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Before we even had data on racial disparities in Covid-19 cases and deaths, sadly, I had expected these outcomes. The patients I care for and track as a clinical researcher at NYU are from minority backgrounds, live in low-socioeconomic status neighborhoods and have low health literacy. They often have poorly controlled medical conditions.
As nurses and other providers, we need to be innovative in the ways that we reach our patients and ensure that they have the resources they need to keep themselves healthy and reduce their risk. We need to spend less time assigning blame about data and statistics that for too long were simply unavailable, when we already know these disparities exist and focus our efforts in areas likely to be hardest hit. This information is finally available, but we knew what the story would be. We have seen it before. While it may be easier to point a finger, we need to instead be taking action.
The people who need our immediate action are those with chronic conditions, like dialysis patients, who are supported by federally subsidized programs and already make decisions about their health based on their basic needs—for instance, spending money to pay rent or buy food, versus filling prescriptions. They are less likely to seek medical care and more likely to rely on their church communities and local groups for support and information.
These patients are the store clerks, cab drivers, security guards and janitorial personnel who have to go to work to earn money. They are the patients who cannot easily tune into cable news or search the web to stay informed about the latest information about the Covid-19 crisis. Their very way of life puts them at risk.
As we take extraordinary measures to flatten the Covid curve, these vulnerable, high-risk patients in the black community need to be part of our coordinated national response. We need to ask important questions: How are these patients receiving information and making decisions about their health when there is a lack of trust in the health care system and those that provide it? Do these patients have advance directives; do they speak with their families about end-of-life care?
Do these patients know that their poorly controlled underlying conditions place them at increased risk, and do they believe this to be true? How are they being transported safely to and from work and their dialysis treatments when they are already at risk or immunocompromised? How are we keeping dialysis patients safe when they are already at risk for catheter-related infections, even when medical staff wear the recommended protective equipment — but more so now that this equipment is hard to come by?
There are further crucial questions. Diet and exercise are important ways to control kidney and heart disease, yet how are patients following the recommended dietary restrictions when grocery shelves are bare and the general population continues to hoard? Many groceries have now shifted to online ordering, a luxury that some, who lack easy access to internet or a credit card, cannot afford. What food remains on the shelf that is SNAP or WIC approved? How do you get exercise outside in a neighborhood that is not safe to walk?
Policymakers need to broaden the scope of federally subsidized programs to address these issues—to support these vulnerable, high-risk patients and to help lower their risks. And they need to make testing available in these communities at great risk, with corresponding federally supported medical care.
Pharmaceutical companies, pharmacies and health systems need to provide medications to patients free of charge and create a system for ensuring that prescription refills are delivered to those in need. Researchers who have relationships in these at-risk communities need to reach out and offer evidenced-based education and develop rapports between these communities and those that are better resourced. We need to inform patients of when it is necessary to seek care and how to go about it safely.
Local politicians should encourage safe practices to keep their constituents healthy, such as crowd control and safe distancing in lines at the grocery store and supporting local food delivery. They should forge relationships with local health systems to stay abreast of the pandemic in their areas, so that they can inform their constituents.
If we fail to take special measures to protect these vulnerable groups, the death rate from Covid-19 will continue to rise, particularly in black communities. We need to act now to prevent African American families and neighborhoods from losing even more loved ones.
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