“This is an abomination, but it is not unexpected.” Dr. Corey Hebert, M.D., New Orleans
COVID-19 is culling the herd of humanity. Beneath the conversation about herd immunity lies a silent and unstated conversation about who will survive. Why are black and brown communities being hit so hard? Why are we more likely than whites to die if admitted to the hospital? Who gets access to health care of any kind, and with regard to COVID-19, to inequitably distributed tests? Who gets a ventilator and who does not?
History matters. There is a peculiar resonance between sentiments popular among 18th century white Philadelphians during the yellow fever epidemic of 1793 and a rumor circulated at the beginning of the COVID-19 pandemic. In 1794, two prominent African Americans reported:
“A solicitation appeared … to the people of colour [sic] to come forward to assist the distressed, perishing and neglected sick; with a kind of assurance, that people of our colour were not likely to take the infection.”
Similar myths of black immunity popular in social media at the beginning of the COVID-19 pandemic prompted black actor Idris Elba to reveal his own infection as a warning not to believe the myth that minorities could not get COVID-19. Another piece of unfortunate thinking at the beginning of the pandemic in the U.S. limited testing to those who had traveled or who had contact with known COVID-19 victims. This initial protocol left out a large swath of individuals, making it difficult to track and limit infection among those who had not traveled internationally, and had not the means to do so. These are but two examples of how myths, cultural assumptions, and social and structural determinants can intersect to create dangerous lacunae that disadvantage all but the most privileged.
Unconscious bias, privilege, and power can combine in obfuscating ways, rendering that which should be self-evident, invisible. The cull impacts people already assailed by low wages, food, housing, and income instability, and over-incarceration. Minoritized and historically disadvantaged populations are highly impacted by living conditions that make it difficult if not impossible to social distance, by jobs that cannot be done from home, and by lack of sufficient health care. Hospitals and the health care system at large were not prepared with staffing, beds, or ventilators to handle the surge of worst-case scenarios, especially for individuals with comorbidities. These populations have been “targeted” by structural determinants, cultural assumptions, and a utilitarian social ethic that deems them essential and yet expendable.
COVID-19 makes visible systemic and social injustices that have been with us since the first Africans arrived in Jamestown in 1619 and before, since Taino people were enslaved and subsequently decimated by Europeans in the gold mines of Hispaniola in the early 16th century. As Maya Angelou once said to me in an interview: “It is ignorant, not wise, to think that we can get on without remembering what happened, who did what to whom, to what success, and for what reasons.” While African Americans struggle to attain generational wealth, the wealth attained through the importing and selling of African people by notable Americans, including signers of the Declaration of Independence, has been passed down through generations of descendants together with appalling notions of white supremacy. Yet and still, African Americans built thriving neighborhoods, businesses, newspapers, universities, and hospitals — not only the well-known ones, like Howard, Meharry, and Provident, but smaller community hospitals, where persons of African descent could receive quality medical care regardless of financial status. Many of these institutions were destroyed between 1949-1973, when 1,600 African American communities were bulldozed for urban renewal or after the Federal Defense Highway Act of 1956 made it possible for thriving communities to be bisected by federal highways. High blood pressure, heart disease, diabetes, and obesity, among other morbidities disproportionately prevalent in minoritized populations are linked to the dismantling of these once thriving communities. More recently, immigrants from the global south and Asia have been treated as dangerous.
“The Cull” cannot be understood either as a natural process or as an occasion for sacrifice when those being culled and sacrificed are already the targets of cultural bias, prejudice, and structural injustices. Such thinking obscures humanity’s dangerous capacity to treat some lives as disposable, their unwilling “sacrifice” even desirable or helpful in service to a “higher purpose” complicit with white supremacy and historical inequality. As Adam Serwer recently wrote in The Atlantic, “The lives of disproportionately black and brown workers are being sacrificed to fuel the engine of a faltering economy, by a president who disdains them. This is the COVID contract.”
Against this backdrop, the Congressional Black Caucus and the Black Health Braintrust sent a letter to Robert Redfield, M.D., director of the Centers for Disease Control and Prevention, stating that “Communities of color continue to disproportionately suffer health inequities due to the history of racism and oppression in the United States.” They requested most urgently “that the Centers for Disease Control and Prevention (CDC) publicly report all available racial and ethnic demographic data related to COVID-19 testing, hospitalizations, and mortality.” The Congressional Black Caucus letter is a plain call for transparency, accountability and ultimately action.
Our present is a time of loss and lamentation; it is also a moment of opportunity — an opportunity for conscientization, mobilization, and repair. Today we need a new moral awakening and with it:
1) recruitment for a broad range of health care professions from among minoritized populations with loan forgiveness for any health professionals who serve communities with limited access after completing their programs;
2) required inclusion of the arts and humanities in medical and other health professional education to promote greater capacity for cultural competency, practitioner well-being, and morally resilient decision-making;
3) affordable health care for all, including a health care system that can handle surge capacity;
4) a recognition that affordable housing and an end to food scarcity are requirements for good health. These are beginning steps, reflective of ideas promoted by many with knowledge and experience; they give direction and grounded purpose for addressing our common yet enduring crisis of health inequality.
Who will survive in America? Ignorance, and indeed indifference, are no excuse for failure to intervene in human suffering. How much of the herd will be culled in successive waves of COVID-19 before we mobilize for humane and systemic change? The coronavirus pandemic has shown us that our destinies are intertwined. It is time to live as if we knew this to be true.