We are now over one month into the official public health emergency and almost three months past the first known case of COVID-19 in the United States. No one is unaffected. My medical colleagues across the nation bravely fight to save patients all across the country. Recently, I operated on a COVID-19 positive patient who required urgent hip surgery. As I left for the hospital that morning, my husband and children implored me to be careful. They worry about me.
I worry too, but not for me. I do not think I will become ill, and if I do, I have great access to extraordinary care at my hospital. I do worry for the black, brown and poor people who are disproportionately dying from this virus. The reality is that we are not all equally impacted by this pandemic. As a physician and champion for health equity, I am not surprised. This was absolutely predictable. This pandemic is exposing many of the known inequities that plague our health care system.
Communities of color and the poor represent a disproportionate number of COVID-19 deaths. In cities like Milwaukee, African Americans account for the most positive cases and deaths despite only making up 27 percent of the population. We are seeing similar trends with the African American population in Chicago, and with the African American and Hispanic populations in New York City.
Inadequate data collection has and continues to prevent us from seeing the full picture. Only 26 states are currently publishing racial and ethnic data on their coronavirus patients. This is absolutely inexcusable. I do not know how to state it in stronger terms. Understanding the type of patients who are most impacted by a disease is essential to developing effective prevention and treatment strategies. One must ask why the data is not being collected. Perhaps because we do not want to know? Or perhaps this is unconscious bias by our leaders? Whatever the cause, intended or not, this inadequate data collection represents nothing less than structural racism. Let’s at least have the courage to call it what it is.
Legislation has been introduced to address this. The bill would require federal agencies to collect and publish information on race, ethnicity, sex, age, primary language, socioeconomic status, disability status and county for COVID-19 testing, hospitalization and mortality rates. This legislation would also create an advisory panel on health equity. We need these measures, and we need them now.
COVID-19 has higher mortality rates for patients with certain comorbid conditions. Black, brown and poor communities have higher rates of these comorbid conditions. The CDC analyzed data from China’s outbreak showing that the fatality rate was 0.9 percent for patients with no other medical conditions. However, the mortality rates for patients with cardiovascular disease was 10.5 percent and 7.3 percent for diabetic patients. Research shows that African Americans and Hispanic Americans are at particularly high risk for diabetes compared to other demographics and African Americans are 20 percent more likely to die from heart disease than caucasians.
One of the reasons the comorbidity rate is so high for these communities is that they do not have adequate access to health care. Many of these populations are primarily served by safety net hospitals, already desperate for more resources to treat the everyday needs of their populations. Furthermore, safety net hospitals are closing at record rates. Last year we saw the highly publicized closure of Philadelphia’s safety-net Hahnemann Hospital. I am compelled to paraphrase Hahnemann’s Dr. Kevin D’Mello: safety net hospitals play an essential role in maintaining the health and safety of the entire public (the rich and the poor), just as police and fire departments do.
When this pandemic finally ends, we cannot forget the lessons we have learned. While the poor are more likely to die, the affluent are not isolated. We are all connected. And while we may not want to acknowledge this, there will be another pandemic. We must be better prepared by improving our safety-net system and the health of our communities. We must address the inequities and racism in our system. Some patients — and some communities — require additional resources to promote health. We must make long-term investments to achieve health equity — to save us all.
Mary I. O’Connor, M.D. is chair of Movement is Life, a multi-stakeholder organization dedicated to promoting health equity, and professor of orthopaedics and rehabilitation at Yale School of Medicine.
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