Duke Medical Ethics Journal   

In April 2020, the Centers for Disease Control and Prevention (CDC) began to collect national data on differences in the impact of COVID-19 by ethnicity, race, and socioeconomic status. Early data suggests significant ethnic, racial, and socioeconomic disparities in both rates of COVID-19 infection and COVID-19-associated mortality (Ambrose, 2020). Due to the increased COVID-19 burden on minority communities and individuals, minority children are more likely to be exposed to infection (Ambrose, 2020). An existing body of work has shown that minority children are also more likely than their White peers to suffer from underlying conditions like asthma and obesity; such conditions have been associated with higher risk of negative COVID-19 outcomes (Ambrose, 2020). Not only do minority children face a higher risk of COVID-19 infection during the pandemic, but they also may face additional pandemic-related obstacles, such as the inability to access high-quality healthcare and unreliable access to and benefits from food assistance programs.

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Racial disparities in U.S. coronavirus testing rates, infections, and hospitalizations extend to our country’s children: numerous studies have highlighted disparities in COVID-19 infection rates by examining testing data. Compared to White children, both Black and Latinx children had significantly higher rates of COVID-19 positive test results during a testing period from March to April of 2020 (Bandi et al, 2020). These statistically significant findings remained even after adjusting for other demographic factors. Furthermore, a recent CDC report analyzed the rates of a rare, coronavirus-associated syndrome called Multisystem Inflammatory Syndrome in children (MIS-C), finding that nearly 75 percent of children diagnosed with MIS-C were Black or Latinx (Stobbe, 2020). Another CDC report examined data regarding COVID-related hospitalizations among children and found that Latinx children and Black children have been hospitalized at a rate eight times higher and five times higher than their White peers, respectively (Stobbe, 2020). Notably, these stark findings reflect only the segment of relatively well-positioned minority children that had both geographical and financial access to testing sites, healthcare clinics, and hospitals.

Among U.S. children, racial and ethnic minority children are significantly more likely to be uninsured. (Flores et al, 2016). In the U.S., Black and Latinx children comprise 53 percent of uninsured American children, despite making up only 48 percent of the total population of children (Flores et al, 2016). Uninsured children are likely to have decreased geographical and financial access to high-quality healthcare services, problems that are further exacerbated as the proportion of uninsured people in local communities increases (Pauly and Pagán, 2007). A large proportion of Black and Latinx children utilize hospital emergency rooms as a source of healthcare when doctor’s office visits are geographically inaccessible or financially infeasible (Stobbe, 2020). In the context of the COVID-19 pandemic, this relative lack of access to high-quality healthcare could lead to more severe illness, unwillingness of families to pursue necessary healthcare services, or a combination of the two (Stobbe, 2020). In short, the U.S. public healthcare system was ill-prepared for the impact of COVID-19 on communities already at the periphery of the national healthcare, social services, and nutrition support systems.

According to data from the Kaiser Family Foundation, about 157 million Americans and their families rely on employer-sponsored health coverage (Gavidia, 2020). However, even within the population that receives employer-sponsored coverage, there are vast disparities in the benefits that are received. For example, employees with higher-paying jobs reap more benefits from their health coverage than do those with lower incomes (Bittker, 2020). Furthermore, 2018 American Community Survey data revealed the racial disparities in the provision of employer-sponsored coverage. Approximately 66 percent of White employees and their families receive employer-sponsored health insurance, whereas only 46 percent of Black employees, 41 percent of Latinx employees, and 36 percent of American Indian and Alaska Natives employees receive employer-sponsored coverage (Bittker, 2020). The coronavirus pandemic and the associated increase in unemployment continues to weaken the already fractured and unequal provision of employer-sponsored health coverage to American families.

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With COVID-19 arose a level of unemployment not seen since the Great Depression (Fairlie et al, 2020). The U.S. unemployment rate jumped to almost 15 percent less than two months after the implementation of social distancing measures (Fairlie et al, 2020). COVID-related unemployment rates also reveal racial disparities: 17 percent of Black individuals experienced unemployment (Fairlie et al, 2020). Latinx individuals were disproportionately hard hit with unemployment reaching more than 18 percent (Fairlie et al, 2020). Increases in unemployment – and the historic rate of adults exiting the job market altogether (which is not reflected in top-line unemployment rates) – are dramatically increasing both the number of uninsured children and families and the number of individuals who rely on food assistance programs.

The percent of families reporting low food security increased by about 20 percent during the pandemic (Adams et al, 2020). The three largest federally-supported food assistance programs for children and families - TANF, SNAP, and WIC - are largely unable to adjust their eligibility models to meet these increased needs. The Temporary Assistance for Needy Families (TANF) program provides state-administered cash assistance to families with limited or no income (Center on Budget and Policy Priorities, 2020). Since 1997, more than two million families have lost TANF benefits as a result of unemployment or other work-based eligibility requirements that vary among states (Pavetti, 2020). The TANF work requirements have “fueled a rise in deep poverty,” especially for the Black and Latinx children that live in states with the most restrictive TANF programs (Pavetti, 2020).