Will COVID-19 Finally Trigger Action on Health Disparities?

Megan Brooks

April 27, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Because of stark racial disparities in COVID-19 infection and mortality, the pandemic is being called a "sentinel" and "bellwether" event that should push the United States to finally come to grips with disparities in healthcare.

When it comes to COVID-19, the pattern is "irrefutable" – blacks in the United States are being infected with SARS-CoV-2 and are dying of COVID-19 at higher rates than whites, Clyde W. Yancy, MD, Northwestern University, Chicago, Illinois, writes in a viewpoint article published online April 15 in JAMA.

According to one recent survey, he notes, the infection rate is threefold higher and the death rate is sixfold higher in predominantly black counties in the United States relative to predominantly white counties.

A sixfold increase in the rate of death for blacks due to a now ubiquitous virus should be deemed "unconscionable" and a moment of "ethical reckoning," Yancy writes.

"Why is this uniquely important to me? I am an academic cardiologist; I study health care disparities; and I am a black man," he writes.

The COVID-19 pandemic may be the "bellwether" event that the United States has needed to fully address disparities in healthcare, Yancy says.

"Public health is complicated and social reengineering is complex, but change of this magnitude does not happen without a new resolve," he concludes. "The US has needed a trigger to fully address health care disparities; COVID-19 may be that bellwether event. Certainly, within the broad and powerful economic and legislative engines of the US, there is room to definitively address a scourge even worse than COVID-19: health care disparities. It only takes will. It is time to end the refrain."

The question is, he asks, will the nation finally "think differently, and as has been done in response to other major diseases, declare that a civil society will no longer accept disproportionate suffering?"

Keith C. Ferdinand, MD, Tulane University, New Orleans, Louisiana, doesn't think so.

In a related editorial published online April 17 in the Journal of the American College of Cardiology, he points out that the 1985 Heckler Report , from the Department of Health and Human Services, documented higher racial/ethnic mortality rates and the need to correct them. This was followed in 2002 by a report from the Institute of Medicine called Unequal Treatment that also underscored health disparities.

Despite some progress, the goal of reducing and eventually eliminating racial/ethnic disparities has not been realized, Ferdinand says. "I think baked into the consciousness of the American psyche is that there are some people who have and some who have not," he told theheart.org | Medscape Cardiology.

"To some extent, some societies at some point become immune. We would not like to think that America, with its sense of egalitarianism, would get to that point, but maybe we have," said Ferdinand.

A "Sentinel Event"

He points out that black people are not genetically or biologically predisposed to COVID-19 but are socially prone to coronavirus exposure and are more likely to have comorbid conditions, such as hypertension, diabetes, obesity, and heart disease, that fuel complications.

The "tragic" higher COVID-19 mortality among African Americans (AA) and other racial/ethnic minorities confirms "inadequate" efforts on the part of society to eliminate disparities in cardiovascular disease (CVD) and is a "sentinel event," Ferdinand writes.

A sentinel event, as defined by the Joint Commission, is an unexpected occurrence that leads to death or serious physical or psychological injury or the risk thereof, he explains.

"Conventionally identified sentinel events, such as unintended retention of foreign objects and fall-related events, are used to evaluate quality in hospital care. Similarly, disparate AA COVID-19 mortality reflects long-standing, unacceptable US racial/ethnic and socioeconomic CVD inequities and unmasks system failures and unacceptable care to be caught and mitigated," Ferdinand concludes.

Yancy and Ferdinand have disclosed no relevant financial relationships.

JAMA. Published online April 15, 2020. Full text

J Am Coll Cardiol. Published online April 17, 2020. Abstract

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