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www.diverseeducation.com16 Diverse | February 4, 2021

A few hours a� er receiv-ing the second dose of the COVID-19 vaccine,
Dr. Valerie Montgomery Rice,
president of Morehouse School
of Medicine (MSM), says she was
“feeling great.” Rice, who says she
has “a history of participating in
clinical trials,” received her fi rst
dose of the vaccine on Decem-
ber 18 with CNN anchor Sanjay
Gupta to raise awareness and
public trust in the vaccine.
Rice and MSM are part of a group of

higher ed professionals, doctors and public
health experts known as the Black Coalition
Against COVID, which is working to
address community concerns and dispel
misconceptions about the disease and the
vaccine and to inspire trust in the medical

community around these
issues to hopefully save
Black lives.
� is is no small feat.
“Black folks’ mistrust in

the medical system really
stems from enslavement,”
s ay s D r. Ve r o n i c a
Newton, an assistant
professor of sociology at
Georgia State University.
She is working with a
research team studying
C OVID-1 9 res e arch
participation in the
Black community.
From the gynecological

experiments conducted
on enslaved African
A m e r i c a n w o m e n
without anesthesia, to
the forced sterilization
of Black women after
emancipation as a form
of social control, to the
Tuskegee experiments

Dr. Veronica Newton

A Cultural
Conundrum

Physicians are fighting against historic distrust and

misinformation in their quest to save African American

patients, who are dying from COVID-19 at disproportionally

high numbers.

By Autumn A. Arnett

www.diverseeducation.com February 4, 2021 | Diverse 17

that withheld treatment for Syphilis from infected
Black men, to even more recently not believing
Black women and putting their lives at risk during
childbirth, there has been systemic institutional
violence against Black bodies by the medical
community, Newton says.
“I think it’s really important that we remember

that it’s institutional racism and sexism that has
led Blacks to mistrust medical professionals, not
just, ‘Oh, Black people don’t have a trust of medical
professionals,’” she says. “It’s more than Blacks all
having a bad experience with a specifi c type of
doctor. It’s across all facets and specifi cities within
the medical fi eld.”
� ese disparities don’t only aff ect poor Black

people. Dr. Geden Franck, an assistant professor in
the school of medicine at Texas A&M University,
pointed out how a lack of cultural responsiveness has
impacted patient care.
“Yes, there are errors

within the system,
there are misdiagnoses
within the system, but
we tend to see there
is a higher percentage
of these when dealing
with cultures or races
that physicians are
unfamiliar with —
lik

1 Department of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA

2 Office of Public Health Practice and Training, Department of Health Policy
and Management, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA

3 Department of Health Behavior and Society, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA

4 Center for Teaching and Learning, Department of Epidemiology, Johns
Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA

Corresponding Author:
Beth A. Resnick, DrPH, Johns Hopkins Bloomberg School of Public Health,
Department of Health Policy and Management, 624 N Broadway #457,
Baltimore, MD 21205, USA.
Email: bresnick@ jhu. edu

Commentary

Public Health Reports
2021, Vol. 136(1) 23-26

© 2020, Association of Schools and
Programs of Public Health

All rights reserved.
Article reuse guidelines:

sagepub. com/ journals- permissions
DOI: 10. 1177/ 0033 3549 20966024

journals. sagepub. com/ home/ phr

The COVID-19 Pandemic: An
Opportunity to Transform Higher
Education in Public Health

Beth A. Resnick, DrPH1 ; Paulani C. Mui, MPH2; Janice Bowie, PhD, MPH3;
Sukon Kanchanaraksa, PhD, MHS4; Elizabeth Golub, PhD, MEd5;
and Joshua M. Sharfstein, MD1

The coronavirus disease 2019 (COVID-19) pandemic has
revealed deficiencies in our public health infrastructure and led to
calls for long- overdue investment, an improved focus on equity,
and new approaches to crisis readiness and response. Higher
education in public health faces a similar moment of reckoning.
The immediacy of the pandemic forced schools and programs of
public health to shift to remote learning and to support response
efforts. The pandemic provides an opportunity to consider funda-
mental changes to improve our approaches to, effectiveness in,
and impact on public health education.

Immediate Educational Changes
Undertaken

Schools and programs of public health were forced to move
quickly in response to COVID-19 to keep teaching students, sup-
porting the training needs of public health agencies, engaging the
public, assisting communities, working across sectors, and con-
ducting research.

