Why African Americans are dying at higher rates from COVID-19

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Mitrobe Network

Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. The new coronavirus isn’t picky about who it infects — so why does data emerging from some states suggest that African Americans are bearing the brunt?
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According to experts, the community is disproportionately impacted by underlying conditions linked to poverty, and often faces challenges in accessing testing and health care.
“We know that blacks are more likely to have diabetes, heart disease, lung disease,” the nation’s top doctor, Surgeon General Jerome Adams, told CBS News on Tuesday.
These chronic illnesses can lead to more serious forms of the COVID-19 disease.
Adams, who is himself black and has high blood pressure and asthma, added: “I represent that legacy of growing up poor and black in America.
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“And I, and many black Americans, are at higher risk for COVID.”
Emerging trend
There is no nationwide data available on COVID-19 cases by race, but a familiar pattern of over-representation by black Americans has emerged in states or jurisdictions that are sharing the information.
Sixty-eight percent of coronavirus deaths in Chicago have been among African Americans, who make up just 30 percent of the city’s population.
“Those numbers take your breath away,” the city’s mayor Lori Light foot said Monday at a coronavirus briefing. “This is a call to action for all of us.”
The trend is repeated in North Carolina, Louisiana, Michigan, Wisconsin and the capital Washington.

Georges Benjamin, executive director of the American Public Health Association, told AFP the issue was also linked to social class, with black people more likely to work jobs deemed essential that expose them to potential infection.
“That population is more public facing,” he said. “More bus drivers, more people taking public transportation to work, more people providing services in nursing homes, more folks working in grocery stores.”
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Access to care
The issue is also likely exacerbated by pre-existing prejudice that black people face in the medical system.
“Like with any illness or pain, African Americans are less likely to have their symptoms believed by those in health care due to implicit bias,” said Brandon Brown, an epidemiologist at the University of California, Riverside.
That is borne out by several studies that have found black people’s pain is less likely to be investigated or treated than their white counterparts.
There are already fears that, as historically undeserved communities, black people and other groups like Latinos will have less access to testing, which in turn is vital in getting early treatment.
A civil rights group has written to health secretary Alex Azar, calling on him to “release daily racial and ethnic demographic data related to COVID-19 testing, disease burden and patient outcomes.”
This, said Lawyers’ Committee for Civil Rights Under Law, was necessary to ensure a robust public health response, and to ensure care and testing wasn’t being administered in a discriminatory manner.
The group said the Centers for Disease Control and Prevention (CDC) was already collecting the information but deliberately withholding it.
Writing in the online magazine Slate, Uche Blackstock, an emergency medicine physician and founder of Advancing Health Equity, said high levels of diabetes, hypertension and asthma among black people were “directly linked to structural racism.”
“We’re already very vulnerable,” she said. “When you add this pandemic on top of us, we’re more likely to be sicker when we present.
“And then we have to worry about whether or not we’re going to receive unbiased care.”

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How do you get infected?

  1. The main route of transmission is respiratory droplets and close contact.
  2. When you sneeze or cough, you send out droplets of fluid from your nose and mouth.
  3. Those droplets can carry infections, and when they enter someone else’s enter the eyes, nose or mouth, the infection can make them sick. This is the way the flu and many viruses are spread.
  4. Most often, you need to be close to the person (within 6 feet) for it to spread this way.
  5. There is the possibility of aerosol transmission when exposed to high concentration aerosol for a long time in a relatively closed environment.
  6. The WHO has stated that the risk of spread from someone without symptoms is “very low” and that fecal transmission is “low”.

Mythbusters

  1. COVID-19 virus can be transmitted in areas with hot and humid climates.
  2. Cold weather and snow CANNOT kill the new coronavirus.
  3. Taking a hot bath does not prevent the new coronavirus disease.
  4. The new coronavirus CANNOT be transmitted through mosquito bites.
  5. Are hand dryers effective in killing the new coronavirus?
    No. Hand dryers are not effective in killing the 2019-nCoV.
  6. Can an ultraviolet disinfection lamp kill the new coronavirus?
    UV lamps should not be used to sterilize hands or other areas of skin as UV radiation can cause skin irritation.
  7. Can spraying alcohol or chlorine all over your body kill the new coronavirus?
    No. Spraying alcohol or chlorine all over your body will not kill viruses that have already entered your body.
  8. Do vaccines against pneumonia protect you against the new coronavirus?
    No. Vaccines against pneumonia, such as pneumococcal vaccine and Haemophilus influenza type B (Hib) vaccine, do not provide protection against the new coronavirus.
  9. Can regularly rinsing your nose with saline help prevent infection with the new coronavirus?
    No. There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus.
  10. Can eating garlic help prevent infection with the new coronavirus?
    Garlic is a healthy food that may have some antimicrobial properties. However, there is no evidence from the current outbreak that eating garlic has protected people from the new coronavirus.
  11. Are antibiotics effective in preventing and treating the new coronavirus?
    No, antibiotics do not work against viruses, only bacteria.

