• Phuc To

What's Missing from COVID-19 Data?

Updated: Dec 22, 2020

The Missing Piece

As of November 17th, there has been an additional 732 new cases since Sunday. The outbreak shows no sign of stopping. But besides informing our understanding of how the Coronavirus is spreading, what else does COVID-19 data tell us? How we collect and interpret COVID-19 data plays a vital role in understanding how the virus affects some communities more than others. We will take a closer look at current COVID-19 numbers by race/ ethnicity and reported data limitations in today's article.

Figure 1: Statewide Percentage of Positive Cases and Death by Ethnicity.

The horizontal bars represent the percent infection and death by ethnicity. The short vertical lines mark the average percent population of each ethnic group. Latinx and white communities have the highest percent of infection, whereas the Native Hawaiian/ Pacific Islanders and multi-race groups make up less than 2% of the population infection. However, when looking at the distribution of positive cases in conjunction with the demographic distribution (percent population of each ethnic group), there are significant COVID-19 racial disparities, with Latinx and Native Hawaiian / Pacific Islander populations disproportionately impacted. Source:https://covid19.ca.gov/state-dashboard/

Figure 2: Statewide and Countywide COVID-19 Cummulative Cases by Race/ Ethnicity

Latinx, white, and Asian is consistently leading the chart in the total number of cases. 42.4% of the confirmed cases are categorized under unknown ethnicity. Source: https://healthpolicy.ucla.edu/health-profiles/Pages/COVID-19Dashboard.aspx

Looking at the total number of cases by ethnicity (Figure 1 & 2), it makes sense to conclude that Native Hawaiian/ Pacific Islander and Native Indian/ Alaska Native are the least impacted populations. However, as explained in our previous reports, cumulative cases do not consider each ethnic group's population size; thus, it does not paint an accurate picture of how COVID-19 affects different communities of color. When looking at the case rate by race/ ethnicity, it is a very different story. (Figure 3).

Figure 3: Statewide COVID-19 Case Rates

In contrast to Figure 2, Figure 3 shows Pacific Islanders/ Native Hawaiians' case rate is significantly higher than other ethnic groups in Orange County and California. In Orange County, PINH's case rate is 1.33 times higher than for Latinos, 2.33 times higher than for the Black population, and 2.99 times higher than the white population. The health gap is even more significant in L.A. county. Source:https://healthpolicy.ucla.edu/health-profiles/Pages/COVID-19Dashboard.aspx

Although breaking down COVID-19 data into case rate by race/ ethnicity reveals the racial disparity of COVID-19 impact — it still is an incomplete story. Pacific Islanders and Native Hawaiian are shown to be disproportionately impacted by COVID-19, but the scale of this impact might have been under-reported due to single-race reporting. More than half of the NHPI population is multiracial, but only single-race, non-Latinx Native Hawaiians and Pacific Islanders were counted. Dr. Ninez Ponce, the director of the UCLA Center for Health Policy Research, also points out that the risk to the American Indians and Alaska Natives community may be hidden because of single-race reporting, as 62% of this population are either multiracial or Latinx.

Another issue with data reporting is the aggregation of Asian American subgroups. The Filipino community might be at higher risk because of a large population of health care workers in the community. Yet, the risks are not seen because of data aggregation into a single Asian category. Another group that often is left out of the picture is the immigrant communities. The current "public charge" legislation generated fear and barrier for this community to assess essential health care services. As insightful as the reported data is, there are still many missing pieces to this story.

Coronavirus does not discriminate, but the social structures and institutions in which our lives are situated do, and the COVID-19 pandemic reveals just that. Data informs policies and distribution of resources. Data tells stories. However, how the data is being collected, analyzed, and presented determines whose stories it is telling and whose stories are being excluded. Demographic data on COVID-19 is essential to equitable storytelling and interventions.

The Stories Behind These Numbers

Photo Caption: At the early stage of the Coronavirus outbreak in California, the Ili family was struck by the virus. In a matter of days, three of five household members were put in the intensive care unit. Read the Ili family's story here.

Our understanding of COVID is grounded in its role as a biological threat that we often forget the historical, political, and socioeconomic dimensions that facilitate its manifestation. A person's risk of infection and chance of recovery lies in their race, immigration status, occupation, income, culture, family, and housing situation. Health experts have said that the contributing factors of higher infection and death rates in Blacks, Latinx, and Pacific Islanders are reduced access to healthcare; higher levels of poverty; crowded housing; multigenerational households that make it more difficult to physically distance or quarantine; and higher rates of underlying health conditions that increase the risk for severe illness from COVID-19, such as heart and lung disease, asthma and diabetes.

