Note: This thread is related to #COVID19.

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Rhea Boyd MD, MPH
+ Your AuthorsArchive @RheaBoydMD Pediatrician, Public Health Advocate and Scholar. Co-developed THE CONVERSATION. I write and teach about racism and health. (she/her/hers) May. 27, 2020 2 min read

Y'all we need to discuss this study recently published in @Health_Affairs. It is looking at COVID disparities here in California. The findings were striking but the analysis basically reified biological race. First, the findings...small thread (promise). 

1. Of the suspected COVID cases, African Americans were the *least* likely to be tested outpatient.

Only 29% of African Americans were tested in the outpatient setting as compared to non-Hispanic whites (56.0 percent), Asians (60.0 percent) and Hispanics (53.8 percent).

2. Instead, the majority of African Americans were tested once they were already hospitalized (!), either in the ED (37.8 percent) or as inpatients (32.3 percent).

This suggests that African Americans had to demonstrate a greater severity of symptoms to access to testing.

3. Then when you look at the African American patients who tested positive, more required hospitalization (52.5%) when compared to non-Hispanic white patients (25.7%) and a higher proportion were transferred to the ICU than their non-Hispanic white counterparts (24.6% vs 10.7%).

4. Which again, suggests African Americans were either sicker at presentation or had to show greater severity to receive testing and care.

So next the authors would highlight the barriers to care right? Yes, BUT, not before they say this...

5. The first thing the authors suggest is, "One hypothesis is that there may be some unknown or unmeasured genetic or biological factors that increase the severity of this illness for African Americans."

@Health_Affairs this is unacceptable. Who reviewed this?

6. The bar to publish on racial health disparities has got to be WAY higher. Reifying biologic race, as a first or acceptable conclusion to racial differences in health outcomes is a part of the structural racism that harms Black patients. Period.

7. If patients delay their presentation, it is not on them, it is ON US, as a system and as providers to get the care to them.

In this case, it could be as simple as offering African Americans tests outpatient. How many patients that weren't tested returned sicker?

8. Sorry, I know I said this would be short, but y'all know this BOTHERS me.

So I'll end it by saying, these disparities illustrate another example of the system functioning as intended.


The assumption is, patients (and Black patients in particular) should change, not us. They should: present sooner, less sick, more competent, and more trusting(!)

The truth is, our healthcare system was never built to serve them.

You can follow @RheaBoydMD.


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