Predictable, but not to this extent...
Whites are now more likely to die from covid than Blacks. Here’s why the pandemic shifted.
pressherald.com/2022/10/19/whites-now-more-likely-to-die-from-covid-than-blacks-why-the-pandemic-shifted/
By Akilah Johnson and Dan Keating October 20, 2022
SOMERVILLE, Tenn. — Skill Wilson had amassed more than three decades of knowledge as a paramedic, first in Memphis and then in Fayette County. Two places that felt like night and day.
With only five ambulances in the county and the nearest hospital as much as 45 minutes away, Skill relished the clinical know-how necessary to work in a rural setting. Doing things like sedating patients to insert tubes into their airways.
But when it came to covid-19, despite more than 1 million deaths nationwide, Skill and his family felt their small town on the central-eastern side of Fayette County, with its fields of grazing cattle and rows of cotton and fewer than 200 covid deaths since the start of the pandemic, was a cocoon against the raging health emergency.
“It was a lot easier to stay away from others,” his widow, Hollie Wilson, said of the largely White and predominantly conservative county of about 42,000 residents. “Less people. Less chance of exposure.”
Covid seemed like other people’s problems – until it wasn’t.
The imbalance in death rates among the nation’s racial and ethnic groups has been a defining part of the pandemic since the start. To see the pattern, The Washington Post analyzed every death during more than two years of the pandemic. Early in the crisis, the differing covid threat was evident in places such as Memphis and Fayette County. Deaths were concentrated in dense urban areas, where Black people died at several times the rate of White people.
“I don’t want to say that we weren’t worried about it, but we weren’t,” said Hollie, who described her 59-year-old husband as someone who “never took a pill.” After a while, “you kind of slack off on some things,” she said.
Over time, the gap in deaths widened and narrowed but never disappeared – until mid-October 2021, when the nation’s pattern of covid mortality changed, with the rate of death among White Americans sometimes eclipsing other groups.
A Post analysis of covid death data from the Centers for Disease Control and Prevention from April 2020 through this summer found the racial disparity vanished at the end of last year, becoming roughly equal. And at times during that same period, the overall age–adjusted death rate for White people slightly surpassed that of Black and Latino people.
The nature of the virus makes the elderly and people with underlying health conditions – including hypertension, diabetes and obesity, all of which beset Black people at higher rates and earlier in life than White people – particularly vulnerable to severe illness and death.
That wasn’t Skill.
The virus also attacks unvaccinated adults – who polls show are more likely to be Republicans – with a ferocity that puts them at a much higher risk of infection and death.
That was Skill.
He joined the choir of critics opposing vaccination requirements, his rants in front of the television eventually wearing on Hollie, who, even if she agreed, grew tired of listening and declared their home “covid-talk free.”
So, she said, Skill commiserated with like-minded people in Facebook groups and on Parler and Rumble, the largely unmoderated social networking platforms popular with conservatives.
“We’re Republicans, and 100% believe that it’s each individual’s choice – their freedom” when it comes to getting a coronavirus shot, Hollie said in January. “We decided to err on the side of not doing it and accept the consequences. And now, here we are in the middle of planning the funeral.”
Capt. Julian Greaves Wilson Jr., known to everybody as Skill, died of covid Jan. 23, a month after becoming infected with the coronavirus. He fell ill not long after transporting a covid patient to the hospital. At the time he died, infection rates in Fayette County had soared to 40.5% among people taking coronavirus tests.
‘A DIFFERENT CALCULUS’
When the coronavirus appeared in the United States, it did what airborne viruses do – latched onto cells in people’s respiratory tract, evaded innate immune responses and multiplied. The pathogen, free of politics or ideology, had a diverse reservoir of hosts and found fertile pathways for growth in the inequalities born from centuries of racial animus and class resentments.
Unequal exposure, unequal spread, unequal vulnerability and unequal treatment concentrated harm in communities that needed protection the most yet had the least. Cumulatively, Black, Latino and Native American people are 60 % more likely to die of covid.
But as the pandemic progressed, the damage done by the virus broadened, and the toxicity of modern-day politics came to the fore.
The message was unmistakable outside a business in Reagan, Tenn., on June 6, 2022.
Brandon Dill/The Washington Post
The Post analysis revealed the changing pattern in covid deaths. At the start of the pandemic, Black people were more than three times as likely to die of covid as their White peers. But as 2020 progressed, the death rates narrowed – but not because fewer Black people were dying. White people began dying at increasingly unimaginable numbers, too, the Post analysis found.
In summer 2021, the nation saw some of the pandemic’s lowest death rates, as vaccines, shoring up the body’s immune response, became widely available.
Then came the delta variant. The virus mutated, able to spread among the vaccinated. As it did, an erosion of trust in government and in medicine – in any institution, really – slowed vaccination rates, stymieing the protection afforded by vaccines against severe illness and death.
After delta’s peak in September 2021, the racial differences in covid deaths started eroding. The Post analysis found that Black deaths declined, while White deaths never eased, increasing slowly but steadily, until the mortality gap flipped. From the end of October through the end of December, White people died at a higher rate than Black people did, The Post found.
That remained true except for a stretch in winter 2021-2022, when the omicron variant rampaged. The Black death rate jumped above White people’s when the spike in cases and deaths overwhelmed providers in the Northeast, resulting in a bottleneck of testing and treatment.
When the surge subsided, the Black death rate once again dropped below the White rate.
“Usually, when we say a health disparity is disappearing, what we mean is that . . . the worse-off group is getting better,” said Tasleem Padamsee, an assistant professor at Ohio State University who researched vaccine use and was a member of the Ohio Department of Health’s work group on health equity. “We don’t usually mean that the group that had a systematic advantage got worse.”
