How The Pandemic Is Widening The Racial Wealth Gap

Good data-based analysis:

Joeller Stanton used to be an assistant teacher at a private school in Baltimore and made about $30,000 a year. In mid-March, when the pandemic was just starting, her school closed for what was supposed to be two weeks. “Up to that point, we were under the impression that it wasn’t that serious, that everything was going to be OK,” Stanton recalls.

But as schools in Maryland switched to virtual learning indefinitely, Stanton was let go from her job. She received her last paycheck in March. “I had about $300 savings that was basically gone by the end of March,” she says.

She says she applied for unemployment but was denied initially. And by April, she had no money to pay for rent and utilities, and was struggling to put food on the table for her two children.

Stanton, who is Black, is caught up in a huge wave of economic stress hitting Americans, especially people of color.

Sixty percent of Black households are facing serious financial problems since the pandemic began, according to a national poll released this week by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. That includes 41% who say they’ve used up most or all their savings, while an additional 10% had no savings before the outbreak.

Latinos and Native Americans are also disproportionately affected by the pandemic’s economic impact. Seventy-two percent of Latino and 55% of Native American respondents say their households are facing serious financial problems, compared with 36% of whites.

“The thing that immediately struck me was how large the gap was by race for the people who said they were facing serious problems,” says Valerie Wilson, director of the Program on Race, Ethnicity and the Economy at the Economic Policy Institute.

The pandemic’s disproportionate financial impact on communities of color reflects — and is worsening — existing racial disparities in wealth, she adds.

Struggles with income, housing, food

“The three groups that are being just ravaged by this epidemic are reporting unbelievable problems of just trying to cope with their day-to-day lives,” says Robert Blendon, professor emeritus of health policy and political analysis at the Harvard T.H. Chan School of Public Health, who oversaw the poll.

Thirty-two percent of Latino and 28% of Black respondents say they’re having problems paying rent or mortgages. About a third of respondents in both groups were struggling to pay credit cards or other loans. And 26% of Latino and Native American respondents say they struggle to afford food, while 22% of Black respondents do.

Among households that reported they lost income, survival is even more of a challenge. For Black respondents, 40% say they’re struggling to pay rent or mortgage, and 43% say they’re having trouble paying utilities. For Latino households that lost income, 46% say they’re struggling to pay mortgage or rent. About a third of both Black and Latino respondents who lost household income said they’re struggling to pay for food.

The fact that many minority groups are also experiencing higher rates of coronavirus infections makes it even harder for them to cope financially, Blendon adds.

“You have people who don’t have savings, they can’t pay bills,” he says. “And then you’re going to tell them, ‘Well, somebody in the household tested positive, nobody can go work.’ How are they going to keep their lives going?”

Stanton’s sister, who works for the city government, got COVID-19 earlier this year and had to isolate in her basement. “She had a cough, and she couldn’t eat because her taste buds were completely gone,” Stanton says. “I would cook meals, and I would take it to the basement, put it down on the floor for her.”

Luckily, she says, no one else in the family — including her 82-year-old mother and her 7-year-old son, who has asthma — got infected.

But Stanton says she has lost a sister-in-law to the disease and had a friend in coma for six weeks on a ventilator. She knows of many others in her community who have died.

And most of her co-workers and friends are out of work.

Worsening existing disparities

Even during the economic recovery of recent years, minority groups were lagging behind, says Wilson of the Economic Policy Institute. “There were significant racial disparities in wages, significant racial disparities in unemployment, significant racial disparities in the kinds of jobs people held.”

Black, Latino and Native American workers were more likely to have jobs that were lost during the pandemic, Wilson says. A Harvard University analysis of the U.S. Census Bureau’s Pulse Survey, released in July, found that 58% of Latino and 53% of Black households experienced loss in earnings early in the pandemic. Wilson’s own research has shown that Latino workers have been particularly affected by job losses during the pandemic.

Wilson adds that people in these groups are also more likely to have jobs that didn’t allow them to work from the safety of their homes, therefore putting them more at risk of getting infected. And they’re also less likely to have substantial savings. As a result, it makes it harder for them to weather times of economic downturn, she says.

Wilson says she worries that the pandemic is worsening racial disparities.

“We’re going to see coming out of this pandemic an expansion of the racial wealth gap,” she says. “We saw the same kind of thing in the Great Recession in 2007-2008 — in particular then with the extensive foreclosures in communities of color and the loss of housing wealth.”

“You just pray”

The pandemic forced Stanton to give up her rental home back in April. But she says she was fortunate not to end up homeless, thanks to her sister.

“My sister helped me get a storage unit,” Stanton says. “I moved my furniture into a storage unit. And I moved in with my sister, me and my two kids — my 11-year-old daughter and my 7-year-old son.”

She is grateful to have a roof over her head, but money, she says, is still tight.

She now gets $280 a week from the state of Maryland as unemployment, but it doesn’t go far.

“The first thing I buy is any personal hygiene items me or my kids need,” she says. She buys food, above what food stamps get her; she pays her phone bill and covers her sister’s utility bills. “That’s my only way of telling her, ‘Thank you,’ to show her that I appreciate what she’s doing.”

What little she has left, she buys a treat or two for her children, who have mostly been stuck indoors since the pandemic began: “Just trying to keep them happy,” she says.

