A group of doctors in Virginia is calling for the Centers for Disease Control and Prevention and the World Health Organization to release information about whether black communities are being left behind as the shortage of coronavirus tests continues in the US.
They’re concerned that black communities and other underserved groups might be disproportionately missing out on getting tested for COVID-19, in the absence of data breaking down who’s been tested so far by race and ethnicity.
“We know in the US that there are great discrepancies in not only the diagnosis but the treatment that African Americans and other minorities are afforded. So I want to make sure that in this pandemic, that black and brown people are treated in the same way and that these tests are made available in the same pattern as for white people,” said Dr. Ebony Hilton, an associate professor of anesthesiology and critical care medicine at the University of Virginia.
Currently, the CDC’s coronavirus information site says a total of 66,371 people across the US have been tested for the virus. The latest data on the site says there are 15,219 confirmed cases nationally. The data provided by the CDC does not include a breakdown of who’s been tested by demographics. Johns Hopkins University’s database, which pulls data from global, national, and state-level reporting, says there are more than 26,000 confirmed cases in the US, but doesn’t include statistics on testing.
The doctors say that the deep-seated inequities that disproportionately affect black communities — like a lack of paid sick leave and adequate health insurance, income disparities, and access to medical facilities — can heighten the effects of a crisis like the coronavirus outbreak.
“I don’t want to speak about black Americans as if we’re all the same, but there’s a lot of reasons not to trust the government to be fair in circumstances like these,” said Dr. Cameron Webb, who is running for Congress in Virginia. “Yes, that's a huge question, who has access to those tests … If you're not an NBA player, it might be a little harder for black people to get access to those tests.”
Finding out who’s had access to tests so far would mean “we’re able to correct our disparities or biases as health care providers,” said Dr. Leigh-Ann Webb, an emergency room doctor at UVA.
Hilton added that doctors have to rely on a lot of diagnostics that can be quite subjective to decide whether someone should get a test or not — feeling exhausted, having a sore throat — rather than measurable objective factors. That, she said, makes the whole process more vulnerable to the implicit biases that every patient and medical professional carry around with them.
She said getting data on who has access to tests is a pressing issue, “with coronavirus having such a high mortality rate, with testing being limited, and with testing also only coming based on subjective descriptions, the only objective description that we have is a fever.”
“The people who are not being tested, if testing is warranted, they need advocates. And as much as they could advocate for themselves, having people specifically who are interested in health disparities, to have people who have a seat at the table advocating for you really helps,” Dr. Leigh-Ann Webb added.
She said the Johns Hopkins database, for example, is tracking gender, age, and location but not race or ethnicity.
”To be fair, I’m not sure that they needed to track the data on race in China,” she said. “But in the US, that would be useful information to have in the future because we already know that this virus affects disproportionately people who have comorbidities and African Americans are disproportionately affected by almost every cardiovascular disease that we have here in the United States.”
Two of the hardest-hit regions in the country, New York City and the city of Los Angeles County, are recommending that people stop getting tested at all, unless a doctor thinks a test could significantly change the course of treatment for a patient. Doctors say that the course of treatment for a person with COVID-19 is not significantly different from the course of action for other respiratory conditions with similar symptoms, because there isn’t a dedicated treatment or cure for the virus.
Dr. Taison Bell, an assistant professor at UVA in the infectious disease and pulmonary critical care divisions, said that while testing might not change a course of treatment, making people aware of how the virus is spreading in their community has the benefit of encouraging people to take the crisis seriously and act accordingly.
“My area was like this too. We weren’t really paying attention until we saw cases going up … I think seeing those dashboards and seeing the cases counted, that does give the community a sense of anxiety, unfortunately, but it does make them more vigilant,” Bell said.
Testing could also be crucial because people who show no symptoms of the illness can still have it and spread it to others if they don’t know they have it and don’t self-isolate.
“Right now, there’s that sentiment in the middle of a crisis that a rising tide will lift all boats, and we know that has never been true in America,” said Dr. Cameron Webb.