Five years after COVID-19 lockdown, racial health disparities linger

NINA MOINI: Five years ago, the state of Minnesota and the rest of the world was experiencing the first weeks of COVID-19. Since then, we've learned people of color experienced a disproportionate burden of COVID-19 cases and deaths. In Minnesota, deaths were concentrated in more socioeconomically disadvantaged neighborhoods.

And two people are joining the program with their perspectives on the disparities in health care then and now. Dr. Kevin Gilliam is the medical director of NorthPoint Health & Wellness Center in North Minneapolis. Thanks for being with us, Doctor.

KEVIN GILLIAM: Thank you for having me.

NINA MOINI: We're also happy to have Elizabeth Wrigley-Field, associate director of the Minnesota Population Center and a sociology professor at the University of Minnesota. She's part of the team that published a study looking at the racial disparities in mortality rates from COVID-19 across neighborhoods in Minnesota. Thank you for being here as well.

ELIZABETH WRIGLEY-FIELD: Glad to be here.

NINA MOINI: I love that we have both the perspectives of providers and researchers with us. I really appreciate you both for that. I want to start with you, Dr. Gilliam. For those who may not be familiar, can you tell us a little bit about NorthPoint and the work that goes on there?

KEVIN GILLIAM: Yeah. NorthPoint Health & Wellness Center began as Pilot City. It was one of the first community health centers established across the country, one of the nine pilot programs. Began in the late 1960s and has been in place, providing medical, dental, behavioral health, and human services for that period of time.

NINA MOINI: OK. And so during the period of COVID-19, I'm not sure if you were in the role that you're in now, but can you talk a little bit about just what it was like providing service at that time and still?

KEVIN GILLIAM: Yeah, it began as quite the confusing time. I remember being in our lobby, having meetings, trying to determine whether or not we should wear masks in the early days, before we knew exactly what we were dealing with, and then determining, if we should work, how that work should happen. Do we see people in person? Do we transition to phones only?

And then as we began to be able to test and to determine if people were infected and beginning to learn what it meant to actually have an infection and what those symptoms really were and how to triage people and also protect ourselves at the same time, it was quite the time.

And then it continues through today, where we presently go back and forth, depending on the how much COVID or other viral illnesses are in the community, with whether or not we're requiring masking of our clinicians, and then constantly offering vaccination to the community to reduce risks even further, while also maintaining people's chronic health conditions and their preventative health care as well. So trying to do a balancing act of all those things at once.

NINA MOINI: Absolutely. And taking it back to that time, Elizabeth, there was a lot of confusion. It's hard to start tracking and researching something you don't know much about. So I'm curious now, five years removed, although, obviously, COVID is still around, how were you all able to conduct this research? And what were some of your takeaways?

ELIZABETH WRIGLEY-FIELD: Well, it was a little frantic because we were trying to understand something as it was evolving.

NINA MOINI: Yeah.

ELIZABETH WRIGLEY-FIELD: The research that I was part of began with a colleague of mine at the University of Minnesota who I'd never met before, JP Leider. We were both members of the Minnesota Population Center. And he put out feelers, is there anyone who'd want to work with me on analyzing all the death certificates in Minnesota as they become live? And I said, yeah, I would.

And so we made a research team. We had death certificates updated weekly throughout the pandemic. And so we could analyze in not quite real time, but pretty close what was happening here. And of course, what we saw was really distressing. We saw a level of death that was high. Minnesota's official COVID deaths were a bit less than 17,000, which is a lot for the size of this state.

But also it underscores the total cost-- or understates the total cost of the pandemic, as people also began to die more heavily from other causes of death, like drug overdose, like traffic fatalities, all kinds of things. So we were able to analyze that as it has evolved over the last five years.

NINA MOINI: And you found disparities, which it's not surprising because there have always been disparities in health care, right? But what have you garnered from all of this research?

ELIZABETH WRIGLEY-FIELD: Yeah, so there have always been disparities. That's absolutely right. A research finding that has always stuck with me is that white death rates during the COVID-19 pandemic, at its height, were about the same level that Black death rates are every year in the United States. So to me, that really drives home just the scale of inequity in death that is always present, even when we're not in a pandemic.

And it's also true that the pandemic was more unequal than ordinary mortality is in a lot of respects. And so in Minnesota, what that looked like is about 56% of Minnesota deaths happened to white people in a state that is 77% white. But that fact really understates the scale of the disparity because our white population is about 10 to 15 years older than all of the populations of color in Minnesota.

