Doctors have known this for a long time, long before the resounding cries of “Black Lives Matter”: Black people suffer disproportionately.
They face countless challenges to good health, including food, transportation, and income. The stress of living with racism has very real physical effects. And they are especially prone to diabetes, hypertension, and other chronic diseases that can be difficult to manage even in normal times.
Then came COVID-19 and George Floyd, one killing black people in alarming numbers, the other throwing a harsh light on systemic racism. In a matter of months and almost 8 minutes, it became clear that the institutions designed to guarantee the two most important things in life, health and safety, had converged to turn against a segment of the population in a severe and horrible way.
It is a brutal blow to the well-being of blacks and new calls for racial justice in all areas, including medical care. Doctors and their patients are reeling from the impact.
“We are exhausted and not doing well,” said Dr. Patrice Harris, a psychiatrist who has just completed her one-year term as president of the American Medical Association. She did not speak so much for herself as for her community.
Police violence is always an injustice, “but its damage is heightened amidst the remarkable stress people face in the midst of the COVID-19 pandemic,” Harris and AMA Trustee Dr. Jesse Ehrenfeld said in a recent opinion piece online.
Floyd’s death is the most extreme example of excessive vigilance that has plagued black and brown communities for a long time. It has been linked to high stress, high blood pressure, and other chronic diseases that contribute to high virus death rates in black people.
As their offices begin to reopen for regular appointments, doctors prepare for the consequences – a wave of sicker, more shocked patients.
As a doctor, Harris knows that he has a certain privilege. But he also knows firsthand the weariness of black lives in America.
Harris was only the second black doctor to lead the AMA in its 173-year history. She gets “those looks” when she walks into the stores. He has been asked to find coffee while wearing a medical uniform and stethoscope.
“It’s not that we don’t have more to give,” Harris said. But there is a feeling among many that if Floyd’s death can’t bring about significant change for African-Americans, nothing will.
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Dr. Brittani James is a primary care doctor. Most of her patients on the south side of Chicago are black.
His neighborhood was one of the last in the city to obtain a COVID-19 test site. They opened first in the richest and whitest areas on the north side.
“When I talk about institutional racism, this is happening in real time,” said James.
She has seen the virus hit many of her patients, while others get more sick from chronic illness, and it’s heartbreaking, James said. “As a black doctor, I feel like I’m failing my patients every day,” she said.
While their clinic has remained open, many patients are too terrified of COVID-19 to enter. That means treating complaints without physical exams or blood tests. She has tried to send patients prescriptions for blood pressure cuffs, but some cannot afford the cost. The options are “to control your blood pressure or adjust your medications blindly,” she said.
For every patient who made an appointment, there are 10 others who haven’t heard from in months.
“There is no way that suddenly there will be no more heart attacks overnight, no more strokes, no more patients with poorly controlled diabetes,” he said. “We have all seen that our patients’ visits stop. Which is scaring me a lot. ”
It is not just happening in Chicago.
James fears a “second wave” of worsening chronic disease and non-COVID-19 deaths is coming.
There are indications that it is already happening.
Government statistics from late January through May 30 suggest an increase in US deaths from chronic disease compared to historical trends. They include 7,000 excess deaths from hypertension, about 4,000 from diabetes and 3,000 from strokes, all conditions that disproportionately affect black people, although the data does not include race.
James says Floyd’s brutal death has added psychological trauma to the mix, and mental health care in many communities is scarce.
“There is an overwhelming need that we do not have the resources to address,” he said. “It is devastating.”
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Royanna Williams, 45, is a black woman in Asheville, North Carolina, who suffers with the lingering pain of autoimmune diseases, which disproportionately affect blacks.
Living with a chronic illness had already left her anxious and depressed, feelings that have multiplied with the pandemic, Floyd’s death, and the unrest that has followed.
“This here is a completely different ball game,” he said.
Williams has started mental health televisions. They have helped
Her medications include hydroxychloroquine. Williams said he thought he would have trouble getting refills the moment Donald Trump started promoting it without evidence that it works for COVID-19. “I was furious,” she said.
He hasn’t had to miss a dose yet, but Trump’s involvement has generated mistrust. “Now I’m afraid to take it,” he said. “I don’t know what’s in those pills.”
She says that white doctors have often ruled out her pain and that it has gotten worse as the pandemic has postponed her physical therapy sessions. Research has shown that blacks are often mistreated for pain, in part due to false beliefs about alleged biological differences. Recently, in 2016, data showed that half of US medical students and residents believed that blacks did not feel pain the same way as other races.
