When the Titanic sank in April 1912, the same harsh distinctions that separated passengers on different decks determined those most likely to die in the frigid grasp of the North Atlantic.
Most of the 1,500 lost were poor immigrants. As wealthier patrons were directed to lifeboats, immigrants found gates blocking shortcuts through areas designated for first class. Immigrants comprised more than half the Titanic’s passengers, yet only 25 percent survived. Even their children weren’t spared. In first and second class, 29 out of 30 kids were saved. In third class, 53 of 76 immigrant children perished.
In a life-or-death crisis, judgments are made about which lives are deemed worthy. Given the longstanding racial disparities in health care and treatment in this country, that’s especially alarming for people of color and those in poverty during a pandemic.
“We cannot allow decades of structural racism to impede Black and Brown families’ ability to get tested and treated for coronavirus," Senator Elizabeth Warren recently tweeted. "When we fight for testing and resources, we mean equal access for all people — rich or poor, Black or white.”
What happened to Kayla Williams, a 36-year-old Black woman in London, is what some fear might become common here. She was sick with a high fever, cough, and breathing difficulties when her husband called paramedics on March 21. Although Williams was believed to have coronavirus, her husband said in an interview that a paramedic told him “the hospital won’t take her, she is not a priority.” She was never tested.
Williams died at home the next day. It’s impossible to know if her lack of treatment had anything to do with race, but it’s the kind of story that deepens mistrust of the medical industry that’s prevalent in many communities of color.
Though the Centers for Disease Control and Prevention tracks testing for the virus that causes COVID-19, its statistics are not classified by race or ethnicity. Yet there’s a blueprint for how racism and implicit bias make health care and access unequal.
Implicit bias is based on stereotypes that unconsciously shape actions, decisions, and responses. That can mean ignored symptoms and a lack of adequate treatment for people of color. For example, the opioid crisis revealed that Black people were prescribed painkillers at a rate far lower than white patients. Doctors weren’t protecting them from the ravages of the highly addictive drugs; they believed erroneously that Black people had a higher capacity for pain or didn’t feel it at all.
While NBA players, members of Congress, and those closest to President Trump can seemingly get coronavirus tests on demand, that’s not the case for most of the country. This pandemic has also brought impossible choices for health care providers facing dire shortages of vital supplies such as ventilators.
In Italy, which has already endured thousands of COVID-19 deaths, doctors are shifting care to patients with better survival chances. Some American hospitals are even debating whether to have universal do-not-resuscitate orders for everyone with coronavirus, regardless of the wishes of the patient or their families.
Such drastic measures could have profound implications on marginalized populations.
"What we fear will happen, what is likely to happen, is persons who are poor, persons who are racial or ethnic minorities, are less likely to get ventilators than those who are wealthy and well-connected,” David Williams, a Harvard School of Public Health professor, said during a recent CBS interview.
What further complicates the issue is that historically marginalized groups tend to be more vulnerable and already have chronic illnesses that could put them at greater risk, he added. “They are more likely to face chronic stressors in multiple domains of their lives. So we’re looking at those most in need being most likely to be disadvantaged.”
Coronavirus is not just a pandemic. It’s also a test of whether racist medical biases will further exacerbate a health crisis that’s as indiscriminate as it is merciless. Yet if our nation’s grim history serves as a guide for how this unprecedented catastrophe may unfold, we may already know who is most likely find the lifeboats, and who will be left to go down with the ship.
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