“What Covid-19 is doing is actually shedding light on a problem that already existed,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity.
Race affects who can flee from a viral hotspot to a second home and who a generation shares a roof with family members. It affects who can work remotely and who has to leave home to keep society afloat. It affects who has easy access to testing and who discontinues treatment because they are concerned about the cost.
In other words, as the US approaches six million confirmed coronavirus cases, race plays a major role in who lives, who dies and who gets help.
Race affects where you live
The advice of experts has been constant: Keep physical distance from others to contract the virus.
But for many marginalized groups, that is easier said than done.
Latino and American Indians and Alaska Native people are 2.8 times more likely to be infected with Covid-19 than White people, according to recent data from the Centers for Disease Control and Prevention. Black people are 2.6 times as likely to be infected.
Higher rates of infection among Black and Latino Americans can be explained at least in part by housing conditions, according to a report released last week by the National Urban League. These conditions are a legacy of discriminatory practices such as redlining and segregation that go back decades.
Black and Latin people are more likely to live in densely populated cities and neighborhoods that expose themselves to more people. They also live more often in empowered, multi-generational homes that create potential for younger people to expose older siblings.
“We’re talking about housing that’s probably older and less quality,” Cooper told CNN. “There are smaller rooms in houses that do not have multiple bathrooms.”
She quoted a Covid-19 patient she spoke to who worked in the hotel’s household. The patient’s family shared a house with one bathroom, and everyone in their family became infected. The woman’s husband died of the virus, Cooper said.
Some Latino immigrants, particularly agricultural workers, live in full housing with other “essential” workers unrelated to them, said Randy Capps, director of research for American programs at the Migration Policy Institute.
“In normal times, it’s a coping strategy, a way to survive and do pretty well with limited income,” Capps said. “But in this environment, it can be problematic.”
Those problems have become apparent in recent months in the Central Valley of California, the heart of the state’s agricultural industry.
The region is now a hotspot of coronavirus, and essential farm workers, Latinos and those living in shared housing – groups that often overlap with each other – are disproportionately infected, Govin Gavin Newsom said last month.
Multigenerational homes are a common reality for American Indians and Alaska Natives, said Stacy Bohlen, chief officer of the National Indian Health Board and member of the Sault Ste. Marie Tribe of Chippewa Indians.
“You are taking into account very poor housing for our people,” she said. “And yet we hold family as a top priority for the way we approach the world.”
That means there could be several generations living in a house designed for four people, Bohlen said. Add to that the lack of running water, sewerage and sanitation facilities on some tribal lands, and even meeting basic hand washing guidelines can be challenging.
Given these circumstances, despite treaties with the U.S. government, over the centuries of experience and neglect, the current situation in Indian land was inevitable, Bohlen said.
“If you look at history and look at where we find ourselves, there is no other way it could have played out,” she said.
It affects whether you can work from home
Another frequently cited piece of coronavirus security advice: Stay at home.
But the ability to work remotely “differs enormously by race and ethnicity,” experts from the Institute for Economic Policy have pointed out.
Black and Spanish workers in the United States are “much less likely” to work from home, economists Heidi Shierholz and Elise Gould wrote in a post in March.
About 20% of Black workers could do their jobs remotely, while about 16% of Spanish or Latino workers could, according to data from the U.S. Bureau of Labor Statistics. In contrast, about 30% of white workers and 37% of Asian workers could work from home.
Those differences have to do with “occupational segregation by race and ethnicity,” Shierholz told CNN at the time.
Hispanics and Latinos are over-represented in sectors such as construction, agriculture and hairdressing – jobs that cannot be done at home. Black people are also too represented among low-wage workers, most unable to work.
This means that they are more likely to be exposed to the virus if they are on the job – if they have one.
Black and Latino people also rely more on public transportation, and they may have to make frequent trips to the store because they can not deliver it, Cooper said.
It affects your risk of serious illness
Even before they become infected, many people’s risk of color face increases.
People who have underlying health conditions, including chronic lung disease, asthma and heart problems, are one of the most vulnerable to serious Covid-19 disease. And because of factors such as less access to healthy food and outdoor space, minority populations experience higher rates of chronic diseases.
“It’s just like double danger,” Cooper said.
Black people are more likely than White people to experience high blood pressure, diabetes and stroke – in fact, they are more likely to die at an early age from all causes. Native Americans have the highest rates of diabetes in the nation. And Pacific Islanders, who have seen among the sharpest spikes in mortality rates in recent weeks, have higher rates of smoke, alcohol consumption and obesity compared to other racial groups.
Those differences also appear in Covid-19 hospitalization rates.
Native Americans are admitted to the White Americans Hospital at 5.3 times, according to recent data from CDC. Black Americans are 4.7 times as likely to be hospitalized, while Hispanic as Latino Americans are 4.6 times as likely.
It affects your access to medical care
When people of color get infected, they do not always get the treatment they need.
Black and Latino Americans are more likely than white people without health insurance and tend to take care of themselves, according to the National Urban League report. So by the time they see a health insurer, they are safer.
Meanwhile, black people have a legacy of distrust in medical institutions, Cooper said. This is in part due to conscious bias that physicians may expose when treating black patients, such as minimizing their complaints or referring less often to advanced care. It also has to do with a history of explosion, such as the infamous Tuskegee syphilis study, in which researchers deceived Black men with syphilis into believing they received treatment when they were not.
That mistrust can make Black people more susceptible to misinformation.
“With that, it’s not surprising that people will not believe what they hear from experts, or be afraid that they will be harmed in some way,” Cooper said.
Native Americans on tribal land are in a unique situation when it comes to health care. In treaties with the federal government, tribes tribed their lands and promised peace in exchange for health care and other benefits, according to the National Indian Health Board. But the federal government has not fulfilled its obligations, Bohlen said.
The Indian Health Service, which is responsible for providing services to American Indians and Alaska Natives, is typically underfunded at between 50% to 60% of need, according to the National Council of Urban Indian Health. As a result, the agency generally runs out of money in the middle of the fiscal year.
“That’s so grossly underfunded that the joke in Indiana once was, ‘Don’t get sick after June 1,'” Bohlen said. “Because credits start October 1st and through June 1st, all that money for specialty care is gone.”
Another barrier facing Native Americans, lack of access to broadband, is affecting their ability to receive up-to-date public health information and participate in telemedicine calls.
How we move forward
The systemic barriers that contribute to the racial differences around Covid-19 are deeply rooted and cannot be easily reversed. They stem from long-standing inequalities in housing, education, employment and other sectors.
“There are just layers and layers of problems that have led to extreme social disadvantage in those communities,” Cooper said.
Still, organizations advocating for Black, Latino, and Native Americans worked during the pandemic to ensure that their communities receive the support they need.
The NAACP recommends that policymakers encourage funding for federally qualified health centers, which are providers on the community that typically serve Black and Brown neighborhoods.
UnidosUS is among the groups calling for an end to President Donald Trump’s “government of public charge,” whose experts have argued that Latino immigrants are unsustainable to seek health care.
The National Indian Health Board is requesting $ 1 billion in investment from the federal government for water and sanitation infrastructure and facilities for Indian health services in tribal communities, among other priorities.
These problems are big and require big solutions, lawyers say. Developing them will peel back the layers and have them tackled piece by piece.
CNN’s Catherine Shoichet contributed to this report.
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