Our national, state and local mitigation efforts need a racial equity lens
Will Ross, MD, MPH, Professor of Medicine, Division of Nephrology & Principal Officer for Community Partnerships, Washington University School of Medicine
This column was originally published in The St. Louis American.
The novel coronavirus disease (COVID-19) pandemic, which started in Wuhan, China in December 2019, has marched across the globe and wreaked a path of death and debility that may soon eclipse the great Influenza Pandemic of 1918. COVID-19 is now present in every continent except for Antarctica and is indiscriminately striking at every demographic group.
As of March 26, there were 495,086 cases globally and a total of 22,295 deaths. Within the U.S., on that date there were 69,197 total cases and 1,046 deaths. The highly contagious and deadly virus, having wreaked havoc in Seattle, California, New York and New Orleans, is now slashing through the heartland.
Within the U.S., there is no sign that the pandemic is abating. What should frighten anyone with common sense and a conscience is the graph of world-wide mortality from COVID-19. The graph shows death by country (on a log scale) as a function of time, with the U.S. deaths in red. What is apparent is that our death rate and the rapid rate of rise precisely mirrors that of Spain and Italy, which have both overtaken China’s death counts.
The difference is that our death rate lags about two weeks behind Spain and Italy. By all accounts, given that our deaths are doubling every three days, when the COVID-19 pandemic peaks in the US within 2-3 weeks we will likely have the highest deaths in the world. These data argue for longer and even more comprehensive Stay at Home or Shelter in Place orders than we currently have in place.
So, who exactly is dying from COVID-19? And who is at risk of dying?
Based on the epidemiological studies in China, we know that over 80 percent of deaths in China occurred in adults over 60 years of age. However, according to the Morbidity and Mortality report by the Centers for Disease Controls and Prevention (CDC) for the week ending March 27, among patients who need hospitalization due to COVID-19 infections, 20 percent were ages 20-44 years; and among those who died, 20 percent were between the ages of 20-64.
However, the CDC data does not identify cases by race, and that may contribute to a false sense of security that African Americans are somehow less susceptible to the infection. That belief could not be further from the truth.
As African Americans, we suffer from higher rates of conditions like asthma, obesity, diabetes and kidney disease; these problems could predispose us to COVID-19 and make us more vulnerable to its complications. African Americans are also more likely to be uninsured or underinsured. According to Dr. Lisa Cooper, an esteemed epidemiologist with the Johns Hopkins Bloomberg School of Public Health, "this is because as a group, African Americans in the U.S. have higher rates of poverty, housing and food insecurity, unemployment or underemployment, and chronic medical conditions, and disabilities."
Although there is a scarcity of data on how COVID-19 affects the African-American community, as well as LatinX and Native American communities, a series of case reports are indicating that no group has been spared by the spread of the virus.
Case in point is Milwaukee, Wisconsin. As of March 26, there were 207 cases in the City of Milwaukee, and the majority of the cases were on the north side of town, primarily among African Americans. In a report by City of Milwaukee Health Commissioner Jeanette Kowalik, the northern half of Milwaukee has seen most of the city’s outbreak of COVID-19 cases. The three-recorded deaths in Milwaukee County as of March 26 were all middle-aged African-American men.
There is no reason this is an isolated phenomenon. While actor Idris Elba and basketball star Kevin Durant quickly became the public face of COVID-19 among African Americans, the gripping photos of Judy Wilson-Griffin, the first person to die of COVID-19 in St. Louis County, and Jazmond Dixon, the first person to die in St. Louis City – both African-American – should have been a wake-up call for all of us.
The problem is that many have not fully embraced the risk of COVID-19 because we are not aware of the number of cases of COVID-19 in the African-American and other underresourced communities. This is primarily due to the unconscionable delay in testing for COVID-19, the lack of testing facilities in the African-American community, and the need for a targeted communication campaign to increase awareness of COVID-19. Any further delays in action will have a devastating effect on the health and economic vitality of African Americans.
While all this information is sobering, there is hope we can contain this threat. It starts by placing a racial equity lens on our national, state and local efforts to mitigate the spread of COVID-19.
