The Covid-19 pandemic is teaching me that the world can change almost overnight when it faces a big problem.
When President Trump declared a national emergency, my medical practice shifted almost instantly from in-person appointments to telehealth visits. The Drug Enforcement Administration allowed doctors like me to prescribe buprenorphine, a controlled substance used to combat opioid addiction, after a telephone consult, a move experts have been seeking for years. The Department of Health and Human Services waived privacy constraints for telehealth visits, which have long tied up this type of medicine, allowing doctors to use commonly available platforms like FaceTime, Facebook Messenger, Skype, and Zoom to provide medical care.
And Congress quickly passed the CARES Act, a $2 trillion aid package to fight Covid-19 that included sending $1,200 checks to individuals and families who were most vulnerable to job loss and other financial stressors.
As a psychiatrist who treats opioid addiction and works at a minority-serving hospital, I am delighted by these long-sought changes. But I am also frustrated that they have happened so quickly. Frustrated because the U.S. has been facing an equally large and equally deadly problem — racism — for years and has done little to address it.
Black people are dying at alarming and disproportionate rates from Covid-19. In cities, the statistics are nothing short of tragic. In Chicago, for example, 70% of coronavirus deaths are among Black people, who make up only 30% of the city’s population. A similar pattern is seen in other cities and counties across the country.
Black and brown people have been seeking reparations to address the systemic injustices they have faced for decades. Yet there has never been an economic stimulus to address the impact of racism on health, quality of life, and advancement.
The country’s response to the new coronavirus does, however, suggest that we are taking steps toward addressing the damaging threat of racism.
First, though, we have to name it. Policy leaders across the country urged Trump to declare a national emergency because they understood the power of naming a crisis. In the same way, we need to declare that racism is a national emergency. It is a virus in the truest sense: a corrupting influence that spreads through communities and across the nation. Systemic racism has harmed — and killed — millions of Americans through its corruption of health care, criminal justice, and the economic marketplace.
Dr. Deborah Birx, who serves as the coronavirus response coordinator for the White House coronavirus task force, recently suggested that Black people are dying of Covid-19 at higher rates due to underlying medical conditions. She is right — if she means that the underlying condition is racism, not its manifestations like high blood pressure and diabetes. Racism has created inequality in access to health care, housing, wealth, education, and employment, all of which undermine health. It is time to name racism as the crisis it is.
Second, we must shift policy to address the circumstances of those affected by the crisis. For Covid-19, that means finding unique ways to care for patients. To address racism, we must do that and go even further. We must not only come up with new ways to reach patients who have been disadvantaged but must also address the dire circumstances that racism has created.
The first time I ever used telehealth was after Covid-19 had emerged as a nationwide threat. My patient, who was homeless, had been sitting in a park all day, waiting for my call. He knew if we didn’t connect, he would not be able to get the medication he needed to help him stay free from using heroin. He adjusted his life to meet health care’s demands. That’s not the way health care should be — it should meet patients where they are and address the circumstances they are in.
During that call, I didn’t stick to my usual script: Any problems filling your prescription? Any medication side effects? Any cravings or heroin use since the last visit? Instead, I talked with him about the challenges he was facing at the shelter. He asked about how to manage his day since he couldn’t stay inside. I also let him know where he could find a hot meal on a daily basis.
I wish our health care system would take a similar approach and see value in working on problems like housing and food insecurity. Some are calling this concept structurally competent care; it needs to become our new normal.
Third, we must deal with the economic consequences of the crisis. For Covid-19, that’s the thrust of the CARES Act. In Boston, where I completed my medical training, the median net worth of white families was more than $200,000. The median net worth of black families was $8. Undoing racism means passing something like the CARES Act to provide funds for those disadvantaged by racism.
I respect Dr. Anthony Fauci, a key member of the White House coronavirus task force, who acknowledged the role of health disparities in Covid-19. He has said that we must deal with these issues once we get beyond the pandemic.
But I disagree with him on that. We must deal with them now.
Morgan Medlock, M.D., is an assistant professor of psychiatry at Howard University College of Medicine in Washington D.C. and the editor of “Racism and Psychiatry: Contemporary Issues and Interventions” (Springer, 2019)