A call to bridge healthcare disparities and reaction to the recent Apple News article “‘Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care”.
Yesterday, Apple News published an article on the ways in which privilege impacts Covid treatment, particularly showcased by President Trump’s recent hospitalization at Walter Reed National Military Medical Center. Written by Casey Ross and Priyanka Runwal, the article titled “Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care” explores the discrepancies in care for the rich and famous versus the average American. While we all know society’s most powerful influencers receive different treatment, even in cases of life and death, the most important disparities that Ross and Runwal touch on are socioeconomic and racial.
“Covid is all about privilege. The more privilege you have, the more you can ignore some of the rules of Covid. Where one person would need to be in the hospital, another person can have the hospital come to them. That’s privilege,” said Lakshman Swamy, an ICU physician at Cambridge Health Alliance in Massachusetts.
Healthcare access has always been different for minority populations, but the sheer prevalence of coronavirus has dragged healthcare’s darkest statistics into the light. The following is a reaction to the points made in Ross and Runwal’s piece, as well as additional data and research that exposes not just the disproportionate impact of the pandemic along racial divides, but linguistic ones as well.
Much like the rest of his presidency, Twitter has been ablaze over the last few days as President Trump’s diagnosis swept the media. His ability to access care, while thousands died at home or waiting for treatment, was met with harsh criticism.
And privileged access isn’t just about cutting in line to get a bed or the attention of doctors. Privilege means access to treatments that simply aren’t available for anyone else, like the experimental drugs the President received. He’s one of less than 10 people to have been treated with a special antibody cocktail, Ross and Runwal reported.
“High-profile individuals — in particular, professional athletes — have had frequent access to testing with fast-turnaround results. For much of the rest of the population, however, confirming a case of Covid-19 has meant waiting in line for a test, and waiting even longer for results.”
The disparate line is not just drawn between the famous and the average American. Covid-19 has spotlighted healthcare disparities already plaguing our nation. Black, Hispanic, and Native American populations have been disproportionately affected. NPR examined racial disparities by comparing the percentage of deaths versus percentage of population, concluding that “African-American deaths from COVID-19 are nearly two times greater than would be expected based on their share of the population. In four states, the rate is three or more times greater.” (Godoy)
“You have this pandemic where you literally see the numbers and faces in front of you that shows you that this disease impacts people differently, depending on what they look like and what jobs they work,” said Alison Bateman-House, an assistant professor of medical ethics at New York University’s Grossman School of Medicine.
Research also links limited English proficient (LEP) populations to areas most greatly impacted by coronavirus. The National Coalition for Asian Pacific Americans Community Development (National CAPACD) concluded that “The percentage of LEP speakers is higher in the COVID-19 hot spots – e.g., a total of 13.5% for the top 30 metropolitan areas – than for the US as a whole (8.3% LEP).” Larger cities are more likely to host diasporas and immigrant populations (New American Economy). But that doesn’t dismiss the desperate need for language access in pandemic-logged hospitals. And when no one is allowed into a quarantined room, or PPE is short, on-site and in-person interpreters simply aren’t available.
We know that language access leads to better outcomes. Improved communication through medically trained interpreters leads to more engaged patients and a reduction in communication errors that can save lives. Still, recent study “A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes” was able to conclude that more than 75% of patients provided with language-concordant care had better care outcomes than those who did not (Diamond).
Knowing that LEP populations are at greater risk from COVID, and knowing that their care outcomes are materially better when an interpreter is provided, it is imperative that healthcare systems support comprehensive language access to prevent further disproportionate illness and death. When interpreters can’t safely be in the room with patients, virtual remote interpreting (VRI) is not only sufficient, but abundantly available and a sustainable long term solution. These disparities must be addressed, and with today’s technology, they can be.
“A portion of the people who are severely symptomatic don’t have access to health care … and they are the population that is just being decimated by this.” – Josh Barocas, an infectious disease physician at Boston Medical Center
Cloudbreak is committed to bringing health equity to the forefront, bridging the gap for limited English proficient and deaf patients. While we cannot root out the societal inequalities of our nation overnight, it can no longer be denied that these inequalities not only exist but have a body count. It is more important than ever that the healthcare industry commit itself to recognizing disparities in care and the social determinants of health that reinforce them. Overcoming them with resources like community outreach, language access, and digital health aren’t just the right thing to do but also the most effective. They can help us bridge equity gaps nationwide and level the playing field for underserved populations.
References & Resources
Diamond, L., MD, MPH, Izquierdo, K., BS, Canfield, D., MD, Matsoukas, K., MLIS, & Gany, F., MD, MS. (2019). A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes [Abstract]. Journal of General Internal Medicine, 34, 1591-1606.
Godoy, M. (2020, May 30). What Do Coronavirus Racial Disparities Look Like State By State? NPR. Retrieved October 06, 2020, from npr.org
National CAPACD. (n.d.). The Need for Language Access in COVID-19 Hot Spots. Retrieved October 06, 2020, from https://www.nationalcapacd.org/wp-content/uploads/2020/06/COVID-19-LEP-by-Language-.pdf
New American Economy. (2019, July 10). Immigrants and the Growth of America’s Largest Cities. Retrieved October 07, 2020, from https://research.newamericaneconomy.org/report/immigrants-and-the-growth-of-americas-largest-cities/
Ross, C., & Runwal, P. (2020, October 6). ‘Covid is all about privilege’: Trump’s treatment underscores vast inequalities in access to care. Apple News. Retrieved October 6, 2020, from https://apple.news/AhfVI4L4hRJaXIX0jWcepsQ
