The Complex Inequities of COVID-19 in South Carolina

Apr 27, 2020

Health experts say COVID-19 doesn't discriminate. But it does seem to prey on some groups more than others, and it's not a simple equation.
Credit CDC

The exact numbers keep changing, but the percentages have remained relatively steady. And they show that African-Americans are South Carolina’s most disproportionately affected group when it comes to COVID-19 cases and deaths.

But they also show that men and women overall are disproportionally affected (though less so than African-Americans), in two different ways.

The Numbers

The U.S. Census Bureau identifies 27.1 percent of South Carolina’s population as black. Meanwhile, the latest report from the South Carolina Department of Health and Environmental Control shows that 36 percent of residents with confirmed COVID-19 are black. That percentage had been a solid 40 just days earlier.

But the largest inequity regarding the coronavirus and African-Americans is in the death rate. Although African-Americans make up a little over a quarter of the state’s population, they make up 57 percent of COVID-19 deaths here.

The gender skew is less pronounced. South Carolina is just about half-and-half male and female (about 51 percent female to 49 percent male), according the Census. But 55 percent of confirmed COVID-19 cases in South Carolina are women, while 56 percent of Covid-19 deaths here are men.

The Whys

African-Americans:

The first thing we should know about the imbalance between the percentage of black residents in the state and the percentage affected seriously by the coronavirus is that it should not be a surprise, says Dr. Coretta Jenerette, associate dean for diversity, equity, and inclusivity at the University of South Carolina College of Nursing.

Jenerette points to historical data showing that African-Americans already are more disproportionately

Dr. Coretta Jenerette
Credit University of South Carolina

affected by health conditions than others groups’ members are. According to the federal Office of Minority Health and the Centers for Disease Control, African-Americans suffer more from obesity, heart disease, high blood pressure, diabetes, and stroke than any other group. All are conditions linked directly to serious complications with COVID-19 and all disparities increase heavily the older African-Americans get.

Jenerette cites what are called “social determinants of health,” the lifestyle factors that affect a person’s health overall. Things like:

“Socioeconomic status, education, your neighborhood and physical environment, your employment, your social support network, and access to healthcare,” she says.

Jenerette says the U.S. has wonderful healthcare. The problem is that it’s not available to everyone equally.

“If you’re from a rural area, do you even have access to being screened for COVID?” she asks. “We have yet to see the data for screenings, We see disparities in outcomes but we don’t know if there are disparities in screenings.”

According to the Housing Assistance Council, African-Americans made up a little more than a third of populations in small and rural cities in South Carolina the last time it counted rural numbers in 2010. The Kaiser Family Foundation reported in 2018 that 25 percent of black South Carolinians live in poverty (as do 25 percent of the state’s Hispanic residents and 28 percent of the state’s Native American residents).

The combination of poverty and living not near medical centers can severely limit access to healthcare, from screenings and basic diagnostics to advanced treatment, which Jenerette says could preempt the kinds of disparities that lead to African-Americans getting sick more often than others.

She also encourages black patients to “not take no for an answer” when trying to get medical help. She says African-Americans often do not seek medical help because they feel they will not be listened to.

Dr. Linda Bell, chief epidemiologist for South Carolina DHEC, says misinformation about the seriousness of COVID-19 is also to blame. Early in the U.S. pandemic, a rumor circulated on social media that if you were black, you were immune to the coronavirus.

Dr. Linda Bell delivering a COVID-19 update for the state.
Credit South Carolina ETV

“I have heard the myth … that African-Americans might not be affected,” Bell says. “Part of that could be that we were not widely testing in all communities, so early on if there was a perception that no one was hearing of African-Americans having infections, that could be a phenomenon of a lack of testing in those populations.”

Bell says these and other myths about preventative measures, cures, and treatments have led people, not just African-Americans, to make bad choices abut their health and to not take the threat of infection seriously.