But she’s far from happy herself. She hasn’t been able to find a new job because of the nature of remote learning. “They don’t need an assistant right now because the kids are not physically in the building,” she says.

And even if she did find a job, she worries she’d have to use pay to cover child care. Her kids are now also learning virtually from home and need constant supervision.

Stanton says the only way she copes with her daily struggles is through faith. “A lot of prayer and a lot of patience,” she says. “I try not to let things bother me because I don’t want to become depressed. So, you know, you just pray. I hope this is all over soon.”

Source: How The Pandemic Is Widening The Racial Wealth Gap

COVID-19 disproportionately impacted immigrants and refugees in Ontario, new report finds

Better data confirming what we know:

The spread of COVID-19 has disproportionately affected immigrants, refugees and those who live in low-income neighbourhoods in Ontario, a new report has found.

The report released Wednesday by ICES, a not-for-profit research institute focusing on health-related data in Ontario, found that while immigrants and refugees in the province accounted for only about a quarter of those tested for COVID-19 between January and June, they represented 43.5 per cent of all positive cases.

“We document disproportionately higher rates of infection among those who landed in Ontario as economic caregivers, refugees, those with lower levels of education and language fluency, those who currently live in lower income neighbourhoods and with more crowded housing,” Dr. Astrid Guttmann, Chief Science Officer at ICES and lead author on the report, said in a statement.

“Apart from addressing many of (the) root causes of higher risk of infections, very high test positivity in certain groups of immigrants also suggests that there may be important barriers to testing that will be important to address if there is a second wave in Ontario this fall.”

The data was pulled from test results conducted between January 15 and June 13. According to the report, rates of testing were lower for most immigrants and refugees compared with Canadian-born and long-term residents—with an exception for economic caregivers who tend to work in health-care and were prioritized for testing.

The data found that of the 4.4 per cent of Canadian-born and long-term residents tested for COVID-19 in Ontario, 2.9 per cent tested positive.

Of the 3.4 per cent of people who identify as immigrants or refugees who were tested for COVID-19, 8.1 per cent received a positive diagnosis.

Refugees alone had the highest positivity rate within that time period at 10.4 per cent.


The report also found that while testing positivity peaked at the beginning of April among Canada-born and long-term residents, there were two “pronounced peaks of positivity” for immigrants, refugees and newcomers in April and May respectfully.

“The pandemic has sharpened the focus on structural and societal inequalities that have long existed,” the report reads. “These inequities put many racialized and immigrant populations at higher risk of both contracting the infection and suffering poor outcomes.”

The highest rates of positivity in Canada were found in racialized immigrants and refugees from Central, Western and East Africa, South America, the Caribbean, Southeast Asia and South Asia, the report found. The rates were also higher for those living in low-income neighbourhoods.

Public health units with larger immigrant populations such as Toronto, Peel Region, Durham Region, Waterloo, Windsor and York also reported a high number of COVID-19 positive patients among that demographic.

In Toronto specifically, 4,027 immigrants and refugees have tested positive for COVID-19 (9.8 per cent of those tested) compared to 3,788 Canadian-born patients (4.9 per cent of those tested).

What data was available and what was missing?

The general findings presented in the report are not necessarily new. Advocacy groups have been calling on all levels of government to support the gathering of race and socio-economic data for months, arguing that marginalized communities are disproportionately contracting or dying from COVID-19.

As a result of these calls, the City of Toronto began collecting race-based data in May.

Toronto Public Health said that of the data collected between May 20 and July 16, 83 per cent of known COVID-19 cases involve members of racialized communities.

It also found that patients with a household income level of $50,000 or less represents more than 50 per cent of reported infections in the city, despite the fact that the 2016 census revealed only 30 per cent of Toronto’s population reported being in that income bracket.

The data released by city officials are based on voluntary questions collected by a local public health unit.

Provincially, officials and politicians have all said they support the collection of race and income-based data, but they have yet to provide any information about the trends they are seeing.

In mid-June, the government proposed regulatory changes that would allow those who test positive for COVID-19 to be asked about their race, income, languages spoken and household size.

The questions are optional and the government said personal privacy would be protected. Since then, not much has been said about the data collection.

The ICES report said they were limited in the creation of the report by incomplete immigration data and could only include information on immigrants or refugees who landed in Ontario from January 1985 to May 2017 and who became permanent residents. They also included second-generation immigrant children under the age of 19 who were born in Ontario to permanent residents.

A “newcomer,” a status defined separately from an immigrant or refugee, is described as an individual who became eligible for OHIP after May 31, 2017

The authors also noted that ICES lacked data on “important risk factors for testing and positivity” such as occupation and living conditions.

“We currently do not have comprehensive data on important outcomes such as hospitalization and death,” the report says. “We have data on demographic and some census-based characteristics but not on the critical structural factors that play an important role in shaping inequities.”

ICES was able to access information on the health-care sector. The report found that employment as a health-care worker, especially among women, accounted for a disproportionate number of COVID-19 cases among immigrants and refugees. Among the 36 per cent of women employed as health-care workers and who tested positive in Ontario, 45 per cent were within that demographic.

Inequities ‘are complex’ and often rooted in racism

The report suggests that the “causes of these inequities are complex and often rooted in social and structural inequities, including systemic racism.”

