We have little choice, but to continue to discuss the danger of COVID-19 through a population health conversation focusing on high-risk individuals, specifically, African Americans and other marginalized groups living in medically underserved and rural communities in Tennessee. This conversation must be amplified by providing current COVID-19 facts and resources such as testing and vaccine sites located within communities across the state of Tennessee. This conversation must be constant and include culturally and linguistically appropriate messages through social media (Facebook, Instagram, Twitter, YouTube, etc.). Additionally, these conversations must take place everywhere in our communities (grocery stores, churches, street corners, barbershops, beauty salons, etc.) and, yes, even in uncomfortable places such as hospitals, wakes, funerals, and every place where precautions should be taken, heard, and acted upon. These culturally appropriate messages must be made available even when we think there is nothing new to say about COVID-19 and its dangers, especially as we see the current COVID-19 cases rise and the mandate for the use of masks and other prevention methods are being relaxed for the general public. We must recognize a false sense of hope does not prevent vulnerable and marginalized groups from getting COVID-19 and suffering its effects of severe illness and potential death.

African Americans are at the highest risk for illness and dying from COVID-19 according to current public health statistics; clear and definitive messages must be crafted to reach them. The facts are approximately 97.9 out of every 100,000 African Americans have died from COVID-19, a mortality rate that is a third higher than that for Latinos (64.7 per 100,000), and more than double than that for whites (46.6 per 100,000) and Asians (40.4 per 100,000). The overrepresentation of African Americans among confirmed COVID-19 cases and number of deaths underscores the fact that the coronavirus pandemic, far from being an equalizer, is amplifying or even worsening existing social inequalities tied to race, class, and access to the healthcare system.

Consequently, how we behave and where we live, dictate our ability to survive this pandemic, just as we did the Spanish Flu in 1919. If you live in Tennessee, or travel to other states, extra precautions must be taken. Currently Tennessee ranks 36th among states in the rate of new reported cases of COVID-19. However, this is overshadowed by the facts that Tennessee ranks 11th in the rate of increase of reported COVID-19 cases, an increase of 97% over the past two weeks, to an average of 1,139 cases per day. Tennessee counties with the highest rates of COVID-19 include Davidson, Shelby, Hancock, Williamson, and Fayette.

Over the past two weeks, hospitalizations were also up (28%) which equates to 287 patients per day, while COVID-19 related deaths were up 161%, to 15 deaths per day. Marion, DeKalb, and

Hancock counties all reported increases in hospitalizations due to COVID-19 per 100,000 of the population at over 900% over the past 14 days. The percentage of fully-vaccinated persons in Tennessee remains at 55%.

Tennessee CEAL in partnership with HealthWorks (a partnership between Meharry Medical College and Morehouse School of Medicine) and the Tennessee Department of Health, (CDC Health Disparities Initiatives against COVID-19) are working in tandem to provide health education and promotion in medically underserved and rural communities. These communities are comprised of vulnerable and marginalized populations (African-American, LatinX, and rural residents), geographical communities (urban underserved communities and rural Appalachia), disabled persons, persons experiencing homelessness, nursing homes, and LGBTQ+ populations.

Evidence-based studies and our lived experiences in doing this work in communities across the state of Tennessee underscore that African Americans and other minorities are overrepresented among persons who are getting infected and dying from COVID-19. It is potentially possible and highly likely that we could see 100 million coronavirus infections and a potentially significant wave of deaths this fall and winter, driven by new omicron sub variants that have shown a remarkable ability to escape immunity.

While it is unlikely that many state and/or local governments will return to mandated requirements for mask-wearing or gatherings in any upcoming COVID-19 surge, it is important that individual and community risks are taken into consideration. For vulnerable populations – including African Americans – who are at great risk for illness and death during this predictable surge of COVID-19, individual and community actions must include minimizing exposure to the virus. In lieu of requiring facemasks, the CDC now publishes weekly community COVID-19 levels (green, yellow, red) and recommends public officials and individuals use these guidelines to assess their own risk and determine appropriate preventive measures. In other words, in most cases, no one is going to tell you what to do any more.

In addition, the national strategies, such as wearing face masks, good ventilation, along with other preventive actions, like staying six feet apart and increased handwashing, can help prevent you from getting and spreading COVID-19. Also, everyone should keep a supply of KN95, N95 masks and COVID-19 tests available; and if you have any cold or flu-like symptoms get tested or test yourself! If you have a positive COVID-19 test result and are at high risk for developing severe COVID-19, see your primary care provider for a prescription of Paxlovid. An increasing number of pharmacies are now participating in a new federal “test to treat” program that are designed to help people quickly find treatment if they test positive for COVID-19. Pharmacies participating in this program offer COVID-19 tests and quick access to a primary care provider and treatment if you are positive.

Below are some facts and strategies for preventing COVID-19 and reducing your chances of getting COVID-19 or if you do, minimize symptoms and possibly avoid hospitalization.

1. It is important to know which risk factors you have that may increase your risk of getting COVID-19 or having poor outcomes.

2. Risk factors are: age (over 65), overall health status (3 or more chronic conditions), and being in close contact with persons for whom you do not know their vaccine status.

3. The most effective strategy is to be fully vaccinated and boosted with a third vaccine.

4. Get tested or test yourself if you have any cold or flu-like symptoms.

5. Paxlovid is an oral antiviral pill that can be taken at home to help keep high-risk patients from getting so sick that they need to be hospitalized. To receive a prescription for Paxlovid, a positive COVID-19 test result and be at high risk for developing severe COVID-19 are requirements.

6. Paxlovid should not be the first line of defense for COVID-19, although a recent clinical trial demonstrated that unvaccinated participants who were given Paxlovid were 89% less likely to develop severe illness and death compared to trial participants who received a placebo. Taking precautions to stay safe and “Live Well” in the age of COVID-19 is our new reality.

7. The CDC recommends COVID vaccines and a booster for everyone over 5 years of age.

8. The CDC also now recommends that adults age 50 and over and people ages 12 years and older who are moderately or severely immunocompromised should get a second booster. According to CNN, the US Food and Drug Administration recently expanded the emergency use authorizations for specific vaccines to include children 6 months through 17 years.

Moreover, part of the solution for mitigating COVID-19 in marginalized communities is the dissemination of population health management and education, ready and routine access to COVID-19 knowledge, resources (health facilities), and vaccine education. Additionally, expand the current workforce for high-risk communities that include community healthcare workers from their communities. An expanded healthcare team will continue to strengthen community resources including adding to a diverse community workforce that will address and reduce health disparities, while advancing health equity.

No one should have to become ill or die, when prevention can be employed.

Paul D. Juarez, PhD, Project Director/Principal Investigator
Vice Chair and Professor Community Engagement and Research
Department of Family and Community Medicine
Patricia Matthews-Juarez, PhD, Central Tennessee Division Lead
Senior Vice President, Office of Strategic Initiatives and Innovation

Department of Family and Community Medicine
Katherine Y. Brown, EdD, Director of Community of Practices and Dissemination
Director of Community Engagement for COVID 19, Tennessee CEAL
National Center for Medical Education Development and Research
Assistant Professor
Department of Family and Community Medicine
Kermit Payne
1Joshua Group, LLC