Over the course of the pandemic so far, one trend that has emerged is that the health
impacts of COVID-19 vary widely by race. Although genetic factors have been considered by some
as an underlying cause, it's clear from the overwhelming amount of public health data
that something else is at play here. If we take the U.S. as an example,
Overall, white people still make up the largest percentage of U.S. deaths from COVID-19, but
white people also make up more than 76% of the total U.S. population.
About 13% of the country’s population is Black, but Black people make up roughly 22% of the deaths from
COVID and that means that Black people in the U.S. are dying at a rate that’s roughly
double their population share. The disease is having a hugely disproportionate
effect on Latinos and Asians compared to their population percentage. The Navajo nation
had at one point the highest per capita rate of COVID-19 in the country.
So, before we get into what exactly is going on with COVID-19 in particular, we do need to
clear a few things up. There are diseases that do have a genetic component that make
them more common in certain groups, right, like sickle cell anemia, for example.
Why is that?
When we think about things like sickle cell,
that's a mutation that's protective against malaria. And so over time, people living in parts
of the globe where malaria is a real threat and risk have sort of selected for that mutation in
time. There is certainly much evidence to show that
ancestry is probably the thing that we're short-cutting to when we talk about race.
And so where people are from, their ancestors, there have been many, for example, adaptive
mutations over time that are a response to the environment.
And there are genetic factors that play a role in how severely someone may be affected by
COVID-19. That’s not only your genetic lottery when it comes to underlying conditions that
might make it more difficult for you to handle or recover from this disease, but also specific
genetic variations in cell surface proteins that the virus latches onto. But these genetic
variables that I'm talking about here aren’t necessarily classifiable by race.
The conversation around COVID-19 and genetics, I think is an evolving one. And we will see
what we learn regarding genetics and whether or not any genetic variance emerge as protective
or as increasing risk. And then another layer is whether any of those are what we would
refer to as ancestry informative marker associated variants. So you might see those variants,
but they might be random. They might not actually be tied to ancestry at all. I think those
are very important and exciting questions that we just haven't answered yet.
See, alleles are different ‘flavors’ of a gene, like how much and in what way that
gene is expressed in an individual. For example, all humans have genes that code
for hair, but what alleles we express determines how much, what color, what texture, etc. And this
is an essential concept to grasp, because according to genetic research of allele makeup, there
is no evidence that the groups we divide into different races have any kind of distinct
unifying genetic identities. Ultimately, there’s so much allelic variation
across and within races that two people of European descent, for example, may be more
genetically similar to a person of Asian descent than they are to each other. And many people may
respond to this by saying, so what about skin color? But the superficial attributes that we
use to classify each other by race, like skin, eyes, and hair, may only seem like such big
divisions because they are so visible. But the genes that code for these characteristics
are only a tiny portion of our genome, and they evolved independently from most of the
rest of our genome, so they aren’t inherently linked to other genetic traits. There may be
a few exceptions to rules like this, like melanin expression in the skin affecting the likelihood
of developing skin cancer, but these are pretty rare, and ultimately—humans share
99.9% of each other’s DNA. So, if race doesn’t pre-determine our health
on a genetic level in a vast majority of cases, then what accounts for the massive racial
health disparities that we see in say, the U.S.?
Black infant mortality is more than two times higher than white infant mortality. Pregnancy-related
mortality is 3-4 times higher in Black populations than in white populations. Black patients
experience significantly higher mortality rates for all kinds of surgeries and receive
poorer treatment when it comes to pain management. Similar trends in treatment disparities stand
out between white populations and other non-white populations—like Latinos, indigenous communities,
and Asian subgroups. And this is across huge swathes of medical treatments and patient
outcomes. And all of this is evidence that even though race is not a genetically or scientifically
valid concept, it’s still a pervasive social construct that does have real-world impacts on health.
We're having a reckoning now I think as a country with what has been a really intergenerational
and systemic and structural disinvestment in communities of color.
And all of that means in terms of denied access to opportunity and resources and how that
manifests in social conditions that make the risk of infection higher for many black and
brown individuals and neighborhoods, and then make the risk of severity that much higher
too. And so, together I think it's important to state that we are learning a lot about
this virus every day, but we will not discover at the end of the day that this is about biology
or genetics when we look at the stark racial ethnic disparities.
The coronavirus pandemic in particular is the perfect lens through which we see that
health is not so much about the actual bodies that we live in, but the social constructs
that are imposed on those bodies. Health is determined by your access to health
care and education, what language you speak, how much money you make, whether you can
afford to take time off of work to get seen by a doctor, whether you live alongside a
lot of people or just a few, whether your job requires you to interact with a lot of
people, and how your healthcare provider is going to treat you, literally. And we
can’t just consider these disparities in retrospect either: there are things we can actively
do as we work toward future solutions to this pandemic, too.
I think it's important for us to do that work to make sure that we have a real diversity
in all the things that we're doing around trials, experimental therapy, access to that,
things like vaccine creation. Representation matters in this work that we're doing. And
as we seek representation, we do it with the full understanding of knowledge that institutionally,
we've earned mistrust from many people of color. Because of, frankly, our past — but
also some of our present. So, we need to address that head on.
Now, in this video we’ve focused on statistics that are unique to the United States, but
similar data from other countries shows that racial disparities in coronavirus infection
and death rates exist in other places, too — like in the U.K., where South Asian and
Black populations tend to be the hardest hit. And all of these investigations are actually
kind of the beginning of the picture, because there are still numbers and stats missing, both
for accurate case counts and for race of the affected patient. So wherever you are in the
world, you cannot consider the effects of any disease without also considering the underlying
societal inequities at play. Much of our modern world has been built on
a foundation of slavery and colonialism and to see the harmful, lingering echoes of those
racist institutions in today’s society, like medicine, public health, all
we have to do...is look at the data.
For more topics on COVID-19, check out our playlist here
and if there's an aspect of the pandemic that you want to see us cover,
let us know in the comments. Make sure you subscribe to Seeker for more and thanks for watching!