I’m Concerned About “US”: A Black Doctor’s Plea for Racial COVID-19 Data
Thousands of people have died in the United States from COVID-19. Among them is a family friend.
I woke up to see my husband crying. “He died,” he said with a whisper. “My mother texted me this morning.”
We found out a week prior that he was in the intensive care unit on a ventilator. His family requested our prayers.
“I saw him at church four weeks ago.” My father-in-law stated, incredulous at the turn of events. “He looked great.”
There are and unfortunately will be many stories like ours. Families grieving under the restrictions of social distancing. The number of deaths in the United States doubles every three days.
Newspapers, like The New York Times and the Chicago Tribune, are sharing obituaries of individuals who have lost their lives to Coronavirus. Their stories and their faces are even more important to see now when families and friends cannot visit hospitals or gather for funerals. People are dying alone; their families mourn alone.
I noticed a trend among the obituaries I read. They feature high numbers of Black people. They look like me, like my family’s friend. A family in Chicago has lost two sisters, Patricia and Wanda Frieson, to coronavirus at 61 and 63. Arnold Obey, an avid marathon runner and retired principal in New York, died at 73.
But the ages of Black and brown victims were also lower than I expected. Dez-Ann Romain at 36. Dave Edwards at 48. Kious Kelly, an assistant nurse manager, at 48.
I am a doctor; I am not on the front lines of this pandemic. As a pediatrician in an Adolescent Medicine fellowship, my clinical work is mostly outpatient. I rely on physician colleagues caring for adults to share their experiences.
Dr. Uché Blackstock, emergency medicine physician and founder and CEO of Advancing Health Equity, recently shared her predictions about the impact of coronavirus on Black patients due to racial disparities. She noted that Black patients were often denied testing due to a lack of travel history or contact with an individual who had positive testing. “We got all of these patients who would come in and had flulike symptoms but didn’t have the flu, and they probably had COVID-19. But we weren’t able to identify them because the criteria is already biased.”
Her predictions were published on March 30th, only two days after Bassey Offiong, a 25 year old chemical engineering student, died from coronavirus after being denied testing several times despite reporting symptoms of fever, fatigue, and shortness of breath.
Dr. Blackstock also warned that higher rates of chronic diseases in the Black community could lead to higher risk of adverse outcomes with COVID-19. Some physicians are drawing similar conclusions based on the racial disparities in their hospital’s coronavirus admissions. An Internal Medicine doctor in a Midwest suburb notes that over half of the patients admitted at his hospital are Black even though the hospital is in a predominantly white community. At another hospital in the Rocky Mountain region, almost 80% of hospitalized patients are Black or brown despite the population being mostly white.
The local and state data that has been reported confirms these suspicions. In Illinois, Black people are 28% of confirmed cases, but only 14.6% of the state population. In Chicago, they make up 70% of deaths and 29% of the city population. In Milwaukee County, which is 26% Black, Black people make up half of COVID-19 cases and 81% of deaths. Racial inequities have also been noted in Michigan and North Carolina.
To understand the full scope of these inequities, all hospitals and health organizations need to start tracking race and ethnicity in COVID-19 data collection. Democratic lawmakers, including Senator Elizabeth Warren and Representative Ayanna Pressley sent a letter to the Health and Human Services Secretary Alex Azar last week requesting the Center for Disease Control and Prevention work with local and state health organizations for comprehensive demographic data collection.
The letter reads, “any attempt to contain COVID-19 in the United States will have to address its potential spread in low-income communities of color, first and foremost to protect the lives of people in those communities, but also to slow the spread of the virus in the country as a whole. This lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities.”
Inequitable health outcomes impact Black, Latino, and Native communities who are disproportionately experiencing poverty, housing and food insecurity, incarceration or detention, unemployment or underemployment, disabilities, chronic diseases, less access to health insurance and paid sick leave, and poorer access to quality health care. Any of these factors could lead to higher rates of infection or adverse outcomes.
To decrease the impact that coronavirus will have on communities of color, we need to change the narrative that only the elderly are at risk. Younger people, particularly those with chronic diseases, are dying and those with moderate or severe symptoms need access to timely testing and appropriate care.
Prevention of coronavirus spread is currently the only effective method for preventing adverse outcomes, including mortality. As Chicago, Detroit, and New Orleans become emerging epicenters of the pandemic, all urban cities with large Black populations, we need all states to follow California’s example of implementing an early, widespread shelter-in-place order to prevent further infections.
Access to resources and dissemination of accurate information is essential for protecting marginalized communities from coronavirus. Communities are innovating their own solutions to protect their most vulnerable members. In Chicago, organizations My Block, My Hood, My City, Good Kids Mad City, and We Women Empowered, are delivering food and hand sanitizers to seniors and individuals living with disabilities. Families everywhere are looking after each other by calling their elderly members. Churches are educating congregations about symptoms of COVID-19 and how to seek help if symptomatic.
The COVID-19 pandemic has brought longstanding health inequities in the United States to the surface. Black, Latino, and Native populations need our attention now to protect them from adverse outcomes from centuries of discrimination.
We must also get to work on addressing the policies that create and maintain health inequities. The lives of my community and so many others depend on it.
Rebekah Fenton, MD is a pediatrician and Adolescent Medicine fellow at Northwestern University and Ann & Robert H. Lurie Children’s Hospital of Chicago.
