Dr. Taison Bell, is a critical care and infectious disease physician at the University of Virginia, where he is the director of the medical intensive care unit. He is also director of the Summer Medical Leadership Program—a summer for premedical students from underrepresented groups.
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HISTORIANSPEAKS: Can you begin by telling our readers what experiences in your life inspired you to become a physician?
BELL: I had severe asthma when I was a child and frequently visited my pediatrician’s office growing up. It became so much of a routine that I got to know all the physicians, nurses, and staff extremely well and vice-versa. I saw them on their good days and bad days. I think that experience exposed me to the inner workings of medicine and a normalized the idea of me working as a physician when I grew up.
HISTORIANSPEAKS: What makes the COVID-19 pandemic unique compared to HIV/AIDS, Ebola, H1N1, SARS, and MERS?
BELL: COVID-19 has really managed to find a sweet spot between the ability to spread and the ability to cause suffering and death. It is not as deadly as Ebola or SARS/MERS but just enough that it has caused hundreds of thousands of deaths. It spreads more easily than influenza but not as easily as Measles. It is these sorts of lack of extremes that have allowed complacency to settle in the US, where we do not have a strong coordinated response and a population willing to strictly adhere to public health guidelines.
HISTORIANSPEAKS: Why is COVID-19 having such an outsized impact on African Americans and communities of color, in general?
BELL: Racism is the simplest single-word explanation for this glaring discrepancy. From a pure medical standpoint, the virus is more likely to infect people who have consistent risk of exposure and cause more problems in people with underlying chronic health conditions. Thus, African Americans and persons of color — who are more likely to have chronic conditions, work as essential employees, and go back home to a dense multi-generational household — have experienced higher rates of infection and mortality than any other racial group in the US. But this is an incomplete discussion if you do not dig deeper into why these differences in health and wealth exist. For example, education disparities and employment discrimination are tied to the lack of opportunity to obtain higher paying jobs that can be performed from home. Obesity and diabetes are causally linked to food apartheid in communities of color where there is a severe lack of access to affordable and healthier foods. African Americans are more likely to live in densely populated urban areas because of redlining and other discriminatory housing practices that forced us into specific areas where our labor and wealth were extracted to enrich White communities. In this sense, COVID-19 is not really a disease but a symptom of the larger disease of racism. And just like in medicine, you rarely get far if you focus solely on the symptoms and not what is causing them.
HISTORIANSPEAKS: What is the state of public health in Black and Brown communities prior to and during this pandemic?
BELL: There’s an old saying that when White folks sneeze, Black folks get pneumonia. The health and wealth of the Black community has been under assault since we first arrived in 1619. While overt acts of racism are no longer embraced in society, the mechanisms erected to favor one group over another persist to this day. You can look no further than the criminal justice system, schools that remain heavily segregated, and attacks on efforts to correct the centuries of inequities (i.e. affirmative action). The “systemic” part of “systemic racism” means that, left unchallenged, these systems will continue to produce the exact results they were designed to produce.
HISTORIANSPEAKS: What role can Black public health officials and researchers in the private sector play in addressing the challenges presented by this pandemic?
BELL: This is the time where the Black community has an opportunity to strike while the iron is hot. The appetite for radical change in how we structure society is growing and we need to continue pushing the bar before the inevitable backlash. There has been growing interest in creating diversity-focused positions in companies and organizations to begin thinking in a broad way about how to adopt an anti-racist approach to doing business. While I applaud these efforts, I think it is past time that African Americans and people of color run these organizations and drive them with more force in the direction they need to go.
HISTORIANSPEAKS: We see modeling designed to determine the death rates for COVID-19. What is the death rate for African Americans and other communities of color? What organizations are doing this work and what will the numbers look like on September 1 and November 1st?
BELL: The death rate for COVID-19 is exceedingly difficult to determine because we do not actually know the denominator of all the people who were infected. However, based on the data I have seen I believe it is somewhere around 1%. In the African American community, we have seen that we are at least 2x more likely to die from COVID-19, with that climbing to as much as 6x in some communities with wide health disparities. I do not have a prediction for the fall, but I do think that the brunt of suffering will be borne by the Black community.
HISTORIANSPEAKS: How would you rate the federal response to the pandemic, especially because the surgeon general is an African American?
BELL: The federal response to COVID-19 has been a complete and absolute disaster that cannot be sugarcoated or packaged any other way. The fact that we have a talented and dedicated African American surgeon general does not change this fact. COVID-19 is under control in several countries that managed to learn their lesson, either from seeing other countries suffer or going through it themselves. We seem to be the only developed country where politicization has interfered with the evolving science around how to prevent further spread. As a result, we have had a shocking number of cases and deaths per capita when compared to our peers.
HISTORIANSPEAKS: What are the challenges related to testing among African Americans and in communities of color?
BELL: Access to testing that is quick, affordable, and widely available is the first barrier. Next is overcoming the distrust in the African American community towards large federally sponsored programs. Let us not mistake the fact that this is an earned mistrust, solidified over hundreds of years of medicine advancing from blatant abuse and mistreatment of African American patients.
HISTORIANSPEAKS: Vaccine development is another crucial component in combating COVID-19. Are African Americans being actively recruited to participate in the trials and are steps being taken to ensure equitable access to the vaccine?
BELL: Access to the latest therapeutics and other breakthroughs remain a challenge to. Diverse recruitment in clinical trials is an area we have struggled with for years. I have recently read articles highlighting this challenge, which gives me hope that diversity in our clinical trial design is receiving a fresh look.
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Previously published on Historianspeaks.org.
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