It is impossible to know whether a 30-year-old white woman with multiple coronavirus symptoms would have twice been denied a test or told that she was just having a “panic attack.”
All that is certain is that Rana Zoe Mungin, a 30-year-old Black woman, is dead.
After nearly six weeks on a ventilator, Mungin succumbed to COVID-19 in New York. What she endured — from her first hospital visit on March 15 to her last breath on April 27 — is focusing attention on institutional racism and biases in health care, magnified by the coronavirus pandemic.
In recent weeks, the inevitable has become impossible to deny. Communities of color are disproportionately represented in coronavirus infections and COVID-19 deaths in many cities, including Boston. Nationwide, Black people account for 30 percent of coronavirus cases, though they represent about 13 percent of the population.
“Racism and health disparities still continues . . . [and] the ZIP code in which we live still predetermines the type of care we receive,” Mia Mungin, a registered nurse, posted on Facebook after her sister’s death.
A Wellesley College and UMass Amherst graduate, Mungin was a social studies teacher at a Brooklyn charter school. She is at least the 28th teacher to die from COVID-19 in New York City, the pandemic’s epicenter.
“As her family has shared, Rana’s battle with COVID-19, is a painful example of the disproportionate impact COVID-19 is having on African American and Latinx families across the country,” Paula Johnson, Wellesley’s president, said in a statement. “Racial and gender disparities in health care are a moral and systemic failure. We can and must do better."
Mungin’s symptoms began with a fever on March 12. Three days later, with a cough, shortness of breath, and a headache, she went to an emergency room. She asked for a coronavirus test; what she received was medication for her asthma and headache, according to her sister.
Her breathing difficulties worsened. On March 19, Mia called an ambulance. As Mungin was examined, she repeated, “I can’t breathe.” That’s when, her sister says, a paramedic “insinuated she was having a panic attack.” Once at the hospital, Mungin again asked for a coronavirus test. This time, a doctor said, "'Her lungs are clear. We’re not going to test for corona, because we don’t have enough tests,’” her sister said in a March interview with a New York television station.
Governors, doctors, and nurses nationwide have been demanding more tests. Without them, doctors must choose who will — and who won’t — receive one even when a person is exhibiting likely coronavirus symptoms. In a medical industry riddled with explicit and unconscious bias, that has dire consequences for people of color.
Mungin “was someone I could particularly identify with as a young Black professional woman, and it just emphasized to me that even across socioeconomic backgrounds, we as Black folks have these disproportionately poor health outcomes due to the way we are treated by the health care system,” Dr. Uché Blackstock, a Brooklyn physician and founder and CEO of Advancing Health Equity, told me. Before coronavirus, her patients were “racially and socioeconomically diverse.” Now, they’re "blacker and browner.”
“From a clinician’s perspective, I understand that when you have limited resources you cannot test everybody,” she said. “But I also know that embedded in that is racial bias as well. Those inequities can be perpetuated again and again.”
When Mungin went to the hospital for the third and final time, “she wasn’t breathing,” her sister said. She was intubated and put on a ventilator. Her family tried unsuccessfully to get her approved for the remdesivir clinical trial. That’s the drug that Dr. Anthony Fauci recently touted as a possible treatment for COVID-19 patients.
I asked Blackstock how people of color can better advocate for themselves during this unprecedented health crisis. She said it was “unfair that the question even has to be asked.”
“There are so many structural barriers and structural inequities, it’s like everything is stacked up against us,” she said. “You can go in fully informed, you can bring someone with you, and that doesn’t change outcomes. The work to be done doesn’t need to be on our shoulders; the work needs to be done within the system. Real structural changes need to be made in health care, and in this country.”
If those changes ever come, they’re too late for Mungin, who loved teaching, family, and her puppies, Bandit and Rosie. No one can say if she would have survived COVID-19 had she been tested and admitted on her first hospital visit. That we even have to wonder at all is an unwavering indictment of this nation’s historical and ongoing indifference to Black lives.
Renée Graham is a Globe columnist. She can be reached at email@example.com. Follow her on Twitter @reneeygraham.