We dealt with the death, uncertainty, and fear of COVID-19 with a stiff upper lip. But our hearts broke when George Floyd was murdered by the police on May 25. George is a symbol of an immense problem. A study reported that one in every thousand Black men can expect to be killed by the police. One in every thousand! Racially directed violence by the police is a public health problem. Clinicians cannot be silent. Clinicians will not be silent.
We propose three avenues for transforming anger into action.
First, we must express solidarity. The COVID-19 pandemic has given us a platform that we can marshall to speak truth to power. Wearing black scrubs, adopting symbols like pins or lanyards supporting the Black Lives Matter movement, leveraging social media, and writing op-eds can make our support explicit. This may provoke anger from some patients and fellow health care workers, but signaling our support will provoke important conversations and teachable moments. This is perhaps the easiest way we can lend our voice and authority to this crucial movement.
Second, we can support the protests in practical ways. These events draw out thousands of people, some of whom have conditions like heart disease, diabetes, and kidney disease. Under the crowded, hot, volatile conditions that sometimes turn violent, people may need medical attention. Although many clinicians may feel out of their comfort zone in a park or on the streets, we are more capable than we think. For additional training, online crash courses such as those from New York City Action Medical and the Do No Harm Coalition can help us learn from experienced street medics and augment our utility in protests.
An additional role we can play in the field is that of reducing the risk of COVID-19 transmission during the protests. The Black community has already faced the brunt of the virus. We fear that these necessary demonstrations may lead to an increase in COVID-19 infections, which could further harm the same communities most affected by police brutality. Providers who are unable or uncomfortable attending large group events can still help by donating medical or personal protective supplies, or by helping organize events to reduce COVID transmission. We can also help organizers design their events in ways that minimize risks of outbreaks and offer advice to protesters to decrease their risk of transmitting the virus when they get home.
Third, we must confront the ways our medical institutions propagate structural violence. This is perhaps the hardest and yet the most valuable role we can play to fight racism. It means overhauling the hiring practices in our health centers and ensuring diversity through the highest levels in our institutions. It means rethinking our medical school admission practices and mentoring high school and college students to make up for the stark racial disparity in the medical community. It means looking internally at our own implicit biases.
We must also strive for equity in clinical care and research. Black patients wait longer to be seen in our emergency rooms and clinics. Commonly accepted tools for risk estimation may underestimate the risk of kidney and heart disease among Black patients. Life expectancy for Black men and women continues to be almost four years shorter than that of whites. