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Reports from New Mexico and California showed that the rate
of obesity in those hospitalized experiencing complications of 2009
H1N1 were higher than the percentage of the general population
that was obese.3 Given the continued prevalence of obesity, diabetes,
respiratory disease, and other chronic conditions among Black people
in the US, it could have been surmised that another pandemic viral
illness affecting the respiratory system would require more proactive
measures such as stronger social distancing and personal protective
equipment requirements in low wage employment, wider efforts
to connect people with higher quality medical care and testing,
increased access to affordable healthy food (which can allow for
improved immunity even without weight loss), and earlier, more
organized demographic reporting of those who tested positive for
COVID-19.1,7,2 As there is increased awareness of the racial and
ethnic disparities and improved demographic reporting, there is an
opportunity to still take proactive steps in effectively distributing
the COVID-19 vaccination to underrepresented minorities when
it becomes available.
In fall 2009, approximately 200,000 people received the H1N1
vaccine at public vaccination clinics in Los Angeles, but Black
people experienced the greatest disparity in vaccination rates.
Anecdotally, some communications via religious leaders, radio
personalities, and chain emails or texts within the Black Los Angeles
community about the safety of the vaccine ran counter to official
messaging, but it is not known to what extent this occurred or if
this had an effect on the vaccination rate.9 According to Plough et
al., some community partners cited individuals stating "Tuskegee",
referring to the Tuskegee Syphilis Experiment, as their reason for
refusal of the vaccine, but the frequency of this was not made
apparent.9 While the cause of low H1N1 vaccination rate among
the Black community in Los Angeles may not have been totally
elucidated, it reveals the many factors are involved in successfully
educating and distributing a vaccine during a pandemic. There
also could have been more efforts of health officials working with
Black leaders and Black communities to build trust and provide
education regarding the safety of vaccination and treatment of
2009 H1N1.9 Active efforts to foster trust between the Black
community and health institutions during the COVID-19
pandemic may help decrease the racial and ethnic disparities in
testing and treatment and could help prevent undervaccination
of underrepresented minorities once a COVID-19 vaccine is
available. Because underrepresented minorities are at the highest
risk of COVID-19, they could face even more amplified health
consequences if undervaccination occurs.
Following the 2009 H1N1 pandemic, there was a call for
pandemic preparedness measures to specifically address the risks
facing the Black community, but that preparation was not sustained,
and ten years later, we find ourselves facing another defensive
effort. Systemic problems are contributing to the health disparities
seen in underrepresented minorities, hindering these defensive
efforts at mitigation. As healthcare professionals, understanding
these biological, social, and economic effects, learning from past
public health efforts, and gathering accurate demographic data
are beginning steps in addressing these systemic problems.
1. Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus disease 2019 case
surveillance - united states, january 22-May 30, 2020. MMWR Morb Mortal
Wkly Rep. 2020;69(24):759-765. https://www.cdc.gov/mmwr/volumes/69/wr/
2. HHS announces new laboratory data reporting guidance for COVID-19 testing.
US Department of Health and Human Services Web site. https://www.hhs.gov/
about/news/2020/06/04/hhs-announces-new-laboratory-data-reporting-guidance-for-covid-19-testing.html. Updated 2020. Accessed June 18, 2020.
3. Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19
mortality. Obesity. 2020;28(6):1005. https://doi.org/10.1002/oby.22818. doi:
4. Dharmasena S, Bessler DA, Capps O. Food environment in the united states
as a complex economic system. Food Policy. 2016;61:163-175. http://www.
sciencedirect.com/science/article/pii/S0306919216300136. doi: https://doi.
5. Cunningham TJ, Croft JB, Liu Y, Lu H, Eke PI, Giles WH. Vital signs: Racial
disparities in age-specific mortality among blacks or african americans - united
states, 1999-2015. MMWR Morb Mortal Wkly Rep 2017. 2017;66:444-456.
6. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and
male sex are independently associated with worse in-hospital outcomes, and higher
in-hospital mortality, in a cohort of patients with COVID-19 in the bronx, new
york. Metabolism. 2020;108:154262. http://www.sciencedirect.com/science/article/
pii/S0026049520301268. Doi: 10.1016/j.metabol.2020.154262.
7. Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility
and long-term consequences. Brain, Behavior, and Immunity. 2020;87:5354. http://www.sciencedirect.com.ezaccess.libraries.psu.edu/science/article/pii/
S0889159120305377. doi: 10.1016/j.bbi.2020.04.040.
8. 2009 H1N1 and seasonal flu and african american communities: Questions
and answers. Centers for Disease Control and Prevention Web site. https://www.cdc.
gov/h1n1flu/african_americans_qa.htm. Updated 2010. Accessed June 18, 2020.
9. Plough A, Bristow B, Fielding J, Caldwell S, Khan S. Pandemics and health equity: Lessons learned from the H1N1 response in
los angeles county. Journal of Public Health Management and Practice. 2011;17(1). https://journals.lww.com/jphmp/Fulltext/2011/01000/
10. Zhao Y., Zhao Z., Wang Y., Zhou Y., Ma Y., Zuo W. Single-cell RNA e
xpression profiling of ACE2, the putative receptor of Wuhan 2019-nCov. BioRxiv.
2020 pre-print publication available on biorxiv.com.
11. Chen, Y.; Shan, K.; Qian, W. Asians Do Not Exhibit Elevated Expression or
Unique Genetic Polymorphisms for ACE2, the Cell-Entry Receptor of SARS-CoV-2.
Preprints 2020, 2020020258
12. Cai G. Bulk and single-cell transcriptomics identify tobacco-use disparity in
lung gene expression of ACE2, the receptor of 2019-nCov. MedRxiv. 2020
pre-print publication available on medrxiv.org.
13. Cohall D., Ojeh N., Ferrario C.M., Adams O.P., Nunez-Smith M. Is
hypertension in African-descent populations contributed to by an imbalance in the
activities of the ACE2/Ang-(1-7)/Mas and the ACE/Ang II/AT1 axes? J.
Renin-Angiotensin-Aldosterone Syst. 2020;21(1)1470320320908186.
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