COVID-19 testing or treatment.
Tipirneni wasn’t sure why single-parent households fared so poorly early in the pandemic. But no matter how the researchers compared the data, it was among the top three associations with higher rates of COVID-19 infections and deaths.
“It seems consistent no matter what way we analyze the data,” she said.
Counties with higher percentage of racial and ethnic minority populations also felt a heavier burden of COVID-19 cases and deaths, the research showed. That played out in Michigan in the early months of the pandemic.
Black residents make up 13.7% of Michigan’s population, but in April, they accounted for 42.93% of COVID-19 deaths. Southeastern Michigan was especially hit hard, and Detroit — where the population is nearly 80% Black — became a national hot spot.
It led Gov. Gretchen Whitmer’s administration to create the Coronavirus Task Force on Racial Disparities to address the problem with community outreach, education and increased testing.
The research, Tipirneni said, reflects the structural racism and societal factors that affect health outcomes in the state and the country.
“Things like who’s living in private housing? Who has to use public transportation to get to their work, which could be an essential worker occupation?” she said. “The factors that we’ve identified have a higher prevalence in racial and ethnic minority communities.
“It’s also sadly not surprising, since these are the kind of social inequities that we’ve had in the country for a long time. What we’re seeing in terms of inequities of COVID isn’t new; it’s falling along the same fault lines that we’ve had for many other health conditions in the past.”
What’s important, she said, is that policy makers recognize these inequities and take action to reach out to the most vulnerable in society to improve their health and their lives.
“While some of these things are not actionable immediately — the big societal structural problems that we need to address over time — there are some more immediate social needs that can be addressed that can help alleviate risk,” Tipirneni said.
- Moratoriums on evictions to keep people in affordable housing during the pandemic
- Better communication and public health messaging targeting communities where English is a second language
- Providing food assistance and making public transportation safer and more accessible
- Expanding access to coronavirus testing
Already, some of that is happening.
In addition to the efforts of the state’s Coronavirus Task Force on Racial Disparities, state health officials said they are shifting the way COVID-19 vaccines are allocated in Michigan to provide more doses to areas that are ranked highest on the CDC’s Social Vulnerability Index.
Using the index helps to ensure that communities at highest risk receive vaccines during this time of scarcity, said Lynn Sutfin, a spokesperson for the state health department. The index also was used to establish coronavirus testing sites statewide, Sutfin said, adding the index status in Michigan “correlates with the communities hardest hit by COVID-19 this spring, as well as areas of that state with high rates of risk factors for severe COVID-19 outcomes.”
In Wayne County, the Social Vulnerability Index is being used to prioritize who should be vaccinated first, said Bill Nowling, a spokesperson for Wayne County Executive Warren Evans.
County leaders worked with Wayne RESA to divide the county into four geographic areas based on student population, and school districts, and ranked those areas using the index.
The areas with the highest vulnerability score will get vaccinated first, he said.
So far, 25.4 million Americans have contracted the virus and more than 427,000 have died, according to CDC data. In Michigan, there have been 556,109 confirmed cases and 14,491 deaths.
Contact Kristen Shamus: [email protected] Follow her on Twitter @kristenshamus.