Rosa Brandon started thinking about death at 40.
That’s typically the age that other people she knew in the Black community started to die from chronic health problems like diabetes and high blood pressure.
At 59, Brandon, who lives in Bethlehem, contracted the coronavirus and ended up in the hospital for three days.
She’s one of many Black Americans who have contracted the coronavirus, which affects communities of color at a disproportionately higher rate. African Americans are more than twice as likely to get the virus as white Americans, with 62 cases per 10,000 people, according to a new New York Times analysis of federal government data. Hispanic Americans are more than three times as likely to be infected as whites. Both groups are dying of COVID-19 at nearly twice the rate of white people.
The virus is claiming Black Americans during a pivotal time, as large-scale protests erupt in American cities, suburbs and small towns over racial injustice, following the police killing of George Floyd in Minneapolis on May 25, and a host of other unarmed Black men in recent years.
The protests have pushed the conversation toward disparities in many other areas, including medical care, raising issues such as implicit bias among health care providers, lack of diversity among those providers, the unequal distribution of health care resources, and policies and practices that have prevented Black people from accessing quality health care — all of which put Black Americans on a trajectory to poor health.
So when the coronavirus spread, it wasn’t surprising that the Black community was hit especially hard. Making the virus more threatening is that many Black Americans are essential workers, live in smaller quarters in dense cities, and suffer from chronic health problems that can cause the coronavirus to be deadlier.
“It’s become a magnifying glass of the disparity that’s already there,” said Dr. Amyna Husain, a pediatric infectious disease expert at Johns Hopkins University School of Medicine.
Government statistics on the persistent disparities are striking:
Black Americans are 3½ times more likely to be diagnosed with end-stage renal disease and twice as likely to die from diabetes.
Black women die from pregnancy-related complications at two to three times the rate of white women.
Doctors and public health experts have long explained the disparities generally as the result of poverty, which disproportionately affects Black Americans, who historically were denied the same opportunities and resources as white Americans. As a result, many have poor access to healthy foods, education, transportation, health insurance and safe housing.
The more systemic problems notwithstanding, health officials can do something to improve outcomes for Black patients with the coronavirus, Husain said, such as setting up more testing and treatment for vulnerable communities.
Other solutions include paid sick leave for essential workers, many of whom work part time or have low-paying jobs with few or no sick days, as well as food delivery, and rent and other financial assistance so people can stay at home when they are sick, said Dr. Panagis Galiatsatos, co-chair of Johns Hopkins Health System health equity steering committee.
The health industry has an ugly history of discriminating against the Black community. Not only were hospitals segregated in many places, but Black Americans were abused as experiment subjects. One of the most well-known examples was a syphilis experiment that went on for 40 years and involved hundreds of Black men whose symptoms were left untreated and whose consent was not given. Another involved the harvesting of cells from Henrietta Lacks, a Black cancer patient from Baltimore who unwittingly contributed the prolific HeLa cell line that led to numerous medical breakthroughs.
That’s why it’s important to have Black providers who can better relate to Black patients, said Dr. Chinenye Nwachuku, a St. Luke’s University Health Network doctor who participated in a protest against racial injustice organized by medical students last month. Research suggests that Black patients treated by Black doctors could have better outcomes.
Black men who met with Black doctors were more likely to receive and accept preventive services, such as blood tests and blood pressure measurements, than those who met with non-Black doctors, according to a study published in 2018 in the National Bureau for Economic Research.
The study showed that Black doctors could improve outcomes for Black patients, such as by narrowing the mortality gaps that exist between Black and white patients.
“The effects are most pronounced for men who have little experience obtaining routine medical care and among those who mistrust the medical system,” researchers noted in the study. “Subjects are more likely to talk with a Black doctor about their health problems and Black doctors are more likely to write additional notes about the subjects.”
But only about 6% of physicians in the country are Black, even though 12% of the population is, according to census data.
Brandon, the Bethlehem woman who had the coronavirus, said she witnessed medical bias last fall when she accompanied her sister, Emily Blackmon, to the emergency room for a serious gallbladder problem. Despite arriving first, the two sisters saw patient after patient, some with seemingly minor injuries, get seen before they did. Brandon said they were the only Black patients in the waiting room.
Blackmon — who also has had a bout with the coronavirus — said she was in a lot of pain and had to wait more than three hours.
“We were pissed off,” Brandon added.
Numerous studies have shown that bias in emergency room triage results in Black patients waiting longer than white patients for similar complaints. One study of nearly 90,000 patient visits published in The Journal of Emergency Medicine in 2013 found that wait times were 11 minutes longer for Black patients than whites on average.
The study found that triaging patients, the practice of giving medical priority to the most urgent, is flawed and that nonmedical factors like race may affect the process.
Brandon’s story is echoed by others, revealing a troubling pattern of bias, said Galiatsatos, from the Johns Hopkins health equity committee.
“Unconscious bias in triage has been studied and it’s one of the things we need to combat as an institution,” he said.
When health workers are asked to be objective, they may dismiss their biases. The better strategy is to be upfront about unconscious bias and train workers to recognize and interrogate it, he said.
“We’re all genetically incredibly similar. When you see disparity, that’s racism. We default to thinking KKK, or blatant racism, but institutional racism is subtle,” he said.
Medical schools should make bias training a core subject that’s taught extensively, said Jessica Fleischer, a medical student at the Lewis Katz School of Medicine at Temple University. She said she learned bias training during a course on how socioeconomics affects health outcomes.
“It’s both not ongoing and not in depth,” she said.
Bias isn’t confined to the triage process.
A report in the journal Pain Medicine that looked at 20 years of studies on disparities in prescribing pain medication found that Black patients were 22% less likely to be prescribed pain medication than white patients.
Biases develop over time and can be hard to recognize or undo, as a troubling survey of more than 400 medical students showed. Published in a 2016 National Academy of Sciences report, the survey found that half the students came to the profession with at least one false belief about the medical differences between white and Black patients, including astounding ones such as that Black patients feel less pain.
Such injustices and disparities motivated Fleischer and her classmates to organize a protest outside of the Temple Medical School building by St. Luke’s University Hospital, Fountain Hill, on Juneteenth.
Medical students organized a Juneteenth protest outside St. Luke's. Participants include: (Top, from left) Kathleen Dave, Sandra Mesics, Jessica Fleischner, John Pisan, Jared Sapin, Alison Von Deylen, Joel Rosenfeld. (Bottom) Rachel Palley, Saira Agarwala, Trina Wijangco, Pooja Krishnamoorthi, Manasa Srivilli, Hannah Sagin. (GABRIELLE RHOADS/THE MORNING CALL)
More than 100 medical school students, St. Luke’s doctors and nurses, and community members knelt in protest for 8 minutes and 46 seconds, which is how long a Minneapolis police officer pressed his knee into Floyd’s neck, killing him.
Organized by medical students who were inspired by the “White Coats for Black Lives” protests across the country on June 6, the action highlighted racial inequities in health care.
The protesters held signs that highlighted the need for doctors to actively change the system, while also pointing out some of disparities for specific groups.
“My patient my problem”
“Medical silence is harm”
“49% of Black Trans people have attempted suicide”
Jared Sapin, another Temple Medical School student and protest organizer, said doctors have to advocate for their most vulnerable patients, instead of distancing themselves from divisive issues.
“We kind of got caught up in not choosing a side,” he said. “We really should be choosing a moral side and actually speaking out instead of sidelining ourselves.”
Morning Call reporter Binghui Huang can be reached at 610-820-6745 and Bhuang@mcall.com.