Panelists at UND discuss COVID-19’s impact on communities of color

Pandemic has exacerbated long-standing inequities in American society, panelists at UND Black Student Association-sponsored event agreed

 

‘The Impact of COVID-19 on the Black Community: A Vaccine Forum’ was held Feb. 3 via Zoom and featured the panelists pictured above. Image courtesy UND Black Student Association.

Deaths among Black people due to COVID-19 are higher than among most other groups. But at the same time, the Black community reports higher levels of skepticism about the COVID-19 vaccines, and is getting vaccinated at lower rates, than is happening among other groups.

Why?

That was the question posed to four distinguished health professionals at a recent forum hosted by the UND Black Student Association. “The Impact of COVID-19 on the Black Community: A Vaccine Forum” brought to the table Dr. Christy Hewling, senior physician director of quality and patient safety, Kaiser Permanente Medical Center, Kennesaw, Ga.; Dr. Kirk Hewling, family medicine physician at Towne Lake Primary Care in Woodstock, Ga.; Dr. Kristopher Chrishon, an epidemiologist and the executive director of academic assessment at Texas Southern University’s Thurgood Marshall School of Law; and Jessica Doty, director of UND Student Health Services.

Together, the panelists answered questions from moderator Dr. Tamba-Kuii Bailey, assistant professor of Education, Health & Behavior at UND, as well as from the audience watching on Zoom.

And from their answers, some common threads emerged: On average, Black people in America have experienced a perfect storm of circumstances that has left them both uniquely vulnerable to COVID-19, and deeply suspicious of the vaccines now being administered as a preventative.

Moreover, changing those conditions will require addressing the structural racism in American society that has helped bring the conditions about, the panelists agreed.

Moderator Bailey asked the first questions of the group: How has COVID-19 affected the Black community? And what characteristics of the Black community might help explain the high COVID-19 infection and death rates that have been so widely reported?

Those disparities are indeed severe, and were evident from the pandemic’s start, Dr. Kirk Hewling said.

“One of the things that stood out at the very beginning was that the number of cases we saw were much higher in the Black community,” he said. In addition, “there was a disproportionate number of deaths in the African American community.

“For those of us who are in public health and health care, some of this was anticipated, because we know that due to some of the comorbidities that are present among African Americans — in particular, hypertension and diabetes — those individuals who have those conditions have tended to contract the virus at a higher rate.”

(Note: A video of the event is available may be watched below.)

Pandemic widens the gaps

But that higher incidence of comorbidities is just one factor, not the only factor, Dr. Hewling continued. There also are disparities in other “social determinants of health.”

For example, disproportionate numbers of African Americans labor in fields that classify them as “essential workers,” he noted. Such workers encounter more viruses than do stay-at-home workers not only on the job, but also on the way to and from the job, given that they’re often using public transportation to commute.

“So there are more opportunities for exposure, and in places where it’s much more difficult for people to social distance themselves,” Dr. Hewling noted.

“Because of those things, it always was pretty clear that we’d see disparities, unless interventions were put in place to make those things better.” And such interventions were few and far between, he suggested.

Dr. Christy Hewling agreed. Then there’s another major contributor: the fact that the pandemic has made it even harder for people – especially low-income Black people – to get treated for their health conditions, thus making a bad situation worse.

“There were health care disparities happening before COVID-19,” she said. “But this pandemic has widened that gap.” Especially in the early days, the shutdown meant fewer people getting routine follow ups, refills on their prescriptions and regular cancer screenings, for example.

Dr. Christy Hewling is an emergency physician, and she noted that emergency rooms are the provider that many low-income people turn to first, when their symptoms become severe. “So, by the time I see patients, their comorbidities – their diabetes or their high blood pressure – already are out of control,” she said.

“You put the virus on top of that, and you have a worse outcome, with mortality rates being much higher – as a consequence of the patient not having gotten the care they needed on the front end.”

The Feb. 3 event, ‘The Impact of COVID-19 on the Black Community: A Vaccine Forum,’ was sponsored by the UND Black Student Association.

Skepticism has deep roots

Given all of those circumstances, asked Dr. Bailey, why are so many in the Black community also hesitating to take the vaccine?

Part of the answer is the history that organized medicine has with the African Amerian community, Dr. Kristopher Chrishon said. “For example, most of us know about the Tuskeegee Study, and how there were African American men who thought they were being treated for syphillis, but were actually just being studied to see how the disease progressed in their bodies.”

