The racial disparities of COVID-19 [PODCAST]

 

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“Some media outlets and public figures have heralded the ongoing pandemic as a great equalizer, referencing the pathogen’s indiscriminate spread and disregard for national borders and tax brackets.

The sobering mortality statistics, however, dispense any notion of an equal-opportunity crisis, revealing a familiar theme among public health challenges in America: significant racial disparities exist, and communities of color are disproportionately affected.”

Ritodhi Chatterjee is a medical student.

He shares his story and discusses his KevinMD article, “COVID is not a great equalizer.”

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. Today on the show, we have Ritodhi Chatterjee, who is a medical student. He just finished his third year, and he wrote this KevinMD article, “COVID is not a great equalizer.” So we’re going to get into that article in a little bit, but Ritodhi, first off, welcome to the show.

Ritodhi Chatterjee: Thank you. Thank you for having me.

Kevin Pho: So tell me a little bit about your story and your journey to where you are today.

Ritodhi Chatterjee: So I am, as you mentioned, completing my third year at Baylor College of Medicine in Houston, Texas. I graduated from the University of Chicago in 2014 with degrees in biology and economics. I worked for about three years as a strategy consultant, and then here I am now in medical school.

Kevin Pho: Fantastic. And how has the pandemic affected you? I know you’re just finishing your third year and going to your fourth year. How have the last few months been?

Ritodhi Chatterjee: So I’m sure a lot of your medical student listeners can attest to this, but it’s been a pretty dramatic disruption to medical education as a whole. So the affiliates of Baylor College of Medicine basically mandated that students were not allowed for about two months. So we’ve kind of been trying to keep busy in that time through volunteering, research activities, and other things of that nature.

Kevin Pho: Sure. So let’s go into your KevinMD article, “COVID is not a great equalizer.” I’m just going to read the first two paragraphs, and perhaps I can ask you the story behind that article and why you decided to write it. So you start, “Some media outlets and public figures have heralded the ongoing pandemic as a great equalizer, referencing the pathogen’s indiscriminate spread and disregard for national borders and tax brackets. The sobering mortality statistics, however, dispense any notion of an equal-opportunity crisis, revealing a familiar theme among public health challenges in America: significant racial disparities exist, and communities of color are disproportionately affected.” So tell me the story behind that article and why you decided to write it.

Ritodhi Chatterjee: So it’s kind of interesting, actually. As part of our third year of medical education, we take a class called DDASH, which stands for determinants, disparities, and social health. And so basically, we learn about social determinants of health, which can be defined as the conditions in which people are born, grow, live, work, and so on. And so as kind of the capstone project to that class, we have to write a final essay, and the essay was supposed to be, they say, at least a thousand words, use five sources or so.

And I had read in the news that African Americans are being disproportionately affected by the crisis. I think in New Orleans, for example, despite making up a third of the population, 70-plus percent of the deaths were in Black individuals. So I was kind of curious: Why is this happening? What can explain this phenomenon? So I started writing, and before I knew it, I’d written close to 2,000 words and had 20 sources. So that’s kind of what originated this piece.

Kevin Pho: So why do we get into that? What are some of the reasons that are affecting the Black community and making them so susceptible to the effects of the pandemic?

Ritodhi Chatterjee: So in the piece, I kind of delved into a couple of categories. First, I talk about economic factors. Black Americans, on average, hold less wealth, have lower wages, and make up a larger proportion of gig workers, people like Uber drivers and things like that, relative to their proportion of total employment. So those are some of the economic factors.

And why is that important, right? In order for someone to stay home and self-quarantine, for example, they have to believe that they’re financially secure. So if you have an incentive to continue working in order to support your family, or say your job is kind of temp work and you’re worried about getting fired, then you’re less likely to stay home, and in fact, you’d rather go to work and continue getting money. That’s economic factors.

From an environmental perspective, Black Americans are disproportionately more likely to live in public housing and areas that are in crowded conditions, and things like urban settings. And then on top of that, there’s the concept of food insecurity, right? If you don’t have proper access to healthy food, if you have to take a bus or drive extended periods of time to get to a supermarket, then you’re more likely to eat unhealthier foods and things like that, you know, food deserts and such. So those are economic factors and environmental factors.

And then I talk about health care-related factors. Black Americans are more likely to have chronic conditions; that’s well characterized in a variety of studies. And then also, access to care is limited in these communities. So those are some of the factors I delve into in the article. And then finally, obviously, there’s implicit and explicit bias that this community experiences. So I think this kind of milieu of social factors has all contributed to the larger proportion of African Americans affected by COVID.

