While early reports from other parts of the country indicate black Americans are disproportionately likely to get sick or die from the new coronavirus, it’s virtually impossible to determine if that grim reality is playing out in Texas because information released by state health officials is notably incomplete.
As part of epidemiological investigations, the Department of State Health Services and local officials are collecting some race and ethnicity data for people who have died from or tested positive for the virus. As of Monday night, though, the state had compiled the information for less than one quarter of the 7,276 confirmed cases reported at that point. And although state leaders acknowledge the demographic data is lacking, they have indicated the state won't be taking steps to mandate reporting to fill in the gaps.
The limited available data provided to The Texas Tribune offers a murky glimpse of the virus' impact on Texas communities of color. Race and ethnicity are reported as unknown for a significant portion of the completed case reports. (Agency officials said some people prefer not to provide the information.)
For patients with completed demographic profiles, the state is collecting race and ethnicity data as separate categories but declining to provide data for individual cases, which would allow researchers to clearly distinguish how many non-Hispanic white Texans are among those who have tested positive. Without that, the number of white people will be inaccurately overrepresented in infections and death statistics.
And while other states and municipalities are putting out figures showing that black residents infected with the virus are dying at alarmingly higher rates, on Monday, Texas had compiled demographic data for just 33 of the 140 coronavirus patients who had died. The races of three of those 33 individuals were unknown.
The need for an accurate public accounting is hardly academic. Data is crucial in helping public health professionals, medical experts and epidemiologists identify specific groups at risk — the elderly, for example — and tailor responses to those communities.
Without key demographic details on race and ethnicity, public health experts warn the state’s ability to contain the outbreak could be hampered among black and Hispanic Texans who already face disproportionate disadvantages confronting the threat of the virus.
“Before you get infected, it’s all about the virus, but once you get infected, it’s all about the person,” said Dr. Rojelio Mejia, an assistant professor at the Baylor College of Medicine.
While the virus may not discriminate in who it infects, the pandemic has served to underscore the health disparities black and Hispanic Texans face.
Public health experts previously flagged the state’s uniquely large uninsured population as a major complication in its work against the virus. The state overall has the highest rate of uninsured residents of any state at 18%. But for Hispanics, the rate is 27%. Among black Texans, it’s 15%, and white Texans 10%.
In some mostly Hispanic communities, nearly one in three people lack health insurance, and health experts have warned that uninsured Texans have likely gone without the care needed to address underlying medical conditions that put them at a higher risk if they are infected with coronavirus.
It’s well documented that black and Hispanic people have a higher prevalence of chronic conditions like hypertension and diabetes that could complicate their ability to survive COVID-19, the disease caused by the virus.
The disparities underpinning the state's medical profile make race-neutral data wholly insufficient in responding to a public health crisis, and the dearth of data tracking the impact on people of color in real time is an “ongoing issue” in public health, said Diana Cervantes, an assistant professor and director of the epidemiology program at the University of North Texas Health Science Center.
“When you have something like this — when you’re all of sudden inundated with a large number of cases — it kind of takes a back seat,” said Cervantes, who has previously worked in both local and state health departments. “Unfortunately, there is a delay.”
A few states have been regularly reporting demographic information, and others are beginning to release preliminary data, but race or ethnicity is missing for thousands of confirmed cases. Still, early figures out of multiple states and large cities indicate that black residents are being infected with the novel coronavirus and dying at disproportionately high rates.
In Texas, anecdotal or piecemeal data is forecasting similar outcomes. Houston's chief medical officer told the City Council on Wednesday that seven of the 11 people who died there from COVID-19 were black, according to the Houston Chronicle. The Dallas Morning News reported Tuesday that black and Hispanic residents in Dallas County were seeing the highest rates of infections, though data was missing for 35% of reported cases.
At a Wednesday coronavirus briefing, Gov. Greg Abbott indicated he would be open to requiring more detailed reporting of race and ethnicity if chief health officials in the state recommend it. But John Hellerstedt, the state health commissioner who has been advising Abbott in the coronavirus response, said the state was prioritizing higher-level data on positives cases to obtain an outline of the infection spread in the state.
"I think if we get this under control better, we will be able to expect that our folks in the field who are providing that reporting and filling in those fields are going to have enough time in the day to get it done," Hellerstedt said.
But limited testing of Texans in general — and of residents of color in particular — is also impeding the efforts of public health workers and epidemiologists to get a firm grasp on the virus' impact across different demographics and communities.
“Undoubtedly, there are a lot of infections we’re not capturing,” said Catherine Troisi, an epidemiologist with the University of Texas Health Science Center at Houston's School of Public Health. “Maybe more African Americans have died because there are more African Americans infected, so then you would work to stop infections, but maybe it’s not that. Maybe it’s because they’re uninsured or have higher blood pressure. … You just don’t know that without the data and the testing.”
Early data about the prevalence of a disease is also crucial to working to overcome the structural racism outside the realm of public health that puts black and Hispanic Texans more at risk of facing disproportionate harm in a health crisis, experts said.
Hispanic and black Texans are far more likely to live in poverty or have smaller incomes than white Texans. They may not be able to afford to stock up on groceries and so are forced to risk more exposure on repeated trips to the grocery store. They might not have paid sick leave, so they’ll continue to show up to work even if they’re sick. They may not have access to a car, so they still have to rely on public transportation.
“That’s why it’s important to have [prevalence data] because you want to find out what could potentially be the reasons for these disparities, but you’re also trying to tailor prevention control measures to that high-risk group,” Cervantes said.
It’s unclear when the state will catch up in its reporting. A spokeswoman for the Department of State Health Services said Texas was lagging in reporting race and ethnicity data because epidemiological investigations "take some time" to complete after lab test results are received.
A spokesman for the U.S. Centers for Disease Control and Prevention, which collects data from the state, said the agency is standing up “supplementary surveillance systems” to address the missing race and ethnicity information and other data gaps. Special studies and programs will improve visibility on this front, the spokesman said.
Flawed data is not unheard of in a health crisis when public health departments are straining to meet other demands in responding to an outbreak. But researchers will likely spend years trying to adjust for the bad data quality in their efforts to “try to answer the questions we are seeking answers to right now,” said Benjamin King, an epidemiologist and research scientist at Dell Medical School.
Without a concerted effort by the state to require more robust reporting, King fears it’s possible much of the demographic data for coronavirus cases may never be sufficiently collected even though the state has signaled a commitment to collect other data points like age groups.
“With all the dialogue around health disparities today — and for the past decades, really — it’s a shame to see that a stronger emphasis isn’t being made to ensure that data is being properly collected,” King said. “Unprecedented times no doubt, but these data issues have plenty of precedence — sadly.”
Disclosure: Baylor University, the University of North Texas Health Science Center and the University of Texas System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.