Introduction Data from the USA reveal disparities in hospitalization and mortality from coronavirus disease 2019 (COVID-19). Social determinants of health (SDoH) could account for disparities in disease incidence and outcomes. We investigated the association between zip code racial composition and COVID-19 incidence and case fatality in Oakland County, MI. Methods We conducted an ecological study using publicly available data on COVID-19 in 70 zip codes in Oakland County, MI. We obtained demographic surrogate markers of SDoH by zip code from the US Census Bureau website. Using negative binomial regression models, we investigated the association between the percentage of Blacks in each zip code and COVID-19 incidence and case fatality, including markers of SDoH as potential confounders. Results Reported COVID-19 cases ranged from 13.2 to 255.2 per 10,000 population. Each percentage increase in Blacks within a zip code was associated with a 3% increase in COVID-19 cases (95% CI: 1.02 to 1.04, p ≤ 0.0001), and this remained significant after adjusting for income or poverty level, number of persons per household, mode of transportation, age, and level of education (incidence rate ratio: 1.02, 95% CI: 1.01 to 1.03, p ≤ 0.0001). Zip codes with a higher percentage of Blacks also experienced a faster increase in COVID-19 rates from April 3 to May 16. However, the proportion of Blacks in a zip code was not associated with case fatality. Conclusion Zip codes with larger Black populations were disproportionately affected by COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-020-00909-1.

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Streptococci, pneumococci and enterococci are Gram‐positive bacteria, which cause significant morbidity and mortality in humans, and can also reside in their human host without causing disease. Streptococci are usually classified by their haemolytic reactions (beta‐, alpha‐ and nonhemolytic) or Lancefield antigen groups A, B, C, F, G and L. Enterococci were actually once classified as Group D streptococci, but as a result of chemotaxic and molecular studies are now considered to be a separate genus. Although effective antibiotic treatments exist, threats to public health are posed by antibiotic‐resistant strains of these bacteria. Organisms can be intrinsically resistant to antibiotics or can become resistant through acquisition of mutations or genes, which render a particular antimicrobial agent ineffective in killing or suppressing the organism. This article will describe diseases caused by streptococci, pneumococci and enterococci, and discuss the antimicrobial agents used to combat infections with these organisms. Key Concepts: Streptococci, pneumococci and enterococci are extremely common among humans and are capable of causing a wide range of disease. Group A streptococci cause millions of skin and throat infections per year and are especially common in school‐aged children. Group A streptococci are usually easily treatable but may become invasive causing serious disease or death. Group B streptococci are a major cause of morbidity and mortality in newborns, however rigorous screening and prophylactic treatment of pregnant women, and monitoring and treatment of infections in newborns have radically reduced Group B streptococcal disease. Pneumococci are the leading cause of community‐acquired pneumonia and otitis media. Enterococci are a frequent cause of nosocomial infections and are usually multiply resistant to antimicrobial agents. Antimicrobial resistance in streptococci, pneumococci and enterococci is a major healthcare problem worldwide, illustrating the need for development of effective agents against these organisms and prudent use of all antibiotics.

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