key: cord-0888401-pum8iz64
authors: Santos, Debora de Souza; Menezes, Mariane de Oliveira; Andreucci, Carla Betina; Nakamura-Pereira, Marcos; Knobel, Roxana; Katz, Leila; Salgado, Heloisa de Oliveira; de Amorim, Melania Maria Ramos; Takemoto, Maira L S
title: Disproportionate impact of COVID-19 among pregnant and postpartum Black Women in Brazil through structural racism lens
date: 2020-07-28
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa1066
sha: 7e7a9cf2a5006611dfa6cefe4140ab7f4025c5bd
doc_id: 888401
cord_uid: pum8iz64

nan

A c c e p t e d M a n u s c r i p t 3 Dear Editor, Tai and collaborators raised important questions about the potential biomedical factors and social determinants that play a role in the observed racial disparities on COVID-19 outcomes in the US [1] .

Evidence of such disproportionate impact is also arising on historically oppressed ethnic groups in Brazil, current worldwide pandemic epicenter [2] . Our group is closely monitoring an overwhelming number of SARS-CoV-2-related maternal deaths in the country [3] . Racial disparities among childbearing women within the healthcare system have been widely described, and already pose difficult challenges to improve maternal outcomes in the country [4, 5] . Thus, it was expected that Black Brazilian pregnant and postpartum women would face additional challenges during the pandemic. We searched the Brazilian Acute Respiratory Distress Syndrome Surveillance System looking for COVID-19 cases among pregnant or postpartum women with complete data on ethnicity until July 14, 2020 (n=1,860), then selecting records of White and Black women (n=669, Table 1 ).

In our sample, Black women had similar mean age and morbidity profile as White women but were hospitalized in worse conditions (higher prevalence of dyspnea and low O 2 saturation), had a higher rate of ICU admission, mechanical ventilation, and death. We previously reported that barriers to access intensive care seem to play a role in the high number of COVID-19-related maternal deaths in the country [3] . However, data presented here may indicate that Black pregnant and postpartum women have been disproportionately affected by COVID-19 due to processes originated outside the hospital [6] . As pointed by Tai et al, biomedical lens can be used to approach racial disparities in health. However, in our sample, clinical risk factors commonly associated with worse prognosis for COVID-19 were not significantly different between Black and White women. Therefore, it is reasonable to rely predominantly on social determinants of health Lens to interpret our findings. In Brazil, this implies recognizing both racism and sexism as structural determinants that shape worse living and working conditions, as well as lack of access to health care and opportunities to the Black population, particularly Black women [7] . By focusing in this group, specifically during pregnancy and M a n u s c r i p t 4 the postpartum period, we direct our lens to the most vulnerable individuals in our society who constitute the base of the power pyramid[8].

Our findings showed that maternal mortality in Black women due to COVID-19 was almost two times higher than observed for White women. This adds to previous observations from US and UK that 

The Disproportionate Impact of COVID-19 on Racial and Ethnic Minorities in the United States

Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study

The tragedy of COVID-19 in Brazil: 124 maternal deaths and counting

The color of pain: racial iniquities in prenatal care and childbirth in Brazil

You Don't Have To Be Infected To Suffer: COVID-19 and Racial Disparities in Severe Maternal Morbidity and Mortality

The authors want to thank all the researchers from the Brazilian Group for Studies of COVID-19 and Pregnancy.

This work was partially funded by "Fund for Support to Teaching, Research and Outreach Activities -FAEPEX" of University of Campinas (UNICAMP). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The authors declare that they have no conflict of interest.A c c e p t e d M a n u s c r i p t 6 A c c e p t e d M a n u s c r i p t