Disparities in Care During the COVID-19 Pandemic – Part 2

Communities of color have long faced disparities in the health care system, in part because of discrimination, poor health, and insufficient insurance coverage. There have been many reports of racial bias in medicine, often called ‘implicit bias’, and that black patients receive inferior medical care to white patients. For instance, pain is undertreated in blacks because of the thought that blacks have less-sensitive nerve endings, or that that our blood coagulates faster or more quickly, or it’s just thought that black pain is rated lower than whites.

Disparities In Treatment

Blacks are more likely than whites to receive drug testing when prescribed long-term opiates, even though whites show higher rates of overdose. Blacks are also thought to be responsible for their own state of health and are blamed for their own health conditions, while whites are thought to be victims of their own state of health and resources should be given to help those ‘victims’. As such, black people are now being blamed for dying from COVID-19. I would like to point out that NO ONE was blamed for contracting and dying from COVID-19 until it was pointed out that black people were contracting and dying from COVID-19 at higher rates than their non-black counterparts.

As far as testing and treatment are concerned, racial bias in medicine could lead some healthcare workers to underestimate the health complaints of black patients, and/or undertreating or being less aggressive with symptoms. A recent article in the Washington Post reported that African Americans appear to be shortchanged even in testing for covid-19. That could make the racial disparities in rates of infection and death even worse, as delays in testing leads to delays in treatment which can lead to preventable death.

COVID-19 Screening Questions

Current screening practices ask questions like, “have you traveled internationally? Have you been exposed to anyone who has COVID19?” These questions miss several important factors… many people don’t know if they’ve been exposed… there is a lack of testing in communities of color, so many people don’t know if they actually have COVID-19…  poorer communities may tend to travel internationally less than more affluent communities, and since they tend to be front-line workers, they may be more exposed to those that have traveled internationally. One study suggests that black people who visited hospitals with symptoms of COVID-19 in February and March were less likely to get tested or treated than white patients. Delays in testing have been linked to lack of testing resources and not ‘fitting the screening criteria’, but many fear that providers may misinterpret or ignore COVID-19 symptoms in black patients.

COVID-19 Testing

As of May 7, only Illinois and Kansas were reporting on who is getting tested. In Illinois, African Americans make up 38% of coronavirus deaths and 24% of confirmed cases — both far out of proportion to their share of the population. What’s worse is that only 13% of those tested are black, suggesting that African Americans are being drastically underserved by the effort to control the spread of the disease. If blacks are not being tested at a rate equal to the threat they face, we lose the opportunity to quarantine those who test positive before they have a chance to spread the virus. And conducting contact tracing to find out who else is at risk is not done. Consequently, the negative effects of COVID19 are on track with other health disparities that we have seen for many, many years.

COVID-19 Deaths

Black Americans are dying of COVID-19 at much higher rates compared with other Americans in some major cities, but most federal officials and states are not keeping track or releasing racial data on the COVID-19 victims, raising concerns about care for the nation’s most vulnerable populations. There is worry that minorities aren’t receiving adequate information, or misinformation, about the illness or access to testing. Additionally, there is a longstanding distrust of the health establishment among blacks. The distrust caused by slavery, racism, and public health events such as the Tuskegee Experiment informs how many African Americans view the government’s response to the COVID-19 pandemic. Having an awareness of the long history of medical experimentation on black people is important. Couple that with the new virus and the development of a new vaccine, many blacks are indeed skeptical.

*For more information on health disparities in general, and to illustrate the impact of health disparities, please watch “Unnatural Causes: Is Inequality Making Us Sick?” https://unnaturalcauses.org. This is a 7-part documentary series that explores racial and social inequalities in health.

The environment in which we live is a major determinant of our health and wellbeing. Clean air, water, soil, plants, food supplies, and even our community environment which includes the Social Determinants of Health, are essential for our personal health. In my blog’s Environmental Health Series, we will continue to talk about the environment and try to answer the question, “What is an unhealthy environment and how does it get under the skin?”The environment’s effect on our health is complicated, but there are ways that we can prevent and reduce toxic exposure.

Stay tuned as we examine Disparities in Mortality During the COVID-19 Pandemic…