How can I protect myself?

Handwashing

  1. A number of governments advise against all non-essential travel to countries and areas affected by the outbreak.
  2. There are misconceptions circulating about how to prevent infection: rinsing the nose, gargling with mouthwash, and eating garlic are not effective.
  3. The CDC recommends that people wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty.
    • It further recommended using an alcohol-based hand sanitiser with at least 60% alcohol by volume (or 120 proof) when soap and water are not readily available.
    • The WHO also advise people to avoid touching the eyes, nose, or mouth with unwashed hands.
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Respiratory hygiene

  1. Health organizations recommended that people cover their mouth and nose with a tissue when coughing or sneezing (which should then be disposed of immediately), or with a sleeve if a tissue is not available.
  2. The use of surgical masks by those who may be infected has also been recommended, as they can limit the volume and travel distance of expiratory droplets dispersed when talking, sneezing, and coughing.
  3. There is no evidence to show that the wearing of surgical masks by uninfected people at low risk is effective.
  4. Only China has specifically recommended the use of masks by healthy members of the public, while face masks have been widely used by healthy people in Hong Kong, Japan, Malaysia, and Singapore.

How to use a mask

  1. Wear a mask if you are coughing or sneezing.
  2. If you wear a mask, then you must know how to use it and dispose of it properly.
  3. Before putting on a mask, clean your hands with alcohol-based hand rub or soap and water.
  4. Cover your mouth and nose with the mask and make sure there are no gaps between your face and the mask.
  5. Avoid touching the mask while using it.
  6. Replace the mask with a new one as soon as it is damp and do not re-use single-use masks.
  7. To remove the mask, remove it from behind (do not touch the front of the mask), discard it immediately in a closed bin, and then clean your hands with alcohol-based hand rub or soap and water.

How do I know if I am infected?

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

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Symptom%
Fever87.9%
Dry cough67.7%
Fatigue38.1%
Sputum production33.4%
Shortness of breath18.6%
Muscle pain or joint pain14.8%
Sore throat13.9%
Headache13.6%
Chills11.4%
Nausea or vomiting5.0%
Nasal congestion4.8%
Diarrhea3.7%
Haemoptysis0.9%
Conjunctival congestion0.8%

Ok I think I’m infected, now what?

  1. Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected.
  2. Public health agencies have issued self-isolation instructions that include notification of healthcare providers by phone and restricting all activities outside of the home, except for getting medical care.
  3. Do not go to work, school, or public areas. Avoid using public transportation, ride-sharing, or taxis
  4. Those who have recently travelled to a country with widespread transmission or who have been in direct contact with someone diagnosed with COVID-19 have also been asked by some government health agencies to self-quarantine or practise social distancing for 14 days from the time of last possible exposure.
  5. Attempts to relieve the symptoms may include taking regular (over-the-counter) cold medications, drinking fluids, and resting. Depending on the severity, oxygen therapy, intravenous fluids, and breathing support may be required.
  6. The use of steroids may worsen outcomes.

Is there a vaccine or a cure?

  1. No vaccine is currently available.
  2. Several organisations around the world are developing vaccines, using several different methods.
  3. By early March 2020, 30 vaccine candidates were in development, with products by Gilead Sciences and Ascletis Pharma in Phase III clinical trials.
  4. Several compounds, which were previously approved for treatment of other viral diseases, such as favipiravir, ribavirin, remdesivir and galidesivir, are being investigated against the coronavirus.
  5. Clinical trials are underway in for lopinavir/ritonavir and of remdesivir.
  6. Bruce Aylward, an assistant director-general of the WHO, has stated “there is only one drug right now that we think may have real efficacy and that’s remdesivir.”

Q&A on coronaviruses (COVID-19)-https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
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