Thread by @DearPandemic

1/ Today we welcome @DrBMBrawner as a guest Nerdy Girl to discuss racial disparities and #COVID19. She is an Associate Professor at the @PennNursing and a nurse practitioner.

Q. Why are we seeing such disparities in #COVID cases and deaths?

2/ A. One word: racism. Individual, institutional, and structural.
There is no biological basis for “race,” even though people in these groups can share genetic traits. Race is a socially constructed way to categorize people that has changed over time, location, etc.

3/ This presents a challenge when these categorizations were used to deem non-Whites to be inferior, with laws and systems put in place to enforce and maintain this declaration.

4/ Just to show a few examples: this land was stolen from Native Americans through genocide, built on the backs of stolen African slaves and continues to be cultivated by Latinx migrant workers (who do the labor that we don’t want to do, but continually face deportation).

5/ When you break down COVID and other health inequities, these groups consistently bear the morbidity/mortality brunt. Therefore when we see racialized patterns in health (or disease), we need to avoid assuming an inherent flaw in Black and Brown bodies.

6/ We can’t say, “oh it’s because ‘those people’ are: lazy, don’t exercise, eat poorly, etc…”.
Instead, we have to consider the biological effects of a shared lived experience; shared social and structural violence--historical and generational trauma--because of skin color.

7/ One practical example is high blood pressure and/or diabetes due to chronic stress: overactivation of the body’s stress response due to daily discrimination, mistreatment, and trauma experienced (by one's self or vicariously through others) as a person of color in the U.S.

8/ #COVID19 just happens to be the health issue drawing our attention now, but HIV, maternal and infant mortality, cardiovascular disease, etc. had already been crying out to wake us up for decades.

9/ Segregation, redlining (systematic denial of loans, mortgages, insurance) and other discriminatory practices dictated not only where people of color could live and work, but also the types of resources that were available in their communities.

10/ From fresh produce to quality healthcare to adequate educational resources, communities of color were historically disenfranchised—and continue in cycles of disinvestment.

11/ With more people occupying smaller areas, population density increased along with the spread of communicable diseases (i.e., tuberculosis).
Fast forward to a present-day example, housing projects continue to be predominantly comprised of Black and Brown populations.

12/ Similar to prior epidemics, COVID thrives on close proximity.
Speaking from experience growing up in Brooklyn, NY, it is impossible to be socially distant or avoid inhaling #coronavirus particles on elevators shared with 100s of a people a day.

13/ Many of our large cities are still plagued by racial residential segregation. With Black and Brown groups disproportionately infected with coronavirus, it’s not surprising that the virus will continue to spread in their living, work and social circles.

14/ We do not have universal #healthcare in the U.S.
Access to testing, diagnosis and care is tied to labor. This is particularly a problem when thinking about health inequities: some Black and Brown workers hold low-wage jobs that do not have benefits like paid sick leave.

15/ So when coronavirus hit and the country was advised to be “safer at home” and shelter in place, Black and Brown populations were disproportionately represented in the essential workforce and therefore had increased exposure to the virus, without ANY #PPE in many cases.

16/ Similarly, without paid sick leave or other means of time off, some people went to work symptomatic or at increased risk for becoming infected.
Some were forced to choose between keeping a roof over their head and spreading/getting coronavirus, and they chose survival.

17/ Q. Have differences in access and quality of care impacted racial disparities in COVID cases and deaths?

A. We have mountains of evidence—across health conditions—to show that Black and Brown people are less likely to receive diagnostic testing, treatment, etc. than Whites.

18/ On a personal level, I cannot tell you how many people had coronavirus symptoms but were initially denied testing. Many of the ones I know went on to be hospitalized (and intubated) with bilateral pneumonia that could have been caught sooner.

19/ Part of the care disparity stems from
👂providers not believing what Black and Brown people say about their symptoms
⬅️attributing their symptoms to other causes (w/out adequate workup/investigation)
🛑 blatant racism and discrimination that exist in the healthcare system.

20/ This is in addition to medical/healthcare system mistrust on the part of patients who delay seeking care until things are “really bad”.
People are tired of being victimized and enduring microaggressions from the very people who vowed to help their health-related concerns.

21/ More about what you can do to take action in the next thread!