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COVID-19 and the US response: accelerating health inequities
  1. Nneoma E Okonkwo1,
  2. Ugochi T Aguwa1,
  3. Minyoung Jang1,
  4. Iman A Barré2,
  5. Kathleen R Page3,
  6. Patrick S Sullivan4,
  7. Chris Beyrer5,
  8. Stefan Baral5
  1. 1School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2School of Medicine, Meharry Medical College, Nashville, Tennessee, USA
  3. 3Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
  5. 5Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Nneoma E Okonkwo, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; nneoma{at}


Health inequities have long defined health and the healthcare system in the USA. The clinical and research capacity across the USA is unparalleled, yet compared to other high and even some middle-income countries, the average health indicators of the population remain suboptimal in 2020, a finding at least in part explained by inequity in healthcare access. In this context, COVID-19 has rapidly emerged as a major threat to the public’s health. While it was initially thought that severe acute respiratory syndrome coronavirus 2 would be the great equaliser as it would not discriminate, it is clear that COVID-19 incidence and mortality have rapidly reinforced health disparities drawn by historical and contemporary inequities. Here, we synthesise the data highlighting specific risks among particular marginalised and under-resourced communities including those in jails, prisons and detention centers, immigrants and the undocumented, people with disabilities and people experiencing homelessness across the USA. The drivers of these disparities are pervasive structural risks including limited access to preventive services, inability to comply with physical distancing recommendations, underlying health disparities and intersecting stigmas particularly affecting racial and ethnic minorities across the country, including African Americans, Latinx Americans and Native Americans. Advancing the COVID-19 response, saving lives and restarting the economy necessitate rapidly addressing these inequities rather than ignoring and even reinforcing them.

  • delivery of healthcare
  • public health
  • infectious disease medicine
  • socioeconomic factors
  • healthcare quality, access, and evaluation

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  • Contributors All authors contributed to the conception of the work or acquisition and interpretation of the data, drafting the piece or revising it critically, and the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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