The University of Arkansas for Medical Sciences’ Fay Boozman College of Public Health is opening a two-year study that could help determine why minorities in Arkansas have suffered more than whites from COVID-19.
In Arkansas, while Blacks make up 15.4 percent of the population, they make up 20.6 percent of coronavirus cases and 19.5 percent of deaths, according to the Arkansas Department of Health. Hispanics, which make up 6.4 percent of the population, make up 17 percent of the cases (though only 5.7 percent of the deaths).
Why the disparity in outcomes? Dr. Wendy Nembhard, chair of the department of epidemiology at the college, asked around, talking to African-American and Hispanic communities in Arkansas and around the country. The answer she kept getting: Historic racism and attendant poverty, which means poorer health care for people of color.
“I kept saying, ‘Is it really?’ Not that there isn’t evidence that historic racism hasn’t happened and it hasn’t created health inequities,” Nembhard said. But she was still curious about whether anything else was going on, “and I didn’t find anyone else asking those questions.”
Hers were questions the National Institutes of Health was interested in as well, which has granted Nembhard and colleagues $1.3 million to follow an ethnically, racially and geographically diverse sample of 600 adults for two years. UAMS will begin recruiting toward the end of November, capturing participants as close to their positive PCR test dates as possible. Once enrolled, their blood will be tested regularly by researchers Karl Boehme, Josh Kennedy and Craig Forrest, who this summer developed a sophisticated antibody assay, to track disease progression.
Nembhard is predicting the research will find that Blacks and Hispanics will have a weaker immune response to the virus, which can worsen outcomes. Science has shown that differences in sex, race and geography will produce subtle differences in immune system response to viruses and to vaccines for such diseases as rubella, smallpox and influenza. Those differences must be taken into account when developers roll out a vaccine into a population group; the differences may indicate different schedules of administration and dosing. “The world of vaccines is more complicated than people think,” Nembhard said.
Because earlier arising coronaviruses — SARS-CoV-1 and MERS (Middle East Respiratory Syndrome) — infected only a tiny number of people in North America, there is no data on immune response and infection process among American Blacks and Hispanics from which to extrapolate their SARS-CoV-2 response.
Equal numbers of whites, Blacks and Hispanics will be enrolled; the white, non-Hispanic cohort will serve as the comparison group. Researchers will average antibody variations within each of the three groups to create a norm. The data will measure both short-term and long-term responses to the disease, with initial data available by late summer. Nembhard said the results should be useful to doctors in the treatment of COVID-19 and in predicting response to future novel coronaviruses.
The study will also collect information on education, income, perceptions of racism and other social variables. “We want to look at that and say, ‘What is the contribution of social determinants to the differences versus the differences in immune response?’ If we don’t see any difference in immune response, then we’ll also be able to look at the data and say, ‘here’s what we saw in terms of social determinants …,'” Nembhard said. “It could be that it’s both, that there is a certain percentage of cases explained by differences in immune response and a percentage of cases explained by racism and poverty and lack of access to care.”
Participants will be recruited by the Arkansas Department of Health. Other researchers taking part in the study include Ben Amick, professor and associate dean for research; Dr. Kate Stewart, professor; and Ruofei Du, assistant professor.