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Race, equity, and the impact of COVID-19 on African Americans

Dermatology World Weekly talked to Sacharitha Bowers, MD, vice chair of the Diversity, Inclusion, Community Engagement and Equity (DICE) Council for the Department of Internal Medicine at Southern Illinois University School of Medicine, about the barriers to care that contribute to the staggering COVID-19 statistics plaguing the African American community. Learn more about Dr. Bowers’ passion for equity work, the strategic approach she’s taking to get ahead of the COVID-19 infection and mortality rates impacting African American communities, and her advice on raising awareness about COVID-19’s impact on vulnerable populations.

DW Weekly: Your professional interest lies in equity work. Tell us more about your passion for equitable opportunities.

Dr. Bowers: I am an immigrant. I came to America from India when I was almost four years old. I struggled with a lot of challenges being different in a predominately white area of the country. I think this is where my passion for social justice work originates from. At the time, I didn’t know that there was a “name” for it [equity/social justice].

Within the space of medicine, my passion for this work is always evolving. For me, it’s hard to think of being a doctor and not being acutely aware of health and health care inequity. Inequities and disparities have always been an urgent matter — even before COVID-19. These disparities have been present since the birth of this nation. COVID-19 is just shining a spotlight on them in a way we haven’t seen before.

DW Weekly: The research tells us that African Americans have disproportionately higher rates of COVID-19 infection and mortality. Can you tell us more about why this is happening?

Dr. Bowers: In March, we saw numbers start trickling in from places like Michigan, Louisiana, and Chicago. They were representing a disproportionately higher number of COVID-19 infection and mortality rates. At its peak, in late March and early April, African Americans represented more than 50% of Chicago coronavirus infections and 70% of Chicago COVID-19 fatalities, but they only make up 30% of the city’s population. They were dying at a rate nearly six times higher than white Chicagoans.

In Illinois, African Americans represent 14.6% of the state’s population, but 40% [as of April 29, 2020] of COVID-19 mortality rates [in the state]. And what’s additionally troubling is that African Americans only make up 11% of individuals being tested [according to the Illinois Department of Public Health], which is less than their representation in the state’s population. Those numbers are replicated throughout the country — early on, we saw it in Michigan, Louisiana, North Carolina, and we keep getting more data. However, I must point out that we have no national registry or way to track this, which is very much needed if we are going to have an impact on changing this trajectory.

We know, from a physician standpoint, mortality rates for COVID-19 are higher with certain chronic co-morbidities such as diabetes, hypertension, obesity, underlying cardiovascular disease, and respiratory disease. We know that these co-morbidities disproportionately impact African American communities, and this is largely due to the impacts of underlying structural racism.

Structural racism and its impact on health disparities are perfectly exemplified by the fact that COVID-19 infection and mortality rates are higher in five specific neighborhoods on the South Side of Chicago. The South Side of Chicago is a historically redlined neighborhood. Residents from these five neighborhoods typically work in low-paying jobs that may not offer health care, and there is limited access to nutritious, healthy foods and quality education. These issues directly impact the co-morbidities that lead to COVID-19 mortality. It’s all interrelated and deeply impacted by structural racism. Disproportionate health outcomes, like what we are seeing with COVID-19, are the result of what happens when inequity and injustice are built into the fabric of society.

DW Weekly: As Vice Chair for Diversity, Inclusion, Community Engagement, and Equity Council for the Department of Internal Medicine at SIU School of Medicine, tell us more about the strategic approach the team is taking to address the disproportionate COVID-19 infection and mortality rates among the African American community in Illinois.

Dr. Bowers: Our Equity-driven COVID Community Task force is a collaboration between our DICE Council, SIU’s Associate Dean for Equity, Diversity and Inclusion, our marketing team, and some key community leaders. We knew that to get ahead of these infection rates, we would have to think beyond clinical medicine. We strategized a collaborative and multipronged approach. We prioritized obtaining accurate local data, developing and disseminating culturally responsive and appropriate educational material to the community, and collaborating with community organizations and leaders for targeted interventions. Coalition building is embedded in our strategic approach. We make a conscious effort to dive into the community we aim to serve because it is important that we let our community guide us.

