"The most common explanations for disproportionate burden involve 2 issues. First, racial/ethnic minority populations have a disproportionate burden of underlying comorbidities. This is true for diabetes, cardiovascular disease, asthma, HIV, morbid obesity, liver disease, and kidney disease, but not for chronic lower respiratory disease or COPD. Second, racial/ethnic minorities and poor people in urban settings live in more crowded conditions both by neighborhood and household assessments and are more likely to be employed in public-facing occupations (eg, services and transportation) that would prevent physical distancing. As stated by Yancy, “social distancing is a privilege” and the ability to isolate in a safe home, work remotely with full digital access, and sustain monthly income are components of this privilege. COVID-19–related exposures are also exacerbated by a greater propensity to be homeless and reside in neighborhoods with substandard air quality. The possibility that genetic or other biological factors may predispose individuals to more severe disease and higher mortality related to COVID-19 is an empirical question that needs to be addressed. These explanations must be considered in the full context of systemic factors such as historical and ongoing discrimination, and chronic stress and its effect on hypothalamic-pituitary-adrenal axis and immunologic functioning. As more data emerge, there will likely be evidence of racial/ethnic health disparities due to differential loss of health insurance, poorer quality of care, inequitable distribution of scarce testing and hospital resources, the digital divide, food insecurity, housing insecurity, and work-related exposures. There is an obligation to address these predictable consequences with evidence-based interventions."