Clear disparities in COVID-19 cases among minorities

The Means Report

AUGUSTA, Ga. (WJBF) – As the COVID-19 pandemic continues on, The Means Report continues its promise to give you the information you need. This week it stems from a recent op-ed piece written in the American Journal of Public Health published there from two local doctors. They are both from the Medical College of Georgia at Augusta University, and they discuss health risks when it comes to the coronavirus, especially when it comes to the minority community, the African-Americans who are adversely affected by this disease compared to other groups.

Brad Means: Dr. Coughlin, I look forward to being together with everybody in person in the studio one day. But thanks for Skyping in with me today.

Dr. Steven Coughlin: Yes, my pleasure.

Brad Means: Let me, first of all, just ask you about healthcare being colorblind. A lot of us might think that it is. My guess is you think that we have a long way to go there.

Dr. Steven Coughlin: Well, some segments of the population have better access to healthcare than others. And the Medical College of Georgia and Augusta University Health have been leaders in this area, and the CRS array and throughout the state of Georgia and surrounding parts of South Carolina.

Brad Means: So just to set the tone right off the bat, you believe, and your colleagues at MCG at AU believe that more African-Americans are likely to get this disease and die from it and not have access to the same treatment others do. Is that an accurate synopsis?

Dr. Steven Coughlin: Yes, that’s correct. Overall African-Americans have about a three-fold increase risk of dying from COVID-19 as compared to other Americans. So these are pronounced health disparity. And here in Georgia, the disparity exists, but it’s not quite as pronounced as in other parts of the US. But in our editorial, which appeared in American Journal of Public Health today, we summarize information from across the United States looking at incidents of COVID-19 and mortality rates from the disease. And we found that there are pronounced disparities by African-American race in each region of the country. So this is very important to address in the midst of a severe pandemic. And we hope that our editorial will draw attention to the need, to do more, to address these important health concerns.

Brad Means: All right, so let’s try to figure out why here. Let’s start with testing. Is it just the testing is not as readily available to that segment of our population, the African-American segment, if so, why isn’t it? I think about the situation in Augusta, you drive down to Christenberry Fieldhouse, you get tested. Is it not that simple for certain parts of our community?

Dr. Steven Coughlin: Well, not everyone has access to transportation. They may have to take a bus or get a ride to go to a testing site. Augusta University Health offers screening by telephone or online. So there are resources to get screened for COVID-19, even if you lack suitable transportation. But an example of a structural problem that may contribute to disparities in the disease, in some parts of the country they’ve had drive through testing sites for COVID-19, but if you lack automobile, then this is not an accessible way to get tested.

Brad Means: Is that the same kind of scenario when we look at treatment after you’ve been tested and diagnosed, and then you try to get treated for this illness? Is transportation and are other factors obstacles to getting what you need?

Dr. Steven Coughlin: Well that’s a complex question. And part of the answer is that we know that among individuals who test positive for COVID-19, African-Americans are more likely to be hospitalized. So they have a higher hospitalization rate. And we also know that there are population differences in health insurance and access to routine healthcare many African-Americans work in service industries and they may lack paid leave or health insurance. So it’s likely that individual who’s showing up late rather than earlier at emergency rooms and seeking healthcare, later then, is recommended. So these structural problems and disparity don’t just affect COVID-19, they’ve been identified for decades for such diseases as cardiovascular disease, high blood pressure, asthma diabetes, and so forth.

Brad Means: Yeah, I’m gonna talk to your colleague, Hr. Hobbs, about those other illnesses and how they impact African-Americans, in a moment. But what about outside of the workplace for those people, for that segment of our population? Do we see disparities when it comes to their home life houses, neighborhoods, communities that might limit that access to healthcare for our African-American neighbors?

Dr. Steven Coughlin: Well, the initial reports that African-Americans were more likely to get COVID-19 or to die from the disease, were in January, February, March. And at that time, the public health surveillance data were very inadequate. And there were scattered reports at various parts of the country, mostly in the Northeast and the Midwest part of the US indicating that pronounced disparities did exist. And these were in cities, such as Philadelphia, New York, Detroit, Milwaukee, and so forth. Chicago was another one. And these cities have large African-American neighborhoods that are very crowded and the households or often multigenerational households, for example, having elders living with younger people. So this increases the difficulty of social distancing when you have substandard housing or crowded living situation. And it’s also true that many African-Americans live in areas that are less urban and also have an increase risk of COVID-19. This includes parts of the Southern United States, North Carolina, South Carolina, Georgia, Mississippi, Alabama, Texas. And it’s important to point out that when individuals work in areas such as fast-food restaurants, grocery stores, public transportation, public works that it’s very difficult to practice social distancing. So in our editorial, we’ve emphasized the importance of providing culture appropriate, tailored health education to let people know how they can protect themselves through hand and surface hygiene. That includes hand-washing, avoiding touching the face, wearing a mask when out in public, and staying six feet apart from others, especially in a crowded locations like grocery stores or pharmacies. So an example of that is in Las Vegas, Nevada, the local health department has started coastally tailored public health messaging to inform people in the African-American community there, how they can protect themselves.

