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This post was written by Dr. Breanna Lathrop of the Good Samaritan Health Center.
Having spent the last decade providing primary care in a community clinic in downtown Atlanta, the COVID-19 pandemic has shifted so much of our approach to health care. Every service at the clinic, which serves primarily those who lack health insurance, is designed to help people feel welcome, connected, and loved. Now patients are screened for COVID-19 systems outside the clinic, and those experiencing symptoms receive assessment in a newly created isolation zone.
We use telehealth to keep medically vulnerable patients at home and wear masks when seeing patients in person. I spend hours telling people who feel sick to stay home and isolate when every part of me yearns to tell them to come in so I can offer treatment and comfort. Our educational programs, cooking classes, prenatal group visits, and exercise initiatives have been replaced with virtual versions. I have gone from hugging most of my patients to limited touch, always through a pair of gloves.
These precautions are necessary but fall short of protecting my patients. In this pandemic, as with so many chronic conditions, the odds are against them. My patients are the working poor; many are immigrants, some undocumented; some are experiencing homelessness. My daily conversations with patients are vivid reminders of how this pandemic is hardest on those who are already marginalized and experiencing health disparities.
Each day, I talk to people who are working in public transit, in factories and food preparation, cleaning hotels and hospitals, usually without any protection. Many have underlying health conditions that place them at higher risk but do not have the ability to stop working. This morning, I was speaking with a young man who told me he is now sleeping in a parking garage. The emergency overnight shelter he previously relied upon closed, unable to operate safely in the pandemic. One woman called me after a week of fever and coughing. She was paralyzed with fear as to what would happen to her if she had COVID-19. As a black woman, her mistrust of the health care system is earned.
We are only a few months into the pandemic, and already the data is showing disparities in hospitalizations and deaths from COVID-19. From Colorado to New York, people of color are more likely to be hospitalized and die from COVID-19 than those who are white. The virus does not discriminate, but our social structures from health care to food access to housing most certainly do. I have been struggling to keep up with the CDC’s frequent updates on protecting people experiencing homelessness. This is necessary because homelessness persists in nearly every U.S. city.
These findings are appalling, but not surprising. Disparities in disease burden, treatment, and mortality fall along lines drawn by race, socioeconomic status, and zip code. This is not accidental. Our nation’s social structures and policies have been built to advantage some at the expense of others. Racism, poverty, and other social determinants of health create a breeding ground for sickness and death. Until we address this reality, our response will always be reactive and fall short.
The crisis response to COVID-19 has highlighted some of the best of humanity. I have watched our staff and volunteers, as well as colleagues across the nation, step up to respond, often at the expense of their personal safety and comfort. My patients have long been my best teachers of resiliency, turning to their communities and creating their own solutions, assuming system-level help is not coming. And while it is cathartic and healing to share the goodness we see in crisis response, we need to call out the way in which this crisis perpetuates and exposes longstanding inequity.
I long to hug my patients and welcome people experiencing illness without a mask, gloves, and face shield. However, I don’t want our health care system or society at large to simply return to normal. Our nation will come out of this whole and healthier if we sit with our current discomfort and commit to changing the structures that made this crisis so severe and inequitable in the U.S. We can use this space, when everything around us has changed, to rebuild for resiliency beyond this crisis.
Start by looking at the response in your community: What is working? Who is doing the work? Find the organizers doing effective work and ask what they need. Commit to supporting them both now and after the crisis. Next, ask which policies and systems have failed to respond, particularly to marginalized communities. Determine how you can use your influence and voice to change these structures. Finally, if you are serving, organizing, and advocating for your community, your work is our best hope.
The opportunity to do better gives me hope. As we respond to the emergent needs across the nation which COVID-19 demands, we can also call out discrimination, racism, and inequity. We can choose to name it for what it is and resolve to not return to our former normal. This is how we emerge from this crisis a healthier nation.
Breanna Lathrop, DNP, MPH, FNP-BC, is the chief operating officer and family nurse practitioner at the Good Samaritan Health Center. With her colleague, Veronica Squires, she co-authored How Neighborhoods Make Us Sick: Restoring Health and Wellness to Our Communities.
