Allison Agwu, M.D., ScM is an associate professor of Adult and Pediatric Infectious Diseases at Johns Hopkins University School of Medicine in Baltimore, Maryland. She cares for patients across the age spectrum, in both the pediatric and adult Ryan-White funded HIV clinics at Johns Hopkins, as the founder and medical director of the Accessing Care Early (ACE) Clinic and the program director of the Pediatric/Adolescent HIV/AIDS Program. Here she discusses disparities in the impacts of COVID-19 in the community she serves.
Of the 6,116 COVID-19 cases in Maryland for which race data was available (around 20% of cases were missing data), as of April 10 African Americans represented 49% of cases and 51% of deaths while representing only 30% of Maryland residents. Whites represented 35% of cases and 40% of deaths while representing 56% of Maryland residents.
What were your thoughts on seeing this data?
While the data being released months into the novel coronavirus first hitting the West coast in January and now rapidly spreading throughout the country deeply concerns me, it, unfortunately, does not surprise me. I worry about how to protect my patients in Baltimore where I practice as an infectious diseases physician.
For HIV – my primary area of focus within infectious diseases — the disparities are even more stark. Blacks represent 49% of new diagnoses in Maryland and account for 74% of people living with HIV in the state while whites account for 5% of new HIV diagnoses and 13% of people living with HIV.
What factors do you see contributing to the disparate impacts of this new coronavirus among your patients?
As a provider trained in both adult and pediatric infectious diseases, I care for the entire age range of patients often within the context of families. A large majority of my patients are Black and even before the COVID-19 pandemic, many of my patients and their families were already plagued with asthma, diabetes, lung or heart disease, and other comorbidities that places them at higher risk of getting sick from COVID-19.
Social and structural determinants resulting from systemic racism and bias contribute to longstanding inequities including disparate access to education, employment, health care and insurance, nutritional foods, poverty, transportation and affordable housing for individuals of color which cumulatively synergize to fuel the increased risk of diseases — non-infectious and infectious.
Even the ability to comply with mitigation strategies (e.g., social distancing, masking, stay at home orders) and access to measures that include telehealth may be limited for many individuals from these communities, given the systemic inequities that already impact them.
Additionally, African-Americans are over-represented in the jobs considered essential, including in transportation and in grocery stores, where risks of COVID-19 exposure and infection are high, and access to means of protection – including masks and gloves — are low.
How can we respond to the impacts of long-standing inequities, and the outcomes we are seeing now?
We cannot afford to shy away from the alarming data. We must ensure that demographic data including race/ethnicity, socioeconomic, health insurance and housing information by ZIP code is collected and disclosed for all COVID-19 cases. We must use this data to expand testing, care and support and social services in communities where the virus has taken hold to stop the spread of this virus, assure equity and access to treatment, and to save lives. Lessons learned from HIV may help to inform how we respond.
What lessons are most critical now, in light of the impacts of disparities on efforts to contain and curtail the spread of COVID-19, and reduce its impacts on individuals and communities?
Moving forward we must make structural changes to our economic, educational, health care and criminal justice systems to bring about the social justice that is needed to promote healthy communities across the country, regardless of race, to address the longstanding epidemic of chronic disease, the current COVID-19 pandemic, and to prevent future pandemics.
Dr. Agwu’s clinical care and research focuses on deciphering health disparities and optimizing care and treatment strategies particularly for young people with HIV. She is a member of the U.S. Department of Health and Human Services’ Adolescent and Adult Antiretroviral Treatment Guidelines and serves on the Board of Directors for the HIV Medicine Association, which produces this blog.