Awareness of that study and its shocking betrayal of trust has created skepticism among African Americans about organized medicine, Dr. Chrishon said. Nor is that the only case in which bias has hurt African Americans’ health care.

Such longstanding discrimination helps explain why only about 30 percent to 40 percent of African Americans say they will get vaccinated against COVID-19, leaving 60 percent to 70 percent who say they won’t, Dr. Chrishon said.

Dr. Kirk Hewling agreed. And the issue “is even bigger than that,” he said.

It includes all of the circumstances listed above – the conditions and discriminations that have created enormous economic, social, financial and judicial gaps between African Americans and the rest of American society.

For example, he asked, when you hear on the news – as happened in Atlanta recently – about a case in which Black students were being treated differently than white students, is your first thought, “Oh, those Black students must be getting really good treatment”?

Probably not, he said. “On the globe that we live on, this brown skin gets you discrimination, gets you lesser treatment.” So, is it any wonder that news of a brand-new, rapidly developed, emergency-authorized treatment “does not inspire confidence in people who do not trust ‘the Man,’ the system,” in the first place?

Then there’s the fact that an already-suspicious population, hindered further by income and education gaps, is especially vulnerable to media hype about bad reactions to the vaccine, however rare those reactions have been.

“It’s just level of education, level of confidence in the system,” he said. “It’s so many different things, and it’s why I have to spend so much time describing the science to patients in order to get them to believe in this tried-and-true treatment.”

So, asked Dr. Bailey, what is to be done, especially to both ease people’s suspicion of the vaccine and make sure it gets widely distributed? For example (and regarding that distribution), is UND thinking about making the vaccine mandatory for all students?

Answered Jessica Doty of the UND Health Services, “right now, I know that the campus is not looking at making the vaccine required. … (Instead), the biggest challenge is making sure that we get the vaccine allocations that we need, so that we can make the vaccine more readily available.”

Around the country, cities, states and the federal government are encouraging people to protect themselves and prevent the spread of COVID-19 by getting vaccinated when a vaccine is available. In Houston, for example, the “Take Your Best Shot” campaign is a direct outreach to those most heavily impacted by COVID-19 — communities of color, seniors age 64 and older, people with underlying health conditions, health care workers and first responders. Houston Health Department image.

Black physicians, nurses and others speak out

On a national level and in the Black community specifically, one encouraging development is among Black health professionals, Dr. Kristopher Chrishon said. They are stepping forward to get vaccinated themselves, encourage their families, friends and patients to get vaccinated, and reassuring patients at every turn about the vaccine’s exceptional effectiveness and safety record, Dr. Chrishon said.

“I think that’s huge, because we know from research that African Americans tend to trust Black doctors more,” he said.

But again, because the above-mentioned disparities extend to the how many Black doctors there are in America, that outreach has a limited effect. The U.S. population is about 13 percent Black, but only about 5 percent of physicians are African American, Dr. Chrishon noted.

“So this (outreach) effort is going to have to be extended to others in health care, if we’re really going to make a difference in the African American population,” he said.

Other challenges include the fact that nationwide, as UND has learned, the vaccine supply is disappointingly low. “As black physicians, we are telling our stories, stepping up and speaking for the vaccine,” Dr. Christie Hewling said.

“But it’s hard, because the allocations of the vaccine are so small. So you want to call patients who are at risk and ask them to come in; but when you have such small number of vaccines, it’s hard to do that.”

Moreover, the vaccine distribution as well as the outreach should be targeted, she continued. For example, appointments with many vaccine providers get made online, and then the vaccine gets delivered in the clinic. But a more targeted approach would remember that lots of people lack access to both the Internet and reliable transportation.

Dr. Kirk Hewling agreed. “With poor, African American folks, I sometimes think that there has to be this huge tent with a sign that says, ‘Get your COVID vaccine here,” he said.

“It should be a very grassroots thing that happens.” Because even if there are plenty of vaccines available in the Atlanta suburbs, for example, a great many metro Atlanta residents wouldn’t benefit, because there’s so little public transportation to the vaccine sites.

Fortunately, “I see that the Biden administration is trying to find ways to penetrate, by setting up lots of satellite sites,” he said. “Now, we just need to ship large amounts of the vaccine to those sites.”

And we have to recognize that a longer-term fix will require addressing the factors that generated the suspicion and the disparities in the first place, Dr. Chrishon said.

“If we’re really serious about minimizing or reducing some of those barriers, we have to have policy in place that addresses those social determinants of health,” he said.

“Until we really do that, we’ll continue to see the disproportionate effect that a virus like COVID-19 will have on African American communities and communities of color.”