It notes that a large proportion of immigrants, refugees and newcomers to Canada hold temporary or minimum-wage jobs at facilities where physical distancing is difficult. These positions may also not have paid sick leave or other health benefits.

ICES says that employment in any of these sectors— such as occupations in retail, factories or transportation– “is considered precarious” and could impact testing and quarantine.

Other factors such as language barriers, education and accessibility to quality healthcare could impact whether a person gets a COVID-19 test.

The not-for-profit is calling for more accessible testing options ahead of a possible second-wave in the fall as well as better training and enforcement of safety measures for those at risk of COVID-19 exposure in the workplace.

“A continued focus is needed on securing funding to house those who cannot safely quarantine in their homes or are homeless, as well as for income supplements for workers must quarantine who do not have employer-sponsored sick leave,” the report says.

The report also noted that the findings should be interpreted in the context of Ontario’s testing strategy. Initially, local public health units were only testing those in essential workplaces, those who had recently travelled and for those with acute medical conditions. Later that strategy evolved to include long-term care homes, hospitalized patients, and the general population, including asymptomatic patients.

“This means that some groups are over-represented in the testing numbers and that positive cases include those who were symptomatic at the time of testing, as well as those who were asymptomatic,” the report says.

“This may distort some associations of characteristics with both testing rates and potential to test positive. It also means that there is an unknown number of untested infected individuals in the general population.


Why the Coronavirus More Often Strikes Children of Color

Mainly linked to lower socio-economic status:

One of the notable features of the new coronavirus, evident early in the pandemic, was that it largely spared children. Some become severely ill, but deaths have been few, compared to adults.

But people of color have been disproportionately affected by Covid-19, the illness caused by the coronavirus, and recent studies have renewed concern about the susceptibility of children in these communities.

They are infected at higher rates than white children, and hospitalized at rates five to eight times that of white children. Children of color make up the overwhelming majority of those who develop a life-threatening complication called multisystem inflammatory syndrome, or MIS-C.

Of more than 180,000 Americans who have died of Covid-19, fewer than 100 are children, according to the Centers for Disease Control and Prevention. But children of color comprise the majority of those who have died of Covid-19.

The deaths include 41 Hispanic children, 24 Black children, 19 white children, three Asian-American children, three American Indian/Alaska Native children, and two multiracial children.

The unique vulnerabilities of these youngsters are coming to light even as the number of infections in children is rising and schools and parents around the country are grappling with nettlesome decisions about reopening safely.

The susceptibility of minority children to the disease is not unique to the United States. Black children hospitalized in the United Kingdom were more likely than whites to be transferred to critical care and to develop MIS-C, according to a study published last week in the journal BMJ.

“Children don’t exist in a vacuum,” said Dr. Monika K. Goyal, a pediatric emergency medicine specialist at Children’s National Hospital in Washington.

Among 1,000 children tested for Covid-19 at a site in Washington in March and April, nearly half of the Hispanic children and nearly one-third of the Black children were positive for the coronavirus, Dr. Goyal found in a recent study.

‘Racial Inequality May Be As Deadly As COVID-19,’ Analysis Finds

Yet another study, highlighting racial disparities in health:

Even during the COVID-19 pandemic, mortality rates and life expectancy are far better for white Americans than they are for Black people during normal, non-pandemic years, according to an analysis published this weekin the Proceedings of the National Academy of Sciences.

The analysis, which looked at U.S. mortality statistics back to 1900, finds an additional 1 million white Americans would have to die this year in order for their life expectancy to fall to the best-ever levels recorded for Black Americans — back in 2014. That year, the average life expectancy for African Americans was 75.3 years — similar to the average life expectancy for white Americans back in 1989, says study author Elizabeth Wrigley-Field.

“It’s as though Blacks have just missed out on the last three decades of [life expectancy] progress,” says Wrigley-Field, a demographer and infectious disease historian at the Minnesota Population Center at the University of Minnesota.

The findings underscore the pandemic scale of the racial inequalities in mortality in the U.S., she says.

“We don’t know what the ultimate scale of COVID-19 deaths is going to be,” Wrigley-Field says. “But what we can say is that white deaths to COVID would have to increase from what they are right now by a factor of [more than] five to make white death rates this year look like the best that Black death rates have ever been.”

She notes that 2014 was also the year when Black Americans had their lowest age-adjusted death rates on record — 1,061 deaths per 100,000. By comparison, for whites, the age-adjusted mortality rate was 899 per 100,000 in 2017 (the last year with available data). To match the lowestmortality rates on record for Black Americans, more than an additional 400,000 white Americans would have to die this year, her analysis found.

Thus far, COVID-19 has taken a disproportionate toll on Black people and other communities of color. Black Americans have experienced the highest death rates from the pandemic — about 88.4 deaths per 100,000, compared to 40.4 per 100,000 for white Americans, according to data compiled by the APM Research Lab.

But there are also longstanding systemic reasons behind these racial health disparities, notes Dr. Utibe Essien, a health equity researcher with the University of Pittsburgh — factors that include Black Americans’ well-documented disparities in access to quality health care.

