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Who Dies The Most During The Coronavirus Pandemic?

MARY LOUISE KELLY, HOST:

Just three months ago, towards the end of February, safe to say most of America was not that concerned about the coronavirus. Today, deaths in the U.S. from COVID-19 are fast closing in on 100,000, which leads us to the question - who in America is dying in this pandemic? Increasingly, we're learning that the hardest-hit communities are also the poorest, the most crowded. They are communities of color, where rates of chronic disease run high.

JARVIS CHEN: Well, it is unfortunately not that surprising.

KELLY: That is Jarvis Chen, a social epidemiologist at Harvard. He and his colleagues have been combing through data, looking closely at confirmed cases and what are called excess deaths. Those are deaths beyond what is expected in a normal year. In Massachusetts, they found excess deaths have surged in the very communities that are already struggling.

CHEN: These are communities in which people may be working, quote-unquote, essential jobs, where they're unable to practice physical distancing. These are communities where people are living in crowded conditions, so that if one person in a household gets infected, it's very difficult for them to isolate and protect the other people in their households.

We know there have been widespread shortages of personal protective equipment, and so essential workers don't have access to them. These are also communities in which people may not be getting access to testing or to care, and so that increases their risk of dying if they do get infected. So it really is compounding of inequality on top of inequality.

KELLY: Just to put this in human terms, I was struck by a line in The Boston Globe, which I know your Harvard team worked with in terms of trying to comb through and make sense of this data. And they write that in Lawrence, Mass., where there's a high Latino population, a funeral home saw its workload double last month. Or that in Medford, which is a city with pockets of diversity and poverty, that burial permits doubled. You're looking at the data that is behind that.

CHEN: Yes. We're trying to look at the data, but there's also a human perspective. So that when I look at the data and I see the number of excess deaths creeping up, you know, 100, 200, 300, over the course of April - that's per week - each of those has implications for people's families, their communities, their social networks. So it's important to remember that excess deaths is reflecting real loss of human life.

KELLY: Was there anything you spotted in the data that surprised you?

CHEN: So one of the things that we've been working with recently is trying to get a handle on when the surge in excess mortality actually started. It's very clear for April that there are very large increases in excess mortality, but we're seeing some hints in the data that that surge in mortality might have started earlier in the less disadvantaged areas.

So what we think is happening in those more affluent areas is those reflect the introduction of coronavirus into communities by more affluent people who were traveling in the early part of 2020, and then what happened is that it spread to other communities, and that's where we see the real surge, sort of like when you light a match and throw it into a bunch of tinder, that it really takes off.

But the earlier phase does seem to be consistent with the idea that it's being introduced by people who have the economic means to travel, before it really takes off in the communities that are more disadvantaged.

KELLY: Why is it important to know now who is dying?

CHEN: So it's important that we try to find this out as quickly as possible in real time because we're probably going to see more waves as we go through this next year. And so knowing what we did and what we did wrong the first time around will help us understand better how to direct the resources.

So for example, creating resources for people and communities to be able to isolate - so housing or temporary housing for people who test positive so that they can protect their families is really important; knowing where to direct PPE as it becomes more available so that not just the essential workers in hospitals but also essential workers in things like public transportation or grocery store workers, those populations can get the PPE that they need; and also, directing testing to communities who need it the most. Those things could be really important.

KELLY: That is Jarvis Chen. He's a social epidemiologist at the Harvard T.H. Chan School of Public Health. Thanks so much.

CHEN: Thank you. Transcript provided by NPR, Copyright NPR.