Examining fatal social flaws as COVID protections evaporate

Though public health guidance and rules shifted quickly over the last two years, this has been consistent: People of color in the United States died from COVID-19 at higher rates than white people.

That’s true here in New Mexico, too. 

Last year, Indigenous, Hispanic and Black people in the state were far more likely to die from the illness than white people, according to data from the Centers for Disease Control and Prevention. 

Researchers posed this question: What if everyone who died of COVID in 2020 did so at the same rate as college-educated white people?

There would have been 71% fewer deaths of people of color, according to a study released just months ago.

For young people of color between 25 and 60 years old, that number jumps even higher — 90% of them would still be here today, researchers found.   

And overall, there would have been half as many deaths in the United States, the study shows. 

That kind of information, and how it reflects the government’s response to the pandemic, is what makes Eleanor Bravo feel like her sister was murdered.

Last survivor of family of five

Carmen Eudosia “Desi” Bravo was born in Manila in 1943 and immigrated to the United States with her parents and two younger sisters in 1950. Desi studied chemistry like her dad at the University of Kansas and went on to run the office of a doctor who specialized in bone cancer before eventually retiring.

Eleanor didn’t think her big sister would ever catch COVID in the early months of the pandemic, because Desi was home-bound and unable to go anywhere. 

“She wasn’t sick, but she’d had a knee-replacement surgery,” Bravo said.

But in October 2020, before the vaccine was available, Desi fell multiple times and was hospitalized in Kansas City. She was released and sent to a nearby rehabilitation center where they weren’t wearing masks, Bravo said. She was infected with coronavirus.

Desi ended up back in the hospital — this time with COVID. She couldn’t breathe and was intubated, her sister recalled. 

“She never regained consciousness,” Bravo said. “She suffered a COVID heart attack and died five days later.”

Desi’s children were only allowed to see her and briefly say goodbye at “the very end,” Bravo said. The family still has not had any kind of funeral or memorial service. She was 76.

“I am so angry. I feel she was murdered. I do. I feel she was murdered,” Bravo said. “She was not sick. She would still be here if not for COVID.”

Explaining away systemic racism

In 2020, the year Desi died, Filipinos had the second-highest mortality rate from COVID of any racial or ethnic group in the country, research shows.

Medical science has a long history of trying to explain away lethal systemic racism — people of color living within unjust systems and dying more often — as either genetic or cultural inferiority. 

But the inequality in COVID death rates has many concrete causes that have nothing to do with those racist assumptions about genes and culture. Those include exposure to the virus at the workplace and poor access to medical care, said Justin Feldman.

Feldman is a social epidemiologist studying inequality and state violence at the FXB Center for Health & Human Rights at Harvard University. He’s the author of the “what if” study mentioned above. 

The first two years

Feldman and co-author Mary Bassett analyzed CDC data and matched it to census data to calculate death rates throughout 2020. They found that racial and economic inequality work in combination to create bad outcomes.

But people don’t always understand that. In publishing the study with the Journal of American Medical Association, Feldman said one of the editors’ questions was: What about obesity?

“They single out obesity, because they are drawing on people’s fatphobia,” Feldman said. “They also are implying that people of color are fat, and those are behaviors they chose, and they brought it upon themselves. It’s a way of individualizing and blaming what’s clearly, to me, a result of systemic racism.”

Often, the problem is actually access to health care, or as we saw last year, to vaccines.

“It took longer for a lot of people of color to get vaccinated for various reasons than for white people,” Feldman said. 

‘We can never let this happen again’

Bravo’s been helping Spanish speakers and elderly people, and people unfamiliar with computers in the Albuquerque area get vaccinated and educated about the dangers of the airborne virus, she said.

She’s heard of whole families not being vaccinated. 

The reason, Bravo said, is misinformation.

“Nothing was in Spanish,” she said. “If you are not wealthy, or not even middle class, and you don’t have a computer, and you don’t read English, you don’t get the information.”

As a community organizer for decades, Bravo said even the New Mexico government didn’t do a good job of reaching out to rural communities. It’s already hard enough to apply for unemployment and other public benefits in rural areas of the state, she pointed out, because many people do not have computers, let alone internet access.

“In my opinion, it’s the populations that don’t have good access to good information streams,” Bravo said. “At the same time, they couldn’t get vaccinated because they couldn’t navigate the state website.”

It was hard enough for elderly people, much less elderly Spanish-speakers, to navigate the state’s vaccination website, she said. “It was not user-friendly,” Bravo said. “I helped so many people get shots because they just couldn’t figure it out.”

Several of the elderly people who Bravo helped  were not going to actually receive the vaccine for two months after signing up through the state, so she had to make some calls.

Still, she said she knows several people who died because they didn’t get vaccinated as a result of not getting the right information.

“I want legislation, and I want better public health policies,” Bravo said. “We cannot forget this. We can never let this happen again.”

Some numbers finally move

Nearly two years into the public health emergency, a couple of the numbers shifted nationally, Feldman said. 

Death rates among older Black and Latino people are dropping to converge with the death rates of older white people, he said.

“But that’s not due to the accomplishments of the Biden administration,” he said. “We still see big inequality in hospitalizations, big inequality in deaths among younger people especially.”

The rates are going to become more even regardless, he said, because some part of the racial inequality was about who had been infected their first time.

The CDC and the U.S. Supreme Court have each embraced the “focused protection” strategy. This has included lifting masking recommendations throughout most of the United States and striking down a vaccine-or-test requirement for workers after they were challenged in court.

The new approach, derided by public health experts, physicians, and disability justice advocates as “letting it rip,” rests on the assumption that rather than eradicating the virus, health authorities will instead let the virus run through the population in the hopes of reaching herd immunity.

So when we’re talking about inequitable rates, the first-time infection factor will even off as the virus saturates more of the population. That leaves existing racist inequities like unequal prior health status and unequal access to health care.

How do we undo scientific racism?

Public health and medical researchers have been talking about racial disparities for hundreds of years, said Dr. Jamal Martin, associate vice chancellor of African American health at the University of New Mexico Health Sciences Center.

Instead, they should be focused on what to do now about inequity that comes from policy choices and political decisions, he said. 

“Research in these areas needs to be transformative rather than transactional,” Martin said. “How do we undo scientific racism and undo the colonial issues that have been embedded in medicine and public health for so long?”

The critical question: Is the health outcome systemic, avoidable and unjust? 

Martin said our collective response to the pandemic in the United States has thus far reproduced racism and legacies of colonialism.

Around medical mistrust and historic abuses, people often point to the Tuskegee experiment that began in 1932. Researchers from the United States Public Health Service watched Black men slowly get sick, go blind and die from syphilis over years without telling them they had the illness or providing medicine — even though treatment was available. 

“Tuskegee was just a drop of water compared to all the issues that relate to what Harriet Washington called medical apartheid that exists in this country,” Martin said.

Accepting a grim ‘normal’

As we enter the third year of the pandemic, state and federal officials are lifting public health protections, publishing pandemic data less frequently and changing the way they evaluate risk of catching the virus.

President Joe Biden said in his State of the Union address, “COVID-19 need no longer control our lives.”

Feldman said that’s problematic. “We’re being asked as a society to accept the new normal of higher levels of disability and death in perpetuity, that will disproportionately fall on some groups that we should care about them not falling on — like people of color, working class people, disabled people.”

We should be asking how we protect immunocompromised and otherwise medically vulnerable people, he emphasized. That implies the need for a set of policies to protect people from exposure in the workplace, the doctor’s office or the classroom, he said.

“That means expanding the social safety net. That means increasing social rights,” Feldman said. “And that has not been even a conversation.”