The Coronavirus Files: The Health Divide, The Hunger Crisis & Reopening the Courts

Published on
June 9, 2020

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The Health Divide, The Hunger Crisis & Reopening the Courts

Another Problem for Minorities: Medical Bias

In an opinion piece for VoxMarya T. Mtshali, a Harvard lecturer specializing in intersectionality and inequality, urges more discussion of “the role of systemic and institutional racism within medical institutions” as the pandemic continues to have a disproportionate impact on black communities. Research has shown that black patients are often forced to work harder to obtain the same level of care, and majority-black communities often have less access to critical medical supplies, such as personal protective equipment, she writes.

Mtshali points to historic horrors, like the Tuskegee syphilis experiments, ended in the 1970s, which intentionally misled black men to believe they were being treated for syphilis, which can be deadly without treatment. In fact, researchers were studying the effect of the disease on the men’s bodies while giving them fake drugs. But Mtshali urges readers not to consider medical discrimination a thing of the past. In a modern example, researchers found that a widely used algorithm for guiding health decisions was characterizing black patients as lower risk than white patients even when they were equally sick, meaning black patients who needed extra care often didn’t get it. The built-in bias occurred because the algorithm used health costs as a proxy for health needs, even though black patients simply had less on average to spend on health expenses. In another instance, “a 2018 study found that black people are more likely to be involved in studies that have been exempted from requiring informed consent (which would fully describe the potential risks of the research to participants).” 

“Throughout American history, black people have endured a medical system that has been simultaneously exploitative and dismissive. And the damaging implicit and explicit biases present in our medical system do not suddenly vanish because we are in the middle of a pandemic,” Mtshali writes. “In fact, the pandemic has made them impossible to ignore.”

Shift to Telehealth Leaves Some Patients Behind

Telehealth systems can make medical care much more convenient. But unfortunately these systems were designed for just that — convenience, not an equivalent substitute for care. That means that as medical centers try to ramp up telehealth options during social distancing, they’re facing challenges, such as the fact that these systems weren’t designed with non-English speakers in mind. 

For The VergeNicole Wetsman follows medical offices with a high number of ESL patients as they try to figure out what to do. Some patients don’t understand the messages inviting them to telehealth calls and cancel their appointments out of fear of arriving at the doctor’s office and getting sick. Others struggle with instructions on how to set up the necessary apps to join their appointments. One primary care clinic in San Francisco reported their share of non-English patients dropped from 14% to 7%, suggesting these patients are not understanding the options available. “Experts are worried that drop-off in care for these groups could exacerbate health disparities — not just around COVID-19, but also in chronic conditions like diabetes,” Wetsman writes.

The Virus in Our Blood

From its stealth to its deadliness, the coronavirus has stunned the world in so many ways. Its versatility in attacking the body is no exception. How is a disease that was once dismissed as a bad flu now seemingly causing kidney failure, strokes, widespread organ damage and some patients to struggle for months afterward? One emerging hypothesis is that the disease attacks our blood vessels, writes Catherine Matacic for Science, leaving some patients fighting for their lives in a “second phase” of the illness. COVID-19 targets cells called endothelial cells, which line our blood vessels, particularly in the lungs. “By attacking those cells, COVID-19 infection causes vessels to leak and blood to clot,” Matacic writes. “Those changes in turn spark inflammation throughout the body and fuel the acute respiratory distress syndrome (ARDS) responsible for most patient deaths.” 

This mechanism of attack might explain why patients with certain preexisting conditions are hit so hard and might point to potential therapeutics as doctors and researchers rush to figure out how to manage the disease. “Already, evidence that inflammation and clotting play a role in COVID-19 has inspired dozens of trials in the United States and Europe of anticlotting, anti-inflammatory, and antiplatelet drugs,” Matacic writes.

Judges Try To Balance Legal Rights And Courtroom Health

In the United States, the Constitution gives us a right to a speedy trial if we’re ever accused of a crime. But that’s a tall order in the time of COVID-19. Across the country, court systems are trying to figure out how to deliver on that guarantee and to move forward with other urgent legal proceedings without putting jurors, judges, attorneys and courtroom staff at risk. Unlike what we see in television and movies, most courtrooms are quite small, making it difficult to ensure social distancing.

Across the country jury trials have been restricted in efforts to stem the spread of coronarvirus. Now courthouses are trying to restart them, implementing new safety measures wherever possible. For Kaiser Health NewsBrian Krans follows this endeavor in California, where a county-by-county patchwork approach is frustrating efforts.

Ethical and legal issues abound. For one, testifying while wearing a mask might “violate the Sixth Amendment, which allows a defendant to literally face their accuser,” Krans writes. And some worry that valid fears of infection might lead to juries with less representatives from communities of color — communities hit hardest by the coronavirus pandemic. That could lead to more bias from juries suddenly skewing more white.

Covering the Childhood Hunger Crisis

As co-director of The Grow Clinic at Boston Medical Center, a center for children suffering from malnutrition, pediatrician Megan Sandel usually hears about trouble securing food from 20% to 30% of the families she works with. Lately it’s been more like 60%, she said. Not only has the pandemic led to soaring unemployment, in some neighborhoods it’s left grocery stores understocked, posing challenges for parents trying to feed their children, especially those with special dietary needs. 

Sandel partnered with Yale child psychiatrist Megan Smith, director of the Mental Health Outreach for Mothers Partnership, this week to tackle the pandemic’s impact on childhood hunger in a Center for Health Journalism webinar. The two discussed how a lack of basic nutrition and family stress impact children during critical development periods and how minority neighborhoods hit hardest by the virus are also some of the most at risk for food insecurity.

“It's not by accident that low income kids of color, particularly black and... Latinx kids have the highest rates of food insecurity,” said Sandel, referring to structural inequities facing minority communities. Food insecurity in these and other neighborhoods is an issue that leads to “undermining the foundation of what is child and family health,” she said.

For more context, data and story ideas about the growing hunger crisis from our webinar, watch the webinar here.

And Don't Miss... 

  • “Tear-Gassing Protesters During An Infectious Outbreak ‘A Recipe For Disaster.’” Kaiser Health News
  • “Study: Hydroxychloroquine had no benefit for hospitalized Covid-19 patients, possibly closing door to use of drug.” STAT
  • “COVID-19 Can Last for Several Months.” The Atlantic

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