The risk factors mentioned above might seem to revolve around personal choices and individual effort. That is far from the truth. In the article "It's Not Obesity. It's Slavery", Dr. Sabrina Strings, an associate professor of sociology at the University of California at Irvine, points to slavery as the underlying reason for the health disparities in the Black communities. "The era of slavery was when white Americans determined that black Americans needed only the bare necessities, not enough to keep them optimally safe and healthy. It set in motion black people's diminished access to healthy foods, safe working conditions, medical treatment, and a host of other social inequities that negatively impact health." she wrote.

The connection between slavery and health inequalities and disparities has also been investigated in a series of essays in the New York Times' 1619 Project. Individual choices and behaviors are often used as scapegoats diverting attention away from a larger issue at hand — systemic racism. In a recent interview hosted by the dean of the UCI School of Humanities, Dr. Frank B. Wilderson III, the chair and professor of African American studies, points out what often is missing in the discussion of racial health gap as follow:

"We've paid fairly close attention to the existence of racial health disparities, but there's been far less discussion on the fundamental causes of those inequities, and so we document disparities related to cardiovascular disease or cancers or COVID-19, and yet missing from that conversation all too often is an appreciation for the much deeper historical causes of these sorts of inequities."

Health inequities are deeply rooted in systemic racism. The devastating rate at which COVID-19 is killing Pacific Islanders urges all of us to look beyond numbers and individual-level factors to recognize the historical, political, and structural causes underlying the community's disproportionate suffering.


Bibliography Arcaya, Mariana C et al. “Inequalities in health: definitions, concepts, and theories.”Global health action vol. 8 27106. 24 Jun. 2015, doi:10.3402/gha.v8.27106COVID-19 Hospitalization and Death by Race/Ethnicity. (n.d.). Retrieved November 18, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

Holpuch, A. (2020, February 28). Inequalities of the US health system put coronavirus fight at risk, experts say. Retrieved November 18, 2020, from https://www.theguardian.com/world/2020/feb/27/coronavirus-outbreak-us-healthcare-sick-leave

Humanities Center at UC Irvine. (2020, Oct 15). Intersecting Realities: Health, Race, and the Ongoing Legacies of Slavery and Jim Crow. (n.d.). Retrieved November 18, 2020, from https://www.facebook.com/watch/?v=635047383870470

Kendi, I. (2020, April 01). Why Don't We Know Who the Coronavirus Victims Are? Retrieved November 18, 2020, from https://www.theatlantic.com/ideas/archive/2020/04/stop-looking-away-race-covid-19-victims/609250/

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News Releases. (n.d.). Retrieved November 18, 2020, from https://www.uclahealth.org/the-full-picture-why-we-need-more-demographic-data-on-covid19

Ray, R. (2020, April 19). Why are Blacks dying at higher rates from COVID-19? Retrieved November 18, 2020, from https://www.brookings.edu/blog/fixgov/2020/04/09/why-are-blacks-dying-at-higher-rates-from-covid-19/

School of Humanities at UC Irvine. (2020, July 07). Race and Medicine: Life Beyond a Cure. Retrieved November 18, 2020, from https://ucihumanities.medium.com/race-and-medicine-life-beyond-a-cure-77a56f2e1a08

School of Humanities at UC Irvine. (2020, July 14). Race & Inequality during COVID-19. Retrieved November 18, 2020, from https://ucihumanities.medium.com/race-inequality-during-covid-19-8a4034878e53

Strings, S. (2020, May 25). It's Not Obesity. It's Slavery. Retrieved November 18, 2020, from https://www.nytimes.com/2020/05/25/opinion/coronavirus-race-obesity.html

UCLA Center for Health Policy Research. (n.d.). Retrieved November 18, 2020, from https://healthpolicy.ucla.edu/health-profiles/Pages/COVID-19Dashboard.aspx

Villarosa, L. (2019, August 14). How False Beliefs in Physical Racial Difference Still Live in Medicine Today. Retrieved November 18, 2020, from https://www.nytimes.com/interactive/2019/08/14/magazine/racial-differences-doctors.html

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