Covid's racial realities exposed in new research that crunches the numbers

Some said it was the virus that “had no face” and was affecting everyone.

Others said Covid had exposed inequality, but couldn’t provide data on how.

Now a group of researchers has crunched the numbers and, according to lead researcher Refilwe Phaswana-Mafuya, a professor of epidemiology and public health at the University of Johannesburg: “What you see when you explore the data is that black African women get hospitalised at a much younger age compared to other racial groups.”

She and a group of researchers from other universities have published a paper in the South African Medical Journal entitled “Understanding the differential impacts of Covid-19 among hospitalised patients in South Africa for equitable response”.

Phaswana-Mafuya told the Sunday Times this week: “This research is not meant to divide us but it gives guidance on interventions going forward. Everyone keeps saying the pandemic exposes inequality but if you don’t get down to the nuances of that, it’s like saying nothing at all. These are the differences we are finally quantifying.”

The team looked at Covid hospital admissions between March 6 2020 and January 24 2021, and found that “an analysis of race, age and sex rates of hospitalisation showed variation”. Black African females had the highest hospitalisation rates at a younger age category of 30 to 39 years compared with other race groups.

“Black Africans [across both genders] were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were hospitalised at older ages than other races, with a median age of 63 years,” said Phaswana-Mafuya.

The data “raises questions about the traditional roles of women — urban and in villages — and being on the bottom rung of the jobs ladder. There are environmental factors, unemployment factors, issues around access to health facilities.”

When it comes to deaths, “one sees similar patterns”. Whites were “significantly more likely to die at older ages compared with black Africans, coloureds and Indians, who died at younger ages”.

Also, the ratio of deaths to hospitalisations by race and gender increased with increasing age in all groups, but “this ratio was highest among black Africans and lowest among whites”.

The median age of black African females dying from Covid was 63 whereas for their white counterparts it was 73. 

“The data raises questions about having comorbidities at an earlier age, or lower immunity, or not being able to get the right treatment on time,” she said. 

The researchers say that admission differences “may be due to racial disparities in exposure and susceptibility due to disproportionately higher rates of non-communicable diseases and disease severity”.

In the early days of the pandemic, the virus was first seeded in wealthy and predominantly white communities when overseas travellers returned. This led to a myth in some communities that it would only affect whites or wouldn’t spread in SA, but it soon seeded in other communities and the stark reality hit home: yet again, poorer communities would bear the brunt of it.

Wits University infectious disease specialist professor Francois Venter, head of health organisation Ezintsha, said the asymmetrical vaccine rollout along socioeconomic lines is exacerbating the problem of who carries the highest burden.

With vaccine rates higher among the well-heeled, protection against hospitalisation and death from Covid is higher too. “If you're rich you’re more likely to get vaccinated. The government has done a shocking job with the uninsured,” he told the Sunday Times, saying that demand creation and access were badly done, while vaccine incentives came too late.

“We know in other countries too, like the USA, poverty strongly correlates to poorer outcomes. Patients get to services later, and they have less choice in general over the situation.”

But even before the virus strikes, environmental factors are at play.

“Poor people just do worse with any illness because of stresses related to nutrition [due to lack of access to healthy food] and immunity, to name but two,” he said, “So every single metric around poverty puts you in a vulnerable position. And then when you do get sick, you get screwed over by the health system.”

Phaswana-Mafuya said government interventions should “focus on a targeted approach as you can’t use a blanket approach in the context of constrained resources”.