COVID-19 vaccines and treatments: closing the racial gap

SHERYL HUGGINS SALOMON | 2/18/2021, midnight
As Black and Latinx communities in New York continue to be hardest hit by COVID-19, experts warn they are being ...
COVID-19 vaccine Michael Appleton/Mayoral Photography Office

As Black and Latinx communities in New York continue to be hardest hit by COVID-19, experts warn they are being left behind with regard to vaccinations and treatments. 

Vaccinations follow a familiar racial pattern

As of early February, NBC New York News reported that just 12% of Black city residents had received at least one vaccine dose, even though they are 24% of the city’s population.  Only 16% of Latinx residents—who make up 29% of New Yorkers—had been vaccinated. White people, who make up 32% of the city’s population, had received 46% of the vaccines. An analysis of national data by CNN in January uncovered similar trends.

“We know there are many contributing factors, from infrastructure inadequacy and technological failures to cultural hesitancy to longstanding health care privileges and disparities,” said Public Advocate Jumaane Williams in a public statement reacting to the data.  “We know too that the government—city, state and federal—each had a role in creating this divide, and has a responsibility to equitably close it.”

To address access, Gov. Andrew Cuomo announced that during the week of Feb. 24, two more mass vaccination sites will open in “socially vulnerable communities,” in addition to the existing Bronx site at Yankee Stadium. They will be located at York College in Jamaica, Queens and at Medgar Evers College in the Crown Heights neighborhood of Brooklyn.

Meanwhile, on Feb. 15, New York State eligibility requirements were updated to include people with certain pre-existing conditions, such as cardiovascular disease, high blood pressure, diabetes, lung diseases, sickle cell disease, pregnancy and severe obesity. It remains to be seen if those changes will also impact access in vulnerable communities. Black people have a higher risk and incidence of such chronic health conditions, says Patricia N. Whitley-Williams, MD, “And so we're even more susceptible to COVID-19.” Dr. Whitley-Williams is a pediatric infectious diseases specialist at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey, as well as president of the National Foundation of Infectious Diseases (NFID). 

Data reveal surprising trends for vaccine acceptance among Black people

The cultural hesitancy mentioned by the public advocate, particularly among Black people, is rooted in a legacy of mistreatment by health care providers and institutions. For instance, National Bureau of Economic Research reported that in the years immediately following revelations of the Tuskegee Experiment (which left Black men who were infected with syphilis untreated), physician interactions with older Black men decreased so much that their life expectancy had fallen 1.5 years by 1980.

Yet, new survey data released by the NFID reveals that they are not the demographic posing the biggest challenge to vaccine acceptance. “Younger Black adults were less willing to be vaccinated, against both COVID-19 and flu,” says Dr. Whitley-Williams. “We also found that Black women were less willing to be vaccinated against COVID-19. This gender gap does raise concerns, because oftentimes women are the ones who make decisions about health care for the family and for the household.”

In addition to mistrust, social media may be a factor in vaccine hesitancy, Dr. Whitley-Williams adds. “Younger Black adults, including women, are more likely to be more savvy about social media. The problem is there's a lot of misinformation on social media.” Among the common myths are that you can become infected with COVID-19 from the vaccine or possibly even die from the side effects. “No, because it's been tested in thousands of people and now millions of doses have been given in the U.S. but across the world,” and those concerns have not been born out in reality, she counters. Plus, “The side effects from the vaccines are mild and certainly far outweigh the risk of becoming infected with COVID-19 and suffering some of the complications, which obviously could be very severe.”

Another misconception that Dr. Whitley-Williams hears, even among health care workers, is that the vaccine was rolled out too quickly to inspire confidence that it’s safe. “The process by which the vaccines were developed was in place and already being developed for the last 10 years. Then along came this new virus and the platform was already developed. So it did not take that much time to create the vaccine. But I can tell you that no steps were skipped,” she says. “These vaccines were scrutinized more than any other vaccines that I've seen before.” 

