The COVID-19 Pandemic is Worsening Health Disparities. Emergency Physicians Can Help
RACISM AS A PUBLIC HEALTH CRISIS
By William E. Baker MD, David A. Kim MD, PhD, and Leon D. Sanchez MD, MPH on behalf of the SAEM ED Administration and Clinical Operations Committee
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Though COVID-19 was initially described as a “great equalizer” to which rich and poor, young and old alike were susceptible, the pandemic’s impact on our society has been anything but uniform. COVID-19 mortality is markedly higher in regions with more poverty, crowding, and racial segregation. In Chicago, Black residents account for 30 percent of the population, but 70 percent of COVID-19 deaths. Nationwide, only six percent of white patients who died from COVID-19 were younger than 60, compared to 25 percent among Latinos. Even among front-line providers, risk of COVID-19 is greater among minorities. Though medical comorbidities are more prevalent among minority and low-income patients and are risk factors for severe COVID-19, comorbidities alone do not explain the stark disparities in cases and deaths by race and socioeconomic status. Lower income
“Though COVID-19 was initially described as a “great equalizer” to which rich and poor, young and old alike were susceptible, the pandemic’s impact on our society has been anything but uniform.” and minority patients make up a disproportionate part of the “essential workforce,” with few opportunities for social distancing or remote work. When patients fall ill with COVID-19 and seek care, minority and low-income patients are more likely to receive care in overburdened and under-resourced public and/or safety-net hospitals. At
the height of the outbreak in New York City, COVID-19 mortality was as much as three times higher in the understaffed and overwhelmed public system (which received a preponderance of lowincome patients), compared to wellstaffed private hospitals, which received vanishingly few transfers from the overwhelmed public system.