COVID-19 in Black and White

Source: Virginia Department of Health COVID-19 dashboard

by James A. Bacon

For many social justice activists — please note, I refrain from using the potentially inflammatory term social justice “warriors” — racial disparities in the United States are a fixation. They have made an issue of the fact that African-Americans are more likely than whites to contract the COVID-19 virus than whites, which supports their contention that the U.S. health care system is unjust, and inequities can be remedied only through government action.

Maybe the system is unjust, maybe it isn’t. If it is, we can argue over the reasons why that might be so despite the transfer of hundreds of billions of dollars from taxpayers and privately insured patients to the poor. But before we jump to conclusions, let’s look at the numbers.

As can be seen in from the graph above, among Virginian patients whose race has been reported, African-Americans account for 4,337 cases, or 23.2% of all cases. That is slightly larger than African-Americans’ 19% share of Virginia’s population. By contrast, whites, who comprise 68% of the population, account for only 8,924, or 48%, of COVID-19 patients. That is what the SJAs (social justice activists) call a “disparity.” To the SJA way of thinking, disparities constitute proof — no further evidence needed — of injustice.

The first question we might ask is why blacks are more likely than whites to contract the disease. Does this disparity reflect inequities in the health care system or some other explanatory factor?

Commenting on CNN, basketball legend Magic Johnson drew a parallel between the HIV epidemic and the COVID-19 epidemic. “When I announced [that I had HIV], it was considered a white, gay man’s disease. People were wrong. Blacks people didn’t think they could get HIV and AIDS.” The implication of his remark is that African-Americans did not immediately take COVID-19 as seriously as they should have.

Other possible factors, suggested Johnson, were the higher prevalence of underlying health conditions such as obesity, diabetes and high blood pressure; the high cost of health care; and the the fact that a higher percentage of African-Americans work in “essential services” occupations where they are more likely to be exposed to the virus. He also said it was more difficult for African-Americans living in inner cites to get test kits. “The problem is people want us to drive to suburban American to get that test. Why can’t you have that testing done right in urban America and right in the inner cities?”

Johnson provides several worthy hypotheses of why COVID-19 has affected African-Americans to a greater extent than whites. They warrant a closer look. But before we draw any conclusions, let us dig a little deeper into the Virginia data. This graph shows hospitalization by race.

African-Americans comprise 858, or 26.7%, of all COVID-19 hospitalizations in Virginia among those whom race is known. That’s higher than the 23.2% who contract the disease. That implies that African-Americans are somewhat more likely to contract severe cases requiring medical attention. This is consistent with Johnson’s argument that African-Americans are more likely than whites to suffer from underlying health conditions that aggravate the disease. It is not consistent with the notion that African-Americans lack access to the health care system. Indeed, it appears that African-American COVID-19 patients make greater utilization of hospitals than whites with COVID-19.

A retort of social justice activists might be that the higher prevalence among non-Hispanic blacks of co-existing conditions such as obesity, diabetes, and hypertension reflect differential access to primary health care, ergo it constitutes a social injustice. I won’t argue that point one way or the other at this time. Either way, we need to distinguish between access to primary health care and access to acute care treatment, or hospitalization.

Finally, let us look at deaths by race.

African-Americans account for 201, or 24.8% of all COVID-related deaths — somewhat higher than their percentage of Virginia’s population but lower than their percentage of hospitalizations. (Conversely, the death rate for whites shoots up to 62%.) If African-Americans die at lower rates than they are hospitalized, it suggests that the quality of care they receive in hospitals is as good as the care received by whites.

Bacon’s bottom line: Any analysis quickly gets complicated. The limited data we have suggests that the greatest problems for African-Americans stems from the travails of lower socio-economic status: higher prevalence of pre-existing conditions, greater involvement in service occupations exposed to the public, living in over-crowded housing, and, one might add, greater use of mass transit. Personal behavior — the willingness to take protective precautions — is a factor that simply hasn’t been examined carefully. Access to protective gear such as masks, plastic gloves, and hand cleanser — a matter of access to cash — could be a factor. What does not appear to be a factor is access to hospitals and the quality of treatment in hospitals once the disease has progressed to the acute phase.

When it comes to addressing a public health emergency like COVID-19, it helps no one to impose a rigid ideological framework on the data in order to confirm pre-existing suppositions. The more factors we consider, even if some are politically incorrect, the better our analysis will be. Flawed diagnoses leads to flawed treatments. Well-grounded diagnoses leads to better treatments —  whether we’re dealing with social issues or epidemics.

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32 responses to “COVID-19 in Black and White”

  1. Steve Haner Avatar
    Steve Haner

    This doesn’t even closely align with the data I cited yesterday. The CDC doesn’t even use the same categories. Table 2a:
    As mentioned yesterday, nationally both non-Hispanic whites and non-Hispanic blacks are dying at rates in excess of their percentage of the population. The disparity is actually higher for the whites. Any real look at this would have to also have that broken out by age. On that table, the data for VA shows a similar pattern, with both groups dying at rates higher than their % of the general population. (In VA, however, the disparity is higher for blacks.)

