Black NC residents dying from COVID-19 at higher rates, data show
Posted April 9, 2020 12:35 p.m. EDT
Updated April 9, 2020 6:35 p.m. EDT
Raleigh, N.C. — Seven days before Chanda Grubbs lost her husband, he wasn't sure he needed a hospital at all.
Adrian Grubbs had been sick for days, but while he waited for the results of a coronavirus test the previous week, he had isolated himself from the public, his wife and children on doctor's orders. On March 19, with some trouble breathing and a persistent cough, he was reluctant to break quarantine.
"We told the doctor how my husband was feeling, and the doctor said, 'OK, let's get him out of quarantine and take him to the emergency room at Betsy Johnson Hospital," Chanda Grubbs said. "And we did."
Adrian Grubbs was 37 years old. A 17-year employee with the City of Raleigh. He hadn't traveled recently and didn't know of contact with any positive cases of coronavirus. He wasn't asthmatic or diabetic. He did have high blood pressure, much like one of out every three Americans.
But by the time he got to the hospital late on March 19, he already had pneumonia. By the next morning, doctors wanted to intubate to boost oxygen levels in his blood. He told his wife from quarantine he was going ahead with the plan.
"Didn't know that was going to be my last time talking to him," Chanda Grubbs said.
The results showing he tested positive for COVID-19 wouldn't come for another several hours.
Adrian Grubbs passed away on March 23, becoming the second announced death from COVID-19 in North Carolina. As of Thursday afternoon, that death toll has reached more than 70.
But early data show impact across the state has not been uniform.
Black North Carolinians like Grubbs are dying from COVID-19 at almost twice the rate of white people, according to the latest statistics from state health officials.
The N.C. Department of Health and Human Services is tracking the racial demographics of 61 people who have died from the disease as of Thursday morning, a number that lags a bit behind the most updated figures. About 38 percent of those deaths have been black or African American, a racial group that makes up 22 percent of the state population.
Only 15 states so far have published demographics for deaths. But figures published so far show disproportionate impacts along racial lines similar to those in North Carolina. Public health experts say it's too early to know exactly why black communities are bearing the brunt of the disease.
N.C. DHHS Secretary Dr. Mandy Cohen said the numbers are partly a reflection of long-standing equity issues in the state and national health system. On average, she said, black Americans have less access to care and higher rates of chronic disease.
"As we head into this crisis, it shines a spotlight on problems that already existed," Cohen said.
Uncontrolled chronic diseases – conditions like asthma, diabetes and lung disease – also raise risks for black patients.
Cohen also noted that black North Carolinians make up a high proportion of essential workers – from healthcare to retail – increasing their exposure to potential infection.
"We need to make sure we're looking out for them as we implement policies," Cohen said.
Data has plenty of gaps
Cohen and other public health experts note there's still a lot they don't know about the spread of the virus. And a lack of widespread testing has given epidemiologists a limited picture of its impact by demographics.
Case in point: North Carolina's own numbers.
The state was one of the first in the nation to start publishing the total number of tests conducted in both public, hospital and private labs – at least those reported to N.C. DHHS. That figure includes both positive and negative tests.
But on March 29, state health officials stopped requiring providers to gather and report detailed information on racial demographics, symptoms and pre-existing medical conditions on each patient they tested.
Now, Cohen said, the labs only have the patient's name and date of birth.
When the case comes up positive, DHHS spokesperson Kelly Haight Connor said, the local health department has to go back and gather demographic information to fill in the gaps.
As of Thursday afternoon, Connor had not answered follow up questions about why the state halted its initial data collection rules.
Without that demographic info, it's impossible to know whether the higher rate of diagnosis for black patients is an artifact of testing or some other factor.
Cohen said breakdowns on positive cases at least provide a "good first window" into what's happening on the ground. They're also working with research and academic partners to fill in the gaps. But she admits it's not a top priority.
"It is definitely not an easy thing to do in the short term, so I would not expect that in the near term," Cohen said.
Families face lingering unknowns
In Harnett County, Chanda Grubbs remains full of questions.
"It's hard to even put it into words," she said. "I didn't expect it. I know he didn't expect it. It just happened so fast. And then to see that he was in that statistic, in that number, I can't even put into words how that makes me feel."
She said she's devastated not only by her husband's loss, but on the figures showing the disproportionate impact on other black families suffering from the disease. Grubbs wants to know why.
She thinks about her husband's high blood pressure – an underlying condition, medical professionals told her. How she has high blood pressure too.
She has questions about why her husband had to be tested for COVID-19 again, days after his initial test, because the original sample dried up. It's a red flag, she said.
Grubbs said she hopes the public is taking advice from public health experts seriously, because the impacts are real.
"My husband literally had to suffer and face this traumatic experience alone," Grubbs said. "No one should have to go through that."