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Announcer: As coronavirus tears an unforgiving path across the country, numbers show it is especially devastating to one group, African Americans.
Paul Rand: One of the most tragic aspects of the coronavirus outbreak has been the disproportionate effect that COVID-19 has had on communities of color around the country.
Dr. Monica Peek: It is not the great equalizer. It is not affecting all aspects of society equally. And it is disproportionately ravaging the most vulnerable communities that have already disproportionately been suffering.
Paul Rand: Dr Monica Peek is an associate professor of medicine at the University of Chicago who has dedicated her career to studying racial health disparities. Her research and the work of many others has shown that many diseases and chronic conditions disproportionately affect minority communities. The coronavirus is no exception.
Dr. Monica Peek: 72% of our deaths here in Chicago residents have been in black Chicagoans. Though again, black Chicagoans just make up 30% of the city's population.
Dr. Monica Peek: The big picture is that racial or ethnic minorities in this city are more likely to be exposed to the virus because they are the ones that are working in jobs that allow the rest of the city to safely stay at home and shelter in place.
Paul Rand: From the University of Chicago, this is Big Brains, a podcast about pioneering research and pivotal breakthroughs that are reshaping our world. This is our special series about how the coronavirus is affecting our society and what the top minds and researchers are focusing on during this pandemic. I'm your host, Paul Rand.
Paul Rand: Dr. Peek was gracious to join us from her home to discuss this important issue. We started by investigating why the coronavirus has so greatly affected black communities. Employment is one of the many structural inequities behind the situation, but dr. Peek said it goes far beyond that and into nearly every aspect of daily life.
Dr. Monica Peek: The way that our society has access to goods and services, the way that our communities are organized and the way that people live their lives, where people live, work and play that differ by race and class, and particularly for cities that are extremely racially segregated like Chicago and Milwaukee. So historically, for example, redlining practices have meant that the neighborhoods that are primarily African American have been more crowded, have had fewer grocery stores and other resources that people need while they're sheltering in place. And there has been a historical legacy of mistrust of healthcare and historical lack of access.
Paul Rand: And so if I can ask you just on the concept of historical distrust, does is based on not being able to pay, or does that issue just run much deeper than that?
Dr. Monica Peek: It runs much deeper than that. We have to realize that our contemporary, our day to day experience, is not historical. It feels like it, but I am the first person in my family who was born with all of their rights, and my family came over with the slave trade. We've been here for more than 400 years. So it's hard for us to think about contemporary African Americans and not have a historical context of our lived experience. So my parents, their parents, their parents have had healthcare experiences that were not ideal. And so these are stories that are not just elements of our history. Our past is not past, it's still present. We're still carrying that emotional and social baggage with us into the healthcare encounter.
Paul Rand: So if I can get arms around the distrust in the healthcare system and the inability or the unwanting-ness or the mistrust of going in and getting care is one thing. Being able to pay is another thing. Are there other considerations that you look at when you think about why the numbers for African Americans are so much higher than they are for the general population?
Dr. Monica Peek: I would say that many of the diseases, the chronic diseases that African Americans are disproportionately burdened with are ones that are in part a reflection of the built in the social environment where African Americans live. And so when we talk about an obesogenic neighborhood where there is plenty of fast food restaurants, low nutrition, high caloric foods where there are not parks and sidewalks and lots of crime and gunfire where African Americans have been historically redlined into. And so a lot of the chronic medical conditions that we see disproportionately burdened by African-Americans is due in part not just because people are not taking care of themselves, but is due in part to the environments in which they have been forced to live.
Paul Rand: What is it that you're recommending to patients if they do think that they're symptomatic or know that they're symptomatic, and they can't bring somebody with them, for example, into the treatment room, what are you recommending for them to think about, and how should they plan about working with the healthcare systems right now?
Dr. Monica Peek: That's an excellent question. I would say two things. One, we have a sort of a dual system of healthcare right now. We have routine medical care that for the most part has converted to tele-health because we want people who have chronic conditions, but don't have coronavirus, to stay home. But that routine care still needs to continue. So that's one part. The other part is for people who are having symptoms that may be concerning for the coronavirus. They do need to be able to lean in and get tested and find places that they can go that should be their regular source of medical care. And if they don't have places that they can go, they should know that hospitals and emergency rooms are still open. All hospitals are still open and functioning. At the University of Chicago, what we have done is set up sort of dual systems of care. So we have our regular emergency room that's open, and then we have a separate ER facility for people who are having cold symptoms, sore throats that we can do separate screening for coronavirus.
Paul Rand: Dr. Peek, one are the interventions that's often recommended to patients of color is that they bring a friend or family member to advocate on their behalf when they interact with the healthcare system. But with social distancing during this outbreak, that of course is not really an option. So what would you recommend folks be doing if they have to interact with the healthcare system today?
Dr. Monica Peek: In general, have a good sense of what their preferences are around their healthcare decisions, and have thought those out in advance. That is the case for anytime they go into see the doctor, but particularly now. Part of the work that I do is around shared decision making and wanting patients to have an active voice in their healthcare decisions. And so I would recommend that patients feel confident that they should be actively involved in the decisions about their care in the healthcare system.
Dr. Monica Peek: Because the coronavirus is an illness that can turn really quickly, that they've given thought about the things that are important to them in the last stages of life should things not work out the way that we all want them to. Would they want to be on a ventilator or not? Not everybody would want that. Some people would rather spend their last days in the comfort of their home with their loved ones rather than alone in the hospital. And so I think this is a time for all of us to think about our, advanced care planning is what we call it, and how we would want to spend our last few days on earth. And I think particularly for African Americans who have not always necessarily trusted that the healthcare system would make decisions that would be in our best interest, if people have those concerns, then they should be actively making sure that they have those concerns written down in advance with advanced care planning.
