COVID-19's disproportionate effect on blacks tracks hospital safety disparities in many communities

 

By Rhea Warren, Sierra Lewter, and Madeleine Voth

May 30, 2020


 

The coronavirus pandemic has put racial disparities in health and health care in stark focus.

African American patients with COVID-19 were 2.7 times more likely than Non-Hispanic white COVID-19 patients to be hospitalized and came in sicker with more severe symptoms, according to a study out Thursday in the medical journal Health Affairs. Even with health coverage, African Americans were less likely to seek coronavirus testing and more likely to wait until it became an emergency to go to the hospital, the study of Northern California patients found.

Not only are a disproportionate share of African Americans and Hispanics dying of COVID-19, but the hospitals that continue to treat them often have far lower safety ratings, especially when it comes to deadly infections.

“The (African American) community always seems to get the bottom of the list care,” said Thomas Hegens, CEO of Phenom Surgical, a Washington, D.C., area medical staffing company. “It’s one of those things where you walk into a facility where you’re looking for that pristine care, and you don’t get it and see it in the waiting room and in the offices where you feel like you are being rushed in and out.”

Thomas Hegens, CEO of Phenom Surgical

It doesn’t have to be this way.

African Americans and Hispanics are more likely to have one or more of the chronic health conditions that dramatically increase the risk of serious illness or death if they are infected with coronavirus. Obesity is a major driver of COVID-19 morbidity and mortality and enhances vulnerability to other chronic conditions. Obesity is also now considered nearly as bad as smoking when it comes to risk factors for emphysema and cancer.

Anyone who needed a real jolt of motivation to lose weight, should have it now. Given COVID-19’s expected resurgence in the fall, it is quite literally a matter of life and death.

“It will not only help prevent severe COVID-19 disease but will also lessen the severity of the other COVID-19 risk factors such as diabetes, hypertension and heart disease”, said Dr. Kevin Kavanagh, the physician and patient safety expert who heads the nonprofit HealthWatch USA.

If an obese patient needs a breathing tube, health care workers have to reposition the patient every day on their stomach which boosts the chance of survival.

The larger the patient, the more difficult it is to reposition, and this can get overlooked in an understaffed hospital, even when there is no pandemic. These fatty tissues create other problems, too. They store the immune cells that can cause cells to dangerously start attacking each other – like they do for people with autoimmune disorders such as Lupus.

The chronic conditions that are more common in the African-American and Latino communities dramatically increase the risk of hospital transmissible infection when patients are undergoing surgery of any type. Infection is also much more likely in a hospital with a poor record of infection control.

Rates of some hospital infections can be found on Hospital Compare and other rating sites including for the Leapfrog Group.

According to a March study in the medical journal Lancet, the key ones to look for are the “hospital acquired infections” because people who die of COVID-19 often do so from a viral pneumonia and up to half of these patients may also have a bacterial co-infection. In the 2009 Swine Flu pandemic, an estimated 29-55% of people who died also had secondary bacterial pneumonia. This was also the case seen in 95% of the patients that died in the 2018 Spanish Flu epidemic.

This makes it so much more important for people of color to do their research before choosing a hospital, to ensure that they have strong family advocates who will ask the right questions, and get help from medical staff to improve overall health and reduce vulnerability to disease, experts say.

“There’s no reason to be trapped in bad medicine,” says Northern Virginia plastic surgeon Dr. Talal Munasifi, a clinical professor at Georgetown University.

Dr. Talal Munasifi, plastic surgeon and clinical professor at Georgetown University

In Washington D.C.,only MedStar Georgetown University and Sibley Memorial hospitals received a B rating by the Leapfrog Group. None received an A. Howard University Hospital received the lowest rating in the nation’s capital with a D.

Hospitals often blame patients’ socioeconomic conditions for low ratings, but patient safety experts say it doesn’t have to be that way.

There are hospitals in lower-income urban areas that earn high scores, said Erica Mobley, Leapfrog’s vice president of administration. She cites the University of Chicago Medical Center in Chicago, Martin Luther King Luther, Jr. Community Hospital in Los Angeles, CA, and Las Palmas Medical Center in El Paso, Texas. They each obtained an A rating from Leapfrog.

Patient safety experts say it’s key is to be your own advocate and to have one when you aren’t in a position to speak for yourself.

“That’s never been more important than now, when about 50% of people with coronavirus either won’t have symptoms or they haven’t started showing signs of symptoms yet,” said Kavanagh. Health care workers, even those with enough protective equipment, can be carriers, he notes. As of April 9, more than 9.000 healthcare providers had COVID-19. However, masks are the best way for carriers without symptoms to prevent spreading the virus; even a cotton mask helps. They are shown to decrease up to 90% of viral particles.

“To prevent as much exposure as possible to COVID-19 carriers, ask to give your information over the phone and not have to fill out paperwork at the facility,” said Kavanagh. “It’s safest to wait in the car and then be taken directly back to the treatment area, by-passing the waiting room and check-in counter.”

How to make your hospital experience safer and better - now and post-pandemic:

  • Be fully candid with your doctor during any pre-surgery checkups.
  • Choose the highest rated hospital possible. “Good hospitals attract good doctors,” said Munasifi. Make sure you are consulting reliable doctors on what hospitals they favor.
  • Check the hospital’s specialty. Lower rated hospitals may be highly regarded for heart or cancer care, for example, but not both.
  • Ask health care facilities about their coronavirus safety protocols. When you make your appointment, you should be asked screening questions regarding the symptoms of COVID. Make sure the facility is requiring both patients and healthcare providers to wear masks and have their temperatures taken.
  • Question your doctor closely about why he or she is suggesting a treatment, especially surgery. Make sure they are tailoring their approach to your specific needs. “Medicine is not ‘never do’ or ‘always do,’” said Dr. Marty Makary, Johns Hopkins University Hospital surgeon, public health professor and author of The Price You Pay.
  • Go into the appointment knowing your symptoms. Don’t let a doctor or nurse nudge you toward an unnecessary procedure with leading questions like, “Do you have leg pain?” Be aware sometimes they may be trying to create business for themselves.

Unless it’s a “true emergency,” it’s also best to stay out of the hospital.

“Only go to the hospital if you need to,” said Kavanagh. “Many ailments can be taken care of through telemedicine or at a doctor’s office, both of which are safer alternatives.”

Because of COVID-19’s disproportionate effect on minority communities, it’s especially important that people of color “develop trust with a health care provider” who also treats them well, said Dr. Georges Benjamin, executive director of the American Public Health Association.

It’s “the most important relationship to have,” said Benjamin, a former health commissioner of Maryland and D.C. “It fosters trust, drives understanding, and you are much more likely to be compliant with their recommendations.”

It’s also important to insist on treatment at the right hospital.

“If you have a choice, then you should go to the place you feel most comfortable and that has a higher quality rating,” said Benjamin. “Knowing what the better hospital is, even for emergency care, can be extremely important particularly when you can tell the ambulance driver that you prefer to go to hospital A and not hospital B.”

“It’s not surprising African Americans don’t trust health care providers,”said Hegens, who grew up in Southeast D.C. “That mistrust has been built over years of not getting fair treatment at particular venues.”

Honesty and transparency are key for appropriate patient safety and should be routinely established within healthcare practices, especially for those who have a wariness towards the system. There are signs of progress.

“Over the last two decades, many physicians have been working to change the culture from a ‘deny and defend’ mentality to a ‘honesty and apology’ mentality, because patients are hungry for honesty,” said Makary.

Contributing: Caitlyn Taylor and Joshua Mitchell

This story was produced by students and instructors in the nonprofit Urban Health Media Project.

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