Dr. Fauci: Too Early To Ease Social Distancing Restrictions; Families, Religious Groups Adapt To COVID-19 During Holiday.
BLACKWELL: Across the country, early evidence shows that African- Americans are dying from COVID-19 at a much higher rate than the percentage of their population. Not every state has released data, but several states did release their findings and it shows that black people are also dying at a higher rate than any other racial demographic. Let's go to Michigan first. African-Americans make up 14 percent of the state's population, but account for 40 percent of COVID-19 deaths. Louisiana, 32 percent of the state's population is black, but they account for 70 percent of COVID-19 deaths. Now, at a task force briefing this week, President Trump said that he wanted to find out the reason why this is happening in black communities.</s>TRUMP: Why is it three or four times more so for the black community as opposed to other people. It doesn't make sense and I don't like it. And we're going to have statistics over the next probably two to three days.</s>BLACKWELL: With us now is Dr. Amani Allen from the University of California and Berkeley School of Public Health; and Dr. Kamara Jones, the former President of the American Public Health Association. Ladies Welcome to both of you. I've been looking forward to this conversation. Dr. Allen, let me start with you, because we hear this type of surprise from the President and other politicians. There's a saying that predates me - probably predates all of us, that when white people catch a cold, black people get pneumonia. The disparities in these things, they're not new. When you hear that that revelation, how do you receive that, that this is new to some politicians? DR. AMANI ALLEN, PROFESSOR, UNIVERSITY OF CALIFORNIA, BERKELEY SCHOOL OF PUBLIC HEALTH. Well, it's not new at all. I mean, we have seen this pattern of racial health disparities for quite a long time, and we see it across numerous health outcomes. It does not surprise me, however, that not only politicians, but perhaps the majority of Americans are not aware of the very drastic and very pervasive health disparities that exist with blacks having higher rates of many illnesses.</s>BLACKWELL: Dr. Jones in your recent Newsweek column, you said that there are three principles that must be enacted for achieving health equity. Let's list them: Valuing all individuals and populations equally; Recognizing and rectifying historical injustices; and providing resources according to me. Now, my plan was to ask you to focus on one because of time, but the truth is, is that they have to work in concert.</s>DR. CAMARA JONES, FORMER PRESIDENT, AMERICAN PUBLIC HEALTH ASSOCIATION: That's right. And these principles are in contrast to how our society is structured today. If I were to put a name on why we're seeing these excess black deaths due to COVID-19, I would say it's due to racism, where racism is a system that structures opportunity and assigns value by race. And as Dr. Allen said, racism has been causing all these excess deaths. Babies dying before their first birthday, mother's dying during pregnancy, all of that. The reason that the country seems to be waking up again as we woke up Katrina or Flint or the Charleston massacre and the like. The reason we're waking up again about the impacts of racism is that these black bodies are piling up so fast that we can't ignore them or normalize this.</s>BLACKWELL: So one of the things that you support in trying to moderate or decrease the disparity is a lottery system that for hospitals that are overwhelmed that ventilators, the resources, you think that, to be fair, there should be a lottery system. Explain that.</s>JONES: Well, there is - the basic thing is, the reason that black folks are even ending up in the hospital more is not that black people are more susceptible. None of us is immune. It's that black people are more exposed, less protected, and we have a higher burden of chronic diseases. So if we get into a hospital situation where there's some kind of local scarcity, because honestly, we shouldn't have scarcity of these resources at all. I'm baffled, first of all, why we haven't wrapped up the Defense Production Act fully and all of that. But even in this country, there - we're not having the same level of epidemic all over the place, so we can be moving resources - sourcing resources according to need. But if we get into a situation where we do have local scarcity, and there are three patients, and one of them needs a ventilator, it is quite dangerous for people to say, well, maybe we should give the one - the ventilator to the one who doesn't have diabetes, or the one who doesn't have heart disease. Because we know as Dr. Allen said, that those - that heart disease, diabetes, asthma, all of these things are over concentrated in black communities. So to be really fair, we need to just do something lottery so that a patient - or doctor doesn't have to make that this decision on their own, where their implicit bias might not make them value one person more than the other. If we want to value all individuals and populations equally, we have to do it that way.</s>BLACKWELL: Dr. Allen, let me come to you, because for many of the reasons we have pointed out here that you identify and many people know that there's a degree of medical mistrust in some parts of the black community. Now, the industry may not be able to overcome that in this crisis. But how can it be moderated? How can that be softened moving forward?</s>ALLEN: Well, I do think that I hadn't thought about a lottery system before. But I do think that that is one strategy for overcoming some of the bias that exists within the healthcare system. And that is going to be imperative for raising the degree of trust among the black community, for institutions like healthcare institutions. We know, for example, that there is significant racial bias within the healthcare system. Blacks, for example, are less likely to receive lifesaving procedures compared to whites. And this is a well-known scientific fact. There are many studies that have shown this. And there's also some recent data suggesting that when black show up to get tested for coronavirus, they're less likely to be referred for those tests compared to other groups. And so I think that there really needs to be a pattern of distributing resources in ways that don't rely on physician decision making, because we know that that implicit bias exists.</s>BLACKWELL: Dr. Allen, all we have really to combat COVID-19 individually is personal hygiene and social distancing - these guidelines. But for a lot of communities, social distancing is not realistic. I mean, if you come home to a community of hundreds of apartments, you live in an urban area. Or your three or four people in a two bedroom, one bathroom where you have a forward facing job, just to say make sure you have some distance or you're caring for an 80-year-old great aunt who lives with you. You know, what, where is the support in communities for these families? I don't hear a lot of legislators of mayors speaking specifically what will you do with or for families who face that reality?</s>ALLEN: I'm glad you asked that question. I think that's a very important question. I think that what we tend to do in this country is give everyone the same thing. Give everyone - we try to give everyone equal resources. However, everyone doesn't start off at the same level. It's not an even playing field. And so there are - well, there are 330 million people in the United States. There are just under 500,000 Coronavirus cases. So that means that the number or the percentage of those infected with coronavirus, or at least what we know so far is point 0.15 percent of the United States population. So that means that the majority of the United States population is not affected. So, when we use these population level, kind of give everyone the same thing approaches, we may not be using the most efficient, we may not be making the most efficient use of our resources, and we're definitely not targeting those that are most at risk. So, another strategy - and I like Dr. Jones's strategy, and additional strategy would call for more equitable types of interventions. And that may include strategies that we in public health call proportionate universalism, or what John Powell at the Othering & Belonging Institute at UC Berkeley calls targeted universalism. And that means distributing resources, according to need.</s>BLACKWELL: Dr. Amani Allen--</s>ALLEN: --double the rate of coronavirus infections in the black population compared to the white population. That means that we need double the testing centers, maybe that means we need double the healthcare facilities, double the number of health care providers. And I think that that is a strategy that may - that really will only be tolerable to U.S. politicians, frankly, and to U.S. society when we acknowledge that inequality has been born through human design.</s>BLACKWELL: Dr. Amani Allen, Dr. Camara Jones, thank you so much for an insightful conversation. I hope everyone at home learned a lot from it. Thank you both for joining us this morning.</s>ALLEN: Thank you.</s>JONES: Thank you.</s>BLACKWELL: Quick break. We'll be back