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COVID-19 and the Racial Crisis

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We live in a deeply and fundamentally racist nation. This is in evidence across a wide range of measures of inequality, from wealth to homeownership, incarceration to life expectancy.

This has also long been true in the field of medicine, which has a variety of racial essentialisms baked into the cake. As Linda Villarosa wrote in her contribution to the Times’s 1619 Project last year, summarizing what’s been demonstrated by many studies:

To validate his theory about lung inferiority in African-Americans, [Cartwright] became one of the first doctors in the United States to measure pulmonary function with an instrument called a spirometer. Using a device he designed himself, Cartwright calculated that “the deficiency in the Negro may be safely estimated at 20 percent.” Today most commercially available spirometers, used around the world to diagnose and monitor respiratory illness, have a “race correction” built into the software, which controls for the assumption that blacks have less lung capacity than whites. In her 2014 book, “Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics,” Lundy Braun, a Brown University professor of medical science and Africana studies, notes that “race correction” is still taught to medical students and described in textbooks as scientific fact and standard practice.

Recent data also shows that present-day doctors fail to sufficiently treat the pain of black adults and children for many medical issues. A 2013 review of studies examining racial disparities in pain management published in The American Medical Association Journal of Ethics found that black and Hispanic people — from children who needed adenoidectomies or tonsillectomies to elders in hospice care — received inadequate pain management compared with white counterparts.

A 2016 survey of 222 white medical students and residents published in The Proceedings of the National Academy of Sciences showed that half of them endorsed at least one myth about physiological differences between black people and white people, including that black people’s nerve endings are less sensitive than white people’s. When asked to imagine how much pain white or black patients experienced in hypothetical situations, the medical students and residents insisted that black people felt less pain. This made the providers less likely to recommend appropriate treatment. A third of these doctors to be also still believed the lie that Thomas Hamilton tortured John Brown to prove nearly two centuries ago: that black skin is thicker than white skin.

People have been saying that the novel coronavirus that causes COVID-19 doesn’t discriminate, but as NPR reported a few days ago, the health care industry still does:

The new coronavirus doesn’t discriminate. But physicians in public health and on the front lines say that in the response to the pandemic, they can already see the emergence of familiar patterns of racial and economic bias.

In one analysis, it appears doctors may be less likely to refer African Americans for testing when they show up for care with signs of infection.

The bio-tech data firm Rubix Life Sciences, based in Boston, reviewed recent billing information in several states, and found that an African American with symptoms like cough and fever was less likely to be given one of the scarce coronavirus tests.

Delays in diagnosis and treatment can be harmful, especially for racial or ethnic minority groups that have higher rates of certain diseases, such as diabetes, high blood pressure and kidney disease. Those chronic illnesses can lead to more severe cases of COVID-19.

That is exactly how things are playing out, with Black communities especially getting devastated by the virus. We don’t have any reliable data at the national level on this, and all data on infections and deaths is of course likely to be inaccurate because of our abysmal, inept federal response to the crisis. What we do have is local data from a few select places. It shows the crisis within the crisis:

From my birthplace of Milwaukee:

As of Friday morning, African Americans made up almost half of Milwaukee County’s 945 cases and 81% of its 27 deaths in a county whose population is 26% black. Milwaukee is one of the few places in the United States that is tracking the racial breakdown of people who have been infected by the novel coronavirus, offering a glimpse at the disproportionate destruction it is inflicting on black communities nationwide.

From Michigan and New Orleans (same source):

In Michigan, where the state’s population is 14% black, African Americans made up 35% of cases and 40% of deaths as of Friday morning. Detroit, where a majority of residents are black, has emerged as a hot spot with a high death toll. As has New Orleans. Louisiana has not published case breakdowns by race, but 40% of the state’s deaths have happened in Orleans Parish, where the majority of residents are black.

From Chicago:

As of Saturday, 107 of Cook County’s 183 deaths from COVID-19 were black. In Chicago, 61 of the 86 recorded deaths – or 70% – were black residents. Blacks make up 29% of Chicago’s population.

Racist patterns in treatment are, of course, far from even half of this story, bu they suggest the larger facts of our society and who and why people are vulnerable. From the ProPublica piece centering Milwaukee:

The reasons for this are the same reasons that African Americans have disproportionately high rates of maternal death, low levels of access to medical care and higher rates of asthma, said Dr. Camara Jones, a family physician, epidemiologist and visiting fellow at Harvard University.

“COVID is just unmasking the deep disinvestment in our communities, the historical injustices and the impact of residential segregation,” said Jones, who spent 13 years at the CDC, focused on identifying, measuring and addressing racial bias within the medical system. “This is the time to name racism as the cause of all of those things. The overrepresentation of people of color in poverty and white people in wealth is not just a happenstance. … It’s because we’re not valued.”

[…]

Because of discrimination and generational income inequality, black households in the county earned only 50% as much as white ones in 2018, according to census statistics. Black people are far less likely to own homes than white people in Milwaukee and far more likely to rent, putting black renters at the mercy of landlords who can kick them out if they can’t pay during an economic crisis, at the same time as people are being told to stay home. And when it comes to health insurance, black people are more likely to be uninsured than their white counterparts.

African Americans have gravitated to jobs in sectors viewed as reliable paths to the middle class — health care, transportation, government, food supply — which are now deemed “essential,” rendering them unable to stay home. In places like New York City, the virus’ epicenter, black people are among the only ones still riding the subway.

Or as Clint Smith succinctly puts it:

Racism kills in many different ways in the United States, piling comorbidity atop comorbidity. This is indefensible.

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