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Poor US counties with crowded housing are 38-times more likely to become COVID-19 'hotspots'


Coronavirus has spread far more rapidly in poorer areas of the US, which had 25 percent more cases relative to their populations by the time they were identified as  ‘hotspots,’ a new report reveals. 

Scientists at the Centers for Disease Control and Prevention (CDC) found that counties in low income brackets where many people lived in crowded housing had 212 coronavirus cases per 100,000 people in their populations when they were dubbed ‘hotspots.’ 

And cases continued to rise in these areas over the two weeks after they were named hotspots, although less steeply, compared to other hotspot counties. 

Poor and minority Americans make up an outsized share of coronavirus cases and deaths in the US. 

The new study underscores the need to detect outbreaks earlier, especially in poor parts of the country – but it is still taking labs in many states too long to get results back to patients to allow contact tracing to slow the spread. 

It comes as US health officials  warn that 75 percent of US states are seeing a ‘distressing’ upward trend in coronavirus cases.  

Between May and July, highly 'vulnerable' US counties (blue)  -  with large poor, minority, and  non-English speaking populations  living in crowded housing - were 38 times more likely to become coronavirus hotspots and already had 121 cases per 100,000  people  when identified

Between May and July, highly ‘vulnerable’ US counties (blue)  –  with large poor, minority, and  non-English speaking populations  living in crowded housing – were 38 times more likely to become coronavirus hotspots and already had 121 cases per 100,000  people  when identified 

‘Hotspots’ – areas of the country where coronavirus is spreading at an alarming rate – have shifted over the pandemic. 

In the first several months of the pandemic, travel hubs and cities on the coasts – including Seattle, Los Angeles, Chicago and New York City – quickly became the nation’s first and worst hotspots. 

After lockdowns and measures some called ‘draconian,’ these regions got their outbreaks under control by late spring, but new hotspots were already emerging across the nation. 

Between June 1 and July 25, a quarter of all counties in the US were named hotspots. 

Over that period, the characteristics of a hotspot shifted. More and more urban areas were inundated with coronavirus cases. 

In March and April, just 11 percent of hotspots were metropolitan areas. By June and July, 40 percent of hotspots were urban.

And the proportion of hotspots that ranked high on the CDC’s ‘social vulnerability index’ surged from 22 percent to 42 percent over the same period of time. 

CDC considers a county socially vulnerable if it has a higher proportion of residents who are low-income, has a low proportion of English-speakers, high proportion of minority residents, lots of crowded housing and relies on public transportation or has poor transportation. 

Although their outbreaks did not grow much more quickly, poor counties (solid blue) already had 25% more COVID-19 cases when they were identified as hotspots, compared to wealthier counties (dashed lines)

Although their outbreaks did not grow much more quickly, poor counties (solid blue) already had 25% more COVID-19 cases when they were identified as hotspots, compared to wealthier counties (dashed lines) 

A county that scored highly on the social vulnerability scale was nearly 38-times more at-risk of becoming a hotspot during the study period compared to counties with smaller vulnerable populations. 

The reasons are many, but well-documented. 

Poor and minority Americans are more likely to have jobs that require them to leave home and yet have poorer access to health care. 

Most transmissions of coronavirus happen within the home making crowded, multi-generational housing hotbeds for viral spread. 

And most public health messaging in the US is communicated in English, making it less likely to reach speakers of other languages and alert them about how to protect themselves against threats like COVID-19. 

On average, there were 97 coronavirus cases for every 100,000 people living in a county when it was identified as a hotspot, compared to the average case rate of 27 per 100,000 people for non-hotspot areas. 

But in poor, underserved counties, there were already 121 case  per 100,000 people by the time they were flagged as hotspots and, within two weeks, that number surged to 234 cases per 100,000 people.  

‘These circumstances could put racial and ethnic minority residents at risk for COVID-19 through close contact with others. Incorporating the needs of populations that are socially vulnerable into community mitigation plans is essential for limiting COVID-19 transmission,’ the CDC authors wrote. 

‘Specifically, implementing recommended prevention efforts at facilities requiring in-person work (e.g., meat processing facilities and grocery stores), including temperature or symptom screening, mask mandates, social distancing practices, and paid sick leave policies encouraging ill workers to remain home, might reduce transmission risk among populations that are vulnerable at workplaces. 

‘In addition, plain-language and culturally sensitive and relevant public health messaging should be tailored based on community needs, communicated by local leaders, and translated into other languages in areas with many nonnative English speakers.’ 

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