COVID-19 and Health System Segregation in the US

Foreword
Chapter 1: Introduction: Challenges Facing People of Color in the Healthcare SystemCOVID-19 continues to wreak havoc in the United States for many Americans, but especially bringing disproportionate untold damage to people of color. This situation is not surprising because the U.S. health system operates on the doctrine of 'separate but equal', whereby the dominant group has access to quality health care and the people of color have access to a lesser quality or zero health care. The health system is segregated, whereby there is, by law, the de jure health system for all, but it is the de facto health system in effect that creates a segregated health system, one for the dominant group and one for the people of color. And 'separation' implies and enforces inferiority in health care.
Chapter 2: Systemic Racism in Public Health in the United States -- A Systematic Review of the LiteratureThis Chapter carries the findings of the systematic review of the literature on systemic racism in public health in the United States. Systemic racism, conceptually, is White-generated discrimination and other forms of oppression against people of color, that generally spreads throughout the society. The racism is systemic, as it represents racist ideas and practices that become embedded in institutions and networks, and which shape race relations in a White-dominated racial hierarchy. Public health is one of many institutions that racism has subverted. And so, racism drives the social determinants of health (housing, education, employment, etc.), and becomes a barrier to health equity. For instance, profound racial bias in health care has also fast-tracked inequitable health outcomes for people of color; the Institute of Medicine (now the National Academy of Medicine) in 2002 in its study of over 100 clinical studies found that racial minorities are less probable than whites to obtain required services, including clinically essential procedures. Health disparities, discrimination, and residential segregation are by-products of racism, which are usually discussed without showing their links to racism. And so, subverting the impact of racism enables the inequities to persist. The disproportionate impact of COVID-19 on people of color is directly related to systemic racism.

Chapter 3: Epidemiology of COVID-19This chapter presents the findings of several systematic reviews and meta-analyses on COVID-19 from scholarly journals over the period December 2019 through TBD 2020.
- Origin and disease progression- Restrictive measures- Risk factors for infectious and severe outcomes- Therapeutics as interventions

Chapter 4: Disproportionate Burden on Cases, Hospitalizations, and Mortality Among People of ColorThis Chapter presents the data and information on the disproportionate devastation of COVID-19 on people of color in the United States. COVID-19 numbers for laboratory-confirmed cases, hospitalizations, and deaths are still growing, and so the data is still preliminary. For instance, for 131 mainly black counties in the United States, the infection rate is 137.5/100 000 and the death rate is 6.3/100 000. This contagion rate is more than 3-fold higher than that in primarily white counties. Moreover, this death rate for largely black counties is 6-fold higher than in principally white counties. People of color are contracting COVID-19 infection more regularly and dying disproportionately. CDC statistics on COVID-19 cases as of April 19, 2020, suggested that about 34% of African Americans were confirmed cases, equally distributed by about a third in each of these age groups: 18-44, 45-64, and 65-74 years; and almost a third were aged under 18 years. About 23% of Hispanics/Latinos were confirmed