African Americans have higher rates of underlying medical conditions, including diabetes, heart disease and lung disease, that are linked to more severe cases of COVID-19. Black people in the U.S. also bear the burden of historic discrimination policies, Essien says, such as redlining policies in housing that limited African Americans’ ability to accumulate wealth through property ownership. And wealth is a significant driver of health, Essien notes.

“I think it’s important to … appreciate that the pandemic didn’t start something new, but that these disparities really, unfortunately, have been seen for decades, if not centuries,” he says.

Indeed, Wrigley-Field says she was inspired to carry out the current analysis after conducting an earlier study on regional mortality rates from infectious disease during the early 20th century. “The thing that we found that stunned us was that white deaths in 1918 during the flu pandemic” — which killed more than a half-million Americans — “were less than what Black deaths had been in every prior year.” A century later, she writes in her paper, “the basic fact endures that Black disadvantage is on the scale of the worst pandemics in modern U.S. history.”

Wrigley-Field says she hopes her analysis will help reframe the discussion in the U.S. about the kinds of policy changes that society can realistically embrace to address health disparities stemming from systemic racism.

“To me, this really changes the question about how we think about, ‘What are we willing to do to stop these deaths?’ ” she says. “Because we know what we’re willing to do to stop deaths from COVID. We’re basically willing to change every aspect of how we live, how we work, how we do our family lives, whether we travel, whether schools are in session. Absolutely everything is on the table. And all of that is controversial, but it’s actually all pretty popular, too. ”

“Meanwhile,” she says, “we have this similar or probably larger scale of deaths happening every year, just to Blacks. But proposals that would try to address that in some way are often very controversial. Most people do not support, for example, reparations. Most people do not support defunding the police, although the opinions about that are changing pretty quickly. … To me, these results, more than anything, just kind of reframe that question about what’s realistic.

“So what are the things that we think are unimaginable that would address racism that we have to similarly say, we have no choice but to do this because the scale of death that’s resulting is unacceptable?”

Source: ‘Racial Inequality May Be As Deadly As COVID-19,’ Analysis Finds

B.C. survey shows racialized people most likely to suffer from effects of COVID-19 pandemic

Confirming patterns elsewhere:

An official survey shows the tumult created in B.C. by the novel coronavirus has hurt racialized people the most, with more than one in five Latin American, West Asian and Black respondents reporting job losses due to the pandemic.

Provincial Health Officer Bonnie Henry said at Thursday’s daily COVID-19 briefing that the results of a recent online survey of 394,000 people confirmed a trend seen in many other places: The virus and the measures taken to slow its growth have disproportionately affected non-white people. The results did not touch on who has been infected, but charted how people of different ethnicities have fared with regards to unemployment, financial stress, and access to health care and food.

“The challenge has not been shared equally,” she said as she revealed the results of the survey done by the BC Centre for Disease Control, a government agency.

The information comes as British Columbia logs an additional 78 confirmed cases of the virus. The numbers have been creeping up all summer, leading to a recent spike that Dr. Henry says is driven by younger people socializing.

The provincial average for losing a job due to the pandemic was 15.5 per cent, according to the survey. Only white respondents reported recent unemployment at below that rate, 14 per cent. People of every other ethnicity reported rates above the provincial average, with the highest affecting Latin American people at 22.6 per cent, West Asian or Arabic people (21.5 per cent), and Black people (21.1 per cent).

That same inequality was seen when respondents were asked about whether they had more money troubles. The provincial average was 32 per cent of respondents saying they had increased financial problems, with 29 per cent of white people reporting these issues.

Neither Dr. Henry nor the provincial health ministry explained why Indigenous respondents were not represented in the survey results released on Thursday.

Japanese, multi-ethnic and Korean respondents were the most likely to report difficulty accessing health care. On the other hand, Latin American, Southeast Asian and Black respondents were the most likely to report feeling more connected to family since the province began its state of emergency in March.

The survey also showed people at the income level of less than $60,000 reported having a harder time meeting their financial needs and putting enough food on the table, and that they were more likely to be out of work.

Among respondents with school-aged children, lower-income households reported more stress on their kids, more barriers to learning and a decreased connection to their friends.

At Thursday’s briefing, Health Minister Adrian Dix and Dr. Henry spent most of their time addressing the increase in cases. Mr. Dix warned anyone ignoring physical distancing at parties this weekend that public-health inspectors will be out enforcing rules at bars and banquet halls.

Since early July, people in their 20s have made up the highest proportion of new cases, according to the Public Health Agency of Canada. From July 29 to Aug. 4, more than 40 per cent of cases nationally for which data were available were reported in people 29 or younger.

In B.C., this group accounts for about 32 per cent of cases since July 1, while people in their 30s make up about 22 per cent. In Alberta, people in their 20s make up the largest proportion of active cases, at 22 per cent, while people in their 30s followed with 19 per cent.


Children Can Get Severe COVID-19, CDC Says — Especially Black And Hispanic Children

Another example of racial disparities. While the study did not include socioeconomic factors, these likely explain part of the differences:

While most children who catch the coronavirus have either no symptoms or mild ones, they are still at risk of developing “severe” symptoms requiring admission to an intensive care unit, the Centers for Disease Control and Prevention said in a new report released Friday.

Hispanic and Black children in particular were much more likely to require hospitalization for COVID-19, with Hispanic children about eight times as likely as white children to be hospitalized, while Black children were five times as likely.