And so just to give an example of what these disparities looked like, if you were a person of color in Minnesota between the ages of 55 and 64, your chance of dying of COVID was greater than if you were a white person 10 years older. And the reason why that particular statistic is so important to me is that that 10-year difference, being age 65 or not, is the difference of how early you were allowed to be vaccinated.

And so we made vaccines available based on your age. But because our racial disparities were so large, populations of color, who were at higher risk of dying, became eligible much later than older white populations, whose risk was lower.

NINA MOINI: So as people are looking back on the decisions that were made during that time, what is your hope that would come out of this research and some of your findings?

ELIZABETH WRIGLEY-FIELD: Well, since we're talking about neighborhoods, there's a really interesting neighborhood pattern that developed in the pandemic that I think is very telling about what we should do differently. If you're looking at the Twin Cities metro area before the pandemic, you could statistically account for racial disparities just by knowing how economically deprived someone's neighborhood is.

Now, that doesn't mean that neighborhood deprivation is the only source of racial disparities. It absolutely is not. It just means that if you knew what kind of neighborhood someone was living in, how poor that neighborhood was, things like that, you wouldn't gain any more information about their risk of dying if you also knew their race. That's true before the pandemic.

In the pandemic, it's completely different from that. Race becomes this really strong predictor of death in a way that just wasn't true earlier. And so that tells us that something different is going on. And a lot of different pieces of evidence suggest that a lot of what was going on had to do with workplaces and the way that some people's jobs systematically put them at risk.

And the reason this is so important is that we actually could do a lot of things to reduce risks at work. Even in jobs that are intrinsically risky in a respiratory pandemic because they involve face-to-face work, having personal protective equipment was incredibly protective. So the highest-risk occupations were not nurses, for example, who you would think would be at the greatest risk because they're caring for COVID patients, but they had PPE.

The people who were at the highest risk were things like line cooks, workers in meatpacking factories, workers who were not protected. And that tells us that one of the things we could do is say, it's actually going to be a priority to have clean air inside workplaces and schools and public buildings. And actually, that would make-- and, for that matter, inside hospitals. And that would make everybody safer.

NINA MOINI: Dr. Gilliam, what is your reaction to this research? And what would you hope would be done differently in the future if a situation like this happens again?

KEVIN GILLIAM: Yeah, I find that research quite compelling and also find it true because many of the people that I see in the community within which NorthPoint resides, many of the people work in areas in the community that put them in harm's way, whether they are frontline staff, whether they work at NorthPoint themselves, or work in service industries that put them in direct contact in the community.

But it also makes me think and wonder about those people's homes. And I think about when I had COVID, I was able to sequester myself in a room in my home with an air filter to try to prevent the infection to spread to anyone else in my home. But many people don't have that same luxury to live in a home that they can cordon themselves off and isolate themselves for the requisite period of time.

And so thinking about our workplaces and the safety and the PPE that's provided there, but then taking that home to folks and how we are able to conduct ourselves differently at home to mitigate spread of disease and the impacts that we find from there. So thinking longitudinally about how we educate people about these respiratory illnesses because thinking back to those early days, we weren't sure how contagious it actually was and the possibility of spreading it within the household.

And then determining who was going to have the severe disease was very challenging to do at the time because we know people that are impacted by the social determinants of health and the things that place them at greater risk, but then there are subcategories of people who might have chronic disease on top of those things. So if you have underlying heart disease, or you have diabetes, or you have chronic kidney disease, or you have moderate to severe asthma or COPD, all these things place you at much higher risk of severe disease.

And so taking the time to explain that. And then later on, we had treatment available, but then there were access issues. And we had to get in within a certain number of days.

NINA MOINI: Yeah, there were issues. It was access. There were unknowns. But it's still so important to do the research and reflect back for next time. So I really appreciate both of you coming on. And if there are any other findings along the way, we'd love to chat with you all about them. Thank you.

KEVIN GILLIAM: Thank you

ELIZABETH WRIGLEY-FIELD: Thank you so much.

NINA MOINI: That was Dr. Kevin Gilliam, the medical director of NorthPoint Health & Wellness Center, and Elizabeth Wrigley-Field, a sociology professor at the University of Minnesota and the associate director of the Minnesota Population Center.