Monthly Mentor: Why COVID-19 is Killing Black & Brown People

By Carlos R. Wise, M.D.

In the early days of coronavirus, (It seems strange to call March 2020 “the early days.”) it was heralded as the Great Equalizer. It was proclaimed in the media almost gleefully. That we would find it just or proof of Karma for our neighbors to share in physical suffering speaks to our absence of humanity. Even I foolishly proclaimed that this virus was non-discriminating — blind to race or politics, which are inextricably bound if we are honest. What the last three months have taught us, for better, is that COVID-19 is not the Great Equalizer, but more like John the Revelator. 

There are those who will bristle at the idea that someone has the nerve to say out loud in a public medium that COVID-19 prefers to kill Black and Brown people, because they know white people who have died, too. Yes, all lives matter, but Black and Brown lives matter less, even to a virus. While Black and Brown people comprise only 12% and 16% of the population of the U.S., respectively, they account for an estimated 65% or more of the total deaths from coronavirus. It seems unfair that once again we are the sacrificial lambs in a moment of crisis. 

Shall we unpack? COVID-19 is an intelligent and efficient virus that has a penchant for exploiting the weak or the weakened. So, it’s no surprise that we would become prey to this disease. 

Pervasive Distrust of the Medical System

This is a real thing among minority populations who do not enjoy white-adjacent privilege. We’ve all heard about the tragedy of the Tuskegee syphilis experiments, the exploitation of Henrietta Lacks, and the black market for our organs —  not unlike the Nazis’ inhumanity to the Jews, but unlike it at once because we have been used in this way not for the space of one war, but for generations. 

As a result, we have a collective distrust of the medical system and often will try any number of home remedies and natural “cures,” many with no proven benefit, before we will set foot in a doctor’s office or hospital. This creates layers of problems for us. First, we miss out on preventive measures that benefit others including counseling on healthy lifestyle choices and vaccines. It’s mind boggling that we have a vaccine to prevent cervical CANCER, and very few black parents will allow their children to get it. Don’t get me started on vaccines for flu and chickenpox! We prefer to get the disease, even knowing that these diseases can and do kill, because of Mrs. Lacks and others who were pawned for the “Greater Good.” 

In this context, when we finally arrive at the doctor it is often too late, and nothing short of a miracle can save us. If we’re brave enough to access the system in time, we’re treated worse than others once through those automated sliding glass doors of the E.R., or the imposing one of the doctor’s office. It is taken for granted that we are “poor historians,” less concerned about our health, “noncompliant,” promiscuous, too poor or too dishonest to pay the bill, “drug-seeking” when we are in pain, or that we don’t feel pain at all. I have spent my career railing against these labels that fly onto our charts like greased lightning, and establish our maltreatment by the system from the jump. I recall noticing as an intern that every black or brown woman presented to the E.R. with pelvic pain or an abnormal vaginal discharge was diagnosed with pelvic inflammatory disease (P.I.D.), and every White or Asian woman was simply diagnosed with pelvic pain. P.I.D. implies the pain originates from a sexually transmitted infection, because there’s no way it couldn’t given the promiscuity of “colored” women. 

My objection to this defamation of these women made me the scorn of my attending, but I didn’t care. The point is, minorities do not have the benefit of the doubt in America’s healthcare system. Your good citizenship is looked upon askance. For this reason, we will often leave and take our chances before the entire therapeutic plan has been worked out in the E.R. The assumption of non adherence actually creates non adherence, just as the assumption of adherence creates adherence. 

“This systemic economic racism leaves us cash-strapped all the time, and less able to afford the $200 copay needed to get that screening mammogram or colonoscopy to find our cancer early...”

Money Talks and…

To exercise the word “economy,” we don’t have the money to pay for care at the same rate others do. There tends to be NO generational wealth to tap in a crunch, or to use to elevate oneself from more dire circumstances. And the reasons and consequences are the exact same monsters. 

