The reproduction number (R) for the COVID-19 virus is being widely used to shape national policies on containment measures in the pandemic. I worry that it could become an instrument of discrimination if no consideration is made of the outsized risk that the virus poses for people in many minority groups.
A value of less than one is considered the threshold for relaxing rules. But there are cavernous disparities in case numbers and deaths for people of different ethnicities (see, for example, go.nature.com/37fffny and M. Webb Hooper et al. J. Am. Med. Assc. http://doi.org/ggvzqn; 2020). The blanket application of R in the context of such population heterogeneities seems questionable. I am concerned that basing policy on a single composite R could devalue the health needs of certain groups.
I am a medical doctor, not an epidemiologist. But it is incumbent on all of us in science to challenge our society and our peers where practices and models could be prejudicial to certain groups. Often, researchers are at best reticent and at worst dismissive about systemic inequality.
Its impacts were all around us long before COVID-19 — for example, in the paucity of Black people in drug trials (Nature Med. 24, 1779; 2018) and in the fact that US pregnancy-related death rates are three times higher in Black than in white Americans, even after controlling for education and socio-economic status (see go.nature.com/2abdmqq). To correct inequality, we must first recognize and acknowledge it.