Kevin Pho: One of the things that you wrote in the article that I found fascinating was the concept of allostatic load. So I was wondering if you could tell me a little bit about what that is and why that’s relevant.

Ritodhi Chatterjee: So it’s a really curious concept that I actually hadn’t heard of before researching this article. Basically, the concept is that we know now that chronic stress affects the body and affects our physiology, right? So through the function of hormones that we study in medical school, obviously, like cortisol and catecholamines, chronic stress can actually lead to increased inflammation, can depress your immune system, and can stress our organs.

So in African Americans and just other communities of color that experience racism, both explicit and implicit, that can lead to increased stress chronically over time. And some studies have suggested that perhaps this leads to greater inflammation, and perhaps this could be one of the reasons that we see this increased pathology in Black Americans and why COVID has disproportionately affected this community.

Kevin Pho: So I’m in internal medicine primary care, and you’re obviously a medical student. So for both medical students and physicians, what can they do on an individual level to address this issue?

Ritodhi Chatterjee: So I think that the biggest thing is realizing that as a physician, our role extends beyond the confines of a specific clinical encounter. You have to think about all the other factors affecting our patients long before they step into the office. And so, keeping that in mind, I think thinking about these social determinants of health, education, access to food, access to health care, things even like gender and race, right, thinking about all these things and how they contribute to the pathology that we see in the office, I think that’s really key. So asking your patients about these things, educating ourselves about these things, and obviously advocating for these things outside the hospital, whether that’s from a policy perspective or just talking to your colleagues and your friends and your patients.

Kevin Pho: So we are filming this on the last weekend of May, and a lot of states and cities are opening up, some faster than others. So can you give a prediction over the next few months about how our reopening strategy, or lack thereof, is going to affect the Black community going forward?

Ritodhi Chatterjee: Yeah, I mean, that’s a really good question. Obviously, we’ll have to trend the numbers and look at not just the number of new cases but the positivity rates, so of the new cases, or of our tests, rather, what percentage is coming back positive. So we’ll have to look at the numbers. It’s hard to predict. But I think, obviously, as I mentioned before, the Black community, due to all these existing factors, will feel the brunt and maximal impact of the reopening, because, as I said, a lot of people can’t socially distance or can’t afford to stay home from work, or their living conditions are such that they’re not able to follow the proper protocols and things like that. So I think if we do see a rise in cases, it’s reasonable to expect that those cases will disproportionately affect this community, as has already been happening.

Kevin Pho: So let’s take a step back. You just finished your third year of medical school and are now entering your fourth. Share with the audience something that you’re passionate about recently or something that you’ve been curious about.

Ritodhi Chatterjee: Right. So looking beyond this concept of racial disparities in health, one of the ways I think I’ve been staying busy over the past two months has been volunteering at the Houston Food Bank, which is actually the largest food bank in the country. And so food insecurity has been something that I’ve been thinking a lot about. This has obviously been an issue even before COVID, but because so many people are now unemployed or unable to access food, food insecurity has spiked. And I think I saw a statistic recently that in Houston, 40 percent of mothers with children under 12 now identify as food insecure. So I think that’s something that we need to address as a country, really. It’s unconscionable that so many people find it difficult to access healthy food or feed their families in one of the richest industrialized countries on the planet.

Kevin Pho: All right, and my final question: What’s your take-home message for the KevinMD audience?

Ritodhi Chatterjee: So I would say the two take-home messages from this article are, one, that the pathology that you see when a patient walks into your office is really just the tip of the iceberg. There are all these social determinants under the surface that are contributing and driving that presentation. And so be aware of that, discuss those things with your patients, and advocate where possible outside of the hospital setting.

And then two, COVID: These disparities we see in COVID cases and deaths, while shocking in their scale, are not necessarily surprising. These disparities have existed in the Black community relative to the rest of the population for really centuries, and this pandemic has really just exacerbated those conditions within our social structures. So we need to continue to advocate at a public policy level for improvements in these conditions.

Kevin Pho: Well, thank you so much for sharing your insight. Ritodhi Chatterjee is a medical student, and he wrote the KevinMD article “COVID is not a great equalizer.” Ritodhi, good luck to you in your future studies.

Ritodhi Chatterjee: Yes, sir. Thank you very much.

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