By Hannah Critchfield

Earlier this month, the Centers for Disease Control and Prevention released a report that found gay, lesbian and bisexual people were at increased risk for severe illness from COVID-19 than heterosexual people.

The federal agency is now recommending states and local jurisdictions begin collecting information on the sexual orientation and gender identity of people who test positive, are hospitalized for, and die of the virus.

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“And that’s a big deal,” said Kevin Heslin, epidemiologist deployed to the COVID-19 response at the CDC and co-author of the study.

North Carolina has not yet determined if they’ll adopt this policy.

“We are reviewing the study from the CDC to determine its implications on North Carolina, and we will continue to align with federal recommendations on data collection for COVID-19 cases,” said SarahLewis Peel, spokesperson for the NC Department of Health and Human Services.

Officials in some jurisdictions, like New Jersey and North York City, have already proposed legislation that would mandate the agencies to collect regular data on the pandemic’s disproportionate impact based on gender identity and sexual orientation. California Gov. Gavin Newsome signed a bill to collect information on LGBTQ people in June. Pennsylvania announced similar actions, though the data has yet to be added to either state’s COVID-19 dashboard.

Early on in the pandemic, human rights organizations warned that the novel coronavirus would have a disproportionate impact on LGBTQ people. Queer people are overrepresented in the so-called gig economy and restaurant industry, where they face an increased risk of exposure to COVID-19. Early analyses also suggested LGBTQ people had more chronic conditions than the general population.

“For BIPOC [black, Indigenous and people of color] trans folks, specifically Black trans women, navigating employment and health care can seem impossible without a pandemic,” said Rebby Kern, director of education policy at Equality NC, an organization that advocates for the rights of LGBTQ people in the state. “When we think about the disparities that already exist – it’s going to make COVID more serious for them.”

Few states were collecting LGBTQ-specific data, making it difficult to quantitatively assess the virus’s impact on people in these communities.

Unique study 

The CDC study looked at COVID-19 health disparities among sexual minorities by using data from the 2017–2019 Behavioral Risk Factor Surveillance System (BRFSS), a national survey that collects demographics on health through self-reporting.

“The power of this report is that the analyses were derived specifically with COVID in mind,” said Heslin. “Unfortunately, we don’t have any information on COVID among lesbian, gay and bisexual people, so the best we could do was to use existing data to look at differences by sexual orientation in health conditions that are risk factors for bad outcomes if you do get the virus.”

Researchers found that lesbian, bisexual and gay people across racial groups had a higher prevalence of conditions associated with the most adverse outcomes from novel coronavirus infection — including asthma, cancer, heart disease, COPD, hypertension, kidney disease, obesity, smoking and stroke — than heterosexual people.

The CDC study did not publish any findings for COVID-related disparities by gender identity — such as whether a person identifies as transgender, cisgender or nonbinary — due to a limited sample size.

It’s part of why researchers are calling on states to include gender identity data in their COVID-19 surveillance.

“That is something that we have to keep pushing for,” said Heslin. “It’s a very important subgroup, but they are small. Unfortunately, people used to do this with LGBs too — say, “Oh, they’re such a small part of the population, nothing that you find is going to be generalizable” — and I think that’s still a hurdle when it comes to transgender and nonbinary people.”

Image courtesy: Max Pixel

Better state data

Kern said they hope North Carolina swiftly moves to collect and publish data about both gender and sexual identity because they believe it will “illuminate the truth that’s always been.”

“If we don’t ask about those identities, then we have a hard time seeing that connection in our COVID response,” said Kern. “We have to have a clearer picture on where to allocate resources and how.”

Currently, the state collects COVID-19 data on gender identity, but not sexual orientation, through options that include “female,” “male,” “female-to-male,” and “male-to-female,” according to Peel.

“However, the limited collection of transgender and other gender identity information among COVID-19 patients prevents our ability to draw any analytical conclusions about possible differences in risk,” she said. These data are not available to the public.

The release of this CDC report comes after the Joseph R. Biden administration took office. Heslin said the study concluded in December and has been working its way through the agency’s extensive internal review process.

“This would have gone to press even if there had not been a change in administration,” he said. “That said – you’re going to be hearing a lot more about health equity moving forward.”

Heslin doesn’t anticipate the federal government issuing any new LGBTQ-specific guidance for vaccine prioritization based on the findings of the report.

I don’t think that CDC would be adding any new priority groups,” he said. “Right now, just getting the data on LGBs would be great. Just knowing what’s going on, in the sense of COVID, would be terrific.”

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Hannah Critchfield

Critchfield is NC Health News' Report for America corps member. Report for America is a national service program that places talented emerging journalists...