Are Illnesses Racist?

The CBS magazine title, “Churches, Schools, Shows Closed: Epidemic Puts Ban on All Public Assembles” may feel relevant to the world today; however, it is actually from 1918, following one of the world’s deadliest pandemics. Resulting in 50 million deaths, the 1918 influenza pandemic shook the world. Even without that scale, though, COVID-19 has shaken our society to its core 102 years later. Now, five months into the pandemic, the issue of race has resurfaced to the forefront of many Americans' minds following the killing of George Floyd, an unarmed Black man. Is this timing coincidental? Few have identified another similarity between the 1918 pandemic and the current one: the heightened awareness surrounding issues of race and how health crises disproportionately harm racial minorities in the United States.

It is important to note that COVID-19 and the 1918 influenza are two very different diseases. The virus that causes COVID-19 is a coronavirus, while an influenza virus (H1N1) caused the 1918 pandemic, also known as the Spanish flu—even though it did not originate in Spain. Nevertheless, similarities in our responses begin to emerge upon closer inspection.

Today’s mass cosmopolitan shutdowns are not unfamiliar to US states, as during the influenza pandemic many cities and governments took early action in imposing quarantines. Closing down schools and banning mass gatherings led to lower death rates than places that implemented fewer measures or did it later. Although the world was nowhere near as prepared as it could have been in 2020, the modern pandemic has come at a time when science and technology are rapidly advancing to improve this crisis. As of July 31, 2020, the COVID-19 pandemic has infected around 17 million people around the world and produced an estimated death toll of 600,000. By comparison, the 1918 pandemic lasted for four years and infected about half a billion people.

Different Time, Same Problem

In 1918, the pandemic not only broke out right before the U.S. entered World War I but also, during the Great Migration, where hundreds of Black southerners migrated north to escape Jim Crow laws—laws that allowed for segregation to be legal following the Civil War. However, this coincidence heightened the sense of alarmism and scapegoating that is still seen today. Black citizens were blamed for bringing influenza and spreading it in cities like Chicago, when in reality everyone was becoming sicker. Out of the 50 million deaths around the globe, 675,000 of them were American. By March of 1918, one-third of the Americans hospitalized were Black. One study concluded that Black people had a higher risk of dying if exposed to the illness. However, it was not the virus that discriminated, but the people and systems put in place.

In cities across the United States, Black patients received lower-tier healthcare from segregated hospitals and were often left to fend for themselves. Outside of inadequate healthcare support, racial discrimination spread like influenza. In 1919, the city of Baltimore’s white sanitation department employees refused to dig graves for Black flu victims after the city’s only Black cemetery, Mount Auburn, could not accommodate any more graves. Similarly, although everyone was being negatively affected, the Chicago Daily Tribune March 5, 1917 headline, “Rush of Negroes to City Starts Health Inquiry,” paints a picture of the prejudice and racial bias that many Asian Americans are now experiencing today.

Following the COVID-19 outbreak and its origin in China, numerous counts of discrimination and violent attacks were reported against Asian Americans throughout the United States. A 16 year-old student in California was attacked in his high school after being accused of having COVID-19 simply because he was Asian-American. This virus has increased the use of racist, xenophobic, and perpetual foreigner stereotypes, and provided insight into Asian discrimination, a historically under-reported area. The most startling aspect, similarly tied to the discrimination against many Blacks in 1918, is the level of discrimination against Asians solely based on outward appearance rather than their actual ethnicity. Similar to the feelings and perceptions of “driving while Black'' there is a new fear of “coughing while Asian.”

Today, the pandemic shows us that these structural systems of inequality are still in place. Out of all the victims COVID-19 has claimed, the highest rates are associated with Black and Brown bodies across various states. In New York City, Latinos represent 34 percent of the people who have died of COVID-19 but make up only 29 percent of the city’s population. Similarly, according to preliminary data from the city’s Health Department, Black people represent 28 percent of deaths but make up 22 percent of the population. In the South, the state of Louisiana reported that 70 percent of the people who died from COVID-19 were Black, but they only make up 30 percent of the state’s population. As the current pandemic continues to disrupt the world, researchers and scientists can only predict what the final results will be.

An Unequal Equalizer

However, why do these racial disparities exist through what is called an “equalizing” disease? How come the same effects from a hundred years ago still exist today in a “desegregated” world? Most researchers point to two main reasons.

First, in both pandemics, minorities can be seen at the front line working jobs and serving roles that put them at higher risk of exposure. During the 1918 influenza, many Black soldiers had the worst or most at risk duties, such as being sent out to clean the trenches after a battle or to exhume and rebury dead soldiers’ remains. Influenza overwhelmed the resources of medical training camps under the burden of urban density and unequal living conditions. Today, Black Americans are more likely to be employed in essential jobs on the front line, where they are more prone to exposure. A study from Scott Stringer, the New York City comptroller, found that 75 percent of front-line workers in the city, from grocery clerks, bus and train operators, janitors, mailmen, and child care staff, are minorities. More than 60 percent of people who work as cleaners are Latino, and more than 40 percent of transit employees are Black.

Secondly, studies have shown that there is implicit racial bias within the healthcare system. This was evident in 1918 when segregation was still legal, but racial bias continues to exist implicitly among healthcare professionals. Not only do Black Americans have lower levels of health insurance coverage, but even with health insurance the quality of care provided is often questionable. According to a study conducted in 2005 by the National Academy of Medicine (NAM), “racial and ethnic minorities receive lower-quality health care than white people—even when insurance status, income, age, and severity of conditions are comparable.” Another study of 400 hospitals in the United States found that Black patients with heart disease received older, cheaper, and more conservative treatments than their white counterparts, with Black patients less likely to receive coronary bypass operations and angiography tests. After surgery, they are discharged from hospital earlier than white patients, sometimes at a stage some professionals would consider inappropriate. Simply stated, Black patients were more likely to receive less desirable treatments. It is often difficult to isolate these experiences, as Implicit Association Tests often show that physicians who harbor racial biases can either consciously or unconsciously hold these beliefs.

The question many have been struggling with is where can we go from here? After recognizing that these inequalities exist, what should people do? It would be unrealistic to ignore the lasting negative impact that racism has had in the United States. The level of social and economic inequality within housing, education, jobs, and health all have underlying roots and connections with race that have exacerbated the spread of COVID-19 for minority and ethnic populations.

Therefore, on the federal, state, and local level, active measures are necessary to protect these vulnerable populations. Providing protections for front line workers— who are disproportionately minorities—and adequate resources to minority communities in particular, such as testing centers, masks, sanitary stations, paid sick leave, and releasing timely and accurate demographic information, can help decrease the rate of spread and prevent further harm coming to these groups of Americans.

Frequently, issues such as these have endured for so long because of the lack of attention brought to them. Therefore, on an individual level, people have the responsibility to stay aware, informed, and place pressure on their government and communities to provide support. No one deserves to suffer from this disease in the first place, much less because of their race. While it is certainly unrealistic to say that staying informed and providing protection to minorities from COVID-19 will solve racism, but it is a good first step to collectively make in a time where empathy, support, and community are more needed than ever.