By Starane Shepherd, MD, Assistant Professor of Neurology, Rush University Medical Center, Chicago, IL
Over the last year of this pandemic, I have taken care of a large number of patients with COVID-19 infections in our neurocritical care unit. At the height of the surge in Chicago, our unit became one of the COVID-19 ICU surge units and battled the health crisis sweeping through my city, Chicago, the United States and the world. While taking care of these patients, struggling for their every breath, one factor stood out to me: their race. Most of the critically ill patients in the ICU were the Black and Brown people of Chicago.
Data from the Centers for Disease Control , as of Jan. 13, 2021, show that death rates of those infected with COVID-19, are significantly higher among Black and Hispanic/Latino people than their White counterparts. In fact, for those who identify as White, rates of mortality are lower than expected. Simplified, this means that racial minorities are dying at a higher rate than expected, while White people are doing better than expected.
The COVID-19 pandemic has continued to expose racial healthcare inequity that exists within America. The average life expectancy for a resident of the Loop, the business district of Chicago, according to research by the Center on Society and Health at Virginia Commonwealth University, is 85 years old. Comparatively in Garfield Park, a predominantly African-American community on the South Side of Chicago, the life expectancy is 69 years old. In a distance of about 7 miles, the difference in life expectancy is 16 years. This death gap is not only present in Chicago but in many cities across America.
The history of race and the effects of racism within the United States are pervasive throughout all spheres of daily life. As physicians, we seek to “do no harm,” but we continue to ignore that the knowledge and practice of medicine itself has been forged in a world of biases as they relate to gender, sex and race.
Despite acknowledging that race is a social construct and not a biological or genetic construct, we as healthcare providers continue to perpetuate flawed assumptions and continue to misuse racial variables within medical education, research and approach to patient care. A recent paper in the New England Journal of Medicine highlighted the role of medical education in perpetuating these racial biases. We do not question using a specific anti-hypertensive regimen endorsed by the American Heart Association in African-Americans, nor do we question an African-American specific estimated Glomerular Filtration Rate when none exists for other races.
We continue to use racial variables in epidemiological data that suggests that race itself is a pathologic factor placing our patients and ourselves at risk for various diseases. In choosing to stay only skin-deep we ignore the various socioeconomic disparities that exist among racial groups in the United States, and often the world, and ignore that race is in fact a risk marker of poor access to care, impoverished living conditions, inequity and racism.
As physicians under-represented within medicine, we are not immune to the effects of racism within the healthcare system. Dr. Susan Moore, a Black family care physician in Indianapolis, presented to a local hospital in Indiana after being diagnosed with a COVID-19 infection. She posted a video on Facebook on Dec. 4, 2020, where she detailed how her symptoms were ignored by her treating physician and was denied access to pain medication as well as remdesivir. She said in her video, "This is how Black people get killed …when you send them home, and they don't know how to fight for themselves." Despite her plea for further treatment, she was discharged to home and in less than 12 hours was admitted to another hospital in Indiana. Despite knowing how to advocate for herself within the healthcare system, Dr. Moore died 3 weeks later at the age of 52.
As healthcare providers, we need to ensure that the healthcare system works to provide equitable care for all regardless of race. We must face our implicit biases and stop teaching our trainees flawed race-based facts. The research we conduct should go beyond skin color and seek to understand why Hispanics, African-Americans and other racial groups within the United States have such disparate health outcomes. The COVID-19 pandemic has further reinforced the underlying inequity and disparities that exists within our society. Racism, not race, is as much of a public health threat as the COVID-19 pandemic we now face. Let us continue to create a fair, equitable and just society for all.