    Now, I suspect that the Table 2A data for Virginia came from Virginia, and it appears that Virginia makes no effort to track Hispanics separately, be they white or black. As with just about everything over the past few months, even the data is suspect.

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Agree, but I would also emphasize long and short term daily lifestyle, knowing that nursing home living is part of lifestyle too.

      Then there is the genetics angle, very complicated subject, and newly controversial now as well (see last weekends WSJ Review section).

      As to Coved-19, See this from MIT, for example:

    2. Steve, the CDC says they use 1997 standards for race/ethnicity distribution for their weighted numbers while Va death certificates ignore Hispanic/nonHispanic origins. Hispanic population in Va in 1990 was 2.6%; in 2000, 4.7%. (
      2019, 9.6% (

      So, yes, suspect indeed.

    3. Nancy_Naive Avatar

      It’ Death Certificate data. It could be screwed up for months as local coroners catch up with the paperwork.

  2. LarrytheG Avatar

    We keep doing this – i.e. showing disparities then asking “why oh why” as if we don’t really know.

    My suspects are that folks with lower education levels end up in lower-paying jobs without health insurance and when things go sideways – it’s a disaster.

    These folks, are at the margins economically. No job = no money for food,rent or utilities… and they tend to share tight living conditions with others like them… i.e. those low-income neighborhoods.

    At that level – you do what you gotta do to survive and if that means working in close proximity to others – like meatpacking, then so be it.

    so the social justice people try to put a guilt trip on everyone else and some folks just take extreme umbrage to that. It’s NOT their fault that these folks are so bad off.

  3. Peter Galuszka Avatar
    Peter Galuszka

    Thought Steve’s 2a table made sense. Jim, can you please explain the disparities? I can’t

    1. Steve Haner Avatar
      Steve Haner

      It gets more complicated the more time I spend on the CDC table. Table 2A is using “weighted” percentages for the demographic breakdown, as opposed to the census figures (another table.) Weighted how? Then I look at Table 2C , which has deaths by age cohort by demographic group, and there is a significant result: among non-Hispanic whites, almost 90% of deaths are 65 or older, but among non-Hispanic blacks, its right about 71%. So the risk for middle aged patients is higher among African Americans it appears. I don’t disagree with Larry’s argument that it’s economics.

      When all is said and done, the risk factor that will matter most will probably have been being old and ill and in a nursing home with poor infection control. And that’s going to correlate with Medicaid percentages and we’re back to poverty. To get back to yesterday’s point about Hispanics, perhaps in that culture families are less likely to put Gramps or Grannie in a home on Medicaid. You sure didn’t want to be in one the last 60 days.

    2. I haven’t had time to look closely at the CDC stats. One possible explanation might be the difference between national averages and Virginia averages. Virginia does not necessarily duplicate the national experience.

      1. Reed Fawell 3rd Avatar
        Reed Fawell 3rd

        Flu statistics, CDC stats versus Va. stats are also wildly off, far far lower in Virginia, and also in comparing this year to past years nationwide too.

        Indeed, these numbers all are all over the map exposing a huge central fact: We are not even close to knowing what we don’t know, and that gap seems to widen by the day, meaning disease data collection is behind the curve nationally as well as locally, and, as to the past, this too was probably always the case. Such is science! And our need to be humble.

  4. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Even the DOC data is getting a little screwy. The total number of deaths is up to 5 now. Furthermore, the number in a hospital has been rising and is now at a high of 15. Finally, the number of staff testing positive is 77, the second highest level. The puzzling aspect of the data is that the total number of positive cases in the facilities is 432, 10 fewer than yesterday and 91 fewer than Monday. The big decrease was driven by an overnight (Monday to Tuesday) decrease of 75 in one facility, Deerfield. That significant a drop in 24 hours seemed implausible to me, but DOC data folks assured me that they confirmed the data with the institution.

    The summary:
    Summary of COVID-19 Cases in Va. Dept. of Corrections
    As of 9:00 a.m., May 12

    Cumulative testing positive 719
    Total Deaths 5
    Active positive cases in facilities 432
    Number in hospital 15
    Recovered 267
    Staff currently tested positive 77

    1. Steve Haner Avatar
      Steve Haner

      The crisis, such that it is, is in nursing homes, old age warehouses, and prisons, both the residents and the staff. In all those cases the government (state, federal, local) is the largest payer of bills, and the economy is (arguably) shut down to protect it from costs and lawsuits.

      Admittedly other congregate settings are a problem, the cruise ships and airports two months ago, the meat processing plants now. The idea that a sidewalk cafe or sunny stretch of beach is a danger is without data.

    2. Nancy_Naive Avatar

      Maybe, just to make Kerry happy, they are sentencing dead people to life…. wait, that’d be cool.

