At present, the US population of about 332 million represents about 4.25% of the population of the world, which is approximately 7.6 billion. With respect to the novel coronavirus 2019 (COVID-19), however, even without the effects of the most recent widespread testing, the United States already has risen to number 1 in the world in both numbers of cases and deaths. Further, the number of cases in the United States of approximately 600,000 represents about 30% of the approximately 2,000,000 cases worldwide. Finally, the number of deaths in the United States of approximately 25,000 represents more than 20% of the approximately 110,000 deaths globally. In the context of these ominous forebodings are emerging clinical and public health challenges in COVID-19 of recurring racial inequalities in mortality. Specifically, as of April 14, 2020, in the United States, 32% of the deaths from COVID-19 are among black residents despite the fact that blacks comprise only 13% of the population. These descriptive data indicate a 2.3-fold excess risk of mortality from COVID-19 in the United States among blacks compared with whites. Quantitatively, it is plausible that this large magnitude of increase of COVID-19 is an overestimate. Qualitatively, however, based on the existing totality of evidence, the observation is real and poses major clinical and public health challenges. For example, for many decades, markedly reduced life expectancies of blacks compared with whites have been noted despite advances in preventive, diagnostic, and therapeutic options. In addition, multiple factors have been identified and postulated to explain the observed persistent mortality disadvantages of blacks compared with whites. Further, the availability of several life-saving, but prohibitively expensive to some, drugs or a vaccine in the United States has also led to marked increases in racial inequalities in mortality among blacks compared to whites.
As Santayana aptly noted in 1905, “Those who cannot remember the past are condemned to repeat it.” In these regards, there are clear short-term clinical and public health challenges that include greater access to and use of health care by blacks and all disadvantaged minorities within the United States. With respect to COVID-19, now is the time to commit to short-term and long-term clinical and public health challenges. All should be considered in the context of the unique barriers that exist in black and other disadvantaged minorities in underserved communities. Despite the markedly increased logistical challenges, these include the achievement of equalities in the widespread rapid testing for the virus and its antibody, public health education on social distancing and handwashing, and access to medical care to decrease the racial inequalities in morbidity and mortality of COVID-19. In addition, the clinical and public health challenges should include numerous sustainable and multiple preventive and therapeutic strategies that have already been identified to be contributing to racial inequalities in mortality between blacks and other disadvantaged minorities compared with whites.
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-Robert S. Levine, MD, Heather M. Johnson, MD, MS, FACC, FAHA, Dennis G. Maki, MD, Charles H. Hennekens, MD, DrPH
