Last Saturday, like that of so many others in America over the past month, my morning consisted of the typical shelter-in-place activities. I made breakfast from the remaining ingredients in our place. I cleaned the bathroom, washed the dishes, and then picked up the apartment. These daily activities have become my respite from the mundane and ridiculous. I read more of my book and watched reruns of sporting events on ESPN that occurred umpteen years ago. It was the weekend, and I sorely wanted to avoid all information about the ’Rona/COVID-19/coronavirus/Trump flu. Then my phone began to ring. I ignored it. It was Saturday just after 12 noon, and it was almost time for my well-earned midday nap. But my phone kept ringing—and I saw it was my mother. I picked it up immediately to make sure everything was OK.
Here is a bit of background about my family. My parents were born and bred on farms in Southwest Georgia—only a short drive away from the homestead of President Jimmy Carter in Plains, Georgia. Most of my father’s side of the family left the family farm; however, they remained in that area, with many of them moving to the big town nearby called Albany, which sits within Dougherty County. Albany, Georgia, is the town that I fly into when I visit my parents. This is also the town where so many of the cousins who I grew up around as a child currently live. In the 1960s, this was the town most well-known as the original epicenter of the segment of the Civil Rights Movement led by Rev. Dr. Martin Luther King Jr. Today, this town is most known for being one of the most COVID-19–impacted cities in America.
On previous calls from that week, my mother had been sharing increasingly horrifying story after story of all the people getting sick from COVID-19. And how the small local hospital network, Phoebe Putney, was overflowing with coronavirus patients. I learned how the health care workforce was stretched beyond the breaking point, and that clinicians confirmed to be living with the virus were even still working to save their patients’ lives. But that day’s news was not about general updates from Albany. Saturday’s news was about the family.
She informed me that two of my paternal cousins had been diagnosed with COVID-19. Immediately, my heart sank into a deep abyss mixed with sadness and anger, but primarily anger. Now, let’s be clear. They were not the first set of my friends that I learned about who were living with COVID-19. Across the U.S., I had close friends and their respective partners who had been in and out of the hospital after diagnosis with this virus. And I had unfortunately lost a couple of amazing colleagues. However, my cousins were the first set of Black people living in South Georgia that I knew who were impacted. And I knew full well that we were in for quite a battle.
Time and time again, I have flown to Albany, picked up my mother, and driven her to urban centers just to receive better health care. After continual frustration over some of the care and treatment that she has received, I most recently flew her to Washington, D.C. for services. I could not and would not tolerate substandard health care for my mother—substandard care that has been shown to be driven by a combination of race and geographic location.
Due to familial proximity and personal experience supporting my parents with their health care, I know the data of that region of the USA all too well. Nearly two-thirds of Dougherty County residents identify as African American. And according to the most recent Georgia Health Disparities Report, from 2008, Dougherty County experiences extremely poor health outcomes based on racial inequity, due to poverty and reduced access to employment. Moreover, the powers that be in Georgia have intentionally limited health care access by refusing to expand health insurance through the Affordable Care Act’s Medicaid expansion. And after the pandemic was fully recognized in the United States, these health disparities were exacerbated by the slow response of Georgia Gov. Brian Kemp to issue a statewide shelter-in-place response to the COVID-19 pandemic. Georgia, predictably, is a state that would not be spared from being highly impacted, as it is home to the busiest airport in the world.
As someone who has spent nearly his entire professional life working in the field of HIV, I spend much of my time pouring over epidemiological data related to infectious diseases, looking primarily at the intersection of HIV and the biological and sociological factors that lead to HIV acquisition, progression, and potentially death. Nearly half of all people who acquire HIV in the United States are Black, and the same is true for people who die from the virus, even though we make up only 13% of the country’s residents. Lack of access to health care, education, and employment are the major drivers to HIV-specific health disparities. In public health, we call that social determinants of health.
In the streets, we simply call that racism.
And racial disparities are no different for COVID-19. The Centers for Disease Control and Prevention (CDC) has informed us that people with particular underlying conditions, e.g., diabetes, hypertension, COPD, and coronary artery disease, have increased risk of progression or death from this virus. We know that in the United States, Blacks are more likely to suffer from diabetes, hypertension, COPD, and coronary artery disease, due to reduced access to food security, recreational facilities, and quality health care services, and more exposure to environmental toxins that exacerbate respiratory illnesses. COVID-19 has laid bare on the table so many of the issues that we continually address to reduce the impact of HIV.
As my mother began to share more and more details, I began to shake. My mix of sadness and anger quickly turned to fear. And, unfortunately, those fears were not unfounded. The following day, one member of my family succumbed to COVID-19. The day after, my other family member, who had actually been sent home since she was deemed to be “improving,” also died. And two days later, her father also passed away. And it is not over. We are still living in fear, as more family members in and near Albany have been diagnosed. My individual family’s anguish looks a lot like that of so many others who have lost loved ones from this particular coronavirus. Loved ones are dying alone in medical quarantine, while those closest to them must be physically isolated from loved ones when they most need comfort. Pain and suffering are equitable to each person and family. This virus can be devastating. However, we also know that at the community level—as with so many other diseases—the impact of COVID-19 is not equitable.
Health departments are finally beginning to release data on the demographics of people who are acquiring and dying from COVID-19. And similar to HIV, African Americans seem to be shouldering the largest burden. There is an urgency to collect data to shed better light on this very subject. Members of Congress have even demanded demographic data from the U.S. Department of Health and Human Services (HHS) so that policy makers and researchers can have a more focused and equitable response to this pandemic.
It is not acceptable that my family’s entire community is being ravaged—not just by the virus, but by all those social determinants of health (read: racism) that have been destroying our community for centuries. My family is preparing to celebrate the lives of those we have lost in a manner that can boggle the mind: virtual funerals and gravesite burials without immediate family members in attendance. I admittedly am angry. Very angry. Not just because they died. That’s the one and only guarantee with life. But because they had so many factors beyond their control fighting against their desires to live.
We are owed a better tomorrow. The mental gymnastics necessary to justify why we cannot, as a country, support each other must end. And they must end today.