The Great Magnifier: Why Collection Racial Data During COVID-19 Is a Necessary Start – But Only the Start (Part 2)
The Coronavirus pandemic, as it has been called, is not the “great equalizer.” Rather, it is more a “great magnifier.”
As current if not limited data continues to be released regarding the racial makeup of those affected by COVID-19, those already committed to health equity are unfortunately not surprised.
While this virus has indeed sickened and killed many regardless of race and income, we have witnessed those with socioeconomic means continue to access testing with ease. However, those in vulnerable communities inhibited by structural and systemic racism, poor social determinants of health, and historically embedded implicit bias in both health care policy and practice, have struggled to be evaluated despite prevalence of comorbidities such as hypertension, heart disease, asthma, and diabetes.
Add in lower wages at jobs still deemed “essential,” a lack of paid sick leave, limited access to affordable medical care, and dependence on public transportation and this global public health crisis becomes even deadlier for many people of color.
The tragic writing on the wall for brown and black communities has been evident since policymakers released initial testing recommendations through a lens of privilege, calling for testing of symptomatic individuals only if they had a fever, cough, and shortness of breath, in addition to having also recently traveled to an affected area or having been in contact with someone known to have COVID-19.
According to Dr. Uché Blackstock, a physician treating urgent care patients in Brooklyn and founder and CEO of Advancing Health Equity in New York City, most who answered “yes” to those questions were both affluent and white, while most black patients answered “no.”
Additionally, initial testing required a physician’s referral. How many of those in the Asset Limited, Income Constrained, Employed (ALICE) population had existing relationships with primary care physicians while working multiple jobs, especially those living in densely populated, economically stressed areas, such as the outer boroughs of New York, the South Side of Chicago, and cities like Trenton and Newark, where drastically low ratios of primary care physicians to residents serve as additional barriers to care?
It’s no surprise, then, that when many of the symptomatic individuals without medical homes in such deeply impacted communities began seeking referrals, little to no medical history was available to fully understand what other conditions might put them at higher risk for complications with COVID-19.
Even as drive-through testing centers opened that simply required proof of residency, the ill were expected to not only have access to a vehicle, but also be in good enough condition to drive. You see, the lens of privilege often does not see through to households in under-resourced areas, who do not own cars and also lack access to childcare, computers and internet services for family members now confined to their homes. The challenge of social distancing is quite different for those who live in multi-family units or densely packed public housing.
Lastly, an unthinkable shortage of tests from the start ultimately resulted in many untested individuals being told to manage their symptoms at home, without medical oversight to monitor any progression of illness.
Because this virus has repeatedly been viewed and approached through a mainstream lens, seemingly young and “healthy” individuals have been sent home to languish and ultimately die, including a disproportionately high number of people of color.
Furthermore, far too few states have even been tracking and reporting the racial breakdown of those infected with and killed by COVID-19 – and, for those to whom we are grateful for doing so, their efforts have revealed disastrous outcomes:
At the beginning of April, African Americans in Wisconsin made up almost half of Milwaukee County’s 945 cases and 81% of deaths in a county whose population is 26% black;
In Michigan, where the black population in 14%, more than 35% of cases and 40% of deaths were African Americans;
And, in my home state of New Jersey, while black residents make up just under 15% of the population, African Americans have accounted for nearly 26% of cases and 22% of fatalities.
Implicit bias has been embedded into our health care systems in such a way that well-intentioned medical professionals have been trained to often unwittingly respond with historical standards that continue to proliferate it.
The first step in beginning to change that is to begin collecting and releasing the racial data of COVID-19 patients nationwide to better determine who is being tested and treated and who’s not.
The challenge is that if municipalities did not already have such a lens through which to look, they are most certainly not considering that now during this crisis.
Hospitals will report such data if in fact states mandate it, but it is always better to request the data up front than to have to look backwards in time to cull it after the fact. Data collection is necessary now so that testing can be better focused in areas severely distressed by the impact.
Conversations are indeed now being held at both a congressional and state level due to the growing unease that more black and brown community members are being denied testing.
In New Jersey, Senator Ron Rice (D-Essex), a Newark-based leader who heads the state’s Legislative Black Caucus, introduced legislation that not only requires hospitals to track and report details on the age, ethnicity, gender and race of patients in New Jersey who have tested positive for or have died from COVID-19 to the Department of Health, but also requires each county and municipality to report how many residents have attempted to get tested or treated, including whether they were indeed tested, admitted, or turned away.
“As a result of decades-long systemic injustice throughout the nation, the poor, minorities and people of color are always subject to greater instances of disease, poor health and shorter lifespans,” Rice wrote in the bill. “COVID-19 shines a spotlight on that disparity as we see minorities, and especially blacks, succumb to this pandemic at an alarmingly accelerated rate.”
Furthermore, in March, Democratic lawmakers issued a letter to Health and Human Services Secretary Alex Azar, stating “this lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities.”
“Any attempt to contain COVID-19 in the U.S. 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.”
Such data is needed to not only more quickly alter screening practices to ensure more adequate testing, including making testing sites more accessible through “walk up” rather than merely “drive through” sites, but also to help better allocate resources and funding to underserved and vulnerable communities both during and after the current COVID-19 outbreak.
However, our efforts should not stop with data collection. The socioeconomic aftermath of this pandemic will also be devastating, especially in vulnerable, under-resourced communities of color suffering from historical disinvestment. Any state or federal relief packages must directly target these areas, including but not limited to the families, businesses, and municipal budgets that drive these communities. Large, midsize, and even small businesses also should be incentivized to adopt anchor measures that will ensure both the hiring and procuring from such hard-hit communities, with job training and job placement dollars accompanying any stimulus package once a return to the “new normal” is in sight.
Data collection is simply a means to the beginning of our work to dismantle the effects of historical structural racism and systemic inequity in our communities by creating more effective policies and procedures related to social determinants of health, including but not limited to investments in education, livable wages, and affordable access to nutritious food, healthy housing, and comprehensive health care.
Then and only then can we begin to correct the disparities that have plagued our health care systems for generations.