There are many uncertainties around the data related to coronavirus in the world. As we pointed out in an earlier blog, the state’s reporting originally had almost 30% of deaths listed as “race unknown”. This didn’t stop local and national news outlets from running with the information that 40% of people who died from coronavirus in Michigan were African American. While the apparent disparate impact on African Americans is unarguably large, highlighting any one datapoint at this time requires thoughtful consideration about the limitations of the data and what the context surrounding that datapoint represents.
Wayne County is undoubtedly facing a public health crisis as its rate of coronavirus cases is at 812 per 100,000, much higher than its northern neighbor, Macomb County (516 cases per 100,000). In Detroit, there are 1,238 cases per 100,000 residents. Per capita rates are one way to help contextualize data. However, since 22% of the state’s cases are still reported as unknown race, looking at the data more closely can help illuminate some of the issues currently in headlines. The City of Detroit is also publishing data broken out by race, which we can use to get a better understanding of the state’s data and how more context can help guide the conversations on race and coronavirus.
Race and Covid Cases
To gain a better understanding, we calculated estimates from the reported percentages. Statewide, 22% of cases have unknown race and 33% of cases are assigned to African Americans. In Detroit, those percentages are 27.5% unknown and 63.9% African American. Since we know the overall case rates, we can create estimates of the number of people that are in each category.
About a quarter of Michigan’s cases are in Detroit, despite Detroit being only 6.7% of the state’s population. When we look at African American cases specifically, Detroit accounts for 47.5% of the state’s cases compared to 38.2% of the state’s African American population.
Detroit also accounts for almost a third of the state’s unknown cases. The unknown cases make it difficult to make any solid conclusions about how this is impacting African Americans in Detroit, though, because 27.5% of the cases don’t have race assigned, which causes the case rate of African Americans in Detroit to be lower than their proportion of the population.
As better data becomes available, we will be able to make more meaningful comparisons between races in terms of having tested positive for coronavirus (more on testing later!).
Race and Covid Deaths
Examining the reported deaths can provide more clarity because missing data is less rampant. This makes some sense since the data for cases are collected in a clinical environment where patient health takes priority and deaths can be reported with a more methodical process. In both Michigan and Detroit, the percentage of deaths with race unknown is about half that of the case data (11% and 14%).
This more complete data points to even more disproportionate outcomes for African Americans in the state. Compared to their percentage Michigan’s population (13.6%), African Americans account for 40% of coronavirus deaths in the state.
Even if we assumed that all the unknown deaths are non-African Americans, the 40% reported wouldn’t change and remains extremely disproportionate. In Detroit, African Americans account for 78.5% of the total deaths (roughly the same as the proportion of the population that is African American), but with 14% of deaths remaining unassigned to a race, it is impossible to make claims on the impact of race on the outcomes of cases.
A Word on Coronavirus and Testing
One possible explanation for Detroit’s large case rate (25% of the state’s total versus 6.7% of the population) is the city’s organized response to the pandemic and early emphasis on testing availability. The state is reporting testing data by Emergency Preparedness Region, so we can get a limited understanding of testing across the state’s eight regions. Without positive tests, there can’t be cases to report. So a city or region having higher capacity for testing would cause them to have more cases because they’re being identified.
As of April 20th, the state of Michigan reports 124,495 tests conducted in the state. This number doesn’t represent the number of people tested, but the number of specimens tested. The state website no longer carries the testing definition, but a screenshot from April 4th explains the limitations of the reported data. Also of note, only one commercial lab is reporting tests as of April 4th (at least one other commercial lab is processing tests). The current testing data reported does not include this information.
Screenshot from michigan.gov/coronavirus on 3/27/2020
Detroit belongs to Region 2S, including Wayne County, Monroe County, and Washtenaw County. This region accounts for 31.5% of the state’s total tests (compared to 24.5% of cases in the region).
Of those 39,201 tests, a significant portion of those tests have been conducted at the Michigan State Fairground where the City of Detroit has been providing free testing since March 29th, 19 days after Michigan’s first case was reported. As of 4/23, 11,704 tests have been conducted with 86.2% having results reported. If we only consider tests with results, the fairgrounds account for 25.7% of Region 2S’s testing.
Additionally, Detroit is also providing testing for the police and fire departments, as well as free testing for homeless shelters. Adding in those tests means that the City of Detroit accounts for 31% of the region’s tests and almost 10% of the state’s tests.
Without accounting for any hospital testing, the City of Detroit has tested a large number of people. If the state provided more local data related to testing, we might have a clearer picture of how testing impacted the region’s coronavirus caseloads.
What’s the Takeaway?
While Detroit residents account for over half of the African American deaths in the state, it will be important to know where the other deaths are occurring. Are they in similarly disinvested communities? Are the non-Detroiters similarly at risk with preexisting conditions and low insurance coverage? Better data is imperative to understanding why African Americans in the state are contracting and dying from coronavirus at a significantly higher rate, especially since the current data shows that it’s not just a Detroit issue, but a state-wide one.
Unfortunately, the current ethnicity data being reported by the state is capturing less information than the racial data. Hispanic/Latino data is assigned to unknown 39% of the time for cases and 27% of the time for deaths. Arab ethnicity is unknown almost 75% of the time in both cases and deaths. Without better data collection, the true impact on racial and ethnic communities in Michigan is not going to be able to be quantified and understood with necessary detail.
As research continues, we’ll be able to understand how Detroit’s quick response to testing impacted the long-term effects of coronavirus. While the current data show that about half of identified African American cases are in Detroit, the large numbers of unknown cases highlights the need for patience as data continues to improve. Ensuring that this race and ethnicity data is well-reported is going to be imperative to understanding the impact of coronavirus on racial and ethnic communities. And having breakdowns to zipcode or even neighborhoods to understand the ways different local communities are impacted and highlight different challenges and opportunities as they respond to this global event. We’ll stay on top of the data as it comes and share more of what we’re seeing along the way.