COVID-19 is a Crisis for Black Americans with Diabetes

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The early data on COVID-19 deaths in America is shocking and outrageous: “African Americans account for more than 40% of COVID-19 deaths in the U.S. where the race of victims has been made publicly known.” In Louisiana, 361 of 512 dead were black or African American; in Michigan, 298 of 531; in Illinois, 129 of 285. Only 21% of the population sampled was African American, suggesting that African Americans could be twice as likely to die in the epidemic.

As the illnesses and deaths continue to multiply, the pandemic is quickly developing into a real crisis for the black community in America.

Although the sheer numbers are alarming, that black Americans would be especially victimized by the coronavirus epidemic was sadly predictable. Nobody yet knows if the novel coronavirus itself affects different races differently when controlling for age and the presence of comorbidities. But that knowledge isn’t necessary to understand the many ways in which African Americans are already at greater risk of severe illness and death.

To begin with: black Americans have much more than their fair share of the conditions that predispose patients to worse COVID outcomes. Compared to whites, African-Americans have higher rates of asthma and chronic lung conditions, advanced kidney disease, AIDS, diabetes and severe obesity. The numbers are remarkable and distressing, and enough for some to conclude that “being black is bad for your health.”

Diet and nutrition loom large on the list of reasons for this unfortunate state of affairs. Minority communities seem to have been particularly poorly served by the good intentions of our national authorities. Groups like the American Diabetes Association and the United States Department of Agriculture have for decades pushed low-fat and low-cholesterol diets that might as well have been calculated to drive the obesity epidemic. These wrongheaded guidelines helped fuel an explosion of unhealthy foods that are high in refined carbohydrates and cheap oils, creating the very outcomes they were designed to avoid. These fast and junk foods – inexpensive, ubiquitous, and hyperpalatable – create a vicious cycle of insulin spikes that instruct the body to convert energy to fat, which only drives more hunger.

Racial and ethnic minorities have been especially victimized by these trends. Many minority communities in the US now tend “to have poorer nutrient profiles and dietary behaviors.” These aren’t simply matters of choice. Black Americans are less likely to live near healthy shopping options; they are also targeted disproportionately by ads for fast food and junk foods. A map of the so-called ‘diabetes belt’ is virtually identical to a map produced by the USDA showing how many citizens lack easy access to a grocery store.

As people with diabetes, writing for a community of readers with diabetes, we tend to focus on the topics of diet and lifestyle, because those are the most important interventions that we have within our own power to improve our own health. Our national authorities, by contrast, have long placed a frustratingly low emphasis on good nutrition research. For decades people with diabetes and people at risk of developing diabetes have been given bad advice. Now is the time to speak clearly about the fact that our modern diet and lifestyle is making us sick, metabolically dysfunctional, and at heightened risk from illness. COVID is just the tip of the iceberg.

There are, of course, other major factors at play in the high death rate of African Americans in the pandemic. Minorities in America tend to earn and save less money and are therefore less able to take time off of work to self-quarantine. They may be more likely to rely on public transportation, and less likely to be able to work from home, putting them at higher risk of infection in the first place. And financial pressure due to the ongoing economic lockdowns may exacerbate all of these factors. We’re seeing it all already in New York City.

Black Americans (and other marginalized groups) also experience massive inequalities in healthcare availability and in health insurance coverage. The conscious or unconscious biases of healthcare workers may also drive health disparities. To put it simply, even in an America where we have successfully ‘flattened the curve,’ African Americans are likely to receive a lower standard of medical attention. And if our healthcare resources do get overwhelmed – whether that’s in New York City or in rural Louisiana – it is likely to be blacks, and other minority communities, that get short shrift.

These inequalities cannot be overturned overnight. But our authorities need to reckon frankly with the fact that these injustices exist, and that they have helped create a situation where blacks will suffer disproportionately. Our local, state and national governments, charitable organizations and diabetes advocates should all be doing everything possible to ensure that COVID testing and quality treatment is available and as inexpensive as possible for black Americans. Privilege and cost should not determine who lives and who dies in the pandemic. These communities have been failed repeatedly in the past – failed with poor education, little economic opportunity, biased and subpar healthcare, and disastrously fallacious nutritional guidelines. Black Americans need help to fight COVID-19. Here is an opportunity to right some wrongs.

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