COVID-19 risks amplified for underserved communities

While coronavirus has swept across the entirety of the United States, several vulnerable groups are being hit the hardest. 

Communities of color, the elderly, and the incarcerated population are facing some of the greatest challenges in the face of the coronavirus pandemic. 

Last week a group of panelists discussed the impact of COVID-19 on these communities during HIMSS 20 Digital’s webinar “The Forgotten Ones: COVID-19’s Impact on the Underserved Communities.” 

The pandemic has propelled the conversation in America about racial inequities in health and what can be done in the future. According to the CDC, African Americans account for nearly 20% of coronavirus cases and Latinos account for 16.7% of all cases.

Damon House, program manager at Microsoft Enterprise Services, kicked off the discussion focusing on the African American community in urban areas. 

“Unfortunately, when we talk about inner city environments, they are structurally set up to exacerbate the transmission of COVID-19,” Housesaid on the panel. “When we look at affordable housing that does not have effective ventilation and air conditioning systems, that is a problem. When we look at public transportation, people in our underserved and urban communities are more likely to use public transport, and you cannot socially distance if you are sitting next to someone on a bus or subway. When you look at education through our municipal leaders – are they getting information out to and through different means where people in the urban communities are likely to hear it?”

Dr. Shelley Cooper, CEO Diversity Telehealth, said that hundreds of years of racism has impacted where individuals live and their access to certain services. For example, many people live in food desserts, or areas where there is no access to fruits and vegetables, resulting in a higher prevalence of diabetes. Diabetes and other chronic conditions are associated with a higher risk of mortality among coronavirus patients.

“All of these factors leading to chronic diseases that weaken out immune systems – we are calves to slaughter almost,” Cooper said. “When you add all of these factors in, we started out behind the eight ball.”

But these access issues also include being able to get medical care. However, here tech could come into play. 

“So, lack of access to healthcare can be remedied by telehealth and telehealth would encompass,” Cooper said. 

Tech, such as telemedicine, can not only help get health services to more communities, but also help get out the message about public health safety. Health education can be dispensed in a digital mode, she said. 

Cooper noted that some vulnerable communities have distrust in the medical system when it comes to the coronavirus. However, one method to getting public health initiatives out there is through local voices. 

“Within African American black and brown communities there are de facto leaders,” Cooper said. “There are leaders that the communities trust, and leaders that the communities are more likely to follow. I think in many cases our religious leaders or our political leaders, and sometimes even our de facto leaders, are people that would be the ones to gather the information and present it to the communities.”

Reaching out to the group you are looking to serve is key, panelist said. 

“One of the innovations I’ve seen in some organizations is to invite members of the community, particularly vulnerable populations to the table to add to the discussion,” Duane Elliott Reynolds, founder and CEO of Just Health Collective, said. “Sometimes that means doing things like covering the cost of their hourly salary in order to have them be able to leave work, because a lot of these folks in vulnerable populations may have financial difficulties. But the critical aspect is to invite them to the table and allow them to provide their perspective which allows you to build trust.”

The prison system is another area where the virus has the potential to spread quickly. 

“Inmates, even though they are in jail, we don’t really care what their sentences are or their crimes,” Iris Frye, founder and Chief Innovator at Parity HIT, said. “They are still human, and they shouldn’t have a death sentence because of their location. As a nation, we have to look at that we can’t just throw them away, and we have to take that on as one of our objectives.”

Action needs to be taken proactively in prisons, and it includes testing and isolating patients, according to the panelists. 

“What is required now is decisive and empathetic leadership decisions to avoid spread,” Reynolds said. “In prison populations this means full-scale testing of inmates and staff, and isolation of those who test positive, then education and providing the proper protective equipment for inmates and staff to mitigate spread. Some are arguing as well that we might think about releasing inmates back into the public to limit spread.”

But it isn’t just the prison populations that are in confined dense areas, Reynolds noted. Immigrants in ICE detention centers are also at risk of having a quickly spreading disease. This too needs to be addressed with similar swift action, he said. 

The elderly community represent another vulnerable population, which can also be in confined areas. But Cooper pointed out the interconnectedness of caring for both our elderly and our low-income workers. 

“Keep in mind that essential workers and caregivers of this population are some of the lowest paid employees that we can think of,” Cooper said.  “So, we have to consider what types of environments the elderly [are] located in and what the atmosphere is like – what the caregivers must endure every day. … I think this actually puts a light on who is caring for our seniors and who is caring for members of our vulnerable population.” 

As nursing homes and long-term care facilities continue to battle the spread of the disease, panelists stressed the importance of getting these facilities the right resources. 

“From an operational and procedural perspective can we ensure the staff in these senior facilities is receiving the right level of training in the most recent protocols and procedures around COVID-19 as their brothers and sisters in arms in our frontline hospitals,” House said. 

While the current landscape is bleak, panelist encouraged this situation to be a learning moment for healthcare. 

“COVID-19 should be a catalyst for broader change as it relates to health equity,” Reynolds said. “Again, these things have existed for hundreds of years. But if we don’t take this as a learning opportunity to think about how we make fundamental change in our systems so that all people receive equitable care, I think we will have missed a great opportunity to improve our healthcare system.”


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