The immediate shift from onsite to remote learning forced
rapid adaptations to teach and engage with students at a distance,
including the use of online formats for classroom teaching, webi-
nars, discussion groups, mentoring, and applied learning.
Sheltering in place also elevated the need for student engagement
in research and practice activities to assist communities in their
COVID-19 response in myriad ways. For example, public health
students across the country assisted with performing contact trac

Overcoming Barriers to
COVID-19 Vaccination
in African Americans:
The Need for Cultural
Humility
Keith C. Ferdinand, MD, FACC, FAHA, FNLA, FASPC

ABOUT THE AUTHOR

Keith C. Ferdinand is with the Department of Medicine, Tulane University School of Medicine,
New Orleans, LA.

See also Benjamin, p. 542, and Rodenberg, p. 588.

“Rescue work by helicopter was slow.

That stopped at dark about 7 o’clock

. . . people began to panic. I told

Kenneth and Keith and those around

me that we may as well make the

best of it, for no one knows we are

here . . . help won’t come until

morning. The rain fell so hard that I

had to take off my glasses & hide my

head. . . . The water, still slowly rising,

had two more inches to go before it

reached the rooftop. We learned:

that communication [and] coopera-

tion are necessary factors for survival

in a disaster.”

—Letter from Inola Copelin Ferdinand

to her sister, Narvalee, after our family

and others spent days amid the

drowning death of my paternal grand-

father and many of her neighbors,

abandoned on rooftops in the Lower

Ninth Ward, New Orleans, LA, during

Hurricane Betsy, September 9, 1965

Racial/ethnic minorities suffer dis-

proportionately from US COVID-19–as-

sociated deaths.1 The tragically higher

COVID-19 mortality among African

Americans from multiple conditions, in-

cluding cardiovascular diseases (CVD)

and certain cancers, highlights deep-

rooted, unacceptable failures in US

health care. The social determinants of

health (limited finances, healthy food,

education, health care coverage, job

flexibility) make disadvantaged commu-

nities more vulnerable to COVID-19 in-

fectivity and mortality and amplify higher

comorbid conditions.2 The Healthy

People 2020 Social Determinants of

Health include the Economic Stability

domain, with employment as a key issue.

Suboptimal job benefits such as health

insurance, paid sick leave, and parental

leave can affect the health of employed

individuals, and African Americans are

more likely to work in blue-collar service

jobs.3 This toxic gumbo of suboptimal

health and adverse environments pro-

foundly diminishes overall African

American longevity, fueling a decades-

long White–Black death gap, with African

American men having the shortest life

expectancy.2 Although December 2020

Pew Research data note that a growing

share of Americans report they probably

or definitely will accept COVID-19 vac-

cination, African Americans continue to

stand out as less incl

Perspective

T h e N EW ENGL A N D JOU R NA L o f M EDICI N E

november 26, 2020

n engl j med 383;22 nejm.org november 26, 2020 e121(1)

The only way out of today’s misery is for peo-ple to become worthy of each other’s trust.— Albert Schweitzer
As the race to develop a vaccine
for Covid-19 has reached phase 3
clinical trials, concerns are in-
creasing about the low rates of
trial participation in important
subgroups, including Black com-
munities. Recent data show that
although Black people make up
13% of the U.S. population, they
account for 21% of deaths from
Covid-19 but only 3% of enrollees
in vaccine trials. This problem
threatens both the validity and
the generalizability of the trial re-
sults and is of particular concern
in vaccine trials, in which differ-
ences in lifetime environmental
exposures can result in differenc-
es in immunologic responses that
could affect both safety and effi-
cacy. Despite long-standing calls
from the Food and Drug Admin-

istration (FDA) and the National
Institutes of Health (NIH) to im-
prove the participation of under-
represented subgroups in drug
trials, the problem persists.1

What are the barriers to great-
er participation of Black people
in Covid-19 trials? Although they
are multiple, a critical factor is the
deep and justified lack of trust
that many Black Americans have
for the health care system in gen-
eral and clinical research in par-
ticular. This distrust is often traced
to the legacy of the infamous syphi-
lis study at Tuskegee, in which
investigators withheld treatment
from hundreds of Black men in
order to study the natural history
of the disease. But the distrust is
far more deeply rooted, in centuries
of well-documented examples of

racist exploitation by American
physicians and researchers.2

How can these long-standing
barriers to trust be overcome? The
presidents of Dillard and Xavier
Universities, two of the 104 his-
torically Black colleges and uni-
versities (HBCUs) in the United
States, recently wrote to their com-
munities saying that they them-
selves were participating in one
of the vaccine trials and asking
their students, faculty, and staff
to consider doing the same. The
pushback from parents of some
students came quickly. One wrote
on Xavier’s Facebook page, “Our
children are not lab rats for drug
companies. I cannot believe that
Xavier is participating in this.
This is very disturbing given the
history of drug trials in the black
and brown communities.”3

Presidents of the four histori-
cally Black U.S. medical schools
recently called for measures to in-
crease the participation of Black

Trustworthiness before Trust — Covid-19 Vaccine Trials
and the Black Community
Rueben C. Warren, D.D.S., Dr.P.H., M.Div., Lachlan Forrow, M.D., David Augustin Hodge, Sr., D.Min., Ph.D.,
and Robert D. Truog, M.D.

