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COVID-19 and Underinvestment in the Health of the US Population.

THE COVID-19 PANDEMIC HAS EMERGED AS THE public health challenge of our time, with almost three million confirmed cases worldwide.1 At the time of writing, the United States is the nation with the highest numbers of cases and deaths due to the global pandemic.1,2 While uncertainty remains about the eventual scale of health harms and societal impact, it seems clear that the United States has proven particularly susceptible to the spread of COVID-19 and the costs associated with containing it. Well over 800,000 confirmed cases have been reported in the United States to date, with more than 50,000 deaths.1 While there currently are little data by race or ethnicity being reported publicly by state health departments, the available data suggest that COVID-19 deaths may reflect long-standing racial inequities. For example, African-Americans account for more than 70% of the 652 deaths reported in Louisiana at the time of writing, despite comprising around 30% of the population.3 Preliminary data from the Centers for Disease Control and Prevention (CDC) on hospitalized confirmed COVID-19 cases, while still limited, suggest this may be part of a broader pattern.4 Cases and deaths are being reported predominantly in urban centers, such as New York City, which alone accounts for almost one-third of all US deaths.1 As the pandemic continues to spread across the United States, and in particular through populations with higher proportions of individuals at high risk of COVID-19 and with lower access to health care, reports of severe disease and death are likely to rise further. Beyond the immediate health effects, more than 26 million jobs have been lost thus far in the United States as a result of the pandemic and associated physical distancing measures.5 It therefore seems pertinent to ask why the United States has been so disproportionately afflicted by