An Integrative MD On Why We Need A Holistic Approach To Race & COVID-19
Early in the beginning of this pandemic, there were whispers of COVID-19 placing undue stress on the Black population. However, the numbers were not in yet and no one wanted to draw a premature conclusion. Months later, though, the data supported what many physicians of color would have predicted: Infection rates of COVID-19 were not only higher in the Black community, but they also carried an increased mortality rate.
The disparities in COVID-19 infection and mortality rates.
Not only did Black people contract the virus more frequently, but they also had a higher death rate from complications of the viral infection. One study published in the Annals of the American Thoracic Society found that 78.9% of the individuals who tested positive were Black and 9.6% were white.
A recent study in Washington, D.C., found similar findings when testing children. Of those children who tested positive, 7.3% were white, 30% were Black, and 46.4% were Hispanic.
According to the Brookings Institute, 15% of Michigan's population is Black; Black people account for 35% of the COVID infections. The estimated mortality rate in Michigan is 4%, and Black people account for 40% of that. Similar statistics are noted in several states. While the actual numbers seem to change daily, the trend seems to be consistent.
Why COVID-19 is disproportionately affecting Black communities.
1. Inequities in health care.
One of the first things we learned about COVID-19 was its affinity for people with comorbid conditions. It has been well documented that Black people suffer disproportionately from chronic conditions such as heart disease, diabetes, and high blood pressure.
This is not because of genetics but can be attributed to socioeconomic conditions, including lack of access to health care and a hesitancy to engage in a system that is perceived as being imbued with systemic racism and is often unaware of its own implicit bias.
Recent studies show that comorbid conditions are managed less aggressively in the Black population compared to counterparts with similar risk factors. Black people get less face-to-face time during a medical encounter, and frequently the legitimacy of their complaints are either questioned or diminished.
These may certainly be significant contributors to mortality rates. There is also the fact that many are uninsured or underinsured and therefore may not seek medical help due to concerns about cost.
2. Working conditions.
Increased infection rates may be secondary to the fact that many front line and essential workers are minorities and this greatly increases exposure. Think of your grocery clerks, your janitors, your bus drivers, and your sanitation workers. These are all considered essential workers because frankly, everything would stop working without them. They have to show up.
Even if these workers have comorbid conditions and are at high risk for complications, they may not be able to stay at home because financially, they could not afford to do so. Oftentimes, even if these workers have symptoms, they may opt to go to work due to finances. To get to work, many of these workers use the public transportation system, another source of potential exposure.
3. Population density.
Other confounding issues are population density issues in neighborhoods. This makes it difficult to social distance or have access to proper protective gear, like masks. These neighborhoods may also have polluted water (i.e., Flint, Michigan), air, and limited access to healthier foods.
We often tout the benefits of these simple things to help us reduce our risk of chronic conditions while also helping our immune system stay more vigilant.
How can these issues be addressed?
There are several factors contributing to the high rates of COVID-19 infection and mortality in Black communities—perhaps more than can be discussed here. All of this raises the questions: What can be done, and where do we start?
In my opinion, truly addressing these issues would take the meeting of many minds and the acknowledgment that something has been amiss in our health care system from the start. But perhaps we can start with the following:
- Provide access to basic preventive gear such as masks and sanitizers. Protect the essential worker.
- Make testing available in the community and without additional cost. If the cost of testing is prohibitive, people won't get tested. That leaves open the possibility of people going back to work and interacting in the community because they are unsure whether they are infected.
- Acknowledge that this is a "we" problem and not a "them" problem. Any infection that occurs has the potential to affect all of us.
- For my fellow physicians, listen and acknowledge patient concerns and work with them to address the many contributing factors. That is, talk to your patients, not at them.
The rest takes a lot of work and input from communities, health care, and governments. Health care disparities have been pointed out to us again and again. Hopefully, this time we stay the course, regardless of how uncomfortable it feels.
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