Brad Means: We’re gonna let Dr. Hobbs, continue what you’ve pointed out in our next segment, Dr. Coughlin. But let me just jump in and say, thank you for what you’re doing. And it is my hope. I’m sure you share this hope that some of these disparities that you’ve outlined decrease and that we can have equality in healthcare. Thank you for what you’re doing to help us get there.

Dr. Steven Coughlin: Yes, our pleasure.

Brad Means: Dr. Steven Coughlin with MCG at AU, our special guests today. And as mentioned, the living legend himself, Dr. Joseph Hobbs, you all know him. He’s gonna talk more about the Coronavirus and its impact when our African-American communities, not just here as Dr. Coughlin pointed out, but across the country when the Means Report continues.

Part 2

Brad Means: Welcome back to the Means Report. We appreciate you staying with us as we continue to talk about the disparities that exist when it comes to the Coronavirus and the testing and treatment options available to our minority communities across the country, especially African-Americans. And I’m so pleased to welcome back to the Means Report our next guest, Dr. Joseph Hobbs. Dr. Hobbs, the chair emeritus of MCGs Department of Family Medicine. I know most people in the community know him. Dr. Hobbs, thank you for your service to this community. And thanks for joining us again.

Dr. Joseph Hobbs: Thank you.

Brad Means: And congratulations on your recent retirement. How’s it going so far?

Dr. Joseph Hobbs: Great.

Brad Means: Well, I would like to ask you to come out of retirement for about the next 12 minutes and help walk me through these disparities that you and Dr. Coughlin have covered in the report that was published recently. And I know that you and I have talked about this before. It’s not just the Coronavirus that adversely affects African-Americans more so than others. Haven’t you seen this in other illnesses?

Dr. Joseph Hobbs: Yes. This particular pandemic basically showed yet again issues related to the most vulnerable among us. Those are people who are challenged by social-economic issues, education, employment because of all of those things they tend to find themselves working in the service where they can’t social distance. And as a result of that, they have a higher likelihood of having contact with the virus. They also cannot shelter in because often the jobs that they are performing are essential jobs, and therefore they have to be out in the public. And they’re kind of a part of our front line workers that are essential to keep our society up and going with food services and mail delivery and all the other things that are so essential to make things work. The thing that creates the disproportionate representation of individuals in that population also create what we call health disparities. And so we are already aware that black and brown populations are disproportionately challenged by health disparities. And as a result of that, their health outcomes are poor, they have more chronic disease, life expectancy is shorter. And a lot of these things are really based upon the structural situations in which they live. This is not anything about biology, but rather their access to services just because they don’t have the resources to do so, even if they’re employed if they’re working in an hourly arrangement, getting to a doctor for preventive services may be difficult. So they can’t participate in the preventive services that may be available.

Brad Means: So what do you think… What is a solution? And it sounds like it almost, what we’re looking for is a complete overhaul here of our approach to healthcare, to make sure that everyone has equal access, but what are some solutions that you see to help resolve this? Is it having more testing available? Is it building more hospitals so that people don’t have to travel long distances to get to one, especially those who don’t have transportation? How do we fix this or make it better?

Dr. Joseph Hobbs: Well, I think that there are things that we need to do acutely. If we’re looking at the pandemic as kind of the subject here is, we need to be able to know the demographics of the patient populations that are disproportionately affected. We need to make sure that we get services into those settings that help people to understand the important things they need to do to avoid transmission of the virus. And likewise, trying to find ways in which those communities can, if they have a positive test or someone becomes ill, that we can do the sort of contact tracing within that community to make sure that we can mitigate transmission of the disease any further. So the big issue here is to make sure that for that population, if we can identify them by let’s say ethnicity, or if we can identify them by logistics, like where they live. We can make sure that testing resources are made available to them in the context of their ability to use those testing resources. I would think that the evening hours, things that are located in public areas within communities that have a high concentration of minorities, African-Americans, or other minority groups that might be disproportionately affected. That kind of takes care of trying to get on top of the identification of this disease process. But more importantly is that we have to find ways, I believe, to try to make sure that the thing that creates the health disparities that existed before there was a COVID-19, that we addressed those too as well. And so how can we address it? I think that as long as we live in a society where healthcare is not evenly made available, we don’t have universal access to healthcare services. And as long as people access to healthcare services or quality health care services, based upon their ability to get insurance, insurance costs money and things of this nature until those things are made universally available, then those individuals who are at the lower end of the socioeconomic strata will certainly begin or will continue to have difficulties with being able to access those services in an equitable manner.

