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Systemic racism is to blame for disproportionately high rates of COVID-19 among Black Americans, public health experts .

"[T]his virus could have harmed anyone ... and yet because of racism and its pervasive hold on every institution in America ... COVID-19 has been the most devastating and deadly for Black Americans," Rhea Boyd, MD, MPH, a pediatrician and child health advocate at the Palo Alto Medical Foundation, told the subcommittee on Wednesday.

One in every 1,625 Black Americans has died from the novel coronavirus, she said.

Boyd also highlighted the virus's disproportionate impact on other racial minorities, particularly the Navajo Nation, Latinx Americans, Native Hawaiian Pacific Islanders, and Asian Americans.

Black Americans, however, have long held the unfortunate distinction of being most likely to die from all causes at an early age, subcommittee chair Anna Eshoo (D-Calif.) noted.

This same trend has persisted in COVID-19, where the overall mortality rate for Black Americans is 2.3 times that of white Americans, she noted.

In Washington D.C., Black residents have died at 6 times the rate of white residents from coronavirus, Boyd said, and similar differences in mortality have been seen in many other states.

While underlying conditions unequally impact Black Americans, she stressed, these figures can't be boiled down simply to those conditions and to higher poverty rates.

"Racial health inequities and COVID-19 are the result of racism," Boyd said, and these differences are "wholly preventable."

That Black Americans were already at higher risk for chronic illness isn't a function of their race, but a result of their lack of access to resources, which is a direct result of racism, Boyd also said.

Building on this theme, Oliver Brooks, MD, president of the National Medical Association and the chief medical officer at Watts Healthcare Corporation in Los Angeles, pointed to CDC findings that patients with hypertension, diabetes, and obesity are more likely to have adverse outcomes than other patients with COVID-19 -- all of which are more common in Black Americans.

But underlying health conditions alone are not the "predominant factor" in disparities in COVID-19 death rates, he said, echoing Boyd.

Differences in access to healthcare, the affordability of services, implicit biases by some clinicians, and African Americans' limited participation in clinical trials all influence health outcomes.

In other words, "racism, not race, affects health," he said.

Additionally, social determinants of health -- which include where people live and work, their access to education, healthy food, healthcare, and the safety of their surroundings -- are as important to one's health as genetics or medical treatments.

Responding to a Crisis

Eshoo asked witnesses what should have been done to eliminate racial health disparities in COVID-19, and all three agreed on the importance of testing.

There should have been "aggressive testing" sooner in the African-American community, Brooks argued, given that obesity, diabetes, and hypertension were linked early on to worse outcomes.

Boyd cited data from Eshoo's own district indicating that African Americans were less likely to be tested, especially in outpatient settings, and consequently had higher rates of hospitalizations and ICU visits. Also, because they were not tested they did not quarantine themselves, which led to greater spread in their communities.

Avik Roy, president of the Foundation for Research on Equal Opportunity, a conservative think tank, called specifically for better testing in nursing homes of both workers and residents and for restricting visitation, which some states banned but others didn't.

"[T]hat would have had a big impact," he said.

Roy noted that residents of nursing homes are disproportionately people of color and Medicaid enrollees.

Brooks also criticized the CDC for not collecting racial and ethnic data on COVID 19 and "even now" the agency is "getting it piecemeal."

"There's a feeling that there was just a neglect on getting information about the racial aspects of COVID-19," he said.

Boyd also suggested that efforts to improve access to telehealth, particularly for patients with diabetes and hypertension, would also have helped prevent disparities in deaths, given the research suggesting those whose disease is well-controlled have a lesser chance of adverse outcomes.

What Now?

To address these inequities, Boyd called on Congress to take "bold" action.

"We need universal healthcare, universal workplace protections, expanded federal and state relief programs, expanded access to housing and nutritional programs," she said.

She also called for drastically reducing the number of people who are homeless or in detention.

Robin Kelly (D-Ill.) asked witnesses what single change would have the most impact on these disparities.

Brooks called for expanding access to implicit bias training. Much, but not all, of the racism that occurs is subconscious, he said. "But, when you have implicit bias training, it makes you first of all, as a white person, think about it, and then second of all, do something about it," he said.

Boyd called for ending residential segregation. Research has shown that addressing segregation would close the Black-white education gap, the unemployment gap, and the gap in income, she said.

"Those are powerful social determinants of health that are shaping our COVID-19 inequities," Boyd said

Witnesses also stressed the importance of more and better data collection: covering age, sex, gender and location, for example, to identify which areas are under-served; and to standardize and organize it in a national database.

Eshoo said that Congress had passed a bill forcing COVID-19 testing labs to collect demographic data, which the CDC plans to implement. But the change won't take effect until August 1, she lamented.

Kelly and other members of Congress recently introduced the "" which would create a commission on health equity to determine strategies for leveraging data to reduce demographic disparities.

Rep. Markwayne Mullin (R-Okla.), who is Cherokee American, specifically called for better data for Native Americans, who in over half of states are lumped into the "other" category on forms.

He suggested that lack of data could impact the treatment those in Indian country receive.

Mullin also highlighted current "pockets" of outbreaks on the reservations and research suggesting that American Indians have three times the rate of diabetes compared to any other race, as reasons for particular concern.

Two weeks ago, witnesses told another House committee that proper sanitation and inadequate housing are driving up infection rates among Native Americans.

Eshoo said her office would work with Mullin and that this was unlikely to be the only hearing on racial disparities.

She also suggested that all committee members representing tribal areas should work together to draft a package of bills focused on tribal concerns around COVID-19.

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