In early March, Madalynn Rucker, then 69, agonized over whether to close her Sacramento consultancy office. On the 16th, she finally succumbed to a barrage of texts and calls from her daughter about the heightened risk of the coronavirus, and told her employees to begin working from home. That was three days before California Gov. Gavin Newsom鈥檚 .
Her daughter was right in more ways than one. While Rucker鈥檚 age alone raised her potential danger of being hospitalized or dying of COVID-19, she and many of her employees share another risk factor: They are black. Rucker wonders if more public health messages targeting African Americans could have helped millions like her better prepare for the disease鈥檚 onslaught.
Officials and commentators said little about race early in the pandemic, recalled Rucker, now 70 and the executive director of OnTrack, a diversity consulting firm. 鈥淐ould this have made a difference in some way? Not just in educating ourselves, but in how the pandemic was controlled and managed?鈥
By late February, that, in addition to older patients, those with chronic health conditions, particularly hypertension and diabetes, were more likely to have severe cases of COVID-19 that ended in ICU admission, mechanical ventilation or death.
It wouldn鈥檛 have been difficult, some community leaders say, for officials to make an explicit connection between the coronavirus risk factors and African Americans and Latinos, who are more likely to have chronic diseases, and at younger ages 鈥 and then craft tailored, respectful messages for them.
鈥淭he messaging I got from the news was, is that if you鈥檙e young, you鈥檙e good, and if you鈥檙e old, you鈥檝e got to stay home,鈥 said Eddie Anderson, the 30-year-old pastor of McCarty Memorial Christian Church, an African American congregation in South Los Angeles.
When Anderson became ill with what turned out to be another viral infection in early March, he was alarmed by the lack of information about how to get tested for COVID-19. The experience motivated him to bring a physician friend to church the next week to explain the disease to his flock.
鈥淚 think targeted messaging to the African American community would have been helpful,鈥 he said.
But public health and infectious disease experts say the novelty of the virus, whose targets and mode of attack continue to confound scientists, meant that specific racial disparities weren鈥檛 a foregone conclusion.
鈥淚 don鈥檛 know that it’s fair to say that it would have been something that could be 100% predicted,鈥 said California Surgeon General Nadine Burke Harris. She called the novel coronavirus 鈥渁 little bit of a head-scratcher.鈥 For example, it doesn鈥檛 appear to affect children under age 2 or pregnant women the same way similar viruses would, she noted.
鈥淪ometimes when you predict too strongly, it can have the effect of assuming that’s going to be the outcome, and it can come across pejoratively,鈥 Burke Harris said.
But the disease has disproportionately hurt blacks. In California, 10% of COVID-19 deaths occurred among African Americans, who make up . A national showed that 33% of hospitalized COVID patients were non-Hispanic blacks, though that group represented only 18% of residents in the surveyed communities.
Officials are finding it鈥檚 still difficult to talk about race and COVID-19. Fear of stigmatization remains high, said Burke Harris, who said she walks a fine line by letting certain groups know about the heightened risks without casting blame on them.
鈥淥ne of the things I鈥檝e been dealing with a lot in having conversations with black media and black health researchers, right, is this notion of, well, wait a minute, as this data is coming out, how are we not blaming black and brown communities?鈥 said Burke Harris, who is black. 鈥淚t鈥檚 like, 鈥極h, are you saying we鈥檙e sicker?鈥欌
Preexisting conditions aren鈥檛 the only reason black people are dying at disproportionate rates of COVID-19, said Dr. Sonia Angell, director of the California Department of Public Health.
Despite states鈥 orders to stay at home, entire sectors of 鈥渆ssential鈥 jobs have disproportionately high rates of minority employees, which increases their exposure risk. These workers don鈥檛 benefit as much from social distancing, Angell said.
鈥淭hey’re the ones that are keeping our care delivery system functioning so that when any of us get sick, we have a place to go,鈥 she said. 鈥淭hey’re the ones that are keeping our grocery stores running and stocked.鈥
The absence of coordinated, official public messaging in February and early March about the potential racial disparity of COVID-19鈥檚 impact created a vacuum into which conspiracy theories rushed.
Initially came rumors that to the coronavirus. At the same time, black media outlets like The (Feb. 4), (March 2), the (March 11) and (March 13) made the connection between the virus and America鈥檚 preexisting health inequalities, publishing forward-thinking pieces about the virus鈥 potential threat to black Americans because of chronic medical conditions, working and commuting conditions, and a historical lack of access to health care and insurance due to institutionalized racism.
Their predictions soon proved true. Local officials began noting higher death rates for black COVID-19 patients in . In the first week of April, city officials in , and made similar announcements. The CDC published its first national data on racial disparities on April 8. A recent CDC study, published April 29, found that black people hospitalizations in Georgia, a disproportionate level compared with overall hospitalizations.
Public health messages targeting specific populations should be voiced by trusted community leaders, or at least someone of the same race, on media platforms where they鈥檙e most likely to be seen or heard, said Dr. Oliver Brooks, president of the National Medical Association, which represents black physicians.
A week after announcing the statewide shelter order, Newsom from 鈥淭he longer you stay outside, the longer we’re going to be inside.鈥
Other targeted messages include Spanish-language public service announcements featuring Burke Harris and LA Galaxy soccer player Javier 鈥淐hicharito鈥 Hern谩ndez. Those have run on Univision; Radio Biling眉e, a Spanish-language public radio network; and other Spanish-language stations, as well as Instagram and Facebook. In Hern谩ndez鈥檚 clip, he encourages listeners in Spanish to seek medical attention if they have COVID-19 symptoms, no matter what their immigration status is.
Targeted messaging can sometimes offend or insult, even with the best of intentions, said Daniel Schober, assistant professor of public health and behavioral psychology at DePaul University in Chicago.
The city of Chicago offended some with a 2015 flu shot campaign that featured a black baby on a billboard next to the words, 鈥淚 am an outbreak.鈥 It inspired graffiti artists to weigh in with .鈥
But the city鈥檚 COVID-19 campaign, featuring Mayor Lori Lightfoot, who is black, has charmed residents, said Schober. The campaign played off social media memes shutting down iconic Chicago landmarks under shelter-in-place directives. The city鈥檚 baking, learning the guitar and sipping tea while exhorting people to 鈥渟tay home, save lives.鈥
鈥淭hat鈥檚 a great example of a message that isn鈥檛 necessarily tailored toward specific racial or ethnic groups, but is really meant to be universal in its reach,鈥 Schober said.
