A new report by the New York City Department of Health and Mental Hygiene displays the racial inequities of medical care during the Omicron rush.
According to the report, “Black New Yorkers and residents of the least privileged census tracts faced longer delays receiving a diagnosis of COVID-19 infection, according to data from between October 1, 2020 to October 31, 2021. For 1 out of 4 Black New Yorkers and residents of the least privileged census tracts, it took 5 or more days to get diagnosed. In comparison, 1 out of 4 other New Yorkers took 4 or more days to get diagnosed.”
“Look at the framework,” said Dr. Janine Knudsen, NYC Health Department special operations medical director for the Office of the Commissioner. “We try to actually step away from blaming these disparities on individual actions, you know, on someone’s individual understanding of how to take precautions from COVID or whether to trust the vaccine or not, because at the end of the day, the disparities are not driven by individual people making right or wrong decisions, but by all the structural factors that really put people at a disadvantage.”
City health experts noted that the Omicron variant of the COVID-19 virus resulted in more hospitalizations in neighborhoods with a “high percentage of Black residents. The health department targeted these neighborhoods using TRIE (the Taskforce on Racial Inclusion & Equity). Some of these areas included zip codes 10026, 10027, 10030, 10037, 10039 (Central Harlem), 10453 and 10458 (Fordham and University Heights in the Bronx), 1124 and 11235 (Coney Island) and 11412, 11423, 11432, 11433, 11434, 11435, 11436 (Jamaica and Hollis in Brooklyn).
The problems the department has/must overcome are multi-pronged.
“I think that the approach that we took in trying to understand why we were seeing such a worst hospitalization rate among Black New Yorkers forces us to ask the question about what are the many different factors that are contributing to this disparity?” said Knudsen. “Because there is not just one factor that’s easily fixable or that you can pinpoint. We decided to frame it as a cascade showing that there are factors that are more downstream, like the way any disparities in the healthcare system—access to care, access to testing. But then we also really had to shine the light on all the upstream factors and histories of structural racism that put Black people at higher risk of chronic disease that put them in positions where they have less access to health care in general, less access to jobs they can work remotely, so they’re, you know, going out into the community getting exposed.”
The areas targeted by TRIE have several other health issues that go unchecked leading to a higher risk of immunocompromised New Yorkers, including those with diabetes. According to the America’s Health Rankings annual report with the United Health Foundation, 15.1% of adult Black New Yorkers were told by a health professional that they have diabetes. Much of this has to do with food deserts leading to consumption of processed foods. According to the management consulting firm McKinsey & Company, in 2020 there were more convenience stores than grocery stores, restaurants and farmers markets in Black neighborhoods.
In a study published by Health Affairs, a peer-reviewed website, Black patients were two and a half times more likely to have at least one negative descriptive term used in the electronic records of Black vs. white patients. At a medical center in Chicago, Black patients’ records were more likely to contain the words, “not compliant,” “refused” and “not adherent.” This study was conducted between January 2019 and October 2020.
Data from the Centers for Disease Control and Prevention showed that Black Americans are 22 percent less likely than white Americans to receive monoclonal antibody treatment for COVID-19. Monoclonal antibodies are created in labs designed to fight infections once presented inside the body.
How did the city fight some of these issues locally?
Knudsen said that the health department was “really focused on making sure there’s good access, particularly in Black and Brown communities.
“Just one example, around vaccines,” Knudsen said. “You know, we’ve engaged in more than a year of our historic vaccination campaign where we’ve really focused on working with community partners to get town halls and other community engagement events to help the community feel like they can trust the vaccine and they know where to get it.”
As a part of the effort, the health department introduced the Coalition to End Racism in Clinical Algorithms (CERCA), which aims to end racial adjustments in clinical algorithms that are used by healthcare providers in making medical decisions. The process, according to the CERCA, perpetuates the biology of people based on race alone.
Their efforts to combat this issue have been a relative success. In July 2021 the number of fully vaccinated adults in TRIE and TRIE zip codes was 18.9% and 64.4% respectively. By December, those numbers hit 90.5% and 95.2%.
“…At the start of the middle of the vaccine campaign in July, only 14 out of the 74 zip codes in those (TRIE) neighborhoods had reached our vaccine targets, which was to have 70% of the population vaccinated,” said Knudsen. “And now it’s February 2022, 73 out of the 74 zip codes have reached that target. So, it just goes to show how important it is to do that trust building and community partnerships to make sure people have access to information and access to the vaccine.”
When the AmNews asked if the city was moving too fast getting back to “normal,” we were directed to the color-coded COVID-19 Alert Level Guidance established on the city’s website. Despite recent reports of a new, more transmissible version of the original Omicron variant (known as BA.2), and cases found in nearly half of all states in the country but circulating at a low level, the COVID-19 risk on the city’s website is coded green meaning “Low.”