‘The Driving Force Is Institutionalized Racism’: Black North Carolinians Are Getting Hit Hard By COVID-19

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By Paul Blest

April 10, 2020

African-Americans make up less than a quarter of the state’s population, but nearly 40 percent of its confirmed coronavirus cases and deaths. 

The coronavirus can hit anyone. But as North Carolina and other states around the country are discovering, it doesn’t hit everyone equally. 

The latest numbers released by the North Carolina Department of Health and Human Services (DHHS) show that the state has confirmed 3,651 positive cases of coronavirus, with 65 deaths and 398 people currently hospitalized. Overall, the state has completed nearly 48,000 tests, and cases have been found in 91 out of 100 counties. 

North Carolina is one of less than a dozen states reporting racial data in COVID-19 cases. That data, collected and published by DHHS, shows that African-Americans are being disproportionately impacted by the disease. Although Black North Carolinians comprise less than a quarter of the state’s population, according to 2018 Census estimates, they’ve suffered from nearly 40% of the confirmed cases and deaths in the state. 

Dr. Crystal Wiley Cené, an associate professor at the UNC School of Medicine and the director of its Program on Health Disparities, said that the high rates of infection tracks with other systemic issues that disproportionately impact Black Americans and North Carolinians. 

“There’s no simple answer, but I will tell you that it’s not surprising,” Cené said. “I think the things driving the disparities in COVID are the same things that drive disparities in other systems. The driving force is institutionalized racism. To me, that’s the pandemic we’re talking about.” 

‘The Driving Force Is Institutionalized Racism’: Black North Carolinians Are Getting Hit Hard By COVID-19
Dr. Crystal Wiley Cené of the UNC School of Medicine

North Carolina isn’t alone. Half of the confirmed COVID-19 cases in Chicago have afflicted African-Americans, although Black Chicagoans make up just 30% of the city’s population, and 69% of its deaths, according to city health data as of April 8. Earlier this week, Louisiana Gov. John Bel Edwards said that African-Americans account for more than 70% of that state’s deaths. 

And in the 131 counties across the country where African-Americans are a majority of the population, the rate of cases was nearly 3.5 times higher than the 2,000-plus counties where white people made up a majority of the population, according to data published by The Washington Post this week. The death rate was nearly six times higher. 

“The driving force is institutionalized racism. To me, that’s the pandemic we’re talking about.” 

Dr. Crystal Wiley Cené, associate professor at the UNC School of Medicine and the director of its Program on Health Disparities

“Why is it three or four times more so for the Black community as opposed to other people?” President Donald Trump said on Tuesday. “It doesn’t make sense, and I don’t like it, and we are going to have statistics over the next probably two to three days.” (This week, the CDC included race and ethnicity for the first time in its Weekly Morbidity and Mortality report, finding that 33% of COVID-19 cases are afflicting black Americans.)

Rep. Carla Cunningham, a Charlotte Democrat who spent 35 years as a registered nurse and now serves as one of six co-chairs of the COVID-19 health working group, pointed towards higher rates of underlying conditions in African-Americans that are known to exacerbate COVID-19 symptoms, such as hypertension and diabetes. She also lamented the lack of information about race and health.

“If you don’t have the data, you can’t attempt to get good health outcomes,” she said.

NC's racial discrepancies in COVID-19 cases
NC’s confirmed COVID-19 cases, broken down by race. Parenthetical figures represent percentage of NC population. Courier graphic by Tania Lili.

For Rep. Robert Reives, a Democrat on the committee’s economic support working group who represents Durham and Chatham counties, there are also economic factors at play. “The truth is working class people of all races in this country represent a disproportionate number of those cases,” he said. “Most hourly wage workers don’t have the option to work remotely, and they’re one missed paycheck away from financial disaster. So when they have that first cough, they have to make a decision.”

Another minor factor at play could be what Cené called the “perception of risk,” specifically citing early misinformation that Black people were supposedly immune to the virus. “I think that’s part of the reason we’re seeing much higher rates among blacks,” she said. “Your beliefs drive your behavior.” 

As with other states, it’s quite likely that North Carolina has had more coronavirus cases than we know about due to limited testing, particularly in rural areas. Cene said that in the town where her mother lives, Sneads Ferry in Onslow County, there’s just one health clinic. When her mother felt sick, she found that the clinic had closed due to the crisis. (Onslow County has seen 24 positive cases and one death, according to DHHS data.)

Both Cunningham and Cene said that the low number of cases reported in rural counties probably has to do more with the lack of testing in those areas than low rates of disease. (The DHHS did not respond to an interview request.) 

“If you have symptoms, you call your primary care physician. Some people don’t have a doctor or health insurance at all,” Cunningham said. “And by the time they go to the hospital their condition is going to be not good.”

More than a million people in the state are uninsured, according to U.S. Census Bureau statistics. Part of the issue is that North Carolina is one of ten remaining states which have not expanded Medicaid. Reives and Cunningham, who both support it, said they hope the crisis shows the need for expansion. 

“We look at healthcare like it ought to be some kind of luxury. Healthcare really needs to be a basic right that we make sure people have access to,” Reives said. “This isn’t the time for political ideology, this is a time we’ve got to figure out how to serve our people, and there’s no downside to expanding Medicaid at this point.”

Cené hopes that the alarming disparities among COVID-19 patients will open up a broader conversation about structural inequality in America, and pave the way for reforms in healthcare delivery led by people who don’t usually get a seat at the table when it comes to decision-making: patients, families, and low-wage healthcare workers such as home health aides and certified nurses assistants (CNAs). 

“I hope that for as much devastation that this has caused and will cause, I hope we emerge from this with a different moral and social consciousness,” Cené said. “We have to start addressing the systems perpetuating these disparities along medicine, education, law…it’s all the same drivers.”


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