The Health Care System Has the Black Community in a Choke Hold
It was the Black woman’s third trip to the emergency department because she was feeling short of breath. She was starting to panic. She knew the COVID-19 death toll was climbing and that it was far worse for Black people than white people, and yet the doctors told her to go home again. But this time she pleaded, “If you all don’t admit me to the hospital, I’m going to die. I can’t breathe.”
This is the story told by Sheila Young, MD, physician scientist and director of the free COVID-19 testing site on the campus of Charles R. Drew University of Medicine and Science (CDU) in South Los Angeles, during an online community forum on the effects of COVID-19 on underresourced communities.
“‘I can’t breathe.’ This is a sentiment we’ve heard before,” Young said.
When New York City police took Eric Garner into custody for selling loose cigarettes in 2014, we heard him say, “I can’t breathe” before he died in a police officer’s choke hold. On May 25, after Minneapolis police accused George Floyd of passing a counterfeit $20 bill, we heard him say, “I can’t breathe” as he begged the officer kneeling on his neck to release him. The officer, his hands resting in his pockets as if he were strolling through the park, didn’t budge until Floyd was dead.
We must hold the health care system accountable for delivering equitable care to Black people during the COVID-19 pandemic and beyond.
And now we are hearing it from Black people at the mercy of the American health care system. A system that is literally supposed to help those who can’t breathe is figuratively applying a choke hold to Black people by sending them home to die when they say, “I can’t breathe.”
Gary Fowler, a 56-year-old Black man, was denied COVID-19 testing and hospital admission by three Detroit emergency rooms where he complained of difficulty breathing. Deshaun Taylor, a 23-year-old Black man, was sent home twice from a Chicago hospital, even after testing positive. Reginald Relf, a 50-year-old Black man, was turned away from an urgent care clinic in suburban Chicago without being tested in spite of his labored breathing, fever, and cough. Kimora Lynum, a 9-year-old Black girl with a fever of 103 degrees, was sent home from a Florida academic medical center without being tested. They all died soon after.
The patient whose story Dr. Young shared at the June 16 community forum was lucky. On that third try, she was admitted to the hospital. But 10 days later, when she was being discharged, she again had to fight with the doctors over her care. This time she pushed them to order home oxygen service because her blood oxygen saturation was in the 80% range, well below the normal 95%. Less than 90% indicates a need for medical attention.
In each of these episodes, the symptoms of Black patients were not taken seriously.
In California, Black people represent 6.1% of the state’s population. They contract the coronavirus at a disproportionately low rate of 4.5%, but they die at a disproportionately high rate of 8.3%, according to Los Angeles Times pandemic tracking updated on August 4.
This raises the question: To what extent are health care providers’ implicit biases — attitudes or stereotypes that unconsciously affect a person’s understanding, actions, and decisions — contributing to poorer outcomes for Black people?
No available data suggest such implicit bias is happening on a large scale and resulting in worse outcomes. But the lack of data is less a sign that the problem does not exist than a reflection of what data we choose not to gather.
Early in the pandemic, many sites were collecting no data on the race of patients who were tested or hospitalized or of those who died of COVID-19. But California soon learned that, like the rest of the country, testing sites were primarily located in affluent, predominantly white neighborhoods, even though Black communities bear a disproportionately large burden of the disease. When that knowledge emerged from subsequent data, leaders serving communities of color were compelled to act. The CDU testing site in south Los Angeles met this tremendous need for predominantly Black and Latinx communities it serves.
Removing Barriers to Testing in South Los Angeles
When armed with early data showing that many clients at the testing center did not have cars, email accounts, or Internet access, staff and volunteers eliminated many testing barriers faced by low-income communities. While most testing centers require people to have email addresses to register for appointments online and to remain in their cars throughout the process, the CDU site — established in partnership with County Supervisor Mark Ridley-Thomas, the Los Angeles Fire Department, and the Los Angeles County Department of Health Services — adapted and allowed walk-through testing and walk-in registration. The extensive outreach campaign to alert the community of these innovations reminds us that ending racial disparities depends on changing the system to meet patient needs rather than expecting patients to conform to the system.
Making testing accessible to the communities that need it most is necessary but simply insufficient. “Our health care system sends the message to people of color, homeless people, and people with language barriers that ‘your life is not as important,’” Dr. Young said. “That’s not OK.”
We all have implicit biases, but even when those biases are pointed out, few acknowledge they are present. So again, just as video proof of police brutality made it indefensible before the world, we need hard data to prove to skeptics within the health care system that these problems are real. We need disposition statistics disaggregated by race to determine the extent to which Black people with similar complaints and disease severity as white people are being sent home by urgent care and emergency department services — only to die days later. These data will compel the health care system to finally face up to the problem of implicit bias and to release the figurative choke hold on Black bodies. This will require honest reflection and a commitment to change in ways that unequivocally demonstrate Black lives matter too.
In the wake of George Floyd’s death, the American Medical Association, the American Academy of Pediatrics, and the American College of Emergency Physicians have all declared racism a public health crisis. We must resolve that crisis. We must hold the health care system accountable for delivering equitable care to Black people during the COVID-19 pandemic and beyond.