WHAT ARE SOME OF THE SYSTEMIC FACTORS LINKED TO DISPARITIES IN COVID-19?
The rapid development of the pandemic has led to health communications, which have unfortunately been complex, contradictory, and in some cases untrue. For example, false rumors emerged that Black Americans were immune to COVID-19. The media also showed gatherings which violated social distancing guidelines and implied that Blacks were not taking the threat seriously. Yet, a recent study found that Blacks were nearly twice as likely as Whites to view the virus as a serious threat to their health. Further, the mislabeling of COVID-19 as the "Chinese virus" has caused an increase in stigma and discrimination towards individuals and communities of Asian descent and is a mischaracterization of the threat the virus poses to other groups. Stigmatization may extend to essential workers as well. Some individuals such as the elderly, those who struggle to understand English, and those with less education may experience difficulties comprehending and filtering complex or inaccurate health communication. While misinformation, unclear health communication, and at-risk job responsibilities can be a barrier to taking appropriate self-protection measures, it can also contribute to stigmatization and undue blame.
While state and regionally mandated stay-at-home orders were implemented to protect the health of our nation, for many, staying at home is a luxury. For example, Black and Latino Americans are less likely than Asian Americans and Whites to be able to telecommute for work. Jobs in fields like food service, retail sales, and personal/home health cannot be done remotely. These workers often do not have paid sick time or health insurance and have experienced disproportionate unemployment rates. Social distancing is particularly problematic for people who rely on public transportation and for those living in overpopulated communities and multigenerational households with no alternative locations to isolate sick relatives. Thus, high-risk, low resource communities are particularly vulnerable to the effects of the pandemic.
The economic burden of medical care and health provider bias may also be factors contributing to COVID-19 disparities. Depending on case complexity, the average cost of inpatient treatment for those with employer coverage ranges from $10-20,000 but for the uninsured it is $40-70,000. While the government plans to provide some financial support to hospitals for the uninsured, the remaining cost is likely to cause extreme financial distress for those with no insurance, potentially resulting in delayed medical care and worse outcomes. Existing health disparities literature also illuminates the implications of health professional bias on the quality of healthcare, which may contribute to medical mistrust or suspicion of healthcare providers, organizations, and systems. Collectively the limitations of our healthcare system may inhibit treatment seeking for members of marginalized groups and exacerbate both short and long-term psychological and behavioral outcomes associated with COVID-19.