Tagged Disparities

Long-Standing Racial And Income Disparities Seen Creeping Into COVID-19 Care

The new coronavirus doesn’t discriminate. But physicians in public health and on the front lines said they already can see the emergence of familiar patterns of racial and economic bias in the response to the pandemic.

In one analysis, it appears doctors may be less likely to refer African Americans for testing when they show up for care with signs of infection.

The biotech data firm Rubix Life Sciences, based in Lawrence, Massachusetts, reviewed recent billing information in several states and found that an African American with symptoms like cough and fever was less likely to be given one of the scarce coronavirus tests.

Delays in diagnosis and treatment can be harmful, especially for racial or ethnic minority groups that have higher rates of certain diseases, such as diabetes, high blood pressure and kidney disease. Those chronic illnesses can lead to more severe cases of COVID-19.

In Nashville, three drive-thru testing centers sat empty for weeks because the city couldn’t acquire the necessary testing equipment and protective gear like gloves and masks. All of them are in diverse neighborhoods. One is on the campus of Meharry Medical College — a historically black institution.

“There’s no doubt that some institutions have the resources and clout to maybe get these materials faster and easier,” said Dr. James Hildreth, president of Meharry and an infectious disease specialist.

His school is in the heart of Nashville, where there were no screening centers until this week.

Most of the testing in the region took place at walk-in clinics managed by Vanderbilt University Medical Center, and those are primarily located in historically white areas like Belle Meade and Brentwood, Tennessee.

“There’s no doubt that some institutions have the resources and clout to maybe get these materials faster and easier,” said Dr. James Hildreth, president of Meharry and an infectious disease specialist.(Photo by Ken Morris/Courtesy of Meharry Medical College)

Hildreth said he has observed no overt bias on the part of health care workers and doesn’t suspect any. But he said the distribution of testing sites shows a disparity in access to medical care that has long persisted.

‘I Pray I’m Wrong’

If anyone should be prioritized, Hildreth said, it’s minorities, whose communities already have more risk factors like diabetes and lung disease.

“We cannot afford to not have the resources to be distributed where they need to be,” he said. “Otherwise, the virus will do great harm in some communities and less in others.”

Data from late March show the location of coronavirus testing sites in Shelby County, Tennessee. It reveals that most screening is happening in the predominantly white and well-off Memphis suburbs, not the majority-black, lower-income neighborhoods.

The Rev. Earle Fisher has been warning his African American congregation that the response to the pandemic may fall along the city’s usual divides.

“I pray I’m wrong,” Fisher said. “I think we’re about to witness an inequitable distribution of the medical resources, too.”

Around the nation, leaders are taking note of disproportionate health outcomes. In Wisconsin, African Americans accounted for all of Milwaukee County’s first eight fatalities.

Gov. Tony Evers said he wants to know why black communities seem to be hit so hard. “It’s a crisis within a crisis,” the Democrat said in a video statement.

The Centers for Disease Control and Prevention is also on the ground on the north side of Milwaukee, as well as several other hot spots, looking into the outbreak in black neighborhoods.

Nationwide, it’s difficult to know how minority populations are faring because the CDC isn’t reporting data on race.

A few states are releasing more demographic data, but it’s incomplete. Virginia is reporting race, yet the state’s report is missing that information for two-thirds of confirmed cases.

Dr. Georges Benjamin, executive director of the American Public Health Association, has been pushing health officials to start monitoring race and income in the response to COVID-19.

“We want people to collect the data in an organized, professional, scientific manner and show who’s getting it [appropriate care] and who’s not getting it,” Benjamin said. “Recognize that we very well may see these health inequities.”

The Usual Disparities

Until he’s convinced otherwise, Benjamin said he assumes the usual disparities are at play.

“Experience has taught all of us that if you’re poor, if you’re of color, you’re going to get services second,” he said.

The subjectivity of coronavirus symptoms is what worries Dr. Ebony Hilton the most.

“The person comes in, they’re complaining of chest pain, they’re complaining of shortness of breath, they have a cough — I can’t quantify that,” she said.

Hilton is an anesthesiologist at the University of Virginia Medical Center who has been raising concerns. She sees problems across the board, from the way social media is being used as a primary way of educating the public to the widespread reliance on drive-thru testing.

The first requires an internet connection. The second, a car.

Hilton said the country can’t afford to overlook race, even during a swiftly moving pandemic.

“If you don’t get a test, if you die, you’re not going to be listed as dying from COVID,” she said. “You’re just going to be dead.”

This story is part of a partnership that includes Nashville Public RadioNPR and Kaiser Health News.

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Must-Reads Of The Week From Brianna Labuskes

Hello! It is once again Friday, which means I’m going to attempt to do my very best to give you a snapshot of some (read: a fraction) of the best stories from the week amid a flood of them.

But first! Take yourself on this journey about how the most well-known coronavirus image (that gray blob with stone-like texture and red crowns and colored flecks) was made. Sometimes when the government is creating informational illustrations it focuses on the vector or the symptoms, but for this coronavirus the CDC’s Alissa Eckert and Dan Higgins went with what’s called a “beauty shot.” It’s a very cool read!

All right, here we go:

The confirmed number of confirmed cases globally ticked past a million this week in a grim milestone that experts still say represents only a percentage of the actual cases out there. The U.S. had recorded over 250,000 cases as of press time, with more than 6,500 deaths.

President Donald Trump invoked his wartime powers to help manufacturers secure supplies needed to make ventilators and protective face masks, but is it too little, too late? New York Gov. Andrew Cuomo, whose state has become the epicenter of the nation’s outbreak, said on Thursday it will use up all available ventilators in less than a week. Meanwhile, FEMA said that most of the ventilators Trump promised to obtain won’t be ready until June.

