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Examining Racial Disparities Observed During Coronavirus Pandemic


The message from protests across the country is clear - black and brown lives must matter as much as anyone else's. The killing of George Floyd may have been the catalyst to the demonstrations we're seeing now, but they are the culmination of generations of racial inequities that shape the lives of people of color. The coronavirus has exposed another layer to those inequities. On average, the CDC has found the death rate of COVID-19 for black people to be more than twice as high than for white people. And for Latinos, it's 50% higher. That's despite the fact that black and Latino people make up just 30% of the U.S. population.

To understand why this is the case and how to change it, I talked with two experts - Dr. Uche Blackstock, an urgent care physician and the founder and CEO of Advancing Health Equity, and Dr. Alicia Fernandez. She's an internist at Zuckerberg San Francisco General Hospital and an expert in health care disparities in Latino and immigrant health. Dr. Blackstock began by explaining how she was able to predict these disparities back in March, as soon as COVID-19 began to spread in the United States.

UCHE BLACKSTOCK: So I think, you know, many of us who have done work within health equity and have been paying attention to racial health disparities, we were very concerned from the beginning because these were communities that already carried a very heavy burden of chronic disease. So we were seeing that diabetes, high blood pressure, obesity and asthma, which were underlying factors that made people do much worse when they contracted COVID-19. We also know that in black communities, that they are disproportionately represented among essential workers and service workers, so they were more likely to be exposed to the public as well as we know that there are higher rates of uninsurance. And so these populations had more difficulty accessing health care. And then finally, looking at, you know, who is using public transportation - again, disproportionately black and Latino communities.

And so these were all factors that not only increased the risk for someone's exposure to the virus but also increased the risk that someone may become very ill once they were infected with the virus. So essentially, what we had was a crisis within a crisis.

MARTIN: Dr. Fernandez, when it comes to the communities that you specialize in, was the writing on the wall?

ALICIA FERNANDEZ: One of the huge issues for both Latino and immigrant communities is the concentration in essential businesses. And even for people who are not in these essential occupations, there is such a fierce financial need that many have to continue to work. When combined with dense living because of multigenerational households or simply the congregate living that comes out of low wages and high rents, this provides very close quarters for the virus to spread. And I think that has hugely contributed to the excess risk.

MARTIN: I imagine also within immigrant communities, there would be a general distrust of the health care system and a language barrier that would also make them more vulnerable.

FERNANDEZ: That's exactly right. So here there are two very important issues. One is language barriers - access to information, knowing what to do to protect yourself, knowing how to get tested and so on. But the other issue is the issue of trust. One of the key aspects within contact tracing is that the sick person gets called up and is asked, tell me everyone you've been in contact with starting two days before you became sick. And there, the person really has to make a very quick decision about how much information to share. What if someone you work with is undocumented? What if they're in a mixed-status family? What if you simply don't know what the authorities are going to do with this information? And I think there, issues of trust are key. And that is an issue that becomes important when we look at racial and ethnic minorities throughout the country.

MARTIN: Dr. Blackstock, in the patients that you have seen, have you been able to determine what the ripple effects of this pandemic have been on African American communities in particular?

BLACKSTOCK: You know, I was working in urgent care here in York City in late March and April and seeing in droves patients presenting with COVID-19. And it really was incredibly devastating to have sometimes three or four members of a family hospitalized at the same time. But I do feel that even though this is, you know, a scary and challenging time, it really is an opportunity for us to start thinking about structural solutions because what we do know is that this pandemic is going to be with us at least until we find a vaccine. And so there are some strategies that we can put in place to really help mitigate the devastation that we've seen so far.

MARTIN: So let's talk about what those are because, obviously, we're talking about racial disparities in America's health care system that have existed for many generations. How do you go about trying to remedy those at light speed right now?

BLACKSTOCK: You know, in the short term, we really need to think about, which are the communities that need the most resources? And so that's one reason why we really need the full racial and ethnic demographic data on testing, infection rate, hospitalization and deaths. And right now we really only have partial data. But aside from that, we really need there to be targeted widespread testing in the communities that are being disproportionately impacted, walk-up testing and mobile testing for people without cars. We also need, as Dr. Fernandez mentioned, robust contact tracing because we know that's an incredibly effective public health intervention.

But really, in the long run, what we need to do is to invest in these communities. You know, we need to fund community health centers and ensure that there are social services for housing, jobs and education because, really, those are the factors that directly influence the health status of our communities.

MARTIN: Dr. Fernandez, I'll leave you with the last word. What else is important for us to understand?

FERNANDEZ: It's really important to include preferred language as a mandatory reporting field because that's what's going to allow public health officials to really target different communities. It also allows for very important desegregation of Asian group so that we know it's Vietnamese who are affected over here; it's Tagalog speakers who are affected over there. We need that kind of information. We also really need to make sure, on the federal level and at every level, that there is consistent education to communities in the languages they speak. This is the time to realize that the health of each of us depends on the health of all of us.

MARTIN: Dr. Alicia Fernandez and Dr. Uche Blackstock, thank you to you both. We so appreciate it.

FERNANDEZ: Thank you.

BLACKSTOCK: Thank you. Transcript provided by NPR, Copyright NPR.