Black Lives Matter

Like being rocked to sleep by the gentle oscillations of lapping water in the center of a lake on a summer's day, declining COVID numbers have given the impression perhaps that this pandemic is behind us and all is well.  I was surprised last week when looking at my news feed that of the five featured stories, not one of them mentioned anything about the pandemic.  I, myself, fall into the same category having not posted for a few weeks now.  Society is opening up, my patients are no longer more afraid of seeing me in the office and so my life has gotten increasingly more busy.

In a conversation that I had with our hospital's Chief Medical Officer at the peak of the pandemic he told me, "what I fear the most is complacency."  It is when we decide that wearing our mask is not that important, when washing my hands after everything I touch in the hospital is not really needed, that we will get ourselves into trouble.  It is even harder at home and away from work.  However, like my grandchild in a game of peek a boo, the SARS CoV2 virus lurks in the shadows ready to jump out and cry, "hear I am!"

Here are the latest numbers of patients hospitalized in the St. Louis area as of June 6th:

I like looking at hospitalizations because this is a number that is the most significant from a societal point of view.  If everyone who was ill had mild disease and could stay home, there would be very little disruption to normal society.  We could in essence vaccinate ourselves and develop herd immunity.  It is when the hospitals are overrun with extremely sick patients and our resources are exhausted that drastic measures need to be taken.  At first glance, the graph looks reassuring.  Following the blue line we see a steady decline across the weeks. Looking at the last few days, though, we see that there is a considerable uptick in two of those three days.  Should that trend continue, the blue line will start climbing once again.

In my own experience, I have seen more patients with positive results in the last week than in the few weeks prior.  My sample is small, but every single case has been in the African American community. I find it interesting that in the very week when we are rightly reminded that "Black Lives Matter," there has been very little news reporting on the elevated risk that the SARS CoV2 virus poses to this community right now. I think that the movement that we have seen across the country of solidarity between people of all races has been great. I applaud those who show support while continuing to practice safe guidelines.  A life snuffed out by over aggressive law enforcement is a tragedy.  It is a wrong that cannot be tolerated. I would like to stand up to say that "All Black Lives Matter," not just the ones taken in violence.

My professional life is dedicated to improving the lives of my patients.  I am passionate about preventing disease. I constantly encourage them to eat healthy and get more exercise.  Vaccines have been shown to save lives and the advances in therapeutics have helped to treat many diseases and better manage many chronic ones.  In my experience there are some in the African American community that can be very suspicious of drugs, vaccines and hospitals, and for very good reasons.

In the 1930's The U.S. Public Health System began an experiment in African American men to treat Syphilis called the Tuskegee Study.  In the 1940's penicillin became available and was quickly shown to be an excellent treatment for the disease. However, the trial continued and withheld that treatment in one arm of the study.  The researchers eventually were soundly criticized for not disclosing this information and the community rightly came to feel that they were being treated as experimental lab animals. This well deserved sentiment of mistrust has persisted in some circles for generations.

In 1976 the government pushed a new "Swine Flu" vaccine to prevent an epidemic that year that never materialized.  The vaccine which was used had a higher than average risk of a potentially deadly condition called the "Guillain-Barre" syndrome. Many citizens became leery of government sponsored health campaigns which feeling persists today.

In recent times, it has been well documented that African Americans receive inferior care for similar conditions than their white counterparts.  This is less likely to occur when their doctor is African American but with only 5% of doctors being African American, few have that option.  I would like to believe that these statistics do not apply to myself, but I cannot guarantee that I do not have subconscious racial biases. It is important that I understand this trend so as to maintain a vigilant attitude to prevent it from becoming a reality in my own practice.

Ultimately, if we truly believe that "Black Lives Matter," then we must all work together to make sure that all of them do.  Patients need to trust the doctors that are responsible for their care and heed their advice.  They must chose to adopt healthy habits.  Right now that includes social distancing and the wearing of masks in public. Is there a way to raise our voices without endangering lives during a pandemic?  Gatherings are a powerful symbol of unity but they do carry extra risk. Doctors, for our part, must earn our patient's trust every day by treating each individual with the utmost respect, truly listening to his/her concerns and tirelessly being an advocate in a system that, historically, has not had his/her best interests at heart. We must all be the solution. We are all in this together.