African Americans and COVID-19: Beliefs, behaviors and vulnerability to
infection
Elyria Kempa, Gregory N. Pricea, Nicole R. Fullera and Edna Faye Kempb

aCollege of Business Administration, University of New Orleans, New Orleans, LA, USA; bKemp Dentistry, Indianapolis, IN, USA

ABSTRACT
In the United States, during the early outbreak of the coronavirus (COVID-19) pandemic, African
Americans experienced disproportionately high rates of infection and mortality relative to their
share of the United States population. New Orleans, Louisiana was one of the places most
heavily affected by the coronavirus during its early outbreak. The study that follows explores
the attitudes of African Americans in New Orleans toward the virus, social and normative
conditions which affected individual behaviors, as well as access to healthcare services and
COVID-19 testing. In part one of the study, qualitative responses were collected from a
sample of African Americans in the New Orleans area to garner perspective about their
attitudes and behaviors related to the coronavirus outbreak. Part two of the study builds on
findings from Study 1 with parameter estimates from a Logit regression to examine how
social, economic and physical conditions determine vulnerability to COVID-19 infection
among African Americans. Implications for how healthcare organizations can address the
needs of vulnerable populations during a health-related crisis are discussed.

ARTICLE HISTORY
Received 13 May 2020
Accepted 22 July 2020

KEYWORDS
Health equity; Social
determinants of health;
African Americans; COVID-19;
Theory of planned behavior

In 2020, the World Health Organization declared the
novel coronavirus, or COVID-19, a global health emer-
gency as it spread ferociously across the globe [1]. The
first confirmed case of the virus appeared in January
2020 in the United States [2]. Within months, the
virus sickened many and resulted in thousands of
deaths.

As more data emerges regarding the impact of
COVID-19 in the United States, it has become evident
that the virus has affected racial and ethnic minorities
at an alarmingly high rate. Specifically, African Amer-
icans have experienced disproportionately higher rates
of infection and mortality than their representative
share of the United States population [3,4]. In early
May 2020, African Americans accounted for approxi-
mately 34% of total COVID-19 deaths in states where
they represent only about 13% of the state’s population
[3]. Some states reported even more egregious dispar-
ities. For example, in Louisiana blacks accounted for
70% of the deaths from COVID-19, but only 33% of
the population. Similarly, in Alabama, blacks
accounted for 44% of COVID-19 deaths, yet only
make up 26% of the state’s population [5].

Some officials have linked the disproportionate
numbers regarding the effect of the virus on African
Americans to individual behavi

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Social Work in Public Health

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/whsp20

Racial Disparities in Healthcare: How COVID-19
Ravaged One of the Wealthiest African American
Counties in the United States

Darius D.Reed

To cite this article: Darius D.Reed (2021) Racial Disparities in Healthcare: How COVID-19
Ravaged One of the Wealthiest African American Counties in the United States, Social Work in
Public Health, 36:2, 118-127, DOI: 10.1080/19371918.2020.1868371

To link to this article: https://doi.org/10.1080/19371918.2020.1868371

Published online: 28 Dec 2020.

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RESEARCH ARTICLE Open Access

Higher comorbidities and early death in
hospitalized African-American patients with
Covid-19
Raavi Gupta1* , Raag Agrawal2, Zaheer Bukhari2, Absia Jabbar2, Donghai Wang2, John Diks2, Mohamed Alshal2,
Dokpe Yvonne Emechebe2, F. Charles Brunicardi3, Jason M. Lazar4, Robert Chamberlain5, Aaliya Burza6 and
M. A. Haseeb1

Abstract

Background: African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other
racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and
assess efficacy of treatment interventions.

Methods: We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients
admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an
urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population.

Results: Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were
included in the study. 88% of patients were Black; and a majority (52%) were 61–80 years old with a mean body
mass index in the “obese” range. 98% had one or more comorbidities. Hypertension was the most common (79%)
pre-existing condition followed by diabetes mellitus (56%) and chronic kidney disease (17%). Patients with chronic
kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it,
suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of
mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly
high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP
(180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil:
lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48%
died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical
ventilation, of which 86% died and of the remaining 370 patients, 30% died.

Conclusions: COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely
due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved
patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for
improving outcomes in African-American patients.

Keywords: Health disparities, COVID-19, African-Americans, Dialysis, ACE inhibitors, Angiotensin II receptor blockers,
Comorbidities, Chronic kidney disease

© The Author(s). 2021 Open Access This article is licensed und