Data released by the Massachusetts Department of Public Health Wednesday on the number of confirmed cases and deaths from COVID-19 by race and ethnicity is incomplete. However, Dr. Joseph Betancourt, the first vice president and chief equity and inclusion officer at Massachusetts General Hospital, said the epidemic is particularly impacting communities with specific social conditions where minorities tend to live. WGBH News reporter Mark Herz spoke with Betancourt on Wednesday, who said that 35-40 percent of people admitted for COVID-19 at the hospital are Latinx. The following transcript has been edited for clarity.
Mark Herz: What [are] the connections between the social conditions you mentioned, minorities, and COVID-19?
Dr. Joseph Betancourt: Those social conditions are myriad, and they include high population density, a tendency to have lower socioeconomic status, working class individuals who really didn't have the luxury of social distancing and had to take public transportation, maybe lived in smaller homes with multiple family members. And so the data that we're looking at really ... is an indication of that.
And I think that fits the profile of places with conditions for high spread [of COVID-19], like some of our surrounding communities — East Boston, Chelsea, and the like. And I think the statewide data will begin to tell that story, and will tell that story more in the days to come.
Herz: And just to follow on what you were saying, the Boston Public Health Commission has put out data showing the rate of COVID-19 cases in four neighborhoods — Hyde Park, Mattapan, Dorchester and East Boston — is higher than in the rest of the city.
Betancourt: That’s also correct. … Now, I would just say what we are seeing was, and is, completely predictable when we think about how disasters impact populations. More often than not, they impact vulnerable populations and minority populations. And I think a situation like this, a respiratory infectious disease, it basically flourishes under certain conditions. And I think everywhere we're seeing spikes in the greater Boston area, those are the conditions where it flourishes.
Again, it's conditions where we see high population density, working class people who live in houses with multiple family members, people who didn't have the option to social distance or work from home, and had to go to work every day, take public transportation. All those factors, I think, very well explain why we're seeing what we're seeing in the greater Boston area.
And this is also not unlike what we're seeing in Detroit and New York and Chicago and New Orleans. Critically, these social conditions matter, and socioeconomic status matters. And I think what we're seeing is that minorities are disproportionately represented among individuals who live in those circumstances.
Herz: What about the course of this disease? Do we know anything about any disproportionate impact in terms of how severe it might be, or what prognoses might be for people?
Betancourt: So we're still getting data on who's recovering, on trajectory, and certainly we get death data that we're beginning to analyze, which is always tragic. But I'd say a couple of things: We know from statistics globally that the coronavirus tends to have a worse impact on individuals who were over 60, and increasingly, as you get older into 70 and 80. We also know that if you have any preexisting condition— chronic diseases such as diabetes, high blood pressure and pulmonary conditions such as chronic obstructive pulmonary disease, if you're on hemodialysis, any of those conditions put you at higher risk.
So, the problem here is that we know that minorities are more likely to have chronic conditions. They suffer from what we call health disparities, where they suffer at greater rates from these conditions, so they're at risk. We might expect that given their unequal burden of disease, perhaps lower access to care, that they will do less well if and when they're infected with the coronavirus.
I guess the last thing I'd say about that is that there are a couple of different hypotheses around what we call viral load.
If you are in a household with three or four or five other people, and two of them have been exposed, and because you could transmit the virus while you're asymptomatic, now you're multiple days shedding virus in that small household. There's this hypothesis that the amount of virus that you're exposed to might lead to worst disease outcome, a worse prognosis. It's still hypothetical. But I think, quite frankly, we may be starting to see some of that as we see individuals at our hospital who tend to be a little bit younger and seem to have more aggressive disease despite not having preexisting conditions.
Herz: You said earlier that this was completely predictable — how preventable was it?
Betancourt: I certainly believe that in situations like this, we can preemptively prevent the spread of respiratory viral illnesses from having the impact they've had. We ... have currently in Chelsea a very, very high rate — almost 88 now per 10,000 individuals — where we ... really [need] to make a difference ... to help Chelsea and [to] help mitigate the continued spread.
But we will be able to predict the next five Chelsea's in the greater Boston area, and so the call that we're making to the Department of Public Health is: Knowing what social conditions lead to the spread of the coronavirus, what are we going to do? What is a full-court press that we're going to put into place that's going to prevent this virus from expanding in some of the other communities where these social conditions are ripe for its spread?
Herz: Well, what would your game plan be for that full-court press?
Betancourt: I think what needs to happen right now is first, we need to be completely transparent with data at the state level. We need to have data that is very clear about the incident rates that are happening city-by-city and town-by-town. That allows us to really identify rate of growth, [and] where ... our hotspots [are]. And I think then we could move into mitigation strategies in those areas, and also predict where the next hotspot will be.
I do believe data collection on race and ethnicity will be also helpful and an adjunct to this, because we can tell a lot about the racial and ethnic demographic of certain communities based on zip code and based on towns and cities. So that'll be helpful. But even within larger towns and cities, racial ethnic breakdown will be helpful there.
I'd say another thing we need to do ... in those hotspots [is], number one, expand testing quickly. Now, we don't need to test everybody if we have limited resources, but we could test index cases, one or two people in a household, and then we could assume that the rest are positive, and we can engage in mitigation strategies there.
Another key thing we need to do is literally go door-to-door and make sure that in situations where people can’t social distance, if it’s difficult, if they have multiple family members in one home, that we provide them with masks, hand sanitizer, wipes, and thermometers so they can symptom monitor.
And in severe cases, where somebody is tested positive and we know that if they go back to the home, they will spread it, we need to create alternative housing. And we're seeing some of that develop already—college dorms, hotels that aren't being used—so we can socially isolate and look after those who are positive, and mitigate the continued spread of the virus.
We need to really understand that this virus doesn't discriminate, that these invisible borders between towns, between our neighbors, they don't exist. Our ability to really deploy resources and prevent these hotspots from emerging will ultimately keep the rest of our state safe, and I guess for me as a doctor, keep me and my fellow health care workers from being overwhelmed.
So we have a collective responsibility here to address the needs of our most vulnerable. If we're to take care of the entire state and our health care workers and our hospitals.
