On Friday, the United States set another record for single day cases of COVID-19. Because of course it did—that’s what happens when you’re in the midst of an exponentially growing pandemic and political leaders are refusing to take the actions necessary to address the crisis. In California, where Governor Gavin Newsome has rolled back the reopening, and in 28 states where some version of a universal mask mandate is now in place, there’s little doubt that the rate of transmission has been cut and the growth of new cases is slowing—but it could still be several days, or even weeks, before these states pass the crest of cases developed under less stringent protections. In other states, like Florida and Georgia, where governors seem determined to “win” by stacking bodies like cordwood, the number of cases being reported is back to being limited by an all too familiar problem—insufficient testing. But then, the last thing that governors Brian Kemp and Ron DeSantis want, is an accurate accounting of their leadership.
However, in both states where the epidemic has been handled well, and in states where cases are exploding, there is one theme in common—Black and Latino Americans are dying at a disproportionate rate. Americans of color are both more likely to catch COVID-19 than white Americans, and more likely to die if come down with the disease. Neither of those effects has anything to do with race. It has to do with racism.
Gastroenterologist, cancer researcher, and University of Washington professor Rachel Issaka, has published in the Journal of the American Medical Association in the past, discussing the value of screening for colorectal cancer and, more recently, weighing the benefits and risks of that screening during the era of COVID-19. But the letter that Dr. Issaka sent to JAMA earlier this month was on another topic.
Structural racism is embedded in medicine’s policies, practices, cultural representations, and norms that reinforce inequities. As the United States confronts the disproportionate impact of coronavirus disease 2019 (COVID-19) on Black people, the unjust killings of George Floyd and other Black Americans has ignited the most cohesive civil rights movement since the late 1960s. Despite the focus on law enforcement and criminal justice, medicine’s history of exclusion and exploitation also fuels this racial reckoning; thus, medical institutions must play a critical role in forging a different path forward. The medical profession must acknowledge its history of inequality; the persistent impact on Black patients and medical professionals (including trainees, faculty, and staff); and the implications on the missions of patient care, education, and research.
Issaka expanded on this theme in an interview with StatNews. The medical profession in America isn’t just racist in the acceptance of Black and brown professionals among it’s ranks, it has a long history of believing that Black people are different: That Black people don’t need as much rest as white people; Black people don’t feel pain like white people; Black people don’t need medication the way that white people do. Despite decades of genetic and anthropological research showing that race is not a reliable indicator of any medical condition, and that there is more genetic variation between people perceived of being the same race, than there is between people seen as different races, the element of these racist beliefs persist in medicine. They don’t just exist in the minds of older practitioners, they survive in the learned actions of younger doctors and nurses, even if those doctors and nurses are themselves people of color. In medicine, racist beliefs have become racist actions, and those racist actions are having consequences that are reflected in the outcomes for Black patients infected by COVID-19.
Of course, it’s not just racism embedded in the medical profession that’s driving higher numbers of cases and deaths among Blacks and Latinos. On Tuesday, North Carolina Republican Senators Thom Tillis highlighted this when declared that he thought people of color were causing their own deaths. “I’m not a scientist and I’m not a statistician,” said Tillis, “but one of the concerns that we’ve had more recently is that the Hispanic population now constitutes about 44 percent of the positive cases. And we do have some concerns that in the Hispanic population we’ve seen less consistent adherence to social distancing and wearing a mask.”
But Tillis’ statement ignored the fact that the numbers he was talking about in his state were driven largely by a massive surge in cases among workers in the food industry. As Arizona Representative Ruben Gallego tweeted on Thursday, “We are the essential workers that were forced to go to work. We pulled the food, slaughtered the animals, packaged the food that fed America. They did it at barely minimum wage and went back homes to big families under one roof because that is all they could afford.”
Tillis has the gall to blame Latino workers for working in unsafe conditions, when he has been instrumental in seeing that those conditions remain unsafe for years. In the middle of the pandemic, Republicans responded to the threat posed to these workers by trying to strip them of any legal protection. And Donald Trump forced them to stay on the job so that white Americans would not be inconvenienced. So naturally, Tillis was there to bat clean-up by blaming them for getting sick.
Structural racism inside medicine affects how people of color are treated. Structural racism outside of medicine means that more Black and Latino workers are in positions where the option of working from home is not available. They are at the center of the sick irony that “essential worker” is practically synonymous with workers who labor in poor conditions, with a lack of benefits, at minimum wage.
Black and Latino Americans were more likely to be in low-paying jobs that demand hands-on labor before COVID-19. Black and Latino Americans were more likely to be in jobs with poor safety protections and high incidence of injury or illness before COVID-19. Black and Latino Americans were more likely to be in neighborhoods underserved by medical facilities before COVID-19. Black and Latino Americans were more likely to suffer from damaged health that comes from living with poverty before COVID-19. Black and Latino Americans were more likely to face health damage from pollution, food desserts, unclean water, overcrowded housing, and the sheer stress of surviving day to day before COVID-19.
Everything about COVID-19 conspires against Black and Latino Americans, because everything about the structure of America conspires against Black and Latino Americans. COVID-19 didn’t create this situation, it only underlined it. In blood.