Despite persistent rumors that children are “almost immune” from the virus, the analysis of 576 children hospitalized for the virus across 14 states found that one out of three was admitted to the ICU — similar to the rate among adults. Almost 1 in 5 of those were infants younger than 3 months. The most common symptoms included fever and chills, inability to eat, nausea and vomiting.

The findings come as school districts across the country are figuring out how to educate the nation’s children while still protecting kids, teachers and family members from the ravages of the virus. The American Federation of Teachers has said it considers in-person schooling to be safe only when fewer than 5% of coronavirus tests in an area are positive.

Researchers don’t fully understand why some racial groups are hospitalized at higher rates than others. But the CDC’s findings are consistent with other studies, the authors of the report said, citing a recent analysis from the Baltimore-District of Columbia region that found that Hispanics had more COVID-19 infections than other groups.

“It has been hypothesized that Hispanic adults might be at increased risk for SARS-CoV-2 infection because they are overrepresented in frontline (e.g., essential and direct-service) occupations with decreased opportunities for social distancing, which might also affect children living in those households,” the CDC researchers wrote.

Underlying medical conditions might have contributed to the children’s hospitalization, researchers wrote, noting that Hispanic and Black children are more likely to suffer from conditions like obesity.

If there’s any good news, it’s that even among children hospitalized with severe COVID-19 complications, the fatality rate remains low, researchers said.

A separate study in the journal Pediatrics also found racial and socioeconomic disparities in children and young adults tested for COVID-19 in Washington, D.C. Hispanic children were more than six times as likely as white children to test positive for the virus; Black children were over four times as likely.

Ultimately, the CDC concluded, it’s crucial to continue prevention efforts wherever children gather, specifically citing schools and child care centers.

Source: Children Can Get Severe COVID-19, CDC Says — Especially Black And Hispanic Children

East Asians have Toronto’s lowest coronavirus infection rate. But other Asian groups are suffering badly

Good article and analysis of the Toronto race-based COVID-19 data

  • Toronto’s ethnic Chinese are weathering the epidemic well – yet it’s a much different story for Filipinos, South Asians and all other non-whites

  • Wide disparities are also reflected according to income, with experts suggesting socio-economic factors like racism and poverty are likely at play, not genetics

North American Covid-19 statistics that group Asian communities together have suggested they are experiencing relatively low infection rates – but new data out of Toronto indicates sharp differences among Chinese, Filipino and other Asian groups in the city.

Toronto’s large East Asian population, which overwhelmingly consists of ethnic Chinese, has the lowest rate of infection among all ethnicities.

But all other Asian groups have been hit hard. Southeast Asians, consisting mostly of ethnic Filipinos, have an infection rate more than eight times higher than that of East Asians; the rate for South Asian Torontonians is more than five times East Asians’.

In fact, all other non-white groups have infection rates that exceed the East Asian rate by huge margins.

This chart shows the wide disparities in Covid-19 infection rates in Toronto, according to ethnicity, with East Asians experiencing the lowest rate and Latin Americans the highest. Graphic: Toronto Public Health
This chart shows the wide disparities in Covid-19 infection rates in Toronto, according to ethnicity, with East Asians experiencing the lowest rate and Latin Americans the highest. Graphic: Toronto Public Health

White Torontonians, meanwhile, have an infection rate that is a more modest 25 per cent higher than East Asians’ – still much lower than the rate for the whole of this diverse city.

Experts suspect that a combination of racism, behaviour and circumstance explains the stark differences among various ethnicities. The fact that wide disparities are also reflected in income-based infection rates suggests that socio-economic reasons are at play, not genetics, they say.

Widespread and early mask usage among East Asians could be a factor, said Dr Jason Kindrachuk, a University of Manitoba virologist who is studying Covid-19.
Covid-19 rate in Canada’s most Chinese city isn’t what racists might expect

But teasing apart causality would take time. “Is it as straightforward as income? Could this relate back to earlier community acceptance of things like masks or social distancing?” he asked.

Either way, the data is crucial to identifying communities that bear the greatest burden in the pandemic, said Kindrachuk.

“In Canada we talk about being a multi-ethnicity community, but we’re starting to identify just how different our communities are, how different the vulnerabilities are … so we need to think about how we provide services to those most in need.”

The Toronto data likely reflected the higher risks of certain jobs, those that relied heavily on non-white employees and were ill-suited to social distancing, Kindrachuk said.

Canada’s care industry has high numbers of Filipino workers, for example, while its meat processing and seasonal agricultural sectors employ many foreign workers from Mexico.

As well as suggesting communities most at risk, the ethnic data also stood in sharp contrast to what Kindrachuk called “shocking” racist rhetoric about “the ‘China virus’ [and the] implicit targeting of the East Asian, the Chinese communities, as being to blame for the virus”.

Poverty, racism and risk in Toronto

Previous data from New York and Los Angeles suggested that Asian residents of those cities had the lowest infection rates among various racial groups. But those US statistics lumped all Asians together, disguising any disparities within the group.

The Toronto data, presented by the city’s Medical Officer of Health Dr Eileen de Villa last Thursday and current to July 16, split up East Asians, Southeast Asians and South Asians. West Asians were grouped with Arab and Middle East people.

