Racism Issues and COVID-19
I read this article today about pulse oximeters, and I thought of several articles I read previously in September.
Pulse oximeters are borne of racist bias in technology. I was today years old when I found out. And it makes sense. They work by sensing the color of blood flowing under the skin, based on how much hemoglobin is in the blood (more hemoglobin = more red = more oxygen). If there is more melanin (dark skin pigmentation), the oximeter’s sensor can overestimate the oxygen levels in the blood. In Amy Moran-Thomas’ article published by the Boston Review, she writes “For a nonwhite person, a reading of 77 like my husband’s could hide an oxygen saturation as low as 69—even greater immediate danger. But EMTs or intake nurses might not be able to detect those discrepancies during triage”. Of course the clinician seeing the patient still has to consider the entire patient picture, and not just the pulse oximeter reading, but it’s scary that your placement in a “critical” vs “not too critical” treatment group can depend on something with its own faults.
This next one is taken from something I wrote as part of a class addressing the Social Determinants of Health back in September 2020.
While most people anxiously await the vaccine so that we can “get back to normal”, not everyone is on board with getting vaccinated immediately. Racial minorities in the United States of America have a higher morbidity and mortality rate from Covid. Recognizing this, the presidents of 2 historically black colleges and universities (HBCU) participated in the vaccine trial and “hoped to encourage the same to ensure that an eventual vaccine has been tested on – and is effective for – people of color”. However they have faced criticism for being “lab rat[s]”, given the history behind medical experimentation on African-Americans in the USA.
Prior to the seeing the CNN news report above, I had read article titled “American healthcare’s racist history helped fuel a fear of vaccines” (Goldhill, 2020). Historically, African-Americans have good reason to mistrust healthcare – the US Public Health service sanctioned the Tuskegee syphilis study and forced sterilization in black women in the past as part of institutionalised racism. In particular, the article referred to a survey in which only 54% of black adults would get the vaccine, compared to 74% of white adults who would do the same. Unfortunately, blacks have been disproportionately affected by Covid-19: while they make up only 13% of the US population, they account for 24% of coronavirus deaths.
Given that fewer black Americans are willing to be vaccinated, the disparity gap will likely get worse. Systemic solutions are needed to perform the difficult task of breaking the vicious downward spiral that includes poor health with pre-existing conditions and lack of access to healthcare, leading to even worse health overall. The institutionalised racism that began hundreds of years ago still affects the black population up to the present. Indeed, Gramlich and Funk (2020) write that “explanations for the disparities included higher rates of pre-existing health conditions… social and economic factors that contribute to health risk, and long-standing inequities in health care access and outcomes for black Americans compared with other racial and ethnic groups.” This is probably just the tip of the iceberg. The present pandemic has unfortunately amplified the disparities but hopefully has raised more awareness that such health inequities need to be fixed.
Edits on December 20, 2020, after I read this article on CNN:
The Dean of the Morehouse School of Medicine* (MSM part of an HBCU) received her vaccine publicly, on CNN, in an effort to promote vaccination among African-Americans. I hope believing in science supersedes non-science bias. I guess this is what you call working with and within culture and race, instead of against it – they can co-exist and even have an additive, synergistic if we let them.
* Note: I did my surgical internship through the MSM in Atlanta, Georgia prior to my Physical Medicine & Rehabilitation residency in Philadelphia. Grateful for the lessons in and first exposures to the American medical system and multiracial society (I probably wasn’t as grateful during that year… I was more tired than anything). Definitely a period of adjustment for me.
References:
Andone, D. (2020). 2 HBCU presidents joined Covid-19 vaccine trials to encourage participation, but past racist experiments haunt such efforts. [online] CNN. Available at: https://edition.cnn.com/2020/09/18/health/hbcu-presidents-covid-19-vaccine-trial-trnd/index.html [Accessed 25 Sep. 2020].
Ellis, NT. (2020). Morehouse dean takes vaccine on TV to remove the stigma as some Black Americans remain hesitant to get the shot. [online] CNN. Available at: https://edition.cnn.com/2020/12/18/us/vaccine-campaign-black-community/index.html [Accessed 20 Dec. 2020].
Goldhill, O. (2020). American healthcare’s racist history helped fuel a fear of vaccines. [online] Quartz. Available at: https://qz.com/1886133/us-healthcares-racist-history-helped-fuel-a-fear-of-vaccines/ [Accessed 25 Sep. 2020]
Gramlich, J. and Funk, C. (2020). (n.d.). Black Americans face higher COVID-19 risks, are more hesitant to trust medical scientists, get vaccinated. [online] Pew Research Center. Available at: https://www.pewresearch.org/fact-tank/2020/06/04/black-americans-face-higher-covid-19-risks-are-more-hesitant-to-trust-medical-scientists-get-vaccinated/ [Accessed 25 Sep. 2020].
Moran-Thomas, A. (2020). How a Popular Medical Device Encodes Racial Bias. [online] Boston Review. Available at: http://bostonreview.net/science-nature-race/amy-moran-thomas-how-popular-medical-device-encodes-racial-bias [Accessed 18 Dec. 2020].
