Central PA Medicine Summer2020 - 18

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WHITE COATS FOR
BLACK LIVES
severe obesity was independently associated
with a higher risk of mortality or intubation
and increased oxygen needs in a study of
COVID-19 patients in Bronx, NY. In
this study, the prevalence of obesity was
significantly higher in non-Hispanic Black
people and Hispanic people compared to
non-Hispanic White people.6 Obesity and
a high fat diet have been shown to impair
the innate and adaptive immune system,
leading to oxidative damage and weakening
host defense from viral illnesses, which
could potentially limit the effectiveness
of vaccines.7

May 30th suggests that there is a disproAdditionally, underrepresented minoriportionate number of Hispanic, Black, and ties have an increased incidence, risk of
American Indian or Alaskan Native people mortality, and risk of complications from
who tested positive for having COVID-19. the severe acute respiratory syndrome
Black Americans represented 22% of positive coronavirus 2 (SARS-CoV-2) infection.
tests when ethnicity was reported, in midst of Higher rates of obesity and type 2 diabetes
representing 13% of the general population may be contributing to the increased risk
in the United States. Ethnicity variables were of underrepresented minorities contracting
reported around 20% of the time early in the COVID-19.3,4 These chronic health conpandemic, and reporting of ethnicity variables ditions may be occurring at higher rates
reached 40% by June 2.1 This delayed the because of systemic issues, such as food
important discovery of the clear trend in insecurity, poverty, and lack of healthcare
disproportionate numbers of minorities access.4 According to the CDC, there are
testing positive for having COVID-19. Lack higher rates of unemployment, poverty,
of a coordinated response to the pandemic, obesity, and lack of access to health care
especially in earlier months, delayed valuable in Black people ages 18-64 compared to
data. Not only are Black people facing a high their white counterparts.5 Hypertension and
rate of viral infection, but the data that could diabetes are not only found at higher rates
be used in mitigation efforts is missing. To in Black people compared to white people
ensure standardized and comprehensive in the US, but also develop at earlier ages.5
reporting, the U.S. Department of Health Machine learning algorithms have revealed
and Human Services (HHS) recently released that both low income and being an underguidelines that required laboratories to report represented minority have a direct causal
full demographic data.2
relationship with obesity. 4 Additionally,
18 Summer 2020 Central PA Medicine

Similar to the disproportionate effects of
the COVID-19 pandemic, following the
2009 H1N1 influenza pandemic, it was
evident that the H1N1 influenza A virus
had a disproportionate effect on Black communities due to existing health disparities as
well as lack of effective communication about
the importance of vaccination.8,9 After the
discovery that SARS-CoV-2 entered human
cells through the angiotensin-converting
enzyme 2 (ACE-2), it was initially thought
this molecular expression could explain why
the Black community was more affected.
However, after several studies analyzing lung
cells through single-cell RNA sequencing,
Asian populations were found to have higher
ACE-2 pulmonary levels than the White and
Black population, while other studies found
no difference among races.10-12 Moreover, it
has been documented that the Black population has a reduced molecular expression
of ACE-2, which predisposes them to
developing essential arterial hypertension
and early organ damage.13 Data from the
2009 H1N1 pandemic demonstrated that
10 percent of those hospitalized with H1N1
were diabetic and acknowledged that diabetes
was more prevalent among non-Hispanic
Black people compared to non-Hispanic
White people.8 The data also found that
those with obesity and severe obesity were
more likely to require hospitalization and
mechanical ventilation.3 Additionally, Black
people are known for having a 2-3x higher
all-cause asthma-related hospitalization and
mortality rate compared to white people.8
Almost one third of those hospitalized with
2009 H1N1 had asthma.8
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