Governors are distraught over their inability to obtain the needed supplies, likening the process of requesting the equipment to eBay auctions. “You now literally will have a company call you up and say, ‘Well, California just outbid you,’” Cuomo said.

Another roadblock is that 2,000 of the ventilators in the national stockpile are unusable because of a lapse in a contract that left a monthslong gap, during which the machines weren’t being properly maintained.

In the meantime, General Motors has shrugged off Trump’s attacks on the company (he said GM and its chief executive were dragging their feet on the project) and are moving full-throttle ahead at producing the needed equipment. “Every ventilator is a life,” said one GM exec.

With so much focus on ventilators, doctors are being advised on how to ration care and being told that they’ll be supported in their decisions not to perform futile intubations.

One quick note on that front: New York lawmakers are moving on legislation that would grant sweeping civil- and criminal-liability protections to hospitals and health care workers dealing with coronavirus patients.

And even though there’s a ton of attention on ventilators, the survival rate of any patient who requires one is only 20% — meaning that even without a shortage, they can only help a fraction of patients.

In other important news on the preparedness front:


Trump warned Americans this week that “hard days” lie ahead and that people should be braced for a “bad two weeks,” with the White House projecting that the death toll could be somewhere between 100,000 to 240,000. For what it’s worth, disease forecasters were mystified over where the task force got those numbers, mostly because we don’t yet know enough about the virus.

(What helped change Trump’s mind, considering he’d previously mused that the country could return to normal in time to fill the pews on Easter? Polling numbers.)

To help states deal with the crisis, CMS relaxed safety rules for hospitals, giving them unprecedented flexibility. The changes include what counts as a hospital bed, how closely certain medical professionals need to be supervised and what kinds of health care can be delivered at home.

The administration decided not to follow suit after a handful of states reopened their exchanges, though Trump seemed to hint that the possibility was still on the table “as a matter of fairness.” Also, to note, if people have lost their insurance because of their jobs, that counts as a qualifying event and they have 60 days to enroll in the federal exchanges, regardless of what Trump does with a special session.

And although Drs. Anthony Fauci and Deborah Birx, along with Vice President Mike Pence, have emerged as the leading voices of the administration’s pandemic response, Trump’s son-in-law Jared Kushner has taken charge behind the scenes. Critics say its adding confusion to an already chaotic situation.

And reports continue to emerge that the Trump administration was cutting pandemic detection positions in China just months before the outbreak.

In other news on the administration:


House Speaker Nancy Pelosi will be creating a special committee to oversee the implementation of the $2.2 trillion stimulus package and any other coronavirus legislation coming down the pike. “Where there’s money there’s also frequently mischief,” Pelosi said, in perhaps one of my favorite quotes of the week. Meanwhile, House Democrats may be raring to get started on a fourth stimulus package, but Republicans are pumping the brakes. At the very least, they say, they want to see how the current stimulus package plays out.

The news came the same day as it was reported that 6.6 million Americans filed for unemployment benefits. That eye-popping number blows past all previous records. And experts say it represents only a sliver of the economic devastation the virus is wreaking on the country. There are many affected Americans who remain uncounted — some have lost jobs or income and did not initially qualify for benefits, and others, encountering state unemployment offices that were overwhelmed by the deluge of claimants, were unsuccessful in filing.

In other news about Congress and the economic damage from the outbreak:


The Democratic National Convention, expected to draw as many as 50,000 visitors, was postponed from July to August in one of the largest disruptions to the 2020 elections so far. On the other hand, Wisconsin is going ahead with its primary on Tuesday, which is causing mixed reactions … including apoplectic rage.

More stories on elections:


Much focus this week was on serology tests that serve the dual purpose of finding Americans who can safely return to some normalcy and helping researchers find treatments for COVID-19. Experts are fairly unified on the fact that to get the country back into operation, we need a way to identify those who are now immune to the disease. And using plasma collected from recovered patients is a century-old practice (which, to be clear, has had mixed results in past diseases).

Beyond studies on actually treating the coronavirus illness (a small study out this week showed a much-touted malaria drug combo had positive results), doctors are also trying to figure out how to treat the phenomenon known as “cytokine storm,” in which the body’s own immune system attacks its organs. This is thought to be the cause of some of the severe cases seen in younger patients.

On a side note, the Food and Drug Administration on Sunday issued an emergency-use authorization for hydroxychloroquine and chloroquine, despite scant evidence that they work against COVID-19.


With Florida (and three other states who had been hesitating) finally caving into pressure to issue the stay-at-home order, the vast majority of Americans are now huddled at home. The good news is that the extreme measures seem to be working in California, which was an earlier disciple of flattening the curve.

Google, meanwhile, is offering the government a report on “mobility data” to help states recognize where social-distancing measures are failing, with a specific focus on how foot traffic has increased or declined to six categories of destinations: homes; workplaces; retail and recreation establishments; parks; grocery stores and pharmacies; and transit stations.

Although things might seem a bit grim right now because of these measures, a look at data from the 1918 flu pandemic shows cities that locked down emerged from the crisis stronger economically than those that didn’t. One caveat, though: Because working-age people were harder hit by the 1918 flu (and the coronavirus strikes worse among older generations), any comparisons might not hold.


So, onto some of the stories I find most fascinating … aka the science behind all of this.


I’m going to cut this off here, or else this will no longer be able to be called the Breeze. If you want a more comprehensive roundup, please check out the Morning Briefings from the week, which are chock-full of more stories than you could ever finish reading. Including ones on workers’ protests and the supply chain; the gun store debate; how jails are “ticking time bombs;” autocrats’ power grab; snapshots from a New York in crisis; health disparities; and a call to arms for medical workers that doesn’t guarantee coverage of potential hospital bills.

Please have a safe and restful weekend, if possible!

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