There is now evidence that blacks with fever and cough are less likely than whites to be referred for the COVID-19 test, said Dr. Malika Fair, director of health equity for the Association of American Medical Colleges.
“Race is a social construct and is not based on biology or genetics,” said Fair.
Dr. Heidi Knoll, white and one of Williams’ doctors, says a history of mistrust and mistreatment is part of what keeps many black people from seeking medical attention in normal times. The cost of COVID-19 and missed government opportunities to manage the pandemic have exacerbated the problem, he said.
His clinic, the Mountain Area Health Education Center in Asheville, was quick to adopt telehealth for COVID-free treatment when the pandemic hit; now almost half of all patient visits are by phone or video. Telehealth spread across the United States during the pandemic, and Knoll, like many doctors, believes it can help reduce racial health disparities by increasing access to doctors.
Williams knows that her health makes her especially vulnerable to the virus. She has been terrified of leaving since March, but staying at home, where she lives with her autistic son and mother, has been stressful.
Recent protests over Floyd’s murder have given him hope that racial change is looming, especially as whites have participated in the protests.
“People are excited about this pandemic,” he said. “Maybe it had to be that white lamb,” slaughtered for whites to pay attention.
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Terrence Nichols has physically recovered from a relatively mild case of COVID-19, diagnosed in March. But as a black man in Chicago, learning about his impact on his community has left Nichols feeling fearful, vulnerable, and angry at the President’s drive to reopen.
Blacks make up about 30% of Chicago’s population, but nearly half of virus deaths, a disparity seen across the country.
In early June, an AP analysis found that approximately 26% of COVID deaths were in black patients, while black people represented 13% of the population in the 40 states that provided detailed demographic data.
When Brookings Institution researchers adjusted for age disparities between races nationwide (the white population in the US is older, and therefore more susceptible to COVID-19 than other races), they found that the rate Black mortality rate was 3.6 times greater than white rate.
“It is ready to reopen due to the economy and rich people are losing money,” Nichols said of Trump. If the virus disproportionately killed rich whites, “I’d think twice,” said Nichols, 44.
Chicago recently relaxed orders to stay home and eased other restrictions, allowing Nichols to resume his job as a pharmacy sales representative, but he’s in no rush to go anywhere other than work.
Nichols will not join the protests in person, but he is “inside the house raising my fist and cheering me on.”
Floyd’s murder “played a chord,” he said. “It’s been going on since before I was born.”
Her father is a doctor. When Nichols was a teenager, the family lived in the mostly white neighborhood of Beverly in Chicago. He remembers that the KKK members chased him there, holding bats, and the officers asked him where he was going when he was walking home.
More recently, Nichols said, the police “had me against the car” and called for reinforcements when I was driving the wrong way on a one-way street.
Routinely, he checks the rearview mirror every time he passes a police car, “to see if they make a U-turn and start following me.” It has happened many times.
“If you are black, it is okay to be harassed,” said Nichols.
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Rosetta Watson is only 38 years old, but she has heart failure and needs valve replacement surgery. When COVID-19 arrived in Chicago in March, doctors postponed the operation indefinitely. The pandemic also delayed obesity surgery to remove the burden on the heart.
He has been kidnapped at home, knowing that COVID-19 could be fatal due to his poor health. He has already killed four of his relatives.
“I don’t know if I’m angry or if I’m just numb,” said Watson.
He recently had his first appointment with his heart doctor since the pandemic attack, and was told that the increased fatigue could be due to the leaky valve. She understands that the COVID-19 cases are more urgent, but the delays are frustrating.
Meanwhile, she watched the news, watched the protests on television, heard about them tearing up the local pharmacy. She supports the cause but not the property damage.
Floyd’s death “is the same as ever. We have always been prejudiced.” The difference now is that “everyone is recording everything they see.”
She has been racially attacked, not by the police, but by strangers who look down on her white boyfriend in racist terms and by older neighbors in her apartment building who make fun of “you” and are not going to ride with her in the elevator.
She has been racially described by a doctor who, when asked by Watson about his nosebleeds, demanded to know if he had been “using recreational drugs like cocaine or heroin.” It turns out that nosebleeds are a side effect of the nasal spray prescribed by the doctor.
“Seriously, it’s 2020. When are we going to grow?” Watson said.
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Follow AP medical writer Lindsey Tanner on @LindseyTanner.
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Associated Press Department of Health and Science receives support of the Department of Scientific Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.
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