It is oft stated in the Black community: “When the country gets a cold, we get pneumonia.”
The genesis of this saying is unclear but the inference is not, nor is it inaccurate. Black people suffer more from adverse medical conditions, with poorer outcomes. COVID-19, the disease process caused by infection from the pandemic virus SARS-CoV-2 has demonstrate its accuracy.
Let us take a broad look at COVID-19, before we take a close look at the disparate effect on the African-American community.
We are facing the greatest healthcare threat that most of us have ever seen. This is not hyperbole. Our patients and community only need us to give them the real message without shouting. When an NMA physician speaks, the community listens; such is the role of the Black physician in the Black community. We respect that and accept that authority. The messages regarding COVID-19 need to come from us, and other trusted sources. Do note that though, with great authority comes great responsibility.
Here is an analogy that gives a visible face to this invisible biological adversary: a wildfire. None of us have experienced anything that parallels what we are living through with this virus, however many areas of the country that have experienced the devastation of a wildfire; all understand the grave threat with wildfires. There are five parallels that frame well what we are facing:
1. COVID-19 is burning through the nation. The frontline, this time the healthcare workers instead of the firemen are at the highest threat;
2. COVID-19 will not be extinguished by our efforts; it will only be contained. The response from the greater community will be what limits the overall scale of human tragedy; in a wildfire escaping, in this pandemic, sheltering in place;
3. The catastrophe will end: in a fire, when there is no more flame, with COVID-19, when there are no more (or minimal) cases;
4. When we look back there will be a trail of destruction; in a wildfire, a ravaged landscape with fatalities; with COVID-19 a ravaged economy with fatalities. And last;
1. 5. In the end, after a wildfire, the forest recovers, people rebuild. With COVID-19, the economy will recover, people will rebuild our lives. There is life after disaster. We are a resilient people. Our sole purpose as health care providers and citizens is to mitigate the damage from COVID-19, and heal the scars that will inevitably be present after this ends.
Now let us explore the disparate effect on the African-American community: overall in the US we are 35% of those hospitalized and dying, but 13% of the population; 2.7 times more likely to have an adverse outcome. Why?
We are 2.2 times more likely to have diabetes, 20% more likely to have high blood pressure, and 30% more likely to be obese. The incidence of COPD (lung disease) in our women is 34% higher than in White women. These are all CDC-identified risk factors for worse outcomes. Bottom line, if we acquire the virus, bad things are more likely to happen. That’s pass number one.
Let us layer on that more baggage. It is now known that the social determinants of health (SDoH) play as important a role in a person’s health as genetics or medical treatment. There are, broadly six SDoH categories: economic stability, physical environment, education, food, community and social content and health care systems. Blacks are adversely affected in these arenas. For example, with poorer housing we cannot generally socially isolate when we have 6 people in a 2 bedroom apartment. Searching for healthy food, or using the bus to get to work (if you have a job and going to work), puts one at higher risk of acquiring the infection. I will separate one out the above noted SDoHs: economic stability, (or lack thereof). Quoting from the Brookings Institute, “at $171,000, the net worth of a typical White family is nearly ten times greater than that of a Black family in 2016.” The Black-White WEALTH gap leads to a Black HEALTH gap that reflects a society that has not and does not afford equality of opportunity to all its citizens.
Lastly there’s the ugly truth of 400 years of racism. Studies show that even when you remove income, insurance coverage, and education as factors, Blacks STILL have worse outcomes. Race in and of itself is an independent factor that affects our health.
So here we are. Where does all of this leave us? With pneumonia.