It’s important to get your information from knowledgeable sources, Dr. Whitley-Williams stresses. She suggests NFID.org as a first stop.  

Black and Brown communities need greater awareness of treatment options

Beyond the racial and ethnic disparities in vaccinations is troubling gap in knowledge about which treatments are available if you do experience moderate-to-severe COVID-19 illness. something that is more likely to happen to you in the first place if you are Black, Latinx or  Indigenous. People in these groups are all at much higher risk of being infected, hospitalized and dying of the disease than white and Asian people, according to the CDC. 

If you become sick enough to be hospitalized, there are number of treatments you may be given, depending on the severity of your symptoms and how long you have been infected, explains Raji Ayinla, MD, chair of the Department of Medicine at Harlem Hospital Center in Manhattan:

• Remdesivir – An antiviral medication which helps to stop the virus from spreading in the body.

• Dexamethasone – A corticosteroid that is used to address the body’s inflammatory and immune responses to the virus. 

• Anticoagulants – Also known as blood thinners, they address life-threatening problems with blood clots that COVID-19 patients can experience.

• Oxygen therapy – This can range from non-invasive procedures that administer oxygen through devices such as a face mask, nasal cannula or helmet; to invasive procedures, such as being put on a ventilator.

• Prone positioning – This involves turning a patient from lying on their back to lying on their stomach in order to prevent fluids from settling and blocking oxygen flow.

• Monoclonal antibody infusion treatments (Lilly’s bamlanivimab and etesevimab; Regeneron’s casirivimab and imdevimab) – These lab-produced antibodies are designed to disrupt the virus' ability to attach and gain entry into body cells in order to prevent hospitalizations, decrease the amount of virus in your body and lessen the severity of COVID-19 symptoms.

The last treatment is the type that former President Donald Trump received when he had COVID-19 and referred to as “Regeneron.” New Jersey’s Rep. Bonnie Watson Coleman, a member of the Congressional Black Caucus, also reported receiving a monoclonal antibody treatments when she was infected with the virus. So did former New York City Mayor Rudy Guiliani and former New Jersey Gov. Chris Christie.

However, these treatments aren’t just available to politicians or other well-connected people. A number of local hospitals are offering them through clinical trials, to anyone who medically qualifies. In some cases, compensation is offered to trial participants. Harlem Hospital is investigating the use of Regeneron’s treatment in people with mild to moderate disease who are: 1) Hospitalized patients, with treatment started within three days of hospitalization; 2) Outpatients who are at risk of progressing to serious disease because they have certain pre-existing conditions; 3) Household contacts of someone who has tested positive. They are still accepting patients in the last two categories, says Dr. Ayinla. “We can give them the infusion at the clinic and this will slow the progression to severe disease. Again, this is still in clinical trials, but preliminary data shows that there is some significant benefit.” Those who are interested should call 212-939- 2950 or email HarlemCOVIDResearchStudy@nychhc.org. 

However, theirs isn’t the only hospital offering this treatment. You can also use the U.S. Department of Health & Human Services’s Therapeutics Distribution Locator to find out if an hospital in your area has received a shipment of monoclonal antibody treatments.

Other treatments you may have heard of in the past, such as hydroxychloroquine or convalescent plasma, are not the current standard of treatment and not being administered at Harlem Hospital Center, says Dr. Ayinla. Neither is ivermectin, a deworming medication that has been used as a COVID-19 treatment in other countries, but is not approved by the U.S. Food and Drug Administration for that usage in the U.S.

Still, despite all of the new vaccines and treatments being developed, it’s still important not to let your guard down with the basics of prevention, particularly with variants of the virus on the rise, says Dr. Ayinla. “Even if one has had COVID-19 and had developed antibodies, or received antibodies or received a vaccine, it's still very important to take all the standard precautions: wearing masks, washing hands, social distancing, test regularly and all of that, because there is still a chance that you can get reinfected.”