People of color across the country — and in Multnomah County — shoulder a disproportionate burden of illness and death from COVID-19.
Researchers at John Hopkins reports, for example, found Black and African American residents represent only about 13 percent of the population in states reporting data on race and ethnicity of COVID-19 cases. But Black residents account for about a third of COVID-19 deaths in those states.
Those inequities extend to Oregon, where people of color are overrepresented in cases and more likely to experience complications from the virus.
The most obvious disparity is this: Latinx people make up 13 percent of the state population and 27 percent of cases. That disparity is driven by an outbreak in Washington County, where nearly half of those who have tested positive for the virus identify as Latinx — more than double the rate of Hispanic residents in Washington County.
In Multnomah County:
Black, indigenous and other people of color represent 40 percent of COVID-19 cases, despite comprising only 30 percent of residents.
Latinx and Asian American residents appear more likely to be hospitalized from the virus, and many of those residents reported underlying health conditions.
Most residents who have died of COVID-19 lived with chronic health conditions — conditions that occur at far higher rates among Black and African American residents.
More than numbers
Black, indigenous and other people of color are also more likely to engage in public-facing essential work. And those same residents are more likely to experience severe symptoms and hospitalization because of higher rates of underlying chronic disease — disease stemming from centuries of unequal access to healthcare and inequitable opportunities for healthy jobs, homes and lifestyles.
But health officials also caution that this emerging picture is incomplete. That’s because race and ethnicity data — who gets tested, who tests positive, who falls ill and who dies — is often still missing or isn’t being collected by medical providers. Public health officials say that kind of information is important when recommending when and how society should open back up.
“This is data so needed for us to make decisions about policy, resources and how we’re going to fight this global pandemic,” Public Health Director Rachael Banks said Thursday as health experts detailed new data showing COVID-19 cases, complications and deaths.
“But it’s important to understand the history that makes some people more vulnerable — not because of choices they’ve made, not because of their age — but simply because they were born Black or Brown,” she said. “This data is rich and powerful and has an additional story... and it’s not only our story to share.”
Whose story we tell
The Oregon Health Equity Alliance, the Coalition of Communities of Color, the Native Wellness Institute and culturally specific leaders in Multnomah County’s Public Health Division led a data review committee to advise regional health department leaders and epidemiologists on how to interpret and release data on race and ethnicity.
Before publishing the data online, the panel on Wednesday, April 29, hosted a webinar for leaders and media from communities of color to discuss the data and its glaring shortcomings.
“We rarely get access to our data first. Often we’re seeing it come to us from outside our communities,” Zeenia Junkeer, ND, executive director of the Oregon Health Equity Alliance, said during the webinar. “This is an opportunity to lead those conversations about what the data shows and what is missing.”
Junkeer shared alarm at race and ethnicity data connected to COVID-19 testing in the state. In more than half of the cases, it was either missing or “unknown.” That’s despite a 2013 state law called “REAL D” that sought to improve collection of race and ethnicity data by state agencies, including the Oregon Health Authority
“There is an opportunity here for advocacy and ensuring our communities are counted in the data and we get access to the resources we need,” she said in the Wednesday meeting.
Andres Lopez, Ph.D., research director with the Coalition of Communities of Color, told the group there’s power in that missing data.
“When we think of data, we think of numbers,” he said Wednesday. “Data is used to define and control knowledge. It informs government priorities, funding, programs.”
“Data helps us tell a more nuanced story about what people are experiencing, the structural inequalities,” he said. “If there’s no data, it’s death.”
Kelly Gonzales, Ph.D., a researcher at the OHSU-PSU School of Public Health underscored Lopez’s words, framing an opportunity to demand the right to shape that narrative.
“We have a tendency to see data as a number, void of emotion, void of stories,” she said. “The folks working in Multnomah County and with the Future Generations Collaborative, there is a commitment to put the heart of our people in those data so the system is helpful and can help dismantle white supremacy.”
