12 September 2020 | New Scientist | 23T
HERE was the home health
aide distraught at having
potentially transmitted
the coronavirus to her patients.
The essential worker, just barely
into his 40s, on a ventilator for
six weeks. The beloved father’s
family whose agony was revealed
in every phone call recorded in
his medical record.
These are the stories of some
of the people with covid-19 whose
medical records I reviewed as a
research volunteer in New York
City. Combined with thousands
of other people’s anonymous data,
such collections are critical for
informing research, clinical care,
government policies and funding
allocations to tackle the pandemic.
Participating in this process,
it became clear that the system
of healthcare data collection
perpetuates systemic racism in
medicine in the US and elsewhere.
It is well established that
people of colour in the US are
more likely to get covid-19 than
white people. In the UK, the same
is true for people from black, Asian
and minority ethnic (BAME)
backgrounds. But the way we
are trying to understand these
patterns is all wrong.
The statistics collected on
covid-19 largely focus on biological
factors, such as comorbidities:
secondary conditions that may
affect a disease’s outcome. With
covid-19, obesity has been linked
to its severity, for example. Many
comorbidities, obesity included,
are also found at higher rates
MIamong people of colour in the
CH
EL
LE
D’U
RB
AN
O
Comment
Alisha Dua is a graduate
research fellow in the
Tri-Institutional MD-PhD
Program in New YorkViews
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pieces p32West. This has led many to
highlight them as the sole
explanation for covid-19 health
disparities. This is an oversimplistic
and harmful conclusion.
While we know that ethnic
minority groups in the West have
had higher infection rates, we
will never fully understand why
that is the case without looking
at aspects of health that aren’t
down to biology. So-called
social determinants, such as food
security, housing and cultural
practices, are not only important
for explaining why health
disparities exist, they are also vital
for knowing how to address them.Consider multigenerational
households. When people with
mild cases of covid-19 are told
to isolate in their homes, the
risk of spread rises with each
extra member in the household.
If they have older relatives living
with them, the risk of a more
severe case of covid-19 increases.
In the West, people of colour are
more likely than others to live in
multigenerational family homes.
Early in the pandemic, we didn’t
collect data on this and many
other social factors to determine
if these households have an
increased covid-19 burden. Such
data would have helped reducethe disease’s spread for everyone,
not just minority populations.
Viruses don’t care about the
colour of your skin.
Published work on covid-19
illustrates the lack of data on social
determinants. On pubmed. gov,
a database of international
biomedical literature, 676 articles
mention “comorbidities” and
“COVID-19” compared with just
52 for “social determinants of
health” and “COVID-19”.
Why is research on the social
determinants of covid-19 so
limited? Unfortunately, this is
the status quo in clinical research.
From the start of their training,
clinicians learn that biological
factors are the most important for
understanding, preventing and
treating disease. Many medical
schools in the US and Europe don’t
have a required curriculum on
social determinants of health.
In schools that do, it is common
for the curriculum to be squeezed
into a single class. The implication
is that social determinants aren’t
a priority in medical care.
By failing to gather data on
social determinants early in the
pandemic, we lost the opportunity
to reduce the spread of covid-19.
We must now prioritise the
collection of such data to ensure
we operate equitable healthcare
systems where minority
communities aren’t left behind. ❚The wrong questions
Covid-19 is affecting ethnic minorities more severely, but we will never
understand why if we don’t collect the right data, says Alisha Dua