COVID-19 And Underserved Populations

Posted by Reeve Staff in Daily Dose on August 30, 2022 # COVID-19

COVID-19's vast reach caused the most damage in underserved areas and populations. The often-deadly virus affected many when COVID-19 was declared a global pandemic. At the pandemic's beginning, urban areas were ground zero for infections leading to calls for lockdowns and social isolation. However, as the world shut down, COVID-19 continued to spread, eventually reaching rural areas.

At-risk Communities

The emergence of COVID-19 was pivotal for public health and medical communities. The two communities discussed the spread of the disease and who was at a higher risk for infection. While both fields acknowledged that everyone should take the proper steps to prevent or reduce the effects of COVID-19, the groups also discovered that some groups were hit harder than others. What COVID-19 did was re-enforce disparities in access to health care.

At-risk communities like the elderly, immunocompromised, Black, Indigenous, and People of Color (BIPOC), and those with disabilities were at an increased risk of contracting and developing severe symptoms of COVID-19. Therefore, to understand the impact of the pandemic on the population, public health and medical professionals looked at environmental or health influences.


The Centers for Disease Control and Prevention (CDC) released a study that discusses COVID-19 and the disability community. The paper stated that most with disabilities are not at an increased risk of contracting or experiencing severe illness from COVID-19. However, the study does caution that those with disabilities may have an increased risk of becoming infected or having severe symptoms if:

  • A person has underlying health issues
  • Communal or concentrated living environment
  • Systematic social or health inequities

People with limited mobility may have limited communication ability or are in close contact with family, health, or other service providers are also at an increased risk of contracting COVID-19.

Inner Cities

There are several reasons why those in inner cities are affected more than others.

  • One reason lies in where a person lives. Inner cities' structural design heightens the risk for infection and transmission. In addition, affordable housing may not have the ventilation or air conditioning necessary to decrease transmission. Stagnant air doesn't allow the virus to be filtered out of the home.
  • Affordable housing is one piece of the puzzle, but so is access to specific services. For example, inner cities are often plagued by food deserts. Supermarkets are rare, and trying to travel to them is challenging. Therefore, the little corner stores or fast-food restaurants are more accessible food sources—additionally, the cost of fruits and vegetables, when compared to processed foods affects shopping patterns. These shopping patterns determine what foods are consumed and their effect on people's overall health.
  • Another reason for an increased risk in the inner city is public transportation. When a person takes a bus, train, or subway, they have little chance of social distancing. COVID-19 can then be transmitted from an exposed person to another who wasn't exposed.
  • Finally, education makes a difference. Local leaders are essential partners in letting their communities know about and understand the full scope of COVID-19 prevention, symptoms, and health care services.

Rural Areas

As the pandemic continued and attention was paid to the rising rates of deaths in rural areas, researchers found more people were dying in rural areas than urban areas. The CDC's Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022, reinforces these findings but also looks at why there is a significant difference in death rates.

Rural communities consist of millions of diverse people. The impact of COVID-19 on urban areas helped public health officials and the medical community discover ways to decrease the risk for those living in cities. However, little attention was paid to the effects of COVID-19 on rural areas. The paper Impacts of the COVID-19 Pandemic on Rural America addresses why rural populations are the most vulnerable. The researchers discovered the impact of COVID-19 on rural areas includes a severe or negative impact on employment, mental health, or economic wellness.

The CDC discovered that the first dose vaccination rate for COVID-19 was lower in rural areas than urban areas. The disparity in vaccination rates has doubled since April 2021. The trend of lower vaccination numbers in rural areas was also reflected in second dose or booster vaccination rates.

Other factors affecting the rate and severity of COVID-19 in rural areas are

  • Access to health care is a challenge. People in rural areas report the lack of access to medical providers and hospitals increases their risk of health issues.
  • Political ideology and the belief of the severity or need to enact COVID-19 protections vary in rural areas.
  • Vaccine hesitancy is higher in rural areas than in urban areas.


The elderly represents a specific group with a high risk of developing and having severe, if not fatal, symptoms from COVID-19. In addition, many seniors have pre-existing health issues that can worsen the viral-induced effects of COVID-19. Therefore, the National Institutes of Health (NIH) recommends early detection and individualized medical care based on their health and medication history.

Race or Ethnicity

COVID-19 has affected ethnic and racial minorities more than white people. As COVID-19 continues to threaten the nation's health, the infection and death rates have decreased amongst BIPOCs, but the disparities remain.

  • The CDC found that Non-Hispanic Indigenous or Alaskan Natives are hospitalized because of COVID-19 than non-Hispanic white people. Furthermore, non-Hispanic Black or African American people's hospitalization rates are double that of non-Hispanic white people. The CDC cites some possible factors for severe symptoms of COVID-19.
  • Health issues can intensify COVID-19 symptoms, especially among those at an increased risk of developing type 2 diabetes -- Black, Hispanic, Indigenous, or Asian populations.
  • The type of work a person does makes a difference. People who can't work remotely or avoid interacting with the public are at an increased risk of exposure to COVID-19. Service industry jobs and medical jobs are examples of jobs that require a person to go to work and interact with the public.
  • Racism takes a mental and physical toll on people. In addition, the stress of coping with discrimination can weaken the immune system and cause premature aging.

Socio-economic Status

The economic impact of COVID-19 was felt by those already in lower socioeconomic statuses. When shutdowns occurred, financial hardship also occurred because many in the service or other public-focused industries lost their jobs. In America, most people receive their health care insurance through their workplace. Therefore, a job loss equals the loss of insurance and access to health care services.

The Census Bureau recently studied how different households with varying socioeconomic levels cope with the pandemic. The study found that low-income families are disproportionately affected and struggle for economic and social rights.

Medical workers doing analysis in laboratory during corona virus outbreak- Science and healthcare concept stock photo - iStockPhoto - Credit: Alessandro BiascioliThe Effort to Address Disparities

The unceasing presence of COVID-19 and its variants pushed researchers to find ways to address disparities and inequities for those in underserved populations or areas. As a result, the NIH formed the Rapid Acceleration of Diagnostics (RADx) programs. RADx aims to speed the development, validation, and commercialization of COVID-19 home and cutting-edge test kits. The hope is that researchers can reduce disparities by understanding the factors that affect underserved populations or areas.

Understanding the factors that affect the risk rates requires understanding the targeted communities. Racial and ethnic minority communities may hesitate to be vaccinated or follow public health guidelines based on their past experiences with the medical and research communities. Including the community in the effort to reduce or prevent COVID-19 infections is vital.

Public health and medical professionals are looking at community-based approaches. These approaches are essential in every underserved area or population affected disproportionately by COVID-19. Through collaborations between school systems, public health departments, and other private or public organizations, people can become involved in the health of their community. People can ask questions or shape how the message and delivery of services are enacted. Engaging the community means listening and respecting the community.

Researchers, public health officials, medical professionals, and community leaders continue to address the disparities in COVID-19 health care services. As the conversation and programs continue to grow and include those most affected by COVID-19, there is potential to create equal access to health care.


Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022. Centers for Disease Control and Prevention. MMWR March 4, 2022 / 71(9);335–340.

Impacts of the COVID-19 Pandemic on Rural America,mental%20health%2C%20and%20economic%20outlook.

Christina Sisti, DPS, MPH, MS is a bioethicist and health care policy advocate. She works to create awareness and improve health care policy for those with long-term health issues.

This publication was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $160,000 with 100% funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, ACL/HHS or the U.S. government.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.