Brad Means: Dr. Hobbs, let me ask you this. Do you think that there is a distrust that exists between segments of our community, communities nationwide, and the government and the healthcare system distrust that maybe turns into reluctance to seek testing or treatment?

Dr. Joseph Hobbs: Yes, unfortunately, that does exist. It exists historically because of some of the things that have happened in medicine that did not necessarily respect the situation in which minority individuals spend themselves. A lot of people will point back to the Tuskegee studies, that looked at sexually transmitted diseases, where one population was tested and had access to drugs. The other population did not. Those are the sorts of things that certainly are not done today because we have research ethics that would not let that sort of thing happened. But it’s a part of the memory of a lot of communities of color of situations where the healthcare system from their perspective fail them. The other thing that happens to them is that whenever they have interactions with the healthcare system, when they then on the back end of this get the bill, if they are not insured, then that creates for them even a greater challenge for them and their families if they are working on the margins of being able to maintain economic stability in their families. So it’s a lot of things that kind of create that sort of reluctance to those in all communities, where they are socioeconomically challenged and are really struggling on a day by day basis just to make ends meet.

Brad Means: Well, so how do we make that struggle go away? Do we look to our churches, places that all of us hopefully trust to play a larger role? Do we need people to go door-to-door and teach some of the things you talked about earlier, social distancing, contact tracing, and get people engaged and say, “Look, you can be healthier, “you can have better access “if you will just let us hold your hand “and go through this together.” Is it gonna take those kind of, I hate to say this boots on the ground, everybody says that, is it gonna take that door-to-door approach as well as the role of some of our more trusted institutions if you will like churches?

Dr. Joseph Hobbs: Yes, churches and other philanthropic organizations out there that work in communities of need and things of that sort. Those are ways in which we can address some of the problems with regards to access and things of that sort. However, I think that we also have to be very mindful that some of the constraints that exist out there are beyond the power of these types of groups to be able to get that message out there. And it is the way that our society is constructed, which also says that we need to have advocacy for policy changes within our local government, with our state government, with our national government that addresses the needs of these populations and their special needs. And these can be things as fundamental as making sure that not only do they have access to living wages, that they have access to education for both themselves to advance for their children so that they don’t find themselves caught in the spiral of poverty and really trying to find a way to create an environment where everybody has access to basic medical services. This will go a long way to addressing the issues of the disparities that we have out there. Many people in these settings really don’t even have access to a primary care physician. Someone who’s gonna coordinates their care through all of this, and therefore they found themselves, unfortunately, having to wait until they have to go and have contact with the healthcare system. And under those circumstances, they are using our emergency rooms and that’s an inappropriate way and an inefficient way to get those sorts of services taken care of. And it’s very expensive at the same time. And they’re caught with those bills when that occurs. But what I would not want to diminish the impact that within the communities, whether these are social activities churches have played a large role in disseminating within our community, a lot of information about health trying to make contact with people about how to get a central services. And no doubt if we can try to do the same thing with regards to this pandemic, which is probably not gonna go away in the foreseeable future, it’s gonna be with us for months. And unfortunately, it could potentially a couple of years or so before vaccine is out there. We have to find ways to make sure that the community is aware that they understand the issues of prevention. They understand the issues of how to take care of themselves if they become infected. And more importantly is that if a vaccine ever becomes available, when the vaccine becomes available, we have to be able to convince the community that the vaccine is safe and appropriate for them to take-

Brad Means: Absolutely.

Dr. Joseph Hobbs: Because people are going to be skeptical about vaccinations because we already have that problem as it relates to the adult immunization that we give to patients every day.

Brad Means: Yes, sir. Dr. Hobbs, I cannot thank you enough. We’re gonna have to leave it there for now. I knew that we should dedicate two shows to this topic, and I hope that we can revisit it soon. Thank you to you and Dr. Coughlin for helping us understand the disparities and for helping us overcome them. We appreciate you. And as I said, your lifetime of service, sir.

Dr. Joseph Hobbs: Thank you very much.

Brad Means: Absolutely, Dr. Joseph Hobbs, our special guest on the Means Report.

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