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Coronavirus Covid-19 Policy Statement

  

National Association of Black Social Workers

Covid 19 and Black Social Workers

A policy statement

 

Background:

The “invasion” of COVID-19 has caused a worldwide crisis. It was declared a worldwide pandemic by the World Health Organization (WHO) on March 1, 2020. To date, more than four million cases have been identified worldwide with more than 300,000 deaths in 215 countries or territories. In the United States, there have been more than 1.45 million cases and more than 86,000 deaths. The first documented case in the United States was on January 21, 2020 in Washington state. The United States has the highest number of COVID-19 deaths in the world[1].

 

What is Coronavirus (COVID 19)?

COVID 19 Is an extremely contagious infectious disease caused by a new coronavirus (novel coronavirus) first noted in Wuhan China in mid-2019. COVID-19 is short for COronaVIrus Disease 2019. Another name for the virus is SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2). This virus affects humans and can be passed from person to person, primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes (or sometimes talks close to another person). There have been cases of humans passing the virus to animals. Coronaviruses are a large family of viruses that can cause illness in animals or humans. They are called zoonotic in that some can jump from animals to humans. Only four of the coronaviruses infect humans. These illnesses can be as minor as the common cold or as serious as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). COVID-19 is a new virus.

 

What are the symptoms of COVID-19?

While the symptoms of COVID-19 can vary, the most common symptoms are fever, cough (dry or productive), sore throat, and tiredness. Another significant early symptom is loss of the sense of smell and taste. Other less frequent symptoms are muscle aches, nasal congestion, and diarrhea. The symptoms are usually mild and begin gradually. Some infected people have no symptoms at all but still can infect others. Not everyone who is infected will have a fever (it takes 2-10 days after being infected to develop a fever). About 80% of infected people recover without serious illness but about 16% of infected people become seriously ill.

 

Who gets COVID 19?

 

When White America catches a cold, Black America catches pneumonia

 

Although everyone is at risk of contracting the infection, Black people are more likely to be infected, have more severe symptoms, and to die from COVID 19 than other racial groups.  Nursing home residents, and those in other long term facilities, such as jails and prisons, are at an increased risk for infection and death. While Black people are not disproportionately represented as residents of nursing homes, they are disproportionately represented as staff in those facilities.  Black people are disproportionately represented in jails and prisons as both residents and staff. People with pre-existing conditions such as cardiovascular disease, diabetes mellitus, cirrhosis, HIV with low CD4 counts, transplant recipients, chronic lung disease such as asthma, hypertension, chronic kidney disease on dialysis, obesity and cancer tend to develop more severe and often life-threatening illness. Black people are disproportionately affected by these health conditions.

 

As such, Black people are disproportionately represented in COVID 19 diagnoses, hospitalizations, and deaths in the United States[2]. The following data represents a sample of these disparate findings:

  • Black people make up 14% of the population in Michigan but are 33% of COVID-19 diagnoses and 40% of the related deaths.
  • Black people make up 27% of the population in Milwaukee, Wisconsin but are almost 50% of COVID-19 diagnoses and 81% of the related deaths.
  • Black people make up 15% of the population in Illinois, but are almost 28% of COVID-19 diagnoses and 43% of the related deaths.
  • Black people make up 33% of the population in Louisiana but 70% of COVID-19 related deaths.

This is not an exhaustive list but representative of communities with significant Black populations and the impact of the COVID-19 on our communities. Our communities are least likely to have access to testing for COVID-19, although we are most likely to contract the virus, and most likely to die from the virus.

 

Why are we at higher risk?

 

Black people are at an increased risk for COVID-19 infection due to systemic racist structures.  For instance, Black people often live in racially segregated and densely populated areas.     While living in a Black community is not inherently a negative situation, racially segregated communities were legislated by the federal government.  In 1934, US Congress created the Federal Housing Administration, which insured private mortgages making homeownership the main means for wealth creation.  Blacks who sought to participate in this homeownership process were limited to certain communities that were “redlined” for being uninsurable by banks, deeming Blacks ineligible for insurance backed private mortgages[3].  In addition to this federally backed policy, White communities created “covenants” that banned non-Whites from living in those communities that were deemed insurable by banks. Racially segregated communities are a matter of US government policy[4].

These communities are often impacted by food apartheid policies[5] where there are no grocery stores with fresh produce within walking distance. Farm subsidy policies impact the price and quality of food available in Black communities, leaving these communities with genetically modified food with longer shelf lives.  The price for these foods is usually higher in Black communities than in White, more affluent communities. The poorer quality of the food in Black communities directly impacts the health of Black people, resulting in the increased likelihood of diseases such as hypertension, adult onset diabetes, obesity and heart disease[6].