That’s exactly what happened as the White death rate surpassed that for Black people, even though Black Americans routinely confront stress so corrosive it causes them to age quicker, become sicker and die younger.
The shift in covid death rates “has vastly different implications for public health interventions,” said Nancy Krieger, professor of social epidemiology at Harvard University’s T.H. Chan School of Public Health. Officials must figure out how to connect with “communities who are ideologically opposed to the vaccine” while contending with “the cumulative impact of injustice” on communities of color.
“Think about the fact that everyone who is age 57 and older in this country was born when Jim Crow was legal,” she said. “What that did was intersect with covid-19, meaning that embodied history is part of this pandemic, too.”
So what contributed to the recent variation in death rates? And why?
The easy explanation is that it reflects the choices of Republicans not to be vaccinated, but the reasons go deeper. The Post interviewed historians and researchers who study the effects of White racial politics and social inequality on health, spoke with relatives and friends of those lost to covid, and compiled data from federal databases and academic studies.
Many Republicans decided they would rather roll the dice with their health than follow public health guidance – even when provided by President Donald Trump, who was booed after saying he had been vaccinated and boosted.
Researchers at Ohio State found Black and White people were about equally reluctant to get the coronavirus vaccine when it first became available, but Black people overcame that hesitancy faster. They came to the realization sooner that vaccines were necessary to protect themselves and their communities, Padamsee said.
As public health efforts to contain the virus were curtailed, the pool of those most at risk of becoming casualties widened. The No. 1 cause of death for 45-to-54-year-olds in 2021 was covid, according to federal researchers.
After it became clear that communities of color were being disproportionately affected, racial equity started to become the parlance of the pandemic, in words and deeds. As it did, vaccine access and acceptance within communities of color grew – and so did the belief among some White conservatives, who form the core of the Republican base, that vaccine requirements and mask mandates infringe on personal liberties.
“Getting to make this decision for themselves has primacy over what the vaccine could do for them,” said Lisa R. Pruitt, a law professor at the University of California at Davis who is an expert in social inequality and the urban-rural divide. “They’re making a different calculus.”
It’s a calculation informed by the lore around self-sufficiency, she said, a fatalistic acceptance that hardships happen in life and a sense of defiance that has come to define the modern conservative movement’s antipathy toward bureaucrats and technocrats.
“I didn’t think that that polarization would transfer over to a pandemic,” Pruitt said.
It did.
A lifesaving vaccine and droplet-blocking masks became ideological Rorschach tests.
The impulse to frame the eradication of infectious disease as a matter of personal choice cost the lives of some who, despite taking the coronavirus seriously, were surrounded by enough people that the virus found fertile terrain to sow misery. That’s what happened in northern Illinois, where a father watched his 40-year-old son succumb to covid-19.
For Robert Boam, the increase in White deaths is politics brought to bear on the body of his son, though he’s reluctant “to get into the politics of it all, but it all goes back to that.”
Brian Boam was a PE teacher at an elementary school in suburban Chicago. On Christmas Eve, the entire family gathered at the elder Boam’s home in an Illinois town where the first Lincoln-Douglas debate was held. Brian Boam was there with his 10-year-old daughter and 6-year-old son.
Robert Boam said his son had survived covid the year before, so “we got on his butt to get that booster shot when he was here for Christmas.” And he did – but got sick again, the 73-year-old said. “Being vaccinated, and all that, and getting covid again kind of bummed him out.”
Just after the new year, Brian Boam, who was hypertensive, went to a hospital feverish and vomiting. It took 10 hours to be seen and even longer for a bed to become available. As he waited, he sent what would be his last text message to his parents. Thanks for all you do. I love you.
He went into cardiac arrest in the emergency room and was transferred to Rush University Medical Center in Chicago, one of the nation’s top academic hospitals. There, his family hoped he would be healed, but his organs began to fail. He died Jan. 8.
“The thing that gets me is the people who still don’t believe it’s serious or even real, but when they get sick, they run to the hospital,” Robert Boam said. “You’re taking away from heart attack patients and stroke patients.”
The pandemic, he said, “should’ve been taken seriously from the very beginning, and it wasn’t. It was denied. It was downplayed. And it all goes back to one person, as far as I’m concerned.”
Asked who that was, Boam would say only: “I’ll give you three guesses. The first two don’t count.”.
Had to clip article, too long to post entire thing...
... METHODOLOGY
The Post applied the standard technique used by the Centers for Disease Control and Prevention to calculate age-adjusted covid death rates by race using the CDC’s provisional covid death data that includes race, ethnicity, age and date of death. Under that procedure, The Post calculated death rates for age groups by dividing the number of deaths by the population in that age group. The Post then used a standardized age distribution to create an overall rate for each race-ethnicity group.
Age-adjusted rates are especially necessary for understanding covid deaths because the majority of people killed by covid are age 75 or older, even though that group represents less than 9% of the U.S. population. Additionally, more than 90% of covid deaths are in people age 50 and older.
The covid death age pattern is important in reviewing deaths by race because White people are disproportionately older. More than 40% of White people are age 50 or older, but less than 30% of Black people are in those older age groups. Hispanics are even younger, with less than 25% age 50 or older.
The age-adjusted rates offset that difference in age distribution to compare deaths as if the races or ethnic groups had the same age distribution.
Whites, Blacks, Asians, American Indians and Alaskan Natives are non-Hispanic. Hispanics are of any race, so the racial groups and the Hispanic groups do not overlap.
For maps, The Post calculated age-adjusted covid death rates for each race in each state over the course of the pandemic using provisional covid death data by state.
