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How COVID-19 Patients Are Affected By Health And Other Disparities


COVID-19 is a respiratory virus that affects everyone, but the pandemic is particularly impacting black and Latino communities across this country. Much of this has to do with the intersection of the virus with health disparities, population density and socioeconomic status. And it may not be as easy for black and brown communities to carry out protective measures like social distancing.

Dr. Joseph Betancourt is a primary care physician and chief equity and inclusion officer at Massachusetts General Hospital. I spoke to him about how social conditions play a part in all of this.

JOSEPH BETANCOURT: I'm originally from Puerto Rico and grew up in a bilingual, bicultural home, so these issues have been very important to me throughout my life. And we understand that vulnerable communities, minority populations, in particular, enter this pandemic at a very significant disadvantage.

I think, first, we know that minorities tend to suffer at greater rates from some of these comorbid conditions that put you at higher risk from having a poorer outcome with a coronavirus infection. We also know that many of those communities have lower access and less access and less easy access to the health care system and live in social conditions that are in many ways more challenging and have created the perfect storm for the spread of this virus in these exact communities. Add into that historic mistrust of kind of sources of information as well as language barriers and, again, we have a recipe for disaster that's playing out around our nation in communities of color.

MARTIN: You talk about comorbidity rates. Can you explain what that means here?

BETANCOURT: Coming into this pandemic, we've learned that individuals with chronic conditions such as diabetes, lung disease, heart disease - in addition to age - lead and portend to poorer prognosis. When we think about those conditions in the United States, they do disproportionately impact minority populations. If we look at our nation's largest killers, they do, again, have a greater impact on communities of color.

MARTIN: You argue that there are structural issues in our society that come into play here. Can you talk about what the most prevalent are?

BETANCOURT: If we think about this virus and how it spread - a respiratory virus - you begin to really understand. What is the environment - what are the social conditions that make a ripe opportunity for spread? And these are the same social conditions in which minorities and vulnerable communities tend to live every day - you know, the first being densely populated areas. So as we've seen these outbreaks in Detroit, Chicago, Milwaukee, here in Boston, in New York, we understand that the more densely populated an area you live, the higher the risk for spread.

Add to that that many of these communities have multiple family members living in perhaps smaller spaces as they care for extended family in the home. And so add to that that many of these individuals are essential workers - so work in health care, in environmental services, work in a supermarket. So they don't have the choice or the luxury to work remotely or get groceries delivered to them.

And when we were telling people weeks ago to social distance, they also didn't have that luxury because they had to take public transportation and be side-to-side with a whole bunch of other people. So those sets of social conditions, in large part, explain why we're seeing what we're seeing today.

MARTIN: You mentioned the fact that, for many of these people - to quote Charles Blow of The New York Times who wrote recently, social distancing is basically a privilege. It's a luxury at this point for a lot of people who just can't.

BETANCOURT: You know, I had a chance to speak to a lot of our environmental services workers at our hospital and food nutrition services early on in the pandemic to tell them about the things that were recommended that they do - handwashing and wiping surfaces down and social distancing. And many of them didn't have the supplies that they needed to keep their environments, you know, as pristine as they would like to from a socioeconomic standpoint as they're balancing food costs with other costs. You know, they said clearly - well, I'm on the train with a ton of people, and that's the only way I could get in here. And so it was clear that it was a luxury.

And again, they couldn't work remotely. They couldn't get groceries delivered to them, so they were out there. And they knew it, to be honest. They knew that social distancing was something that they just couldn't do and couldn't afford to do.

MARTIN: Do the disparities get better if you look at more rural communities or just smaller cities, where there's not as much population density?

BETANCOURT: There's no doubt - and I think we're going to get better data - that if you do live in a less densely populated place, your exposure, just by the numbers is going to be less. I mean, we have reports of, you know, individuals still gathering perhaps, even in rural or suburban areas, because of the information not getting out in their language or through a source that they can trust. So I think from a science standpoint, we might predict that would be the case. But I think socioeconomic status is always going to play a role, some way, somehow, no matter how densely populated an area is.

MARTIN: Do all states collect race-specific health data?

BETANCOURT: Some states haven't done much at all. For a long time, we've been pushing states and the federal government to do a better job of racial and ethnic data collection, primarily because we know the disparities are so significant across the country. And if we don't collect that data, we'll just never be able to know with any certainty how well we're doing it at the state and local level. I will agree that socioeconomic status plays a role, but I think it's naive to not look at the data and understand that minorities are disproportionately represented among those with low socioeconomic status.

MARTIN: If you could sit down in the Oval Office or with Anthony Fauci, what do these communities need right now to minimize their exposure in the first place?

BETANCOURT: The more we test, the better we're able to identify individuals who are positive and think about ways to protect them and isolate them, in fact - give them an opportunity to not be in a crowded home to avoid spread.

No. 2 - testing's not going to solve this problem. The fire is already happening. It's akin to putting a whole lot of fire detectors in a place where there's a raging fire. We do need fire detectors to see where it is spreading in the community. But really, major efforts need to be spent on mitigation, so we're launching an effort where we will be going door to door delivering what we're calling care kits that will have masks, that will have - we're hoping - hand sanitizer, wipes so that people could actually do the things that we're asking them to do and not leave that to chance.

And then third, we are securing housing. We have a hotel now that we've been able to identify that wasn't being used that we're going to take over the management of. And that is going to provide a place for individuals who test positive to go and convalesce - we'll be able to symptom monitor them - so that we mitigate the spread within their household and within their communities.

MARTIN: Dr. Joseph Betancourt - he's a primary care physician and chief equity and inclusion officer at Massachusetts General Hospital.

We so appreciate your time. Thank you.

BETANCOURT: Thank you so much for having me.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.