Lynn Rampe, a researcher and epidemiologist with the Multnomah County Health Department, said the Public Health Division has been aggressive about gathering data on race and ethnicity because it can serve a proxy for tracking another lurking disease — racism.
“Race has a role in who gets protected and who gets sick. It’s not race that determined these outcomes, but the experience of racism,” she said. “If we know where disease lives and who it affects, we can better protect people. This helps us support people and programs and puts voice in policymaking and resource allocation.”
Speaking to members of the media in a general briefing Thursday, April 30, Junkeer challenged the system to seize this chance to write a history that is true, transparent and fair.
“Our world will never be the same,” she said, “and we should use this opportunity to create truly equitable systems structures, policies and programs with communities that are most impacted, centering them in all our decisions.”
What we know. What we don’t.
Aileen Alfonso Duldulao, Ph.D, a research scientist and senior epidemiologist in the Multnomah County Health Department, laid out the national landscape of COVID-19 in Thursday’s briefing.
Because they are more likely to do public-facing work, Black, indigenous and other people of color are contracting the virus at a higher rate.
And, because of unequal access to health care and higher rates of chronic disease, — stemming from centuries of inequitable access to health jobs, homes and lifestyles — Black, indigenous and other people of color are more likely to die from COVID-19, Duldulao said.
Locally, nearly half of all lab reports from COVID-19 test results shared with the County omit information on race and ethnicity.
“That means we don’t know who has access to testing and who doesn’t,” she said. “Not having all the testing data is hiding a lot of disparities we may see. We need reliable data to trust we have the testing we need, where we need it.”
That limits some aspects of Multnomah County’s regional dashboard, which shows data based on people who have not only tested positive for COVID-19, but also have had access to tests. The dashboard relies on available data on age groups, race & ethnicity, and gender to show particular demographic trends . This week the County also added housing status.
Duldulao called out the work of the Communicable Disease Services epidemiologists, among them Russell Barlow, Kevin Jian, Allison Portney and Taylor Pinsent, who gather that data on their own during the course of interviews and interpret the data so County leaders can allocate resources in a more equitable way.
The data suggest Multnomah County is following the national trend, but the local numbers are small, especially when drilling down on cases of hospitalization and death. Duldulao said a lack of adequate testing and poor quality data collection on lab reports are driving the county’s concern.
“Again, the data is based on who has access to testing,” she said. “Once we ramp up testing, we will see a lot more cases and more disparity.”
Call to Action
Public Health Director Banks called on labs, healthcare providers and government agencies to be more diligent about collecting information on race and ethnicity, so Public Health can feel as confident as possible in its recommendations about when and how to reopen in the midst of COVID-19.
Banks called on the healthcare system to:
Collect race and ethnicity data
Ask each patient how they self-identify
Use the Race, Ethnicity, Language and Disability (REALD) classifications
Prioritize patients of color for testing
Reduce barriers to testing, including cost or language access
“We need it to happen at every lab, at every visit,” Banks said. “For individuals, if you’re not asked, tell people, ‘this is what I am and this is how I want to be categorized.’”
Banks called on individuals to continue being diligent in their efforts, even as the skies turn clear and the weather warms. She asked everyone in the community to continue:
Practicing physical distancing and good hand hygiene.
Seeing your provider to care for chronic conditions. If you don’t have one, call the County at 503-988-5558 to schedule an appointment.
Staying home if you have a cough or fever, and if symptoms worsen, seeking medical care.
Using your smartphone, tablet or computer to check for symptoms — in Spanish and other languages at C19oregon.com
Banks asked people who feel comfortable wearing face covers to do so if they can’t remain physically apart from others, but underscored that guidance is voluntary.
People might have health conditions or disabilities that complicate the use of a face covering.
“And quite frankly Black and Brown people who are worried about how they are going to be perceived, and if they are going to be perceived as a threat,” she said. “We know these actions are harder for some people and a privilege for other people. We know it’s easier for some people to telework. We know that it’s easier to stay away from a sick family member in a 3,000-square-foot house than in an intergenerational apartment.”