Andrea K. McDaniels: A View on Health Inequities During the Pandemic

Andrea K. McDaniels

Crystal Flowers-Hardy was a day care center owner with a big a personality who understood the challenges faced by the children she looked after, many of them from the troubled West Baltimore neighborhoods near her center.

She trained her teachers to consider the trauma the children may have experienced being exposed, both directly and indirectly, to gun violence in their crime-heavy hometown. Soothe and comfort rather than punish. Talk and console. Practice patience.

She wanted to give the children a chance at a better life, to protect them from the stress that consumed their bodies and could lead to health disparities that can significantly shorten life expectancies in African Americans compared to whites.

But Hardy-Flowers, who worked so hard every day to give others a fighting chance, lost her own life to COVID-19, a disease in many ways also influenced by health disparities. She died from complications of the virus on Dec. 31 at a local hospital after being admitted around Christmastime. She lived with chronic obstructive pulmonary disease and feared for her life should she contract COVID-19 with such a serious preexisting condition.

Crystal Hardy-Flowers dances with children at a 2018 cotillion | Permission from Baltimore Sun Media. All Rights Reserved.

I featured Ms. Hardy-Flowers in a series of stories in 2014 about the impact of violence on children and families, a project that won a 2015 AAAS Kavli Science Journalism Award. I wrote about her again in January, nearly seven years later, with sadness and heartache after her death. A woman doing good things was taken by a horrific disease that is killing African Americans and other people of color at disproportionate rates.

The pandemic has only further exposed the racial inequities that have existed in one of the world’s richest countries for decades ― a topic that I wrote about extensively for eight years as a health and medicine reporter and now as an opinion writer. African Americans are more likely to suffer from underlying health conditions, live in dense areas, work in essential jobs that expose them to many people, and deal with challenges accessing health care. All are factors that contribute to the race disparities associated with COVID.

They are inequities I see in my own life, where COVID has touched me personally. I know far too many people who have contracted or died from the disease. I sat on pins and needles for two days awaiting test results of a close elderly relative who had been exposed, scared that the virus might affect her already fragile health. It seems my white friends and colleagues have not been going through similar experiences.

The bright spot in all of this is that the inequities are being exposed on the front end of the epidemic. Early on, scientists picked up on the disproportionate infection rates in communities of color. Journalists and scientists pushed for the Centers for Disease Control and Prevention and local health departments to track cases and deaths by race and make the statistics public. Testing and education campaigns began to be targeted to communities of color. I wrote an editorial for The Baltimore Sun advocating such steps.

Now we see news outlets doing their own data crunching on vaccination rollouts and pushing states to break down vaccine statistics by race. What we are finding is the age-old story in American health care. White Americans are getting shots in their arms while once again people of color who most need it are being left behind. The news stories regarding vaccine patterns are putting the pressure on states to come up with alternative ways to get the vaccine to sometimes hard to reach populations. Such news coverage, and editorial comment by myself and others, is holding government accountable and will hopefully save lives.

Real-time research also has shown the hesitancy many African Americans have in getting the COVID vaccine, honed by years of mistrust because of mistreatment by the medical system ― the Tuskegee syphilis study, the most notorious, but not the only example. Aware of the sad history, public health officials are launching outreach campaigns and using influencers and Black doctors to build trust and make inroads in Black communities. I wrote a column about why I, as an African American woman, plan to get the vaccine and why I trust the science.

One or two decades ago this kind of early accountability reporting by race would not have occurred. The AIDS epidemic was portrayed as a white gay man’s disease when it first broke out in the United States. The result was the medical community missed out on, or perhaps ignored, the disproportionate number of African Americans that had the disease.

Years of targeted treatments to this population were missed as funding was devoted to white men, and too many people died that shouldn’t have. “Although race was missing from AIDS reports in 1981, within a few years it became clear that minorities suffered disproportionately from the new disease,” Linda Villarosa wrote in a 2017 New York Times Magazine cover story about Black gay men with AIDS. It is an equity problem that still exists today, and that the medical community still finds difficult to resolve.

Medicine can learn from its past mistakes and not let COVID get so out of hand that the consequences linger for decades. With intentional approaches, all populations can be treated. The medical profession also needs to use an equity lens on every health matter ― not just massive challenges such as a pandemic. Technology makes it easier than ever to analyze massive amounts of data on even the rarest diseases. But researchers can only analyze what is diligently collected ― data that once might have been ignored.

Health and medical journalists also need to make questions about race a normal part of their interviews on all health matters. Health disparities are too common for doctors and scientists to ignore. If journalists are told the relevant data is not available, they need to press their sources in the medical community for answers or even find ways to create databases on their own.  

Unfortunately, recognizing the disparities didn’t save the life of Ms. Hardy-Flowers. She continued to put her child-care children first, even as she put her own self at risk, coming to work even on days she could barely walk across the parking lot. But more focused research, education, testing and vaccination efforts will eventually save the lives of other African Americans and help get the country to a point where all people are treated equally in health care.

Andrea K. McDaniels is deputy opinion editor at The Baltimore Sun, where she writes editorials and a column that runs every three weeks. She has a special interest in social justice, race and health issues.