by Dr. Donald R. van der Vaart
Former Secretary, North Carolina Department of Environmental Quality
As the country continues to focus on COVID-19, there seems to be more information that is revealed every day. Some of it is contradictory, and some of it is difficult to understand.
For example, early in the pandemic, we were told that older people, specifically those over 70 years old, were more in danger of succumbing to the disease than younger individuals. While this appears to be true, we have since learned that much younger patients are suffering as well. Similarly, statistical trends indicate that COVID-19 appears to impact certain racial and ethnic groups disproportionately. Death rates for black and Hispanic people are higher than those of whites and Asian Americans.
The difference was not ignored by the Cooper administration, which blamed the disparities on “structural racism” in the North Carolina health care system. A recent News & Observer article written by reporters from the Report for America/GroundTruth Project and The North Carolina Local News Lab Fund devoted considerable time to the issue.
In the article, the contributing reporters quote secretary of the N.C. Department of Health and Human Services Dr. Mandy Cohen, who contends that poor policy decisions, such as failing to expand Medicaid, have contributed to the problem. Secretary Cohen has been a staunch supporter of Medicaid expansion and the Affordable Care Act (Obamacare) since her days working for the Obama administration. To date, 37 states and the District of Columbia have expanded Medicaid to acquire additional federal funds to cover a greater share of their state’s adult population. The Republican majorities in the N.C. General Assembly have not expanded Medicaid.
Yet, Medicaid expansion is certainly not the silver bullet. States including New York, Michigan, and Maine expanded Medicaid years ago and still report significant racial disparities in COVID-19 deaths.
The general malaise of racial disparities in health care outcomes has been the subject of considerable research. There are a number of reasons cited for the disparities, many of which are socioeconomic in nature. This leads some to describe these factors generally as “social determinants of health.” On COVID-19, the News & Observer article quotes political activist and co-chair of the Poor People’s Campaign Rev. William Barber:
“It’s not the germ, it’s not the virus and it’s not merely race. Because to say it’s just race is to say that people’s biology has a certain predisposition to the disease,” Barber said.
Instead, he said, it’s “the existing disparities prior to the pandemic that are further exposed and exploited by the germ once the pandemic hits.”
But some medical doctors and researchers disagree with Rev. Barber’s assessment. There appears to be a strong relationship between people’s biology, specifically vitamin D production, and COVID-19 outcomes.
After studying global data from the novel coronavirus (COVID-19) pandemic, researchers have discovered a strong correlation between severe vitamin D deficiency and mortality rates.
Led by Northwestern University, the research team conducted a statistical analysis of data from hospitals and clinics across China, France, Germany, Italy, Iran, South Korea, Spain, Switzerland, the United Kingdom (U.K.) and the United States.
The researchers noted that patients from countries with high COVID-19 mortality rates, such as Italy, Spain and the U.K., had lower levels of vitamin D compared to patients in countries that were not as severely affected.
They argue that vitamin D production by the body is critical in fighting many diseases, and COVID-19 is one. This, combined with the medical fact that browner skin impedes vitamin D production, may explain at least part of the racial disparity that Secretary Cohen attributes to the “structural racism” of our health care system. At a minimum, the physiological components of these disparities deserve the attention of researchers and the acknowledgment of policymakers and public health officials.
The importance of vitamin D cannot be overstated. Studies have found that vitamin D supplements may avoid adverse pregnancy outcomes for women with darker skin. Another study concluded that vitamin D supplements even reduced cancer in black people. “This lack of vitamin D could completely fill in the health disparity gap for cancer survival between white and black Americans,” the researchers wrote.
There is no question that quality health care provides the foundation for better health outcomes. In our fight against the Wuhan coronavirus, we should use all of the possible weapons at our disposal. Vitamin D deficiency is easily corrected. If Secretary Cohen is genuinely interested in value-based health care, perhaps she should push for vitamin D supplements for those North Carolinians with vitamin D deficiencies.
This has been updated from the original version