By Dr. Oliver Brooks
President, National Medical Association
It is oft stated in the Black community: “when the country gets a cold, we get pneumonia.”
The genesis of this saying is unclear, but the inference is not, nor is it inaccurate. Black people suffer more from adverse medical conditions, with poorer outcomes. COVID-19, the disease process caused by infection from the pandemic virus SARS-CoV-2 will likely demonstrate its accuracy. We also are starting from behind being poorer and with less access to basic resources. Pneumonia is more likely than just a cold.
At present the CDC has noted that those with chronic lung disease, moderate to severe asthma, serious heart conditions, those immunocompromised including cancer treatment, severely obese, diabetic, with renal failure, or liver disease are at higher risk for severe illness. That warning should be clearly heard by the African American community. We are 2.2 times more likely to have diabetes, 20% more likely to have high blood pressure, and 30% more likely to be obese. The incidence of COPD (lung disease) in our women is 34% higher than in White women. Bottom line, if we acquire the virus, bad things are more likely to happen. That’s pass number one.
Let us layer onto that more baggage. It is now known that the social determinants of health (SDoH) play as important a role in a person’s health as genetics or medical treatment. There are, broadly, six SDoH categories: economic stability, physical environment, education, food community and social content and health care systems. Blacks are adversely affected in this arena. For example, with poorer housing we cannot generally socially isolate at home each in a different wing of the house; we may have 6 people in a 2-bedroom apartment. Searching for healthy food or using the bus to get to work (if you have a job and going to work), puts one at higher risk of acquiring the infection. Add the health risk factors above and we see a potential recipe for disaster.
I will separate one out the above noted SDoHs: economic stability, (or lack thereof). Quoting from a Brookings Institute study, “at $171,000, the net worth of a typical white family is nearly ten times greater than that of a Black family in 2016. Gaps in wealth between Black and White households reveal the effects of accumulated inequality and discrimination, as well as differences in power and opportunity that can be traced back to this nation’s inception. The Black-White wealth gap reflects a society that has not and does not afford equality of opportunity to all its citizens.” Allow an addendum; The Black-White HEALTH gap reflects a society that has not and does not afford equality of opportunity to all its citizens.
So how will we know if this is borne out in the COVID-19 pandemic? Only by data, and this we do not have, nor a plan for to get it. Democratic lawmakers noted an apparent lack of racial data that they say is needed to monitor and address disparities in the national response to the coronavirus outbreak. In a letter to Health and Human Services Secretary Alex Azar, two lawmakers said comprehensive demographic data on people who are tested or treated for the virus that causes COVID-19 does not exist. U.S. cities with large black and brown populations such as Chicago, Detroit, Milwaukee and New Orleans have emerged as hot spots of the coronavirus outbreak. “This lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities,” the letter warned.
So here we are. Blacks are at higher risk of complications from COVID-19. Blacks are theoretically more prone to acquire COVID-19, and if we are disproportionately affected we don’t even know. Where does all of this leave us? With pneumonia.
Oliver T. Brooks, MD is the 120th President of the National Medical Association and the Chief Medical Officer of Watts HealthCare Corporation.