 

These communities often lack high quality medical facilities[7]. The Affordable Care Act of 2014 sought to expand Medicaid insurance throughout the United States.  Medicaid provides payments to medical facilities for low income citizens.  States with high populations of low income citizens refused to accept the expansion of Medicaid from the federal government[8].  This resulted in the closure of hospitals and other medical facilities in poor, rural, and Black communities.  Health care providers were forced to close their practices or to limit the number of Medicaid eligible patients in their practices.  Consequently, Black communities have limited access to high quality medical care during this COVID-19 pandemic. 

 

In addition, Black people are more likely to work in essential service industries where they are at an increased risk of being exposed to COVID-19.  These jobs are often low wage with little benefits, such as health insurance[9], or with the privilege of the ability to shelter-in-place without the loss of wages[10]. While there is appreciated attention placed on doctors and nurses as front line workers, there is little attention on the support staff in medical settings, such as sanitation, food service, administrative support, and other important roles.  Black people are heavily represented in other service industries such as restaurants, transportation, and sanitation. 

 

Racism plays a major role in the medical outcomes of Black people[11].  Physicians are less likely to refer Black people for testing.  Black people report having negative interactions with medical staff who don’t believe that they have the symptoms with which are presented.  Racism causes chronic stress which exacerbates the impact of the COVID-19 in Black people.

 

Policy Implications

 

As Black social workers, we are both the service provider with an essential role, and at risk of being the client as we are exposed to the COVID-19 virus as we engage in our daily practice. As such, we must advocate for the following policies:

 

  • We must advocate for reparations. We should support the Commission to Study and Develop Reparation Proposals for African American Act (HR 40) sponsored by US Representative Sheila Lee (D-TX).While this is a legislative act to seek proposals for reparations to African Americans, it is important that we advocate for this commission to fully explore the much needed reparations owed to African Americans.Enslaved Africans were kidnapped and brought to what is now the United States of America to build the infrastructure for what is now the United States of America for zero compensation.Furthermore, we have been subjected to ongoing policies that prevent us from truly enjoying the fruits of our labor.COVID-19 has highlighted the race based disparities engineered by racist policies.

     

    The National Coalition of Blacks for Reparations in America (N’COBRA) defines reparations as:

    a process of repairing, healing and restoring a people injured because of their group identity and in violation of their fundamental human rights by governments, corporations, institutions and families. Those groups that have been injured have the right to obtain from the government, corporation, institution or family responsible for the injuries that which they need to repair and heal themselves. In addition to being a demand for justice, it is a principle of international human rights law.

     

    The United Nations’ Report of the Working Group of Experts on People of African Descent on its mission to the United States of America (2016) found that reparations are owed to African Americans by the United States government because of the “racial terrorism” inflicted upon African Americans throughout our tenure in this country. This UN panel found that “the dangerous ideology of white supremacy inhibits social cohesion amongst the US population”.

     

    N’COBRA suggests that reparations should come in the following forms:

    Reparations can be in as many forms as necessary to equitably (fairly) address the many forms of injury caused by chattel slavery and its continuing vestiges. The material forms of reparations include cash payments, land, economic development, and repatriation resources particularly to those who are descendants of enslaved Africans. Other forms of reparations for Black people of African descent include funds for scholarships and community development; creation of multi-media depictions of the history of Black people of African descent and textbooks for educational institutions that tell the story from the African descendants’ perspective; development of historical monuments and museums; the return of artifacts and art to appropriate people or institutions; exoneration of political prisoners; and, the elimination of laws and practices that maintain dual systems in the major areas of life including the punishment system, health, education and the financial/economic system. The forms of reparations received should improve the lives of African descendants in the United States for future generations to come; foster economic, social and political parity; and allow for full rights of self-determination.

     

    While the recommendation is to support HR 40 in the US House of Representatives, this bill is to form a commission to study reparations.  We must advocate for the realization of reparations.  We must be made whole for the harm that has been inflicted upon us since we placed our feet on this land in 1619.

     

  • We must advocate for universal COVID-19 testing for our community.We must also advocate for personal protection equipment (PPE) for our community to collectively protect us from the ravaging effects of COVID-19. As Black social workers, we are often on the front lines working directly with families in our communities.Because of the essential nature of our profession, it is important that we have the tools to effectively engage with our client systems.As social workers, we could inadvertently put families at risk for this virus, particularly if we are asymptomatic.Furthermore, we could be interacting with families who are asymptomatic who are putting us at risk for contacting the virus.Asymptomatic people are carriers of the virus.This puts our families and any others whom we are in contact at risk for the virus.Because we often live in racially segregated communities, we could put our entire community at risk if we do not know our status.

