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Author Notes:

Correspondence to Nneoma E Okonkwo, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; nneoma@jhmi.edu

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.

Competing interests: None declared.


Research 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.


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

COVID-19 and the US response: accelerating health inequities.


Journal Title:

BMJ Evidence Based Medicine


Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© Author(s) (or their employer(s)) 2020.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
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