As our nation mourns the loss of 1 million Americans to COVID-19, Charlotte Center for Legal Advocacy reflects on the tragic loss of our neighbors to the pandemic.   We mourn their deaths, we mourn for the families and friends that loved them, and we mourn for our community that continues to cope with this loss every day. 

While a monumental milestone, what is lost in the number is the disproportionate impact the pandemic has had across ages, races, income level, and healthcare access.   Older Americans account for 93% of deaths, including more than 200,000 deaths of residents and staff at long-term care facilities.  This figure, though tragic, is likely a gross undercount as it does not account for the nearly one million people living in assisted living facilities.  Some calculations indicate that roughly one third of COVID deaths were in facilities that house not only seniors with disabilities but also younger people (ages 31-64) living with disabilities.  The Nation Council on Disability noted, “For decades, federal and state healthcare data collection practices failed to capture baseline information about the functional disability status of patients and the public, leaving people with disabilities uncounted during and after public health emergencies.”  People with disabilities were often sidelined when resources in hospitals and personnel were scarce.  Furthermore, the existing shortage of care workers for people with disabilities prior to the pandemic was further exacerbated during the health emergency, leaving people with disabilities and their caregivers without sufficient support and at even greater risk of being institutionalized.

The disparity in rates of infection and death are further evident when race and income level are considered.  Hispanic, Black, and American Indian and Alaska Native people were about twice as likely to die from COVID as White people.  Hispanic and American Indian and Alaska Natives were at about one and a half times greater risk of contracting COVID than their White counterparts.  This variance is also tied to income inequality, as low-income workers were often employed in industries deemed “essential” and were left with no choice but to return to work despite the potential for increased exposure.  As a result, employees in several industries exempt from stay-at-home orders, including food services, agriculture, and manufacturing were twice as likely to die from COVID than others the same age. 

What lies at the heart of this disparity is years of systemic divestment that led to large gaps in healthcare resources and infrastructure for Black, Indigenous, and People of Color across all income levels.  This inequity existed long before the pandemic and was simply laid bare by the public health emergency.

Throughout the pandemic, we recognized that the families and individuals for whom we fought for fair access to health care and public services were also the families and individuals feeling the effects of the pandemic most intensely.  Life may have begun to return to normal for some in our community, but these vulnerable populations continue to be impacted by the effects of the pandemic.  When the public health emergency ends, tens of thousands North Carolinians without access to affordable healthcare will no longer be eligible for Medicaid in North Carolina, a state that has elected not to provide health insurance to all low-income adults.  (This Medicaid gap results in a population with income levels that make them ineligible for Medicaid yet too poor for premium subsidies through the federal Health Insurance Marketplace.  Without expansion, hundreds of thousands in our state will remain without access to affordable healthcare.)  Just as we mourn with our community for this tragic milestone, so too will we stand with our community to advocate for people living with the disabilities, People of Color, and low-income children and families that have been further marginalized by this public health crisis.