DW Weekly: In what way?

Dr. Bowers: Organizations such as the NAACP, our local Ministerial Alliance, our school district leaders, and the Boys and Girls Club, to name a few, often know our community much better than we do, as they interface with them in so many different ways. They’ve also built up trust with the community in a way that the medical establishment has not. As part of our DICE Council, we have a team of community leaders who we meet with quarterly — local pastors, educators, the president of our local NAACP chapter, etc. While these people are not in health care, their influence is instrumental in helping us adequately serve the community. They give us guidance on how best to help our community, particularly marginalized populations whose voices are not heard.

DW Weekly: You mentioned that the disproportionate COVID-19 infection and mortality rates are replicated across the country. What advice would you give to your physician colleagues who want to get ahead of the curve and get the word out about how their communities are grappling with COVID-19?

Dr. Bowers: If I were to give any advice at all, it would be to start somewhere.

Fortunately, members from our group have been able to interface with state and public health officials who are taking heed of this issue. Chicago Mayor Lori Lightfoot implemented the Racial Equity Rapid Response Team to address the disproportionate impact of the coronavirus pandemic on African American communities. Targeted efforts like this can contribute to getting ahead of the curve. In fact, the African American mortality rates in Chicago have dropped from close to 70% to under 50% [as of this publication]. There is still stark disparity, but the numbers are trickling downward.

I join national conversations on Twitter and other social media outlets knowing that my voice is just as impactful on these channels as long as I’m mindful of my approach.

Medical journals are another vehicle to get the word out. Many publications are accepting research, abstracts, and other forms of content on the data of COVID-19’s disproportionate infection and mortality rates in African American communities. Highlighting data in these platforms is very strategic, especially since many physicians, health care personnel, and public health officials have access to these publications and an appetite for such data.

Most importantly, know that even the “smallest” acts can make the biggest differences. Whether it is donating monetarily to efforts, checking in with your local food pantries or homeless shelters, or making masks for members of your community, we can all make an impact during this crisis.

DW Weekly: Access to care in marginalized communities is a constant battle. Can you tell us how telehealth can improve access to care even beyond the pandemic?

Dr. Bowers: If we’re going to make telehealth a viable platform long-term, we’ve got to think about the barriers that can keep patients from getting telehealth care. We have to fix the digital divide, which is the chasm between those who have access to computers and the internet and those who don’t. In addition, acquiring the necessary equipment to aid in successful telehealth sessions is another issue for marginalized communities. Do people who we want to reach via telehealth have smartphones, tablets, laptops, or desktops? How will we get it to them if they don’t? What policies will fund these resources so we can get them in the hands of those who need them most? Telehealth has the potential to curb access-to-care issues. However, physicians need answers to these initial questions and the opportunity to interface with telehealth software technicians to share feedback on what works and doesn’t work so that we, as a society, can get a handle on this digital divide.

DW Weekly: What can/are dermatologists doing to mitigate the spread of COVID-19?

Dr. Bowers: Some dermatologists are on the front lines in high risk areas like New York. For those of us who aren’t, everything we do to keep people home during this crisis is going to help physicians on the front lines see less infection and preserve their PPE. Keeping people home and maximizing our telehealth is a life-saving benefit we can provide.

I want to commend the AAD with their proactive response during this time. They really were ahead of the curve. Very early on, the Academy put out information and resources helping to push telehealth so we could still provide care while keeping patients at home to help flatten the curve.

DW Weekly: What do you want your colleagues to know as you help navigate these health care inequities, especially during a pandemic?

Dr. Bowers: As a final call to action for equity, I want all my colleagues to know that, though COVID-19 was framed early on as “the great equalizer,” we know it is anything but. I call it the “great magnifier,” as it has taken existing disparities and blown them to exponential and deadly proportions. To think of things with an equity lens really does take an intentional approach, especially in specialties like ours where we sometimes get shielded from the patients who need care the most. I encourage all dermatologists to intentionally think about how different populations in their own communities may be on the outside of our care bubbles, and how we can pull them inside so that we can help change the trajectory of COVID-19, but also change the trajectory of health care inequity overall.