More Maps, Graphs, and Charts.

I will use this space to post weekly updates to explain our local data and how it relates to the rest of the state.

On first glance, it looks like San Antonio and Bexar County have a disproportionate number of people under 40 infected. But wait, I thought only older people got sick?

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Yes, and no. Everyone is potentially at risk. Everyone of any age can get infected. Case counts reflect those we test, and we test based on symptoms and job-risk. If you’re a health care worker or first responder, you’re more likely to get tested. And most health care workers and first responders are going to skew younger, at least younger than 65.

But it also reflects the percentage of the population that are younger. Now, these data are a bit altered because our census age groupings are different than how the COVID data are reported. This is a best estimate of how those cases fall.

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Source: COSA/Bexar Dashboard

The blue bar indicates the percentage of our population that falls into the age groupings beneath it. The orange bars are the percentage of cases for each age group, modified to best align to the census age groupings. The grey bars indicate the percentage of people who have died in each of those age groups.

Our largest population in the city (36%) falls into the 35–64 age group. So it’s not surprising that we have a higher proportion of people in that age group infected. There are just more people.

Now, that doesn’t really hold for the younger age groups (0–17 and 18–34), primarily because we know that age group is less likely to get sick if infected, so isn’t likely to go for testing. We may have higher numbers in that population as well, but we’d only know if we started screening asymptomatic people.

The next age group looks like it has fewer cases, but it’s only a 10 year window vs 30 years. The number of people infected over 65 is consistent with what we have expected based on the epidemiology of COVID-19 to date.

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Unfortunately, this population is also more likely to require hospitalization, ICU care, or die.

NONE of that is to say that if we’re young, we’re not at risk. We are ALL at risk. Someone of any age can die from COVID-19. Those with underlying health conditions, and with age often comes underlying health conditions, are at higher risk.

We have started to collect information on race/ethnicity which has been telling. Nationwide, we are already seeing a disproportionate number of African Americans adversely impacted by COVID-19.

In Bexar County, we don’t have data on hospitalizations or ICU care by Race/Ethnicity, but we do know that African Americans make up a larger proportion of cases here than would be expected. The African American population in Bexar County is only 7.2% of the entire population, but accounts for almost 14% of our cases and 33% of deaths due to COVID-19.

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Novel Coronavirus San Antonio

If there were no health disparities, each orange and grey bar would be the same height as its corresponding blue bar. Unfortunately, our pattern is similar to what we see across the country. This health disparity has more to do with poverty than race or ethnicity, specifically. But social scientists will explain how poverty and race/ethnicity and therefore health access are interlinked.

I wrote before about the high risk population in San Antonio. To date, we have fewer cases in the Hispanic population than we’d expect. There could be many factors to explain that:
* Are Hispanics being tested as often as other groups?
* Are Hispanics likely to seek health care?
* The numbers are still small. The small sample size skews the data.
* Are the data collected by patient report? I am Hispanic and identify as such — and if you look at me, it’s a good guess — but I don’t have an Hispanic name, so if you noted it after the fact, I might be classified as “White/non-Hispanic.”

There is no doubt we have health disparities. And there is no doubt that everyone is at risk. If you’re white and under 40, you may be less likely to die, but that doesn’t mean you won’t get sick or require hospitalization. And most importantly, it DOES mean you can be a risk to others.

Now we must work to prevent the spread of COVID-19 in our highest risk populations, before we see more cases.

Dr. Rohr-Allegrini is an epidemiologist and tropical disease scientist currently working to prevent diseases through immunizations.

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