There’s an old adage used in the African American community to describe how communities of color suffer during national crises: “When white folks catch a cold, Black folks get pneumonia.” Now, when some white folks get COVID-19, countless Black and brown people perish.
The national health pandemic has brought to America’s communities of color an existential threat of epochal proportions. This should not surprise us: Those at highest risk for the worst of COVID-19 — Black and brown communities and people living with diabetes, as well as other chronic diseases — largely overlap, often in low-income and underserved communities. Systemic and structural racism resulting in a lack of access to quality health care, jobs that put them even more at risk, and work and living arrangements that leave them without the ability to safely distance from each other are proving deadly.
The inequities in our system are not new; they are simply coming home to roost.
In Maryland, it is not a coincidence that we have relatively high numbers of Black residents and that we are now in the top 10 states in the nation for COVID-19 deaths per capita. Here, Black residents die more from COVID-19 than any other racial or ethnic group, making up roughly a quarter of the population but more than one-third of recorded coronavirus fatalities. Majority-Black Prince George’s County has the most confirmed cases of any Maryland county.
People living with diabetes and other related health conditions are susceptible to the most severe COVID-19 cases. Although Maryland public health officials have not published statewide data telling us what chronic conditions were prevalent among our state’s COVID-19 victims, we know 40% of Howard County victims had diabetes, according to WBAL-TV, portending a bleak prognosis for the more than 600,000 Marylanders who live with the condition. A staggering 95% of Baltimore County COVID-19 deaths involved diabetes and other underlying conditions, and nationwide, nearly 90% of hospitalized COVID-19 patients have at least one chronic disease. Diabetes and other preexisting chronic conditions are the most predictive and correlate with the poor virus outcomes we have.
With Gov. Larry Hogan focused on expanding testing availability as he slowly reopens the state in a safe way, it is imperative that we keep the needs of our most vulnerable citizens top of mind. To do so, Governor Hogan and our mayors need to direct more resources to the parts of the state suffering the most, and they need to do it in ways that meet our vulnerable populations where they are. While drive-thru testing sites are an important first step, these sites are demonstrably fewer and farther between in majority-Black counties than they are in whiter areas. According to the Maryland Department of Health website, three of Maryland’s counties with the largest Black populations — Prince George’s, Baltimore City, and Somerset — have about two dozen, around a dozen, and one COVID-19 testing sites respectively as of late last week. Compare that to whiter, wealthier Montgomery County’s more than 30 sites alone to see the disparity laid bare.
To connect the provision of health care to those who most need it, moreover, we need to start thinking about the way people live in disadvantaged communities and advocate to bring testing and other resources to them. The emphasis on drive-thru testing, while well-intentioned, overlooks fundamental barriers to care faced by Marylanders most at risk.
Drive-thru testing cannot help residents who lack a car. Likewise, putting test site information on the internet is useless to many in underserved communities who lack internet access. Instead, we should deploy text-messaging for information updates and use networks of community health workers and mobile health vans to deliver tests and other screening. Mobile neighborhood-based clinics have begun to appear around Baltimore City, but more is still needed. In addition to expanding the number of tests, investment in resources to support test administration, clinical follow-up and contact tracing for those who test positive is crucial.
There are many ways to accomplish these goals, including through alliances with clinics, nonprofit advocacy and public health organizations, and creating partnerships with larger health care providers who have the staff and infrastructure to reach at-risk communities.
Testing in low-income and underserved areas requires a different approach. No governor can quickly undo the generations of structural racism creating barriers to health care that have laid the foundation for the threat our most vulnerable communities face today. That is something we will have to work on for many years to come.
Yes, Governor Hogan’s quick action to acquire coronavirus tests and commitment to increasing their availability statewide are excellent first steps. Now, let us hope our other state leaders take those critical resources where they need to go — to those whose lives are disproportionately, and literally, depending on it.
Dr. Sherita Golden (firstname.lastname@example.org) is the vice president and chief diversity officer for Johns Hopkins Medicine. She also serves on the American Diabetes Association’s board of directors. Tracey D. Brown (TBrown@diabetes.org), who lives with type 2 diabetes, is chief executive officer of the American Diabetes Association, the nation’s largest voluntary health organization and a global authority on diabetes.