Race

Ryan Duff

April 24, 2020

Understanding the disease of racism during a pandemic, and what healthcare providers need to do to address it.

As the COVID-19 pandemic continues to spread across the country and change every aspect of our day-to-day life in the wake of illness, death, and economic recession, frontline healthcare and hospital workers fight for the safety of their patients and themselves. Pharmaceutical companies race to find effective treatments and potential vaccines for a virus that has been described as ‘the great equalizer.’ Though the virus infects without discrimination, it currently spreads through a society that has provided a man-made pre-existing condition that allows for a more targeted and deadly disease course than anything nature could have concocted.

The condition of race.

As this infectious disease rampages through an ill-prepared healthcare infrastructure, we as healthcare providers need to demand what was, and is now more than ever, desperately needed for our most vulnerable patients. In Minnesota this problem may seem to be well handled given our markedly low infection and mortality rates. But we are in the early stages, and our department of health director admits that the early data surrounding race and infection rates of minorities in the state may not accurately reflect the true rate based on many tested individuals not reporting ethnicity. This is not to say that minorities are unconcerned with the pandemic. On the contrary, evidence suggests that minority groups are more concerned than whites about contracting and spreading the illness and African Americans are more than twice as likely to know someone who has been infected than white Americans.

The disproportionate unemployment rate in Minnesota and in the U.S broadly since before the crisis began translates to higher uninsured and homeless rates across the state for people of color. This problem assuredly will be exacerbated as millions lose their jobs in an economy fueled by low-wage and precarious labor – jobs predominantly made up of women and people of color. This means more cramped conditions that starkly contrast physical distancing recommendations and the inability to receive preventive care for the illnesses that increase morbidity and mortality form the virus, like hypertension and diabetes.

Prisons may be the most overtly punitive method of discrimination during a pandemic. America has the largest prison population, both per capita and in gross population. This population is overwhelmingly poor people of color. As America is already seeing in New York and Chicago, these prisons are massively overcrowded and ill-equipped to separate their populations leading to rampant outbreaks. As schools across the country remove students from crowded dorms and hotels are cleared out of guests, we need to address this tragedy that other countries have done en masse to protect already vulnerable populations from further disease spread.

And the struggle does not end once one enters the hospital – our healthcare system is not immune to implicit bias and that bias is already being structurally implemented as result of this pandemic. As supplies become scare and severe cases begin to mount, decisions to ration life-saving care will become an unfortunate reality. If we do not take into account systemic racism’s role in predisposing minority populations to worse clinical data that our rationing algorithms are based, then a ‘saves-the-most-lives’ approach implements an ostensibly unbiased algorithm that, in practice, is biased against the poor and people of color. We know that the average baseline health characteristics and longevity of people of color are worse than whites due to systemic factors such as living near toxic chemical producing facilities and not having access to healthcare to manage chronic conditions. When the assessment of ‘objectively’ rationed care does not take this into account, we set up a discriminatory triage system that neglects our most vulnerable communities.

This virus does not only cause disease – tragic, horrible, and agonizing that despite earlier misclassifications as a disease of the elderly has taken more than its fair share of otherwise young, healthy victims. But as we are seeing in the Midwest and across the U.S, this pandemic will highlight the already glaring inequities in healthcare that will (and should) be heard thunderously across the country and the world. This virus is the PET scan that shows in vivid detail the glaring metastatic disease of institutionalized racism that has been widespread throughout the country since its inception. Now more than ever, it’s time for us to address that insidious cancer with bold action in the legislature. It’s time for us, as leaders in the healthcare field, to demand a fighting chance to those who’ve been purposefully kneecapped by a pervasive system of oppression by working with those whose calls for action have gone unaddressed for too long. If we are serious about combatting this crisis with the sense of urgency it demands, we need our policymakers taking comprehensive action to address racism, head-on, right now.

About the Author: Ryan Duff is a 3^rd year medical student at the University of Minnesota with an interest in internal medicine and critical care.