  5. LarrytheG Avatar

    I was at the eye doctor this morning. Everyone had masks. I was waiting to check out while someone else was waiting to check in and was finding out that Medicare/Midcaid cover the examination but not the glasses … while coughing repeatedly…

    Needless to say – it’s put the kibosh on by standing…..

    the guy apparently had no clue or perhaps he did and was expressing is displeasure.

    At any rate… I was ready to leave… and I suspect others also.

    1. Steve Haner Avatar
      Steve Haner

      With my dental appointment this week, I came in the back door (to hand sanitizer and a temp check) and went out the front, preventing that cross traffic flow. And I suspect they sent us out to the front desk and exit spaced out by design….

      1. LarrytheG Avatar

        yes… but was the guy in the chair you sat in… “okay” ?

      2. Nancy_Naive Avatar

        Okay, suppose you failed the entry exam, would they turn you back through the door the next guy is entering? Would you have to leave by a window? Were they prepared to disinfect the path you took?

        Finally, would they bell you and make you cry, “unclean, unclean,” as you made your way home?

        1. Steve Haner Avatar
          Steve Haner

          You two are total idiots. Idiots. We’re letting idiots drive this. Dentist offices have been practicing infection control all along. The waiting room is the only danger zone, and now there is no waiting room. Idiots.

          1. LarrytheG Avatar

            My dentist has not been open except for emergencies… and the problem is not only the waiting room but the chair and equipment in the treatment room.

            Are we (should we?) sanitizing everything in there in between patients?

            If you found out that someone with Covid19 had been to your dentist, would you still want to go or have some hesitation?

            You call this “idiot”? Yep… I agree but not the way you thought.

            You guys cannot get it in your head that the virus is not political. It’s keeps come back to that…

          2. Steve, I totally sympathize with your frustration in this regard, but no name calling, please.

          3. Steve Haner Avatar
            Steve Haner

            Nanny (I mean Nancy) used idiot to describe Trump recently. No argument from me. But actually, Larry and Nanny Nancy are cunning and intentional fear mongers, enjoying the chaos and disinformation they spread. So for them it was the wrong word.

          4. LarrytheG Avatar

            what? How can one be “cunning” and an “idiot” at the same time?

            Must be something in the coffee this morning… 😉

          5. Nancy_Naive Avatar

            And what is a humorless idiot?

          6. Nancy_Naive Avatar

            I did no such thing… I said some idiot in the White House and specifically said, “who shall remain nameless”.

            BTW, prior to AIDS, many dentists did not wear any protective gear, no mask, no gloves. They even called it “wet finger”. In the early days of the AIDS epidemic, dentists were responsible for a number of cases. Sure, they autoclaved the instruments, but not the drills and other equipment. Dentist offices were among the worst in the medical field.

          7. LarrytheG Avatar

            yep – “idiot fear mongering” and all… Dental offices are places where bodily fluids are mixed with various pieces of re-useable equipment….including spatter (which is why even hygienist now wear face shields) …

            I would think the entire room and equipment would have to be totally disinfected between every patient… and new PPE and face shields, etc..

            I’ll give a report on what I see when I go in a week or so.

          8. Nancy_Naive Avatar

            Nanny, huh? Nanny Nancy. Gee, I wonder if I can think of a… Of course, Surly Steve.

  6. 8022 with unknown race of 26,746 is 30% of the total. That’s way more than enough to make these statistics useless.

    What happened with the VDH getting better racial breakdowns to look at this issue?

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      “What happened with the VDH getting better racial breakdowns to look at this issue?”

      Good question. Around his April 8th new conference, the Virginia Governor told us that Virginia was developing a cutting edge, best in the nation, best practices system, breaking down all these Coved – 19 statistics by race, so as the insure in Virginia world class equities for all peoples of color.

  7. Nancy_Naive Avatar

    “please note, I refrain from using the potentially inflammatory term social justice “warriors”

    You just did… kinda along the lines of “an idiot in the White House, who shall remain nameless, Trump, suggested putting a UV flashlight where the sun don’t shine.”

  8. Peter Galuszka Avatar
    Peter Galuszka

    Bacon. Such a wonderful white guy

  9. Nancy_Naive Avatar

    When wealth is passed off as merit, bad luck is seen as bad character. This is how ideologues justify punishing the sick and the poor. But poverty is neither a crime nor a character flaw. Stigmatize those who let people die, not those who struggle to live. -Sarah Kendzior, journalist and author (b. 1978)

  10. TBill Avatar

    I feel the scientific answers could be very complex. Yes the COVID differentials could be socio-economic factors, but it could also be related to past exposures to viruses.

    As an analogy for a more complex case, altitude sickness is now thought to be related to whether or not your parents were acclimated to high altitudes. If so that trait can be passed on. Therefore I assume it is not out of the realm of possibilities that susceptibility could be related to parental past exposure to germs or vaccines, or lack thereof.

    It goes without saying that us divisive Americans want to take advantage of new data to prove political points; Hurricanes are 100% proof of climate change Armageddon unless fossil fuels are immediately banned, right?

  11. For crying out loud, we cannot even come to terms on a reliable test, still?

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