Dr. Monica Peek: Me being a physician working in the healthcare system, I know that our teams work as hard as we can to make sure that we work with patients to understand their wishes and to respect those wishes. But I also understand the historical legacies that hospitals have left within the African American community. And so as patients are entering the healthcare system during these trying times for a sense of emotional safety, I think that families should have conversations with themselves about what they would want and make sure that everyone is on the same page before people get sick and enter the healthcare doors.
Paul Rand: And so as we go a little bit further, is this that the trends that we're talking about, you mentioned some major metro areas, are these trends happening across the country in rural areas with a higher propensity with people of color than other areas? Or in this case, is it not necessarily people of color, but economic status, sociological factors or otherwise?
Dr. Monica Peek: We do not have in our country a good hand on exactly what is happening with this epidemic. A lot of people are pointing to areas where there seems to be fewer cases, but because we are not doing public health screening, we don't have a good sense of prevalence because we know that this is a disease that can be spread asymptomatically, but we're not testing asymptomatic persons. We have a better sense of our death rates, unfortunately. But even those are not true estimates because there's some people that are dying at home that we suspect have coronavirus, and we may tell them, it sounds like you have it, but you seem like you're physically stable enough to just shelter in place at home and not come in and get tested. They may accelerate and die without ever being tested. And so our death count is not accurate, and certainly our prevalence of who has a disease is not accurate. And so we really have no idea.
Paul Rand: Got it, got it. My understanding is that the CDC is not tracing race or ethnicities with people that are either getting the virus or dying from the virus. Is that accurate?
Dr. Monica Peek: That is accurate. And right now, they're not. And there have been calls from the AMA and individual leaders, and I think you'll see an increased call from other national organizations because we cannot intervene on what we don't completely know. And what we have seen from individual cities and states is extremely concerning. But we cannot have a national strategy if we don't have national data. And to erase the data is to ignore the problem.
Paul Rand: Now Monica, you've been doing quite a bit of a sharing of your thoughts and information. You did something recently on the CBS Evening News. How are you finding receptivity to the information that you're sharing? Are people surprised by it? Believing of it? Not believing of it. What are you picking up?
Dr. Monica Peek: I think there is a hunger for trying to better understand the numbers that we see. I know that there was a lot of shock and disappointment when the numbers around disparities in coronavirus mortality were first released. People were searching for a better sense of understanding about why this was. And I remember our mayor saying that these numbers just take your breath away. And I think a lot of people felt that way. And I really admire how she stepped up, and how our governor has stepped up and really want to get more data, more information, and to try and tackle the issue, immediately creating task force and trying to create policies that trying to address this issue that are fair to all citizens and to try and be sensitive to how policies may be disproportionately affecting the most marginalized communities and what can we do to counteract what we're seeing in the numbers.
Dr. Monica Peek: What every natural disaster does, like Katrina, what every economic downturn does, what every emergent situation does is disproportionately impact the most vulnerable among us who are just scraping by day to day. And so the disproportionate impact is what I would have expected.
Paul Rand: Right, right. Do you have any sense, is this one going to be any different for some of the reasons that we've talked about earlier? And do you have any degree of, if the right word is optimism, that of understanding the degree of connectivity that we all actually do have and how relying on each other to be healthy is so important. Do you have any degree of optimism we're going to get it better as we come out of this?
Dr. Monica Peek: One, this is a pandemic. It has touched every country on the globe, every community in the world. It is not something that was localized, and so... Katrina was horrible. They were living, you could see them on TV, on their roofs for days. But that was in New Orleans. Most of our day to day experience was not impacted.
Dr. Monica Peek: Every one of us has been impacted by the coronavirus, and we know it's going to have a surge in the fall. These are the kinds of viral illnesses that that peak in the fall and the winter. And this is a kind of virus that again, because of its immune response and other kinds of things that make it unique, is going to be with us for a while. And so it is changing the very fabric of how we're doing our day to day business. And so it is forcing us to live our lives differently going forward. And so because of how it is having a global impact on our economy and this nation and because it is going to continue having impacts, we are being forced to think about how we are restructuring ourselves in a way that's more sustainable and more protective. That is going to have to include essential workers, and those who have historically been more marginalized. Otherwise the short term fixes and patches will not lead to the outcomes that we need to have a healthy nation that is economically prosperous.
Paul Rand: Understood. It's interesting, I think there's not many people that are paying much of attention to this in some form or another and don't get incredibly angry at how we ended up in this situation, how it seems to have been handled or not handled, and the challenges that go with it. I imagine, from your perspective, studying what you've studied, this just must make you even more upset because it only underlines the challenges that you've long identified.
Dr. Monica Peek: Yes. Well, I would say that health disparities are one of the great moral failings of our time. While we have made some significant strides since the civil rights era in thinking about equity in general and thinking about health equity, a lot of our gains are at significant risk of being undermined and turned back because of federal policies that are currently in place. And it's important that people understand that we as a nation are only as strong as the weakest among us. We're all vulnerable to coronavirus. There are some communities that will be more devastated by them, but ultimately we will rise or fall as a nation together.
Matt Hodapp: Big Brains is a production of the UChicago Podcast network. If you like what you heard, please give us a review and a rating. The show is hosted by Paul M. Rand and produced by me, Matt Hodapp, with assistance from Alyssa Eads. Thanks for listening.