Introduction: COVID-19 and Health Equity

Animated map of confirmed COVID-19 cases spreading from January to March 2020 Source: https://commons.wikimedia.org/wiki/File:COVID-19-outbreak-timeline.webm

This volume examines the ongoing COVID-19 pandemic with a focus on health equity.

Prepared by selected health faculty from across City University of New York (CUNY) campuses and sponsored by the office of the CUNY Dean for Health & Human Services, this open-educational resource (OER) includes the following sections:

1. A history of pandemics

2. The virology of COVID-19

3. The epidemiology of COVID-19

4. Social determinant of health and COVID-19

5. Health care workers and responses to COVID-19

6. Ongoing challenges

According to the Centers for Disease Control and Prevention (CDC), the present pandemic was first identified in December 2019, when a cluster of patients in Wuhan, China reported shortness of breath and fever. By early January 2020, Chinese authorities identified and isolated a new coronavirus as the cause. Not long after, the CDC published information about the novel virus on its website. Later in the month, the World Health Organization (WHO) stated that the novel coronavirus could be transmitted from human to human.  By the end of January 2020, the WHO International Health Regulation Committee stated that the novel coronavirus was a “public health emergency of international concern.” On the same day, the US Department of Health and Human Services similarly announced that the SARS-CoV-2 virus was a public health emergency. Through January 2020, diagnostic tests to identify the new virus were being developed. By mid-February the WHO officially named the novel coronavirus COVID-19. On March 11, 2020, the WHO officially announced that COVID-19 was a pandemic. And, a few days later US states began to shut down, including public schools in New York City.  By March 17, human vaccine trials began. And, in mid-December 2020, a nurse in New York received the first dose of the COVID-19 vaccine (outside of a clinical trial). Although many other milestones occurred (for further information see https://www.cdc.gov/museum/timeline/covid19.html), this abbreviated timeline documents the beginning of the pandemic and highlights the extraordinary speed with which the disease spread and the efforts (many unsuccessful) by US government agencies, pharmaceutical companies, and others attempted to prevent the spread. It provides a backdrop for understanding the chaos that ensued early in the pandemic. Health care workers cared for many very sick COVID patients without adequate personal protective equipment and patients died alone in hospitals. During this time, the US was led by a president who spouted bizarre transmission routes and bogus cures and did little to provide the country with the guidance it sorely needed. Misinformation and disinformation ran rampant across social media resulting in uncertainty and fear across the country.

For many, this chaos and confusion continue still today. The already existing health inequities in the US were further exacerbated by the spread of the disease and the limited access to a variety of resources, including vaccinations and treatment. While public health professionals, many health care practitioners, and individuals in marginalized communities (especially people of color, the poor, the elderly, and incarcerated individuals) already knew about the horrific inequities in health and the health care system, the pandemic hit these marginalized communities especially hard. This volume examines selected topics at the interface of the pandemic and health inequities. It was prepared in the Spring and Summer 2022 and is shaped by the knowledge currently available and the historical, political, economic context of this time.

As of July 2022, there have been more than 93 million cases and more than one million deaths from COVID-19 in the United States. As home-testing for the virus has developed, it is difficult to determine the actual number of cases. It is also impossible to assess the magnitude of long COVID-19. With the US facing the monkeypox epidemic now, it will be useful to reflect over the last few years and determine what we have learned from the tragedy of COVID-19.  It is hoped that this volume will contribute, at least in small part, to that knowledge.