Separate census figures show that Toronto’s East Asian population is 84 per cent Chinese; ethnic Filipinos similarly dominate the Southeast Asian category, representing 79 per cent of the grouping.

East Asians had a Covid-19 rate of 40 infections per 100,000, far below the citywide rate of 145. They make up 13 per cent of the City of Toronto’s population of about 2.7 million – but less than 4 per cent of all infections.

This chart shows the wide disparities in Covid-19 infection rates in Toronto according to ethnicity, illustrated as percentages of total population and total infections. Graphic: Toronto Public Health
This chart shows the wide disparities in Covid-19 infection rates in Toronto according to ethnicity, illustrated as percentages of total population and total infections. Graphic: Toronto Public Health

The second-lowest infection rate (50 per 100,000) was among whites, who make up 48 per cent of the city’s population, and 17 per cent of infections.

Every other ethnic group has fared much worse.

The highest rates are among Latin Americans (481 per 100,000) and Arab/Middle Eastern/West Asians (454 per 100,000). Those communities are relatively small, at less than 3 and 4 per cent of the city respectively – but they suffered 10 per cent and 11 per cent of all Covid cases.

The larger populations of black Torontonians and Southeast Asians had identical infection rates of 334 per 100,000 people. Blacks make up about 9 per cent of the city, and Southeast Asians about 7 per cent, but experienced 21 and 17 per cent of all infections respectively.

South Asians (grouped with Indo-Caribbeans), had an infection rate of about 224 per 100,000. They make up about 13 per cent of Toronto, but have suffered 20 per cent of infections.

Canada has not been releasing race-based Covid-19 data on a national level, something critics call a blind spot.

But the Toronto data echoes previous geographical data from British Columbia, where the rate of Covid-19 infection in Richmond – the most ethnically Chinese city in the world outside Asia – has been the lowest in the metro Vancouver region.

In her presentation last week, Dr de Villa said there was “growing evidence … that racialised people and people living in lower-income households are more likely to be affected by COVID-19“.

“While the exact reasons for this have yet to be fully understood, we believe it is related to both poverty and racism,” she said.

She noted that 83 per cent of reported COVID-19 cases in Toronto involved a patient who identified as a member of a racialised group, compared to 52 per cent among the general population.

The race-based data from Toronto showed that “risk distribution was very unequal”, said Dr David Fisman, a professor of epidemiology at the University of Toronto. But this could be an overlapping function of wealth and income, he said.

There were dramatic differences between infection rates depending on income, with the rate steeply declining as incomes rose. The infection rate among residents of households earning C$150,000 (US$113,000) or more was 24 per 100,000 – less than one-sixth the rate suffered by the lowest earners, on less than C$30,000 per year, at 160 infections per 100,000.

The risk of Covid-19 in Toronto declines steeply as income increases, this chart shows. Graphic: Toronto Public Health
The risk of Covid-19 in Toronto declines steeply as income increases, this chart shows. Graphic: Toronto Public Health

“We were seeing this anecdotally in hospitals; the lockdown extinguished spread [of Covid-19] in higher-income areas, as a lot of professionals with service jobs got to go online,” he said.

“Lower-income folks are more likely to be people of colour and more likely to be in essential in-person work,” such as jobs in factories, food processing or care facilities, Fisman said.

“We can see that the epidemic split off in Toronto into two epidemics: one for wealthier Torontonians, and another, more prolonged, epidemic for those of lesser economic means.”

Kindrachuk agreed – the income divide was “eye-opening”, he said. “If you have a high income, you likely are going to be able to weather the storm … there is a complete disparity between how the burden of this disease looks between high and low income brackets.”

As for genetics, Kindrachuk said he doubted that it explained the stark disparities among ethnicities. “I haven’t seen evidence that there is a difference” on a genetic basis, he said.

ICYMI: Toronto’s marginalized communities disproportionately affected by coronavirus, data suggest

Better data on what we have seen worldwide:

COVID-19 has infected racialized and low-income people in Toronto at far higher rates than the general population outside of long-term care homes, data released by the city suggest.

Doctors, community organizations and public-health workers have long suspected that racialized people – especially those who are Black – have been disproportionately affected by COVID-19. The findings released Thursday by Toronto Public Health showed that despite making up 52 per cent of the population, racialized people accounted for 83 per cent of COVID-19 cases between mid-May and mid-July.

The data reveal health inequities that existed long before the pandemic and will continue to if governments don’t look to address the upstream causes, experts say.

“Racism essentially sets up whether you’re able to have a life in which you can protect yourself from risk for any disease, including COVID, or whether you are forced into exposing yourself to risk,” said Arjumand Siddiqi, the Canada Research Chair in population health equity.

According to the data, Black people had the highest share of COVID-19 cases (21 per cent), followed by South Asian or Indo-Caribbean (20 per cent), Southeast Asian (17 per cent), white (17 per cent), Arab, Middle Eastern or West Asian (11 per cent), Latin American (10 per cent) and East Asian (4 per cent). All groups except white and East Asian were overrepresented based on the size of their overall population. Black people had six times the rate of COVID-19 cases compared with white people, while Latin American as well as Arab, Middle Eastern or West Asian populations had nine times the rate.

The data from Toronto Public Health do not include long-term care and retirement home residents, as these people are not asked about their race or their income. The data also did not include Indigenous identities. The data were collected by public-health officials between May 20 and July 16 and provided voluntarily.

