By Kathreen Harrison
On May 13, the Maine Center for Disease Control (CDC) released data that indicates the COVID-19 infection rate for Black or African American residents of Maine has surged from 7.67% to 11.82% of the total infected cases in the one-week period since May 6.
In other words, mirroring the national trend, COVID-19 has slammed the African American and Black population in Maine particularly hard, possibly upwards of 7 times as hard as the White population – although the data are not definitive, since over 300 infected people in Maine chose not to disclose their race or ethnicity to CDC epidemiologists. The percentage of positive cases of COVID-19 among Whites during the same one-week period appears to have dipped, from 90.69% to 82.77%. According to population estimates by the U.S. Census Bureau in 2019, 1.6% of Maine’s population is African American or Black.
A significant disparity in infection rates along racial lines is not a surprise to epidemiologists and public health specialists. According to the national CDC website, “History shows that severe illness and death rates tend to be higher for racial and ethnic minority groups during public health emergencies.” The site blames economic and social conditions such as work circumstances, underlying health conditions, varying access to health care, and living conditions for the disparity.
As soon as the COVID-19 crisis hit Maine in mid-March, leaders of Maine’s immigrant communities and their allies predicted that the virus was going to impact communities of color particularly hard, and formed a number of virtual working groups that have been meeting regularly for the past two months to help their communities. Some groups are topic-specific, focusing on health for example, or education; others are region-specific; many include members from across the state.
On March 13, a working group that included 80 representatives from a wide array of organizations targeting the health needs of immigrant communities during the crisis – including Mufalo Chitam, executive director of Maine Immigrants’ Rights Coalition, which represents over 70 partner and member groups – met with Dr. Nirav Shah, Director of the Maine Center for Disease Control (CDC), at their request. Communication with the CDC – as well as other governmental departments such as the Department of Health and Human Services, the Department of Economic Development, and the Department of Labor – has continued since that time. Increased testing and expanded contact tracing have been two frequently-cited needs by advocates for the communities.
Lisa Tapert, CEO, Maine Mobile Health Program, in an email exchange on May 14, emphasized the significance of barriers that prevent vulnerable community members from accessing health providers. She said she would like to see testing stations set up in immigrant communities and highlighted the importance of working with leaders of those communities to ensure greatest impact. “I would like to see the CDC work with organizations such as Mano en Mano, Maine Access Immigrant Network, New Mainers Public Health Initiative, and others to figure out where those tests are needed. It’s only a matter of time before we have additional outbreaks if testing is not available.”
Abdulkerim Said, founder and executive director of New Mainers Public Health Initiative, based in Lewiston, the state’s second-largest city, reached by telephone on May 14, said cases are on the rise in Lewiston, with signs of community transmission now identified. He said that contact tracing, one of the primary tools for controlling spread of the virus, is not working for the immigrant community as currently configured. He explained that to be effective, contact tracing needs to be done from within the community, by people who are already trusted by members of the community.
On May 14, the City of Lewiston convened a meeting with Said, Fatuma Hussein, executive director of Immigrant Resource Center of Maine, and Doctor Rashid, of NMHI, to discuss the rising rate of positive cases in Lewiston, and request help from the immigrant community in addressing the spread of the virus. A second meeting, to include Auburn, is planned for next week. The CDC website lists 109 cumulative positive cases in Androscoggin County, and according to Said, local hospitals in the Lewiston/Auburn area have reported more than 40 new positive cases in the past four days. Said said that community members are concerned about the economic reopening underway in Maine. “While Maine is opening, New Mainers are stressed and worried about who is going to be the next victim,” he said.
Living conditions are cited by the national CDC as factors that commonly lead to a disproportionately heavy impact of sickness on minority groups during public health outbreaks. The New Mainer working groups have identified living conditions in the communities they represent as a key concern. Because many immigrants work at low-wage jobs, and rent is expensive in Maine, housing is often shared, which makes residents vulnerable during this highly contagious pandemic. Said says that in his community many people live in one apartment, and share the same bathroom. He wonders how community members testing positive for the virus can isolate from other members of their households.
Crystal Cron, president of Presente Maine, an advocacy group for the Latinx community in Maine, notes that, “Many community members live four to five families in an apartment, with each family sharing a bedroom, and that makes it almost impossible to social distance. If you get sick and need to isolate from your family, where do you go?” Cron and Said and others representing the immigrant community would like to see the CDC expand its definition of congregate settings to include crowded residential apartment buildings, which they see as potential hotspots for transmission because of the near-impossibility of isolating individuals when they test positive. Dr. Shah has repeatedly said at press briefings that household transmission of COVID-19 is a big player in the spread of the virus in Maine.
At the March 13 meeting with Dr. Shah, advocates began urging that reporting of race and ethnicity be made mandatory when epidemiologists make contact with individuals testing positive for the virus. To date, however, only reporting of age and gender is required, which is why 331 cases are listed as ‘not disclosed’ in the race and ethnicity category on the CDC website. Alison Beyea, executive director of the ACLU of Maine, has stated, “In many Maine communities, disclosing identifiable health information is as good as slapping a target on someone’s back. Given the dangers faced by vulnerable communities, especially communities of color, the government has a special obligation to protect individual privacy from such disclosure.”
Dr. Shah has expressed many times in press briefings his concern that the release of data relating to race and ethnicity carries risks of targeting against members of those communities. The Maine ACLU shares those concerns, as do members of the working groups. At the moment the data relating to race and ethnicity is released at the state level only, and none of the working group members are advocating for a change to reporting at the county level. At the same time, all agree the release of data about race and ethnicity have been important in drawing attention to the vulnerability of communities of color to the virus in Maine, and therefore to the need to pay special attention to these communities in relation to health care. The ACLU urges making the disclosure of information about race and ethnicity mandatory, with Rachel Healy, Director of Communications and Public Education of the Maine ACLU stating, “We believe collecting and examining demographic data related to this pandemic is a critical step toward fixing the problem. Knowing which communities are most vulnerable to COVID-19 – or to any other crisis – can help us ensure a response that is equitable.”