Editors’ Note: This article was accepted on April 13, 2020, and was accurate at that time. Because information about SARS-CoV-2 and COVID-19 is evolving rapidly, please verify these recommendations and information.
Explore This IssueACEP Now: Vol 39 – No 05 – May 2020
The state of emergency was issued on March 12, 2020, in New York. All nonessential businesses were forced to work from home or shut down, and schools closed while implementing remote learning plans. As an emergency physician, I knew our duty was the same. Immediately our colleagues from near and far braced, with personal protective equipment (PPE) or not, to tackle the invisible perpetrator that assaulted lungs and closed eyes indefinitely. They say hindsight is 20/20, but somehow seeing the devastation in China and Italy was not foresight enough. As of this writing, it is April 2020, and in the United States hot zones, more patients are diagnosed, are admitted, require ventilators, and die every day. This is the new reality in America 2020—but for some, nothing has changed.
Pandemic with an Unequal Toll
Underrepresented minorities have always lacked access to health care and suffered the worst health care outcomes in the United States—and the COVID-19 pandemic is no different. As a black woman from New York City, I have many friends’ parents, childhood neighbors, and 40-year-old cousins who have died from COVID-19. The question is why?
Novel coronavirus (SARS-CoV-2) risk factors include obesity, lung disease, diabetes, hypertension, and other immune-compromising diseases. Minorities in the United States disproportionately have higher rates of all these comorbidities. We were taught this in medical school and residency, so we should be able to better identify and treat these patients, but the reality is we have not. COVID-19 makes that clearer than ever.
Data from Johns Hopkins University reveals that African Americans are three times more likely to contract SARS-CoV-2 and six times more likely to die from COVID-19 than any other racial group.1
Of course, comorbidities play a role but are not the only factors. Social factors and practitioner bias add to these glaring disparities. Mandating that citizens social distance is great—if you have space to distance. Have you ever lived in “the projects,” high rise apartments with more than five families on each floor of a 10-floor building? How are you able to go outside for fresh air at a distance of six feet? Have you lived with three generations in one household? How can you quarantine from elderly loved ones? Have you had a kidney transplant, like my husband’s mother, but have to take public transportation to work every day because you are an essential health care employee? Have you ever had your physical complaints minimized because of false beliefs of how African Americans perceive pain?
If it sounds like I’m getting personal, it’s because I am. The practice of medicine is personal, and the relationship between doctor and patient is confidential and protected. Similarly, medical outcomes of increased health disparities across race and increased mortality rates are personal to every friend and family member of mine who has lost a loved one this week.