Glenn Ellis: COVID-19 ushers in new era of health inequities

After over a year’s worth of weekly columns, centered around the COVID-19 pandemic and its devastating impact on all of us, this is the last one on the subject. Instead, I decided to devote this column to what we should have learned from the past year of being in the throes of the pandemic. After all, we are far from the end of this pandemic in spite of the massive vaccine rollout.

The COVID-19 pandemic has forced the entire world to work, feverishly, trying to understand this sinister virus and stop its horrible effects on us; but it has also highlighted the severity of the health disparities that have been faced by people from minority racial or ethnic groups and other marginalized populations, long before the pandemic. Without question, no other racial or ethnic group’s disproportionate pain and suffering from COVID-19 has been more prominently on display than the Black community in America.

But, hey … we now have vaccines; we know all about social distancing; and we know about the benefits of face masks. Sooner or later, we will get to the “other side” of the pandemic. Our lives, in some way, will one day go on, and then we will all have to go back to that same health care system that provided the same unequal care to Blacks. But we’re moving into a new world for health care and medicine; one we could never have imagined — in part due to the damage that the pandemic has done to the health care system; and in part due to actual lingering effects of COVID-19 infection. I am hoping that we are paying attention to an issue that will have an enormously huge, negative impact as we prepare for a post-COVID-19 world: the growing numbers of people who survived being infected with COVID-19, only to find themselves facing health problems they didn’t have before they were infected.

Tens of thousands of people in the United States have lingering illnesses following COVID-19. In the U.S., we call them post-COVID “long-haulers.” Estimates are that 50% to 80% of patients continue to have bothersome symptoms three months after the onset of COVID-19 — long after tests no longer detect virus in their body. We can only guess how many people may develop this long-haul COVID-19. More than 30 million Americans were known to have been infected by the virus, so heaven only knows how many more were never diagnosed.

This is especially important for Black people. Long-haulers often suffer chronic damage to their lungs, heart, kidneys or brain that the virus inflicted. Some can actually develop what’s known as long COVID-19. A very recent study published in Nature Magazine found “that the cell damage, inflammatory immune response, abnormal blood clotting, and other complications of acute COVID-19 infection can leave in their wake long-term symptoms such as chest pain, shortness of breath, ‘brain fog,’ fatigue, joint pain, and post-traumatic stress disorder.”

All of these “roads” lead to chronic diseases. This is the issue that was used to explain away the disproportionate rates of infection, hospitalization and deaths in Blacks throughout this pandemic. The toll on Black America has been especially high. Research from APM Research Lab in 2020 has shown that when adjusted for age, the risk of death from COVID—19 is as much as nine times higher for Black Americans than it is for whites!

In addition to possibly increasing our vulnerability to making worse or developing chronic conditions, many of our communities are located in poor areas with high housing density, limited access to quality education, and high unemployment rates — all risk factors for poorer health outcomes.

It is universally accepted in medicine that prevention, early detection and ongoing patient monitoring are the pillars of essential primary care. During the COVID-19 pandemic, many Blacks who require this chronic disease management have canceled or postponed many outpatient visits. Should we expect they will magic resume their previously inconsistent scheduled appointments and non-compliance with prescription medicines? What will our primary care network look like moving forward? We’d better pay attention, because as always, Black people are going to get hit worse.

According to the U.S. Centers for Disease Control and Prevention (CDC), federally funded community centers FQHCs), serve roughly 28 million Americans who are primarily low-income individuals (91%), people of color (63%) and uninsured individuals. Needless to say, this is a recipe for disaster for Black folks as we look over the horizon to health care after the COVID-19 pandemic.

The pandemic has decimated the budgets of not only our health care system, but also municipalities; states; and even the federal government. The trickle effects will result in a spiraling of the budget cuts in services at all levels — that include the very core of addressing the epidemic of chronic conditions — of our primary care system.

Yes, this pandemic is horrible. But I can’t imagine the unequal burden of chronic conditions that Black people bear in a health care system that is not preparing for the aftermath of COVID-19 and the decimation of our nation’s primary health system.