The COVID‐19 Pandemic Illuminates Persistent and Emerging Disparities among Rural Black Populations

On April 7, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, spoke at a COVID‐19 press conference noting the then emerging racial disparities in COVID‐19 cases and deaths in large cities like Chicago and Milwaukee. Specifically, he noted, “…[h]ealth disparities have always existed for the African American community…it's shining a bright light on how unacceptable that is, because yet again, when you have a situation like the coronavirus, they are suffering disproportionately.” ¹

In the past 2 weeks, these disparities have become even more salient. In South Carolina, where black persons comprise 27% of the population, the percentage of COVID‐19 cases and deaths among black persons was 38% and 46%, respectively, as of April 8. ² By the following week, those disproportionate percentages of COVID‐19 cases and deaths had grown to 41% and 56%, respectively. ³ South Carolina, like many southern states, has a significant rural, black population. A notable South Carolina outbreak has occurred in Clarendon County, a rural, majority black county. ⁴ Although not “rural” by most definitions, small, majority black cities such as Albany, Georgia, have experienced over a thousand COVID‐19 cases and dozens of deaths, among which 77% were black persons. ⁵

The South, where 94% of black rural populations live, has the perfect storm of more lax “stay at home” and social distancing policies, higher rates of underlying conditions, and lack of access to health care services, inviting racial disparities in COVID‐19 cases and deaths to be even more stark in rural communities. ⁶ Rural counties in the South are less prepared for the coronavirus due to state‐level policies, sociodemographic, and health characteristics. ⁷ Further, rural black populations tend to be older and have a greater prevalence of underlying conditions, such as obesity and diabetes. ⁶ Finally, most states that have yet to expand Medicaid have large rural black populations and have experienced a disproportionately high number of hospital closures in the past 10 years. ⁸ These factors, coupled with less broadband access among rural black populations, necessary for telehealth screening and other visits, leave rural black populations without access to the care they need if they become infected with the virus. ⁹

Dr. Fauci rightly notes that the coronavirus pandemic shines a bright light on racial disparities, but let us work and hope that the big city lights do not blind the world to both the persistent and emerging disparities experienced by rural black populations.