Should the convergence between the social and biological vulnerabilities of black communities and the COVID-19 pandemic be considered?

The context of the COVID-19 pandemic has highlighted the structural inequalities and vulnerabilities experienced by black communities in the world, and in Brazil it is no different. The data generated in Brazil demonstrate that Brazilian inequality is alarming. Underreporting, non-prioritization of data that consider the variable race and color, and social groups in social vulnerability, help the unequal instrumentalization of epidemiological surveillance; many deaths from the black population are not being accounted for. Structural racism and the invisibility of the black population have been intensified with the pandemic. There is emerging evidence that COVID-19 may disproportionately affect black people, who in addition to the vulnerability resulting from socio-spatial conditions, appear to be more susceptible to contamination with a more serious and lethal outcome. Finally, biological differences, such as impaired functioning of the immune response, can be increased by structural racism. In this sense, we reinforce that possible relationships between social and biological vulnerabilities of black communities and the SARS-CoV-2 infection pandemic need to be considered and investigated.

Dear editor,

United Nations data show that disparities in mortality rates caused by the new Coronavirus SARS-CoV-2, reveal that the pandemic is related to the socioeconomic conditions of the affected people and also to ethnicity [1]. Among these we also highlight the political aspects and the organization of health systems in the countries. A community cohort study carried out in England [2] showed ethnic disparities in hospitalization for COVID-19, where black individuals had more than twice the risk compared with white individuals; this remained after adjusting for socioeconomic, and physical and mental health confounders. Differential ethnic impacts of COVID-19 have also been reported in the U.S., disproportionately made up of 20% blacks, and these accounted for 52% of those diagnosed with COVID-19 and 58% of COVID-19 deaths nationwide [3]. The Centers for Disease Control reported that more than 9000 health professionals in the USA acquired COVID-19 and that black health workers were disproportionately affected (21% of infections; 13% of the population) [4]. The second death notified in Brazil by Covid-19 was on April 11, 2020, a black woman, a domestic worker in the city of Rio de Janeiro (RJ), who acquired the disease from her bosses who had returned from vacation in Europe [5]. The National Confederation of Articulation of Black Rural Quilombola Communities (Confederação Nacional de Articulação das Comunidades Negras Rurais Quilombolas / Conaq), has already counted until August 2020 [6] quilombola deaths in 11 Brazilian states, with an average of 1.5 deaths per day. The epidemiological bulletin of the Municipality of São Paulo on April 30, 2020, pointed out that the risk of death of blacks in the city by the coronavirus SARS-Cov-2 is greater than that of whites, around 62% [7]. These facts are no coincidence, they simply expose the Brazilian reality of extreme inequality and social stratification. It is the poorest, the Brazilian black populations, on the outskirts of large cities and in rural areas who are dying in the pandemic. Ethnic health disparities have traditionally been examined for non-communicable diseases, especially obesity [8], diabetes, and cardiovascular diseases [9]. The black populations in Brazil and the United States face a higher prevalence of diseases such as diabetes, tuberculosis, hypertension, and chronic kidney disease, which place them in a high-risk group for COVID-19. Previous research suggests that the perception of being undervalued in a society based on race or ethnicity can harm mental and physical health [10]. The perceptions of members of a community of black women regarding the aspects of stigmatization and personal feelings about their group were evaluated, the results provided evidence that the perception of social stigmatization is related to the activity of the immune system. Specifically, black and Latino women who saw their group as being most devalued by society exhibited high baseline levels of interleukin 6 (IL-6), one of the cytokines responsible for fever and inflammation in response to infections or injuries [11]. Although it has been well reported that in the COVID-19 pandemic there is a disparity in relation to the disease’s involvement in the black community, interestingly there are no studies evaluating the intersection between social and biological vulnerabilities with the pandemic caused by the SARS-CoV-2 Coronavirus. In this sense, we emphasize that this theme needs to be reinforced and investigated.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.