Black Texans already face health care disparities. The coronavirus is making it worse.

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In late January — while the world focused on the coronavirus in China — Cedrick Smith was in Houston issuing a warning to his Facebook friends.

Smith, a medical director at an urgent care facility, then ticked off a series of tips: Don’t eat unattended free samples at grocery stores (“YUCK!”), cough into the corner of your elbow and wash your hands vigilantly (“wash under your nails!!”).

The messages were mostly meant for his black followers. As a black man himself on the front lines, Smith knew his community could very well take a shellacking: He’s seen firsthand how systemic racism and oppression play out in the health care system. “I knew that the virus, no doubt, would disproportionately harm African Americans,” Smith said.

“Even as privileged as I am as a physician, not a day goes by that I don’t think about my blackness and how it is perceived,” he said.

As the new coronavirus spreads throughout the state, black Texans feel as though they’re facing a more pronounced susceptibility: Longstanding inequalities make them less likely to have access to proper health care, and more likely to face racial bias that prevents them from getting proper treatment. They also suffer disproportionately from certain maladies — like high blood pressure or heart disease — that make the virus more deadly.

While racial data in the state paints an incomplete picture of the coronavirus’ impact on black Texans, early national data shows black people dying at higher rates from the coronavirus.

It’s not that the coronavirus is only targeting black people — thousands of Americans of all races have also died from COVID-19 — but the alarming rate at which black people are dying exposes the class and racial inequality that makes people of color more vulnerable to the contagion’s deadly effects.

For many medical experts, the racial disparities are easy to explain. One analysis showed that some doctors were less likely to refer black people who show symptoms of COVID-19, the disease caused by the coronavirus, for testing. And at a time when elected officials advocate for staying home, black Americans disproportionately belong to the part of the workforce that does not have that luxury. This fear has become even more pronounced as the Texas governor looks to reopen the parts of the economy as early as Friday.

So far, COVID-19 is killing black Americans at a devastating rate. Black people account for roughly a third of positive tests in Michigan and represent nearly 40% of deaths in that state, even though they make up 14% of the population. In Louisiana, about 58% of the people who have died are black, though only a third of the state’s population is.

In Texas, community activists and lawmakers are pushing for greater transparency on racial data. State Sen. Borris Miles, D-Houston, wrote a letter to Gov. Greg Abbott asking for increased testing in black communities in his district. And earlier this month, state Rep. Shawn Theirry, D-Houston, sent a letter to Abbott requesting the appointment of an emergency COVID-19 racial disparities task force.

A spokesman for Abbott did not respond to a request for comment about whether the governor would take such action, though Abbott said at a recent press conference that he’s “concerned about a disproportionate impact of those who contract or suffer severe consequences from COVID-19 who are representatives of minority communities.”

Texas isn’t the only state that’s been slow to collect and publish racial data. The Centers for Disease Control and Prevention only recently began publishing some detailed data on the racial breakdown of COVID-19 cases.

Kandice Webber, a black critical care nurse in Houston, said it’s not uncommon for her to see black and white patients — similar in age and symptoms — receive varying levels of care.

Still, some have inaccurately tied these disparities to individual behaviors. When asked by a reporter about the disparity between the rate at which black Americans are contracting COVID-19 as opposed to other racial groups, Surgeon General Jerome Adams said, “African Americans and Latinos should avoid alcohol, drugs and tobacco.”

His statements are at odds with health and race experts, who note that the rapid spread of the disease, a lack of testing, and a lack of early communication about its threat, combined with confusing — and false — rumors that black people were immune, left an information vacuum in some communities.

Minkah Makalani, an associate professor of African and African Diaspora Studies at the University of Texas at Austin, said the history of redlining and segregating black people in Texas and elsewhere to underserved urban areas also plays a part in the disparate outcomes.

“There’s often inadequate or no social services, poor quality sanitation standards and poor housing to meet the increased capacity,” he said.

Decades of those practices exacerbate health issues, he said, often culminating in a deadly combination for black Texans: condemnation to substandard housing, food deserts, inadequate access to health care and inferior health care services.

“The problem with segregation, redlining and Jim Crow is not simply that it confined people to particular areas, but that those areas were then underserved by the state and local governments,” he said.

“There’s a myth that because black people were once slaves they endure more pain than other types of people and usually when we do complain about issues, they’re not taken seriously.”

Research has also shown that stress brought on by racism, discrimination and subtle microaggressions can lead to bad health outcomes like heart disease, which can in turn make people more susceptible to the virus. The word that Smith used to describe this — “weathering,” a term coined by public health researcher Arline Geronimus, details the long-term negative toll that things like fear of interactions with law enforcement, unfair interactions at work or outright racism can cause on the immune system.

And no black person is immune to those effects, Smith, the Houston-area medical director, said.

“The disparities that exist and those types of pressures and stresses on the body are going to play a factor,” he said.

“That’s part of why I sent out that warning in January,” he added. “Because I know these disparities exist and that the risk for us is higher.”

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