Reparations for Black American descendants of persons enslaved in the U.S. and their potential impact on SARS-CoV-2 transmission

Abstract

Background: In the United States, Black Americans are suffering from a significantly disproportionate incidence of COVID-19. Going beyond mere epidemiological tallying, the potential for racial-justice interventions, including reparations payments, to ameliorate these disparities has not been adequately explored.

Methods: We compared the COVID-19 time-varying R_t curves of relatively disparate polities in terms of social equity (South Korea vs. Louisiana). Next, we considered a range of reproductive ratios to back-calculate the transmission rates β_i→j for 4 cells of the simplified next-generation matrix (from which R₀ is calculated for structured models) for the outbreak in Louisiana. Lastly, we considered the potential structural effects monetary payments as reparations for Black American descendants of persons enslaved in the U.S. would have had on pre-intervention β_i→j and consequently R₀.

Results: Once their respective epidemics begin to propagate, Louisiana displays R_t values with an absolute difference of 1.3-2.5 compared to South Korea. It also takes Louisiana more than twice as long to bring R_t below 1. Reasoning through the consequences of increased equity via matrix transmission models, we demonstrate how the benefits of a successful reparations program (reflected in the ratio β_b→b/β_w→w) could reduce R₀ by 31-68%.

Discussion: While there are compelling moral and historical arguments for racial-injustice interventions such as reparations, our study considers potential health benefits in the form of reduced SARS-CoV-2 transmission risk. A restitutive program targeted towards Black individuals would not only decrease COVID-19 risk for recipients of the wealth redistribution; the mitigating effects would also be distributed across racial groups, benefiting the population at large.

Keywords: COVID-19; Health disparities; Mathematical model; Racism; Reparations; Risk structure.

Fig. 1

Fitted 95% confidence intervals for the ratio of the population in overcrowded housing to total population by Louisiana Census tract. In tracts where overcrowded housing is documented, the estimated ratio of Black population in overcrowded housing to total Black population is 0.0565, double that of the non-Black population (0.0283).

Fig. 2

Estimated time-varying R_t for the COVID-19 outbreaks in Louisiana (blue) and South Korea (red). Shaded areas represent 95% confidence intervals.

Fig. 3

a. If we assume the lower bound on the basic reproduction number reflects the risk of the non-Black population, then to explain an estimated R_t of 4, β_b→b would have to be more than quadruple that of β_w→w. This holds across different values of the off-diagonal terms (which affect the curve only through their geometric mean (β_b→wβ_w→b)^1/2. b. Arrow shows the potential effects of reparations for a range of R₀ derived from the Louisiana outbreak. Arrowhead ends in a shaded area that represents the range of transmission ratios (β_b→b/β_w→w) assumed to obtain from a successful reparations program, and the decreases in R₀ that would result.