Eileen de Villa, Toronto’s medical officer of health, said targeted testing, improved communication and access to social supports – such as voluntary isolation sites for those infected with or exposed to COVID-19 – could address these stark inequities in the short term. But she emphasized the city must work to address the root causes.

“We need to focus on the social determinants of health, like affordable housing opportunities, access to employment and income supports and educational opportunities. And yes, we need to address systemic racism,” Dr. de Villa said.

Mayor John Tory said community organizations will be a key partner in identifying solutions.

“This includes engaging with local community groups to better understand risks and the concerns that residents in these areas have, so that we can work together with them to address those concerns,” Mr. Tory said.

Floydeen Charles-Fridal, the executive director of Caribbean African Canadian Social Services, said her organization, based in the northwest part of the city that’s home to one of its largest Black populations, does the sort of front-line work that has been chronically underfunded for years.

CAFCAN usually spends about $10,000 to $15,000 annually on food-related programming but instead spent nearly $40,000 in the first month of the pandemic on hot meals, food hampers and staff to prepare and deliver them. Food insecurity was already an issue in the neighbourhood but grew worse after lockdown-related job losses, Ms. Charles-Fridal said. A University of Toronto study published last fall found Black Canadians experience food insecurity at nearly twice the rate of white Canadians, even after adjusting for factors such as education, income and home ownership.

“It took COVID-19 and the murder of Black folks here and across the border for people to really understand how anti-Black racism is working,” Ms. Charles-Fridal said.

Studies have repeatedly shown that South Asians and Black people have much higher rates of diabetes and high blood pressure than the general population. For people with one of these underlying conditions who become infected with COVID-19, there is an elevated risk for more severe outcomes, including death.

Michelle Westin, a senior analyst at Black Creek Community Health Centre, which serves neighbourhoods with some of the highest rates of poverty, said she was not at all surprised by the data.

“We know that we have community members that are living in crowded apartment buildings, people who are working in the service and factory industries, people who are underemployed so they don’t have paid sick days,” Ms. Westin said. “So they’re working in positions that are putting them at greater risk for catching COVID.”

In a report published after the Black Experiences in Healthcare Symposium held earlier this year in Toronto, organizers noted there were “disparities and inequities in health care access and delivery for racialized Canadians.”

Tracey Thompson, 52, experienced this first-hand. Ms. Thompson, who is Black, contracted COVID-19 in mid-March and still lives with serious long-term effects from the virus. She said she was turned away from the emergency room twice, and has not been able to see a doctor to get medication to relieve her symptoms, which are still present.

“I just haven’t been able to access health care in a reasonable fashion,” Ms. Thompson said. “I think that being Black and being a woman didn’t do me any favours in that.”

Toronto Public Health also reported Thursday that having a low income and living in crowded spaces were major risk factors for COVID-19: 27 per cent of cases were among those living in households of five or more, and 51 per cent of cases were among those living in low-income households.

The two are closely connected, Ms. Charles-Fridal said. “When people have low income what that also suggests is they may very well be in [public] housing and living in places where they cannot practice physical distancing.”

Earlier this month, a group of homeless people and activist organizations filed an application with the Superior Court calling a bylaw that bans tents and camping in city parks unconstitutional. Evicting people from parks, they said, would then push them into crowded communal spaces where they faced an elevated risk of contracting COVID-19.

ICYMI: Black Children Are More Likely to Die After Surgery Than White Peers, Study Shows

Yet another study showing racial disparities in healthcare:

Black children are more than three times as likely to die within a month of surgery as white children, according to a study published in the journal Pediatrics on Monday.

Disparities in surgical outcomes between Black and white patients have been well established, with researchers attributing some of the difference to higher rates of chronic conditions among Black people. But this study, which looked at data on 172,549 children, highlights the racial disparities in health outcomes even when comparing healthy children.

Researchers found that Black children were 3.4 times as likely to die within a month after surgery and were 1.2 times as likely to develop postoperative complications. The authors performed a retrospective study based on data on children who underwent surgery from 2012 through 2017.

Olubukola Nafiu, the lead author of the study and a pediatric anesthesiologist at Nationwide Children’s Hospital in Columbus, Ohio, said the authors were not surprised to find that healthy children, across the board, had extremely low rates of mortality and rates of complications after surgery. But what surprised them was the magnitude of the difference in mortality and complication rates by race.

“The hypothesis we had when we started was that if you studied a relatively healthy cohort of patients, there shouldn’t be any difference in outcomes,” Dr. Nafiu said.

The authors, in their paper, acknowledged limitations of the study: They did not explore the site of care where patients received their treatments or the insurance status of patients, which can be used as a proxy for socioeconomic status. This meant they could not account for differences in the quality of care that patients received or the economic backgrounds of the patients.

Another limitation was that because mortality and postoperative complications are so uncommon among healthy children, it is possible that most of the cases came from a few hospitals, Dr. Nafiu said.

But while Black people are more likely to receive care in low-performing hospitals, that may not be the main factor driving the gap this study found, Dr. Nafiu said. The hospitals examined in the study were all part of the National Surgical Quality Improvement Program, a voluntary program, meaning they had the resources to be part of the program and the belief that quality improvement is important.