Gender:

In a recent interview with PBS’s Cristiane Amanpour, author and physician Sharon Moalem stated that he has studied 12 countries in which women are more often infected by COVID-19 but men are more often dying of it.

In South Carolina, that same dynamic is in play. Moalem cited his own research showing that with only one X chromosome, males have less robust immune systems than females, who have two X chromosomes and, therefore, twice the immune system potential.

But as for why women are more often infected by COVID-19, Ann Warner, CEO of the South Carolina Women’s Rights and Empowerment Network (SCWREN), says it comes down to the work women do, both paid and unpaid.

“[Women] are more likely to be working in high-risk jobs in the workforce and they are also more likely to be caring for people who are sick,” she says.

Warner says SCWREN looked into the numbers and found that more than two thirds of jobs that put

Ann Warner
Credit SCWREN

workers in close contact with people – restaurant staffs, childcare professions, and healthcare – are held by women.

According to WREN’s analysis, 80 percent of the state’s healthcare staff, across all levels, are women. That number is consistent with national statistics compiled by the U.S. Department of Labor and with global statistics compiled by the World Health Organization. About 60 percent of low-wage workers in this country are women, according to the Bureau of Labor Statistics.

The Ways Forward

Warner says that when looking at any data about the disparities wrought by the coronavirus, it’s important to consider race and gender together.

“It’s absolutely the case that women of color are the most disadvantaged in our state and who are absolutely working these frontline jobs,” she says. “So we’ve got to look at race and gender together.”

For Warner, the way towards equity in health starts with valuing frontline workers, especially grocery store workers and childcare support workers, who she says are just now being seen for the first time as vital components of society.

For Coretta Jenerette, the way forward starts with better education among African-Americans about how to best look after their health. But awareness alone isn’t enough, she says.

“At some point, we’re going to have to move from awareness to action,” she says. “We need to carry out some of these plans that have been put in place to eliminate the disparities and inequities and move towards more racial equity in South Carolina and nationally.”

DHEC and state officials are already working on a set of plans to educate African-Americans about their resources and options. In a statement, the department said it is doing the following:

  • Working with churches to help communicate prevention messaging
  • Taking WIC services only over-the-phone
  • Expanding options in a variety of food categories to address WIC product shortages
  • Working with environmental justice advocates to raise awareness
  • Increasing availability of public health data to help provide information to assist in decision making, including demographics
  • Providing sneeze guards to restaurants and DMVs.

For Monty Robertson, the director of the Alliance for a Healthier South Carolina at the South Carolina Hospital Association, the way forward shows a lot of promise. As much trouble as this pandemic has caused, he says, it has given governments, schools, businesses, and community leaders a chance to build from the kinds of conversations people are having as we navigate the situation. And, he says, AHSC plans to take its efforts to the people.

Monty Robertson
Credit Twitter Image

“We’re going to go beyond just our healthcare leaders or healthcare professionals to address these issues,” he says. “Schools can make policies around healthy food. Employers can make policies around active living, healthy eating policies. I think there’s an opportunity for folks who are working in different sectors to affect change through policies.”

Like Warner, Robertson hopes the pandemic gets people to stop seeing statistics about inequities as disconnected pieces. If we’re going to address inequities, wherever they lie, he says, it’s going to take a holistic approach.

Jenerette adds that the conversations we need to have as we come out of this need to revolve around privilege (the idea that getting to healthcare centers or understanding healthy food and lifestyle choices are neither automatic nor universal), an understanding of implicit biases we might feel towards other groups, and empathy.

“There’s a lot of discourse about, can we teach nurses specifically, but healthcare providers in general to be empathetic?” she says. “Sometimes healthcare providers aren’t necessarily empathetic to people who don’t look like them or share their experiences.”

Bridging those kinds of gaps at the outset, she says, could go a long way towards achieving more equitable outcomes in residents’ health.

Scott Morgan is the Upstate Multimedia Reporter for South Carolina Public Radio. Follow Scott on Twitter @ByScottMorgan