We pay more for everything even when we present with all things equal. We pay more interest on less. We are less likely to be extended credit at all. We are more likely to be denied a mortgage which for three generations has been a source of inherited wealth. We are paid less on our jobs and less often promoted, charged more for a new car, and more likely to be denied insurance and charged exorbitant rates when we are not denied. This systemic economic racism leaves us cash-strapped all the time, and less able to afford the $200 copay needed to get that screening mammogram or colonoscopy to find our cancer early, before it ravages our bodies and leaves us weakened and vulnerable or dead. It is the proverbial vicious cycle at its finest. 

What does the Middle Passage have to do with coronavirus? I’m glad you asked. 

The journey from Africa to North America was ripe with peril; but among the greatest of them if we can quantify worse fate from worse fate, was the likelihood of severe dehydration and starvation. We can go a long time without nutrition and calories. The human body is remarkable, and will simply forgo the manufacture of nonessential things like hair and fingernails to keep making what it needs to survive. 

Thirst, not so much. We are more than 2/3 water, and this is barely negotiable. As kismet would have it, people were more likely to survive the Middle Passage if they were genetic salt retainers, and therefore, less prone to dehydration. Survivors or the Middle Passage cast a diaspora of descendants who are, to this day, more likely to have hypertension. Not that our cultural food preferences, lack of exercise, and propensity for obesity which we DO control, are not also implicated; but there is this genetic set-up, too. The Middle Passage explains some hypertension, heart disease, and strokes any of which might ring a death knell if you get COVID-19. But the density of diabetes in our population compared to White and Asian America, is largely lifestyle, and we have to do better. 

The Frontline is a Dangerous Place 

Because we are collectively less well-educated, we are more likely to work a service job that puts us in the path of coronavirus. We ARE the transit workers, the food-service industry workers, the cashiers at your local favorite places, the Uber and Lyft drivers. When we are well-educated, we still tend to choose service professions like nursing and teaching. Let’s face it, children are viral mediums in Carter’s and bows. What’s more is that none of these kinds of jobs allow you to retreat to your home to wait out the pandemic. And you are less likely to have sick leave or paid vacation time to escape risk, or to use to quarantine and recover if you get COVID-19. You are more likely to show up sick, than to acknowledge your possible vector status, because if the car isn’t moving, you are not making money. I get it, but we have to care enough about each other to stay at home when we are sick, and to do simple shit like wear masks when we are out and feeling well. 

Weathering 

There is a cumulative effect of all we have unpacked in this manuscript. It’s called the weathering effect — of years (generations really) of systemic racism, and how all of these storms continuously swirling, keep Black and Brown people in a continuous state of unrest— in constant “fight or flight” mode. This translates into unhealthy levels of stress hormones as a chronic condition, instead of occasionally as a condition to allow you to survive an imminent threat. 

We are not supposed to be “on” all the time, and doing so raises cortisol, insulin, epinephrine, and norepinephrine levels beyond healthy limits, and results in the evolution of many of the chronic diseases in the suitcase we’ve spent these moments unpacking. It also leads to our premature physiologic aging. Black seldom cracks or cracks late on the outside (thank God for melanin), but the inside is another story; and far less beautiful. 

COVID-19 is not the Great Equalizer. It is the Great Revealer of inequities that are deeply rooted with broad far-reaching boughs. If we are to survive this pandemic and the next — and there will be others to come — we must understand that our fates as neighbors are linked, and no one will thrive until everyone can thrive. Just as there was a systematic building of constructs that disenfranchised people of color, a systematic undoing of those constructs is due, or we will perish together as fools.

Meet the Writer

Dr. Carlos Wise is the acting Chief Medical Officer at the Veterans Association of Columbus, Georgia. An Atlanta native and graduate of Morehouse School of Medicine, Dr. Wise boasts a proud medical career of over 20 years. His past service includes Director of Education at Columbus Regional Medical Center, where he mentored four groups of residents to graduation. He also served as a flight surgeon for the United States Army, where he earned the Bronze Star during his time in the Iraq War. His proudest accomplishment, however, is being a father to Audacity’s co-founder and editor-in-chief Jessica Wise (pictured left) and her sister Megan.