Health Equity, COVID-19, and What Should be Common Sense Healthcare Design
It was her eyes that morning as she stretched her little arms out toward me. It is always those big oblong orbs peering beseechingly at me that makes me pause. There was no exception last Monday morning at 5:51 AM. My 21-month old daughter gazed at me not knowing that I was about to head into work at the emergency department for the first time since the COVID-19 pandemic kicked into gear in Atlanta. That night I would not be coming home.
It has now been over a week since I have seen my daughter and husband, and I have begun to feel the effects of exposing myself to COVID-19 while caring for patients. When confirmed cases started to rise, my emergency medicine colleagues and I knew that healthcare workers in Wuhan, China had become “prime vectors of transmission” by going back home to their families. There was a simple solution; we would just need to isolate ourselves from our families. We “just” needed to have a bedroom and bathroom separate from the rest of the family.
Only one problem. My husband, daughter, and I were already living in a one-bedroom apartment. We had chosen this lifestyle to make the best use of our funds. The prospect of having to urgently find a separate place to stay was overwhelming. Yes, I am a Harvard-educated emergency physician, so I have privilege. But I am also a Black female physician with staggering student debt and other expenses. The demands of COVID-19 have made me even more acutely aware of the gap between my peers and me.
Indeed, as numerous outlets are starting to report, COVID-19 has shined a blinding light on the deep-rooted inequities in America in communities of color at every level. From the disproportionate number of essential workers for whom there is no remote alternative to the higher than average rates of chronic disease in younger populations, methods to prevent the spread of COVID-19 have not included what should be common sense design principles. From my own formal training and lived experience, I know that what is happening (or not happening) right now in response to COVID-19 is an artifact of design principles that insert equity, if ever, only on the second pass.
The “social distancing” solution does not account for the service worker with high blood pressure and asthma who has to take mass transit to a workplace that does not offer personal protective equipment and then returns home to care for a family of five. It does not incorporate the value of proactive screening in vulnerable communities with higher rates of chronic diseases that leave members of the population disproportionately at risk. It does not stifle the fear of racial profiling that a mother feels in watching her son walk outside with a bandanna covering his face in place of a mask. And it certainly does not protect the woman who does not feel safe at home.
There is no public design for equity. The numbers we are seeing of confirmed COVID-19 cases and deaths speak truth to the fallacy of colorblind policies that repeatedly and systematically do not take into account the health disparities, economic fragility, and implicit bias affecting communities of color.
Fortunately, I found an apartment where I can stay so I do not expose my family to COVID-19. This is something I can do. But on the frontlines, I see masked patients lay helplessly in their hospital beds awaiting the natural course of disease and the verdict of how their bodies will fight in spite of how ill-prepared they are for this fight. It is a struggle to find the words when I have to explain why we cannot yet offer tests to patients like the anxious husband and breadwinner with no symptoms who lives in a separate room from his wife with poorly controlled diabetes. As healthcare professionals, our job is to keep sight of the vulnerable and provide the best possible care to all patients. It eats away at you to work with these constraints, knowing that you trained to do better.
At the end of my shift, as I store my N95 face mask in my brown paper bag, I realize that I no longer take these resources for granted. When I leave the hospital, I watch as whatever semblance of normalcy dissolves around me further still: toilet paper gone from the shelves at the grocery store as I head back to an unfamiliar home with no one else there. But this is where I pick up our fight as mothers to protect our babies and as wives to shelter and nurture our families. For now, I do this to the best of my ability from a distance. I will not go home tonight or any time soon to protect the grandparents whom my daughter adores, my husband who keeps me grounded, and the little girl whose smile lights up my world.
