Op-ed: Local, national government must address inequalities exacerbated by pandemic

 

COVID-19 is this generation’s first truly global pandemic. There are no vaccines or effective treatments. It is a universal threat, for now.

 

However, history suggests that with time, this universal threat will narrow its focus to the most vulnerable among us. American epidemics and natural disasters as varied as the H1N1 influenza epidemic, the California wildfires and Hurricanes Sandy, Katrina and Maria have taught us that the poor and politically disfavored will suffer.

 

In nearly every natural disaster or epidemic, a stark divide emerges between those with resources and those without. During the California wildfires, several counties failed to release timely evacuation orders in Spanish. Similarly, during Hurricane Sandy, New Yorkers heard evacuation orders, but low-income communities and communities of color had difficulty marshaling the resources and alternative housing necessary to evacuate. During Katrina, the levees were not expected to break, but when aid was delivered, it was too little too late.

 

As resident physicians, across specialties, we see daily the impact of a society that has systematically excluded people of color from good health. Our patients are more likely to die in childbirth, experience critical delays in treatment for heart attacks and die from certain cancers. This is the baseline. Now, coupled with a pandemic and the reality of scarce resources, we fear that these trends of unequal care will be amplified in Los Angeles.

 

When we understand that low-income communities often have more need for clear messaging and early intervention, disparities in outcomes during epidemics become predictable. These disparities were evident in the HIV and H1N1 influenza epidemics and are becoming readily reapparent in the United States’ response to COVID-19.

 

New York City, New Orleans and Detroit are among the cities with the most infections per 1,000 individuals. There is little to no racial data on the distribution of cases, save for a handful of states, but the preliminary data predicts poor outcomes for Black and brown communities. In Illinois, Michigan, North Carolina, and Wisconsin, Black people are severely overrepresented among COVID-19 cases. Given that spread is curtailed by self-isolation, which necessitates space and ample savings, it is understood that poverty affects citizens’ abilities to protect themselves and their loved ones. As these numbers rise, we find ourselves gravely concerned over this pandemic’s impact on citizens in low-income and minority communities across the country and in Los Angeles.

 

A dangerous interplay of social systems is setting up our patients of color to have worse outcomes overall from COVID-19.

 

People of color are disproportionately represented in food services, sanitation work and low-income community health work. They, like us, are front-line workers. Many will expose themselves without personal protective equipment in order to provide basic services. People living in multigenerational homes, often in cramped quarters and working jobs with scarce access to PPE, are set up for increased risk of infection.

 

Once infected, we worry that access to health care will be unequal. Black, Latinx and Native Americans are disproportionately uninsured in Los Angeles, the consequences of which have already proven fatal. American society has endorsed social distancing based on the premise that our communal health and well-being are interconnected. Our two-tiered health care system does not reflect this reality.

We believe that better data collection is essential for the provision of equitable health care. We agree with the recent call on the Department of Health and Human Services to start gathering racial and ethnographic data in this pandemic. These insights will allow us to swiftly reallocate resources where they are most needed and provide up-to-date translations for all community messaging. Although the new Families First Coronavirus Response Act mandates free testing for all, the fees associated with an emergency room visit serve as a powerful deterrent from seeking care. Some insurers have offered waivers on all fees related to health care for COVID-19. Los Angeles hospitals should pledge to do the same for the uninsured.

 

Furthermore, hospitals must consider health justice when designing their surge plans for the coming days and weeks. In keeping with utilitarian principles, physician leaders argue that scarce resources like ventilators should be directed toward young patients with fewer preexisting medical problems. This deepens health care disparities by disadvantaging people of color, who have higher rates of chronic disease. Without policies and systems in place that counteract the institutional racism in our health care system, these guidelines do not acknowledge the realities of race and class in Los Angeles.

 

Finally, as physicians, we must question policies and practices that unfairly assign value to our own labor over that of other front-line staff. Our call to #GetMePPE needs to be extended to include all front-line workers – from janitors to cooks to bus drivers.

The coronavirus pandemic will lay bare the racist and classist structures that undergird our health care system. However, it has also demonstrated how quickly change can be enacted when there is a will to do so.

Without action, we risk repeating the errors of natural disasters in uniquely American ways.

Now is the time to create a health care system worthy of our patients – one that faces our history of unequal care in Los Angeles and responds with the swiftness and decisiveness that this era demands.

 

Huston-Paterson is a resident physician in surgery at UCLA. Labora is a resident physician in obstetrics, gynecology and reproductive sciences at UC San Francisco. Richardson is a resident physician in emergency medicine at Northwestern University.