During Michigan’s first COVID-19 wave, Dr. Jocelyn Ang set out to study a population that was largely overlooked at the time: COVID-positive children in Detroit. The city was a pandemic hotspot, and researchers were increasingly seeing a disproportionate impact on minority communities, but most of the focus was on adults because the virus was seen as particularly dangerous to older people with underlying conditions.
Ang, an infectious disease expert at Detroit Medical Center Children’s Hospital of Michigan, looked in a different direction — and that curiosity paved the way for a landmark study showing that children of color are significantly more vulnerable to severe illness from the coronavirus than other children. Ang’s findings join a growing body of research that doctors and scientists believe could help end generations of healthcare disparities in the U.S.
“We’re seeing a lot of reports like ours highlighting disparities that we hope will lead to more actions from the public health sector about this,” Ang says. “As physicians, we can make sure everyone gets proper medical attention. But regarding public health and social inequities, there’s still a lot to be done.”
The alarming numbers that Ang and her colleagues reported could be a catalyst for this process. Ang found that of 78 COVID-19 patients in Detroit ages 18 and under, 82 percent required hospitalization. That’s 10 times the national rate of coronavirus hospital admissions among kids. Of those who were hospitalized, 37 percent were admitted to the intensive care unit. Seventy-three percent of the kids in the study, which was published in May in the journal Global Pediatric Health, were Black; 13 percent were Hispanic.
“It became clear that COVID-19 was disproportionately impacting Black and Hispanic communities due to structural racism increasing their risk of exposure to the virus,” Ang says.
Similar racial disparities were already evident among adults — while Black people make up 14 percent of Michigan’s population, they’ve accounted for 40 percent of COVID-19 deaths, according to the Michigan Department of Health and Human Services. But the disparities had not yet been highlighted so clearly in children.
While researchers have been studying racial disparities in healthcare for decades, the scale of the problem has never been so clear — nor so widely recognized. The Centers for Disease Control and Prevention reported that COVID-19 hospitalization rates nationwide are 2.8 times higher in the Hispanic or Latino and Black populations compared to the general population. Black people who contract COVID-19 are twice as likely to die than the general patient population; Hispanic patients are 2.3 times more likely.
Ang’s study did not look at the causes of the higher hospital admissions it uncovered, but she points to the well-known disparities in healthcare access and a higher prevalence of underlying health conditions among communities of color as contributing factors. Some 44 percent of the children in the study had conditions such as asthma and obesity.
“These groups have more crowded environments, multigenerational households, and parents who are more likely to be employed in places like factories and grocery stores, where transmission rates are high,” Ang says.
These populations are also more likely to live in areas with higher exposure to air pollution, which studies find correlates to higher COVID-19 mortality rates. Understanding why certain populations experience worse outcomes will hopefully lead to more targeted interventions for those groups, Ang says.
Inequities exposed by the pandemic — like those underscored in Ang’s study — may already be prompting change, according to Dr. Herbert C. Smitherman, vice dean of diversity and community affairs at the Wayne State University School of Medicine. The Biden administration’s Build Back Better plan, for example, which aims to mitigate some of the damage caused by the pandemic, focuses heavily on strengthening infrastructure, both physical and social, in Black and brown communities.
“The pandemic has simply exposed a long history of institutional race-based policies that have tied people of color to the bottom of the economic ladder,” Smitherman says. “It didn’t create the disparity — it simply exposed it to the country. The question is, What’s the catalyst that’s going to transition us from discussing this issue to taking action and implementing policy to change it?”
In April 2020, leading physician groups — having noticed high COVID-19 case rates among communities of color — called for the release of racial demographic data about infection rates, hospitalizations, and deaths from COVID-19. Putting a spotlight on the disproportionate effect on minority communities has led to numerous articles in prestigious medical publications, like The New England Journal of Medicine, urging policymakers to think big when it comes to finding solutions.
Smitherman and Ang say more research is needed to fully understand health inequities and to bolster policies to combat them. For now, Ang says, the best antidote for disparities related to COVID-19 is to get everyone, including children who are eligible, vaccinated. “It is of utmost importance to vaccinate eligible children with comorbidities and from vulnerable racial and ethnic populations,” she says. “If parents choose not to vaccinate children in the vulnerable population, this could leave their children unprotected against the infection, with a potentially fatal outcome.”