     

  • We must advocate for a minimum maintenance income that is given to every adult regardless of income or work status.COVID-19 has highlighted the wealth gap in this country.With approximately 30 million unemployed Americans, at this writing, a disproportionate number of the unemployed are Black.While it is the norm to have higher unemployment among Blacks than Whites, even in times of economic prosperity, we are devastated by the economic impact of this pandemic. This maintenance income will ensure that every American is able to have adequate food, water, shelter, and safety.

     

  • We must advocate for the expansion of the Affordable Care Act and specifically the expansion of Medicaid in every state.COVID-19 has highlighted racialized health disparities in this country.This expansion will provide the necessary funding to support the medical care of our low-income citizens. This expansion will also provide the necessary funding of medical facilities located in Black communities.

     

  • We must advocate for the full rights to vote in this country. COVID-19 has highlighted breaches in social policy and the need to increase our advocacy efforts.Black communities need to be mobilized to advocate for our needs.Electoral politics is essential to advocacy.The Voting Rights Act of 1965 provided a framework to protect our rights to vote.It is renewed every 25 years by the pen of the US President.However, it has been under attack, particularly since the election of President Barack H. Obama. The 2013 Supreme Court tore down many of the protections to accessing the ballot with the rationale that a Black President is evidence that there is not a need for specialized protections to vote.Many of the electoral districts with significant Black populations are plagued by gerrymandering which ensures that the minority of voters maintain control of the electoral process.The Voting Rights Advancement Act was introduced in both chambers of US Congress in December 2019 to counter the harmful impact of the 2013 Supreme Court ruling. It was passed in the House of Representatives in December 2019.It has yet to be voted on in the US Senate. We must advocate for the passage of this act. We must ensure that we are fully participating in the electoral process.We must ensure that our community is registered to vote, and that we participate in the voting process. We must also ensure that we hold our elected officials accountable to the needs of our community, whether or not we voted for that official.We must participate in the election of all levels of government elections.

     

  • We must advocate for full participation in the 2020 Census by members of the Black community.It is important that we are counted in the census to ensure that there are adequate funds allocated for our communities.We must monitor the count process.We must study the budget allocation process to ensure that we are getting an equitable share of funds.

Submitted by Tanya Smith Brice & Burnett Gallman (Columbia, SC chapter)



[1] Worldometers. (2020). Number of novel coronavirus (COVID-19) deaths worldwide as of May 14, 2020, by country. www.statista.com/statistics/1093256/novel-coronavirus-2019ncov-deaths-worldwide-by-country/ (Accessed May 14, 2020).

[2] Dyer O. (2020). Covid-19: Black people and other minorities are hardest hit in US BMJ. 369 :m1483

[3] Coates, T. N. (2014, June). The case for reparations. The Atlantic.; Shapiro, T., Meschede, T., & Osoro, S. (2013). The roots of the widening racial wealth gap: Explaining the Black-White economic divide (Research and Policy Brief) (p. 8). Waltheim, MA: Institute on Assets and Social Policy.

 

 

[4] Gross, T. (2017, May) A ‘Forgotten History’ of how the US government segregated America. National Public Radio, Fresh Air.

 

[5] Brones, A. (2018, May). Food apartheid: The root of the problem with America’s groceries. The Guardian.

[6] Lucan, S. C., Maroko, A. R., Patel, A. N., Gjonbalaj, I., Elbel, B., & Schechter, C. B. (2020). Healthful and less-healthful foods and drinks from storefront and non-storefront businesses: Implications for 'food deserts', 'food swamps' and food-source disparities. Public Health Nutrition23(8), 1428-1439.; Robinson, C. A., & Trent, M. (2019). Adolescent Health Disparities: Historical Context and Current Realities. In Promoting Health Equity Among Racially and Ethnically Diverse Adolescents (pp. 29-54). Springer, Cham.

[7] DeLeire, T. (2019), "The Effect of Disenrollment from Medicaid on Employment, Insurance Coverage, and Health and Health Care Utilization  ", Health and Labor Markets (Research in Labor Economics, Vol. 47), Emerald Publishing Limited, pp. 155-194.; Akinyemiju, T., Jha, M., Moore, J. X., & Pisu, M. (2016). Disparities in the prevalence of comorbidities among US adults by state Medicaid expansion status. Preventive medicine88, 196-202.

[8] Donn, S. McGrath, M. & Holahan, J. (2014). What is the result of states not expanding Medicaid?: Timely Analysis of Immediate Health Policy Issues.  Robert Woods Johnson: Urban Institute.

[9] Harper, A. (2020). COVID-19 exposes mistrust, health care inequality going back generations for African Americans. ABC News. April 28, 2020.

[10] Yancy CW. (2020). COVID-19 and African Americans. JAMA. Published online April 15, 2020.

[11] Harper, A. (2020). COVID-19 exposes mistrust, health care inequality going back generations for African Americans. ABC News. April 28, 2020.

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