Editor’s note: This story was produced by North Carolina Health News.

Mecklenburg County District Court Judge Donnie Hoover and his wife, Josephine, have shared almost everything since the couple met in high school more than 50 years ago. Unfortunately, the lifelong sweethearts now also share a COVID-19 diagnosis.

When Josephine was hospitalized on March 16, Judge Hoover immediately went into self-quarantine while awaiting the results of his test. On March 27, Hoover learned that he, too, had contracted the virus.

The Hoovers represent real-life modeling of who is being affected and how. With each new release of data, the disturbing trend becomes clearer: African Americans are disproportionately contracting COVID-19.

Blacks make up 32.9 percent of Mecklenburg County’s population but, as of April 4 were 43.7 percent of the 650 confirmed cases for which racial demographics were available. The numbers are even worse statewide. As of April 8, blacks accounted for 912 or 38 percent of the COVID-19 cases in which race is known, as well as 35 percent of fatalities, despite comprising only 22 percent of the state’s population.

“Certainly, African Americans are disproportionately impacted, and I’d like to understand some of the whys behind that,” Mecklenburg County Commissioner Mark Jerrell said in an interview. “I’m very concerned about that—it’s alarming, and it’s something we have to get under control immediately.”

North Carolina is one of the few states to release coronavirus data by race. In a joint letter to Health and Human Services Secretary Alex Azar, Massachusetts Senator Elizabeth Warren and Representative Ayanna Pressley argued that more states must follow suit. Warren and Pressley said comprehensive demographic data on people who are tested or treated for COVID-19 is necessary to monitor and address disparities in the response to the outbreak.

Across the country, cities with large black and nonwhite Hispanic populations are emerging as new hot spots for the spread of the virus.

The why is not a secret, notes Dr. Uché Blackstock, founder and CEO of Advancing Health Equity.

Blackstock, a former emergency room doctor and professor of emergency medicine at NYU, says when New York City became the epicenter for this pandemic, she knew what lay ahead for communities rife with the underlying factors that increase the likelihood of serious complications such as diabetes, high blood pressure, obesity, asthma, or worse.

“Our communities were already more vulnerable,” Blackstock said. “I immediately thought about how black communities will be affected because of how the virus works. There’s also the effects and manifestations of structural racism.”

According to Blackstock, thinking about the implications of race and racism has so far been a low priority during this crisis.

“The data being collected is mostly around age,” she said. “It is so important to also think proactively about how we can use a lens of racial equity even when we’re developing testing criteria.”

The initial screening guidelines favored more affluent whites over people of color.

Getting a test required exhibiting symptoms, having traveled to China, Iran, South Korea, or Italy within 14 days, or having had contact with someone with a confirmed case of COVID-19.

“There was a delay in figuring that out,” Blackstock said. “Meanwhile, coronavirus was circulating in our communities.”

Social determinants of health are also playing a huge role in Charlotte and around the state where many African Americans hold hourly low-wage jobs. The fear of lost wages or loss of employment may lead low-income African Americans to work when they are ill and further contribute to the spread of the disease within their communities.

Well-documented health disparities indicate that African American COVID-19 patients will have worse outcomes because more are uninsured and tend to rely on hospital emergency rooms for primary care.

In Milwaukee County, Wisconsin, the first eight people to die of complications from COVID-19 were African American. The state of Louisiana released data on Monday showing that, while African Americans account for 32 percent of the population, they account for 70 percent of COVID-19 deaths to date. In Chicago, more than half of all infections and 70 percent of deaths are African American.

In a review of 27,000 patient billing records generated in February and March, health care consulting firm Rubix found that “African Americans and Hispanics with household incomes of less than $50,000 per year may be at higher risk for COVID-19, or related symptoms. If COVID-19 disproportionately affects underrepresented minorities, particularly those with lower socioeconomic status, this could potentially contribute to increased COVID-19 transmission and economic damage in already vulnerable communities.”

North Carolina, as well as much of the South and Appalachia, is part of the Stroke Belt and the newly defined Diabetes Belt. Both diseases put people at more risk when they contract COVID-19. According to recent data published by the Centers for Disease Control and Prevention, people with diabetes and cardiovascular diseases who caught COVID-19 were more likely to be admitted to the hospital and, once there, were more likely to end up in an intensive care unit.

The health disparities, social determinants, and structural racism are destined to collide, potentially making outcomes for African Americans worse.

“Based on what we know from copious research studies, there is bias in terms of how health care providers determine care,” Blackstock said. “Patients are going to require ventilators. There are a limited number, so you’re asking clinicians to make decisions about who gets ventilators and who doesn’t.”

Fortunately for the Hoovers, that didn’t become an issue. On March 30, Judge Hoover received the good news that Josephine was being discharged. He rushed to pick her up at Presbyterian Novant Hospital.

“She looked wonderful, but it was sort of bittersweet,” Hoover said. “We couldn’t touch. We couldn’t hug.”

The couple must be extra vigilant at home for two weeks, using separate bedrooms and bathrooms and keeping a safe, six-foot distance.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.

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