February 9, 2021
By: Eugene T.RichardsonMD, PhDMomin M.MalikPhDWilliam A.DarityJr.PhDA. KirstenMullenBScMichelle E.MorseMD, MPHMayaMalikMSSWAlethaMaybankMD, MPHMary T.BassettMD, MPHPaul E.FarmerMD, PhDLeeWordenPhDJames HollandJonesPhD
In the United States, Black Americans are suffering from a significantly disproportionate incidence of COVID-19. Going beyond mere epidemiological tallying, the potential for actual racial-justice interventions, including reparations payments, to ameliorate these disparities has not been adequately explored.
We compared the COVID-19 time-varying R t curves of relatively disparate polities in terms of social equity (South Korea vs. Louisiana). Next, we considered a range of reproductive ratios to back-calculate the transmission rates b i ®j for 4 cells of the simplified next-generation matrix (from which R 0 is calculated for structured models) for the outbreak in Louisiana. Lastly, we considered the potential structural effects monetary payments as reparations for Black American descendants of persons enslaved in the U.S. would have had on pre-intervention b i ®j and consequently R 0 .
Once their respective epidemics begin to propagate, Louisiana displays R t values with an absolute difference of 1.3 to 2.5 compared to South Korea. It also takes Louisiana more than twice as long to bring R t below 1. Reasoning through the consequences of increased equity via matrix transmission models, we demonstrate how the benefits of a successful reparations program (reflected in the ratio b b ®b / b w ®w ) could reduce R 0 by 31 to 68%.
While there are compelling moral and historical arguments for racial-injustice interventions such as reparations, our study considers potential health benefits in the form of reduced SARS-CoV-2 transmission risk. A restitutive program targeted towards Black individuals would not only decrease COVID-19 risk for recipients of the wealth redistribution; the mitigating effects would also be distributed across racial groups, benefiting the population at large.
The novel coronavirus which causes COVID-19 was first reported in Hubei Province, China in December 2019.1 In the ensuing 5 months, the outbreak spread to nearly every country in the world.2 As of 11 December 2020, the United States had the highest number of reported cases with 15,474,800 confirmed infections and 291,522 total deaths3—although this certainly represents an underestimate of the true number of cases given the poor scale-up of testing coupled with a high rate of asymptomatic infection.4,5
As has been the case in previous pandemics, communities of color are suffering from an increased incidence of COVID-19—and therefore disproportionate mortality—when compared to white people.6, 7, 8 Early in the outbreak, the aggregated relative risk of death for Black people compared to the white people was 3.57 (95% CI: 2.84-4.48).9 Such a difference is the product of, and further contributes to, vast disparities in Black and white health that are a concatenation of legacies of enslavement, legal segregation, white terrorism (e.g., lynchings during the Jim Crow period), hyperincarceration, lethal policing, and ongoing discrimination in housing, employment, policing, credit markets, and health care.10, 11, 12, 13 The mismanagement of the SARS-CoV-2 response in the U.S. has exacerbated these disparities,14 but at the immediate outset, path-dependent structural inequalities such as greater overcrowding, concentration in frontline work, and hyperincarceration led directly to greater exposure and transmission among Black people.