On April 6, Gov. John Bel Edwards broke the news that 70% of the COVID-19 deaths in Louisiana were black folks. Given that only 32% of the state is African American, this disproportionate impact was stunning. African Americans in Illinois, Michigan and Wisconsin are dying of COVID-19 at disproportionate rates as well.
While top-level findings are important, they leave many unanswered questions. Where are these deaths occurring? If they are occurring in nursing facilities or prisons, that is critical information for efforts to mitigate the spread. How many of the people dying worked in industries where adherence to social distancing guidelines and practices such as working from home are not possible? Are deaths happening in low-income neighborhoods, where families often have one bathroom to share and no ability to isolate a sick family member? Mitigation measures can be developed for these situations.
One thing is certain, the prevalence of underlying health conditions does not explain the shocking gap between black and white COVID-19 deaths between black and white Louisianans. Black Louisianans’ rate of high blood pressure at 42% is not different enough from white Louisianans’ rate of high blood pressure at 38% to explain the COVID death disparity. Nor is black Louisianans rate of diabetes (18%) compared to white people (13%). Heart disease is also commonly associated with COVID-19 deaths, but, as it turns out, slightly more white Louisianans suffer from heart disease (6.6%) than do black Louisianans (4.9%). The state must look beyond commonly cited issues of health disparities to explain and address the difference in COVID-19 deaths between black and white people.
Louisiana needs COVID-19 death data by race/ethnicity, age, gender, occupation, parish, and ideally ZIP code and census tract. To date, Arizona, Illinois, Maryland and South Carolina, among others, are releasing data on cases by ZIP code. Cook County (which includes Chicago) provides detailed data on every single death in the county. Michigan is even releasing data on the numbers of people infected and dying in correctional facilities. Much of this data is typically available on a person’s death certificate.
While it is encouraging that Louisiana began releasing data by race, last week’s data raised more questions. This week’s data does little to answer those questions. State government announced that the death rate among African Americans had shrunk to 56%, but race was marked as “unknown” for nearly 8% of the deaths. Little information on how the state collects and recategorizes COVID-19 data over time is provided. This level of data transparency is inadequate and will hinder the state’s efforts to reduce deaths among black Louisianans.
Though Louisiana is trailing other states, we can learn from their mistakes and differentiate when the reported ZIP codes represent a patient’s home address versus the hospital where they received care. Additionally, deaths in group quarters (such as nursing homes, retirement homes, and jails) should be reported separately. Such data could address questions, such as why a small parish like St. John the Baptist has nearly the highest death rate in the country. Is it related to chronic exposure to toxic air quality or to a high number of deaths in a veterans nursing home? More granular data could shed light on these questions.
Every day that Louisiana delays releasing daily COVID-19 death data by race/ethnicity, age, gender, occupation, parish, ZIP code, census tract and group quarters further cripples our collective ability to mitigate the impact of this deadly disease. State officials are facing many challenges and being asked to make life or death decisions on a far too-regular basis right now, but the timely public release of necessary data is one of those life or death activities. Tuesday of last week was the deadliest day so far in Louisiana, but for whom? How do we know where to focus efforts to stem these tragic losses in coming weeks?
The data may reveal uncomfortable truths, but if the state is serious about decreasing death rates among African Americans, it needs to release detailed data now. Without it, we’re fighting this pandemic with one hand tied behind our backs.
Lamar Gardere is executive director of The Data Center, a nonprofit research institution based in New Orleans.