We must ensure that all symptomatic individuals can get rapid access to COVID-19 testing and results without accruing a cost. Currently the Cortex corridor has the only testing site in St. Louis city, and that is available to those who are referred by providers in the BJC hospital network. Amid the unprecedented collaboration between St. Louis city and county health departments and area hospitals to develop a regional response to COVID-19, there is ongoing discussion on how to urgently stand up a COVID-19 testing facility in North St. Louis.
This effort must include community leaders, as well as respected institutions such as the St. Louis Regional Health Commission and the Integrated Health Network, and the Missouri Foundation for Health. Likewise, there is an active effort by the regional response team to develop and execute a targeted communication campaign to increase awareness of COVID-19, particularly in the African-American community.
There is no room for delay; so many lives are as stake. Based on all available data, we need to act within two weeks to flatten the curve – that is, slow the spread of the disease. That means slowing the rate of infection to ensure that healthcare systems and hospital bed capacities are not overwhelmed, so that ultimately lives are saved.
There are proven ways to accomplish this: enforce even stricter social distancing guidelines and, above all else, stay at home. And let us remember a Hausa proverb: “However long the night, the dawn will break.”
*Note: It was announced on March 31 that Affinia Healthcare will open a COVID-19 testing site in North St. Louis City on April 2.
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Dr. Will Ross is associate dean for diversity at Washington University School of Medicine and professor of medicine in the Nephrology Division. Over the past two decades he has recruited and developed a diverse workforce of medical students, residents and faculty while promoting health equity locally, nationally and globally through collaborations with the Centers for Disease Control and Prevention (CDC), and public health officials in Ethiopia, Haiti, and South Africa. He is currently assisting the development of an undergraduate program in public health in northern Haiti. As a public health and health policy expert, Dr. Ross focuses on systems integration and conceptual frameworks to reduce health-care disparities. He is a co-founder of the Barnes-Jewish Hospital Center for Diversity and Cultural Competence and served on the task force that created the Washington University Institute for Public Health, while serving as co-director of the new MD/MPH program. He is vice chair of the Washington University Commission on Diversity and Inclusion. He has been instrumental in redesigning local access to health care for the underserved as the founder of the Saturday Neighborhood Health Clinic and co-founder of Casa de Salud Latino Health Center. Dr. Ross is also a founding member of the Collegiate School of Medicine and Bioscience, a magnet health professions high school in St. Louis.
Dr. Ross previously served as the chief medical officer and director of ambulatory clinics for the St. Louis Regional Medical Center, the last public hospital in St. Louis. In 1997 he was appointed a charter and founding member of the St. Louis Regional Health Commission, which has leveraged over $400 million dollars to St. Louis to maintain an integrated network of safety net primary care clinics and public health services. He served as Chairman of the board of directors of the Missouri Foundation for Health, where he directed the Foundation’s creation of the nonprofit center, Health Literacy Missouri. He served on the Institute of Medicine’s Health Literacy Roundtable, where he evaluated health literacy efforts at the international level. He is currently Chairman of the board of directors of the Mid-America Transplant Services Foundation, Chairman of the St. Louis City Board of Health, and a member of the CDC’s Health Disparities Committee, where he promotes diversity in the public health workforce. He is a founding associate editor of the new public health journal, Frontiers in Public Health Education and Promotion. He was recently elected to the Group on Diversity and Inclusion Steering Committee for the AAMC, where he focuses on strategic planning to advance faculty diversity and inclusion.
Dr. Ross is a principal investigator of the Epharmix E-Interventions for Medical Care Study and co-investigator of the APO 1-1 GUAARD Replication Study. Dr. Ross has received numerous honors and awards, including the 2005 State of Missouri Martin Luther King Distinguished Service in Medicine Award, the 2009 Washington University Medical Center Alumni Faculty Achievement Award, the 2011 Health Literacy Missouri Trailblazer Award, the 2013 Samuel Goldstein Leadership in Medical Education Award, and he is a member of Alpha Omega Alpha. A graduate of Yale University, he completed medical school at Washington University School of Medicine, an Internal Medicine residency at Vanderbilt University, and a Renal Fellowship at Washington University. He completed a Master’s of Science in Epidemiology at the Saint Louis University School of Public Health.
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Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.
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