(The Dallas Examiner) – Since the beginning of the COVID-19 pandemic, health disparities have been at the top of health issues in the United States. Many racial and minority groups lacked the same access to health care, which was especially noticeable at the peak of the pandemic between 2020 and 2021.
“COVID-19 really put the spotlight on areas where the health care system is disjointed or imperfect and when that happens, which is all the time, the communities that suffer the most are those that are already struggling to begin with,” said Dr. Cynthera McNeil, an internal medicine provider and professor at Wayne State University.
Black, Hispanic, American Indian and Alaska Native people have suffered the heavier health impacts of the pandemic with the disparities, especially worse during variant surges and narrow when cases and deaths declined.
Dr. Tara Walker, an acute care nurse practitioner who is also a professor at WSU, said the problem early on was not knowing how pre-existing condition increased the severity of COVID-19.
“What we did not realize is that, especially early on, is that those patients that we were treating had a lot of coagulability issues and their blood was thickening, and it set them up to have a lot of, it put them at risk for pulmonary embolism and a lot of thrombosis. So patients would start to turn the corner and then they would suddenly die,” Walker recalled. “And we would see that during their cat scan, they were full of blood clots. So those were the chronic conditions that I saw in the hospital that put people at greater risk is you know, not to mention the obvious of any type of malignancies, or any type of autoimmune diseases. But those things really put people at risk.… It riddled people’s bodies and that was traumatic actually from a health care standpoint.”
By mid-December 2020, Texas received its first shipment of the vaccine and residents were asked to make appointments to get vaccinated. Older citizens and people with certain medical conditions were first to be scheduled. However, Blacks and Hispanic people were less likely to get vaccinated during the initial phases of the vaccination rollout, but over time the trend reversed amongst Hispanics who showed less reluctance to the vaccines.
“With the hesitancy that I saw with the vaccinations, routed from a long history of medical mistrust. So, I remember early on actually, we were all talking about this – how we didn’t know what this disease was. We knew that people were, especially in our communities, our friends [and] associates were dying quick and there were a lot of things in the news about this was a disease that was brought to kill minority people, especially Black and Brown people,” Walker said.
“And then as the months went on and they started to talk about vaccination. It still was a double whammy because Black and Brown people didn’t want to take the vaccination. I also recall a conversation you couldn’t get a vaccination out in the suburbs, but all of the clinics in the city were wide open because of vaccination hesitancy. And I think it just highlights the impact of medical mistrust that you feel like you know, a system or something is trying to kill you, but then when something is produced out of the system that can have benefits … you may still get COVID but it won’t be as deadly as it was in 2020, they still did not want to take it and so it was an uphill battle.”
Walker said she began doing many talks and seminars within her sorority, church groups and network of friends to encourage them to get vaccinated. When she was vaccinated, she posted it on social media because she felt that people who knew her would be more comfortable getting their vaccinations if they knew that she was and was doing well afterward.
She asserted more could be done to assuage the disparity on an infrastructural level but emphasized the duty of a health practitioner to educate the community and be a positive example.
As the number of people getting vaccinations increased, the Dallas County website revealed that the number of COVID-19 cases and deaths begin to decrease. Businesses began reopening. People started returning back to work and school. Eventually churches and recreational facilities opened, as well. However, not everyone rushed back to the life they once knew, or for some, their “new normal.”
“What we’ve seen is just with the reinstitution, a lot of people have experienced a lot of anxiety as it relates to returning back into just the normal flow of life in general,” said Dr. Umeika Stephens, psychiatric nurse practitioner, family nurse practitioner and a professor at WSU. “But again, there’s still so much information that’s developing about COVID. So we see now people who were having and are still having a lot of symptoms, long COVID symptoms. And so it’s still evolving, in terms of what we are even seeing over a long-term period. But with that we have seen a lot more with anxiety as it relates to returning back just even into the normal flow of life.”
Many workers have remained hesitant to return to work. For many businesses, many office workers continued to work from home. It wasn’t until the end of January that the number of employees returning to the office reached 50%, according to a Bloomberg report.
“So even that mindset of ‘I don’t leave the house, I’m not at risk.’ All that needs to kind of be reevaluated and we need to talk about that COVID is here and you need to figure out what is the best layer of protection for yourself, whether that’s still wearing your mask, whether that’s getting the vaccine, whatever level of protection. But it hasn’t gone away, and I don’t foresee it going away,” McNeil said.
Currently, just over 62% or 1.4 million residents of Dallas County have received at least one dose of a COVID-19 vaccination and 2 million have been completely boosted. Of those vaccinated, 17.8% or 320,000 were Black.
Still, the doctors stated that people with underlying conditions were especially encouraged to get vaccinated.
“The virus is here to stay. I think it’s about coming to grips with a new way of life,” McNeil said. “I guess it is one of those things where you have to get used to the normalization that COVID is here to stay and then go about your life in ways of how you can best protect yourself, especially if you have comorbid conditions like COPD or hypertension. I do think that getting the vaccine could potentially be a layer of protection for individuals, especially if they have underlying health conditions.”
There are many underlying health conditions that could increase the severity of COVID-19 or make it fatal, according to the Center for Disease Control, such as:
- Chronic kidney disease
- Chronic liver disease
- Chronic lung diseases
- Dementia or other neurological conditions
- Diabetes (type 1 or type 2)
- Heart conditions
- HIV infection
- Immunocompromised condition
- Overweight and obesity
- Sickle cell disease
- Solid organ or blood stem cell transplant
- Stroke or cerebrovascular disease
Some behavior risk factors the CDC listed include:
- Physical inactivity
- Smoking, current or former
- Substance use disorders
McNeil stressed the importance of learning from the past three years and not repeating the same mistakes that were made pre-COVID-19.
“Social determinants of health have a very strong impact on the health outcomes of individuals, especially those individuals in underserved, underrepresented urban communities,” she said. “So before another, whatever comes along, we really need to put a lot of effort in the educating and exposing, [and] in creating ways to address these underlying barriers that have historically and continue to be the despaired efforts for urban communities.”
Robyn H. Jimenez/The Dallas Examiner contributed to this report.