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Early in the COVID-19 crisis, patients in my clinics frequently joked that African Americans and other minorities were immune to the coronavirus. Initial reports of those infected with SARS-CoV-2 didn’t reveal patient demographics, leading some to mistake no news for good news. Once race and ethnicity data began to be evaluated, however, we saw the stark truth.
As of early May, African Americans make up nearly 28% of COVID-19 cases in the U.S. They also account for more than 18% of COVID-19 deaths. These are startling statistics for a demographic group that represents only about 13% of the U.S. population.
In some areas of the country, the disparity has been even more striking. In April, reports from Chicago stated that African Americans made up 72% of people dying from COVID-19 although they composed only a third of the population there. Similar stories came out of Louisiana, Michigan and New York City.
Why are Black people disproportionately affected by the pandemic? The answer is multifaceted. A thorough response highlights the economic and social disparities that have affected the Black community for decades. In my view, African Americans are succumbing to COVID-19 at higher rates than other Americans because of a toxic combination of:
These factors are not new to COVID-19. During the H1N1 epidemic in 2009, we saw the same effect. About 30% of Americans with H1N1 flu were Black, although they composed only 12% of the U.S. population. Eleven years ago, this outbreak did not receive as much media attention as today’s COVID-19 outbreak, partly because social media wasn’t as pervasive and government officials did not mandate shutdowns.
For the public, media and governmental officials, the current pandemic is highlighting the existence of health disparities and their impact on Black populations, contributing to Black peoples’ shorter life expectancies (compared to that of white peoples’) even when controlled for socioeconomic classifications.
Minority health disparities are a recurring problem and an everyday reality, pandemic or not.
Wash your hands, wear a mask, keep your distance and stay at home: These instructions can’t be stressed enough during the COVID-19 pandemic. They seem straightforward, but nuances in Black communities, including a variety of social determinants of health, can complicate them.
I’ve heard some men say they are hesitant to wear a mask in public because, in the minds of many, face coverings worn by Black men are associated with criminal behavior. Many Black men have told me that they fear racial profiling, being arrested, and worse, being shot and killed if they enter business establishments wearing a face mask.
Additionally, some Black people disregard public health information due to generational distrust. Past racial discrimination, poor communication between government or healthcare entities and minorities, and lack of culturally sensitive healthcare may cause some African Americans to dismiss the importance of directives from public health and government officials related to mitigation of the COVID-19 virus or other public health matters.
This issue highlights the need for more culturally sensitive communication. One-size-fits-all messaging does not resonate with all minorities. Minority communities often respond better to messages communicated by a community member or a medical professional who looks like them (i.e., is of the same race or ethnicity). The medical community must understand this dynamic and the reasons for it in order to best disseminate important and lifesaving information to minority communities.
Black medical professionals are vital to addressing the COVID-19 health disparity. While we must work harder to engage the African American community and communicate important information about COVID-19 risk factors and health-protective measures, it also is paramount to recruit respected community members (e.g., spiritual leaders, elected officials, other influencers) as spokespeople, partners and surrogates to help us more effectively disseminate such messaging.
Regardless of race, all clinicians can help protect the African American patient population by helping disseminate truths about COVID-19. Black people are at higher risk of infection and death from the virus. The more regularly the Black community hears that, the more seriously they will heed instructions to protect themselves.
Additionally, healthcare providers, healthcare institutions, health insurance providers, employers, and governmental and elected officials must work together to ensure that all individuals, including minority populations, are provided with more opportunities to access quality medical care for the prevention and management of chronic disease states. Minorities must have access to routine preventive healthcare, health screenings, immunizations and health education so that the incidence of health disparities and chronic disease states will be eliminated, thereby reducing heightened susceptibility to pandemics such as COVID-19.
Dr. Modlin is a urologist and kidney transplant surgeon at Cleveland Clinic, where he also serves as Executive Director of Minority Health. He is Founder and Director of Cleveland Clinic’s Minority Men’s Health Center and the Annual Minority Men’s Health Fair. He also is a member of Cleveland Clinic’s Board of Governors, a member of the Board of Directors & Trustees, and former President of Cleveland Clinic’s Medical Staff. Dr. Modlin has also been appointed by Ohio Governor Mike DeWine to serve on his newly created Minority Task Force which is tasked to examine the disproportionate number of African Americans afflicted with and dying from the coronavirus.