The COVID-19 pandemic highlighted social inequality in its impact on communities of color.
Dr. Christina Johnson’s warning to the audience during our February 4, 2021, Community Conversation was direct and clear: prepare a difficult conversation. Her topic? Systemic racism and how COVID-19 revealed inequalities in our society.
Dr. Johnson, an Atlantic Medical Group family medicine physician and community health advocate, said that, in many ways, the pandemic was a reckoning. It clearly showed a disproportional rate of disease and death in communities of color.
She explained: “Racism assigns value to people, based on their race. Now we all know from the human genome project that we are 99.9% the same. But, in certain societies, we’ve created differences in opportunity, in structural availability of things like health care, housing, and jobs that are safe. And, because of those differences ... we see (different) outcomes in something like COVID-19.”
What are social determinants of health?
Dr. Johnson explained that our health is partially based on our own choices – what we eat, how much we exercise, how often we visit the doctor. But there are other factors that contribute to our health called “social determinants of health.”
They can include the amount of pollution in our neighborhood, access to quality education, adequate transportation, job opportunities and healthy food options.
These factors create health disparities for whole populations of people, Dr. Johnson said. So, health care providers need to be aware of these factors, as well as a patient’s context and history, in order to provide the best care.
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How have social determinants of health increased the impact of COVID-19?
COVID-19 is a respiratory pathogen and spreads more easily where people live in close proximity. Dr. Johnson said because of discriminatory housing policies from the 1940s, certain ethnic and racial groups are relegated to dense housing. Many multi-generational families live in small apartments. In these situations, it is difficult to social distance or to isolate if you were exposed to COVID-19. She linked housing to school segregation and lower rates of health literacy. For example, understanding that mask wearing prevents the spread of COVID-19. She connected educational disadvantages and financial barriers to job opportunities. She cited fewer African Americans and Latinx people in health care careers. Dr. Johnson also noted that your type and place of employment and ability to access computers and broadband internet to work or to attend school remotely impacts your safety. All of these factors combine to expose marginalized communities to greater risk for COVID-19.
How do those increased risk factors translate into real-world consequences for communities of color?
Last year, COVID-19 was the single largest cause of death for African American, Latinx and Asian American populations in New Jersey. Dr. Johnson cited a statistic that over 30% of African Americans have a close friend or relative who was affected by or died from COVID-19.
“When patients come into my office, one of the first questions that I ask them is whether or not they’ve had any personal experience with COVID-19 themselves or with family members who have died. And what we’re talking about is a form of grief and stress that I think, even beyond this pandemic, the country is going to have to really deal with.”
Dr. Johnson added that communities of color have responded to these challenges by turning inward to help each other by sharing information, resources and support.
How have these communities reacted to this dangerous virus?
Dr. Johnson remembered the frightening early days of the public health crisis. “When the pandemic first started and the lockdown happened, around March ... people were terrified. They just didn’t want to go out.”
Despite that fear, she said, many people still had to go to work. “In order for you to stay home, you have to have enough money saved up to pay for your bills, to pay for your rent ... you need money to buy food, utilities, your medications.”
Dr. Johnson linked these economic realities to a lack of job opportunities and gaping wealth disparities in the African American population. “African Americans, for example, bring in about 60% on the dollar for what Caucasian Americans usually do. The wealth gap between the two communities (results in) African Americans having about 5% as much wealth as the larger ethnic population (of) Caucasians do."
What conversations are you having with your patients to inspire action to stay healthy during the pandemic?
Dr. Johnson noted that while communities of color face unique challenges, they are also characterized by hope and perseverance.
“When I'm talking to patients and they come into the office, they’re feeling stress and devastation from COVID. But they also really want to improve their overall health. They want to reduce those modifiable risk factors, their weight, blood pressure, and COPD. If they smoke, they want to stop smoking. So, we turn what could be thought of as this sort of overwhelming negative into a hopeful positive.”
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Only 5% of COVID-19 vaccinations across the country have gone to African Americans. Why is the percentage so low?
According to Dr. Johnson, many in marginalized ethnic and racial groups mistrust medical professionals and the pharmaceutical industry. Some comes from a long history of unethical medical experiments on African Americans and a legacy of segregated hospitals. Some people feel uncertain about the vaccine because of this context.
How can communities of color be reassured that the COVID-19 vaccine is safe?
Dr. Johnson explained that because of effective vaccines, childhood diseases such as chicken pox, mumps and measles have been virtually eradicated. The same types of research and careful processes that developed those vaccines were used to create a COVID-19 vaccine. The COVID-19 vaccines currently approved by the FDA, from Pfizer and Moderna, went through all of the needed steps for approval. The clinical trials were completed to develop vaccines that are safe and effective.
Did the clinical trials represent of communities of color?
For the Phase 3 clinical trials of both the Pfizer and Moderna vaccines, there was roughly 9% African American participation and between 14% and 20% Latinx participation. During the Phase 3 clinical trial, the safety and efficacy of the vaccines were measured, and they were approved for distribution to the general public.
Do you recommend the COVID-19 vaccine to all of your patients?
Dr. Johnson responded that patients should think about their own health. Have you had any reactions to vaccines in the past or to a component of a particular vaccine? What is your exposure to the virus where you work? Are you obese? Do you smoke? Do you have a disease that impairs your immune system? Did you have an organ transplant? Are you older and at risk because of your age? Finally, given all of your personal factors, is your risk of getting COVID-19 and having a severe illness worse than the side effects of the vaccine? Dr. Johnson reaffirmed the safety and efficacy of the COVID-19 vaccine and noted that no one has died because of the vaccine.
What are the side effects of the COVID-19 vaccine?
Most of the side effects related to the vaccine are site reactions such as soreness in the arm. Some people experience chills, fever and/or headaches. Dr. Johnson said she received both doses of the COVID-19 vaccine. She experienced a headache as a side effect. She said that the decision to receive the vaccine comes down to a simple calculation. “If your risk of having COVID-19 and getting severe disease and ending up in the hospital and dying is worse (than the side effects), then get the vaccine.”