Adil Haider, dean of the medical college at Aga Khan University, who was not involved with the study, said that it told a key piece of the story about racial disparities in surgical outcomes, but that there were still many questions about what drives disparities.

Dark skinned patients left out of COVID-19 studies, as minorities some of the hardest bit by the virus

Of note, another example of systemic bias and discrimination:

Clinical images of patients with hives, swollen lips, chickenpox-like rashes, and red or purple lesions on the feet known as “covid toes,” have been published in medical studies since the start of the pandemic, demonstrating how the virus can affect the skin.

These images can help doctors diagnose patients who are otherwise asymptomatic – if they have light skin.

But images of darker-skinned patients have largely not been included in medical studies showing how COVID-19 can present on the skin, even as the disease has disproportionately affected people of colour in Canada and the United States. Symptoms can appear very differently on dark skin tones, underscoring the need for inclusion in clinical studies.

“Black folks in Canada, specifically Toronto, are overrepresented in terms of the burden of COVID-19,” said Bolu Ogunyemi, a dermatologist and clinical assistant professor of medicine at Memorial University in Newfoundland.

“So it’s unfortunate that we’re actually underrepresented in records of the manifestation from skin for this disease.”

The COVID-19 studies reflect a pattern in which darker skinned patients are largely missing from medical literature, part of an issue of racism within the medical system.

A literature review in The British Journal of Dermatology found that out of 36 studies showing images of COVID-19 presentations on skin published between December, 2019, to May, 2020, there were zero images of dark skin tones.

Researchers evaluated each clinical image using the six-point Fitzpatrick scale, which categorizes skin tones from lightest to darkest, and found that 92 per cent of the 130 images were of skin in the first three categories, which range from the lightest coloured skin to a medium tone. There were zero images of skin in the two darkest Fitzpatrick categories.

While it is not yet clear how significant these skin lesions can be in diagnosing COVID-19, understanding what they look like could lead to earlier testing. Some provinces, such as Nova Scotia, have added symptoms of red or purple fingers or toes to a list of symptoms that indicate a person should get tested.

“We’re still trying to figure out what these manifestations actually mean,” said the main author of the study, Jenna Lester, who is an assistant professor of dermatology at the University of California, San Francisco.

“But if there is a rash that patients can identify themselves when they were perhaps asymptomatic and can use it as a way to know they need to get tested but we’re not showing it in dark skin – it is a huge disservice to patients.”

Including examples of what diseases can look like on dark skin is important because indicators such as redness may be difficult to spot on dark skin, said Lynn McKinley-Grant, associate professor of Dermatology at Howard University College of Medicine and president of the U.S.-based Skin of Color Society.

Redness on light skin can appear as a different shade on darker skin, she said, or not appear at all. Doctors may have to employ different diagnostic methods to determine the issue, such as using touch to see whether the skin is warm. Sometimes, darker skin can also react very differently.

“In the textbooks it’ll describe a rash as flat and not itchy, but in darker skin types, it’ll be raised and itchy, but still be in the same pattern,” Dr. McKinley-Grant said.

The Skin of Color Society has shared images on social media of darker skin showing symptoms that are similar in appearance to COVID-19 symptoms.

While most health care units in Canada do not yet collect race-based data on COVID-19 patients, statistics show that the most diverse geographic areas also have some of the highest rates COVID-19. In early June, after health care professionals across the country raised concerns about the lack of data on how COVID-19 has affected racialized populations, Ontario had granted some health units permission to begin collecting race-based data.

In the U.S., where race-based data are available, studies show that African-Americans are almost three times as likely to test positive for the virus than white people.

Some doctors in Canada have linked the lack of representation in COVID-19 studies to larger issues of representation in medical studies and textbooks, across all disciplines.

Edgar Akuffo-Addo, a first-year medical student at the University of Toronto, says he has experienced this first hand.

In a first-aid training course he recently completed, Mr. Akuffo-Addo said participants were instructed to check for signs of shock by pressing down on a patient’s fingernails and waiting to see how long it took to turn red again.

“I tried to do the test on myself, and I couldn’t see it on my own skin,” he said. In addition, he said all the patients featured in the video training materials were white.

Mr. Akuffo-Addo describes the lack of representation as “troubling and worrying” and has embarked on his own review of clinical images of skin conditions related to COVID-19, and has so far examined 1,000 images in studies from Spain, France, Italy, the U.S. and Canada. Mr. Akuffo-Addo said that he confirmed with the authors of those studies that all patients were white.

Dr. Ogunyemi said the study of dermatology has been historically white.

When the field was first developing in Britain, the U.S. and Canada, he said, there was a smaller proportion of people of colour, so the criteria for the diagnosis of skin issues was centred around people with lighter skin. But these criteria have not changed significantly since that time.

“The problem is our population in these countries is changing – but the definition of skin disease is not keeping up with the pace.”

Studies also show that a mistrust of the medical system is a major reason why people of colour may choose not to participate in medical studies, stemming from a history of mistreatment as well as discrimination within the medical system.

Dr. Ogunyemi said that because the information on treating dark skin may not be readily available, Canadian doctors may have to take additional steps to ensure they are comfortable and able to treat people with dark skin.

“I think like a lot of things, you have to take a conscious effort, you have to go out of your way.”