How hard is the novel coronavirus hitting black, Hispanic, Native American and Asian communities across Nebraska?
We don’t quite know.
The Nebraska Department of Health and Human Services and many county health departments haven’t been tracking coronavirus cases by race or ethnicity — even as limited data from other states and cities show black and Hispanic residents faring worse in infection and death rates compared with their overall share of the population.
The Navajo Nation, spread out across three Southwestern states, also is battling a major coronavirus outbreak.
“As more data about the impact of the COVID-19 pandemic becomes available, it is increasingly clear that the disease is hitting the most vulnerable and disadvantaged populations in the U.S. the hardest,” said Dr. Lisa Cooper, a professor at Johns Hopkins Bloomberg School of Public Health, on the Johns Hopkins coronavirus tracking site.
The Johns Hopkins Coronavirus Resource Center says 38 states have released a breakdown of coronavirus cases by race.
A Nebraska DHHS spokeswoman said the department is working to gather and compile that information. Nebraska is a heavily white state — about 78.6% — but has a growing Latino population. Cities and some smaller rural communities are more diverse than the state overall.
“We are aware of the requests for race/ethnicity data, and as the state public health authority, this information is important to us as well,” spokeswoman Leah Bucco-White said. “Race/ethnicity isn’t always available in the electronic data submitted to us, and we have been working with the local health departments on enhancing the process to capture that information.”
The state had 2,421 confirmed coronavirus cases as of Friday.
Even without hard data, some say it’s likely that minority groups in Nebraska are seeing higher rates of infection.
Coronavirus hot spots are cropping up in smaller Nebraska communities with large manufacturing or meatpacking plants, like Grand Island and Lexington. The workforce in those plants includes Latinos, Somalis, Sudanese and, in Omaha, several ethnic groups from Myanmar. Nearly one-third of Grand Island residents and roughly 60% of Lexington residents are Latino.
That’s even led some in Grand Island to blame those workers for the broad spread of the virus there, said Audrey Lutz, the executive director of the Multicultural Coalition of Grand Island. Hall County, home to Grand Island, has the highest number of coronavirus cases in the state.
“The reason why the racial scapegoating is happening is, who does the hardest labor in our communities? The immigrants who do jobs other people don’t want to fill,” Lutz said. “I definitely want to underline the point: They are not causing the problem. They are merely victims of the circumstances of their lives. They work in meatpacking. They work very closely together.”
“It’s just exacerbating people’s prejudices that they’re already holding,” she added.
Dannette Smith, the CEO of Nebraska DHHS, said during a town hall Thursday that she doesn’t want to alarm people with any data that shows certain groups are more susceptible to the virus, or may fare worse if they catch it. But the information could help develop prevention strategies and inform people with certain preexisting conditions.
The Douglas County Health Department is one of the few in Nebraska tracking those numbers.
Douglas County’s population, dominated by Omaha, is about 69% white, according to U.S. Census Bureau estimates. But only 50% the county’s 376 confirmed coronavirus infections, as of Friday, affect white residents.
Black residents make up 21.2% of Douglas County’s coronavirus cases, but only 12% of the county’s population. Latinos make up almost 13% of the county, and nearly 17% of current coronavirus cases.
Asian residents are over-represented, too, fueled by growing infections among refugees from Nepal and Myanmar, many of whom work in meatpacking plants. About 4% of Douglas County residents are Asian, but they make up 9.5% of the county’s coronavirus cases.
One Nepalese-Bhutanese businessman said last week that he knew of at least five confirmed cases in his tight-knit refugee community.
Douglas County’s numbers represent a relatively small sample size, and the lack of widespread testing means it’s hard to pin down the number of people who actually have COVID-19, the disease caused by the coronavirus.
It’s also unclear what information on race or ethnicity is being collected when people get their nose swabbed for testing.
“At drive-thru sites, people crack windows open and provide information to someone who writes it down on a clipboard,” David Williams, a professor of public health at the Harvard T.H. Chan School of Public Health, said on a conference call with journalists last week. “My suspicion is it is sometimes not asked. Those collecting the data don’t see it as a priority and aren’t asking it.”
Phil Rooney, a spokesman for the Douglas County Health Department, said the county is collecting that data during its follow-up investigations, after someone tests positive and health workers try to trace how they were exposed and with whom they’ve had contact. “We are investigating all the cases, and some jurisdictions may not be able to do that,” he said.
Data from Iowa shows that black and Latino residents there are getting sick at a disproportionate rate. Four percent of Iowa residents are black, and roughly 6 percent are Latino. But 14.2% of those with confirmed coronavirus cases are black, and 21.3% of those testing positive are Latino. The race or ethnicity of almost 16% of people is unknown.
The virus is highly contagious and can infect anyone, regardless of race. Most people will experience mild to moderate symptoms and recover.
But black and Latino populations, for example, often have higher rates of diabetes, heart problems or high blood pressure, conditions that can worsen the effects of COVID-19.
They are also more likely to have jobs — such as grocery store workers, nursing home nurses or aides, meatcutters or bus drivers — that can’t be done from home. Those jobs also may involve greater interaction with the public or involve higher-risk populations including patients in hospitals or nursing facilities.
“The minority populations in a lot of the states that have been seriously affected at this point are more likely to be living in communities that have less access to care, who are also more likely to be essential workers who cannot stay home and work from home and are more likely to need public transportation,” Dr. Jasmine Marcelin, an infectious disease specialist at the University of Nebraska Medical Center, said during a Facebook Live chat on Wednesday.
The ACLU of Nebraska and 22 other organizations, including several Latino and workers advocacy groups, sent a letter to Nebraska Gov. Pete Ricketts and state health officials Tuesday, asking that they collect and release coronavirus infection and mortality rates by race or ethnicity.
“We’d like to see concrete numbers and with that, language accessibility,” said Rose Godinez, legal and policy counsel for ACLU of Nebraska.
The letter asked for more translation of county health department news, press releases and other handouts related to the coronavirus into languages other than English, something Ricketts said state and local staff are working on, and that a portion of coronavirus relief dollars be allocated for the needs of nonwhite Nebraskans.
“The data released so far has shown that by and large black people are dying at disturbingly disproportionate rates,” the letter said. “For example, black people represent 43 percent of COVID-19 deaths in Illinois, but make up only 14 percent of the state’s population.”
Kenny McMorris is the president and CEO of Charles Drew Health Center, which has several clinics in predominantly black North Omaha. The virus is magnifying existing health inequities along lines of race and class, he said. People living in poverty are more likely to lack health insurance and a primary care doctor or provider.
Health care providers must gain the trust of minority patients, provide interpreters and translated materials into different languages and not make assumptions about people’s level of health literacy, he said. Not everyone is following up on the ever-evolving news and guidelines from the U.S. Centers for Disease Control and Prevention.
Common coronavirus prevention strategies aren’t feasible for everyone, McMorris said.
“It’s very difficult to have someone isolate in a one-bedroom apartment that houses eight people,” he said.
More testing and contact tracing of people potentially exposed to the virus will help give a clearer picture of infection rates everywhere, including among different racial and ethnic groups, Marcelin and McMorris said.
In the meantime, McMorris said health care providers need to make “sure we are providing care that’s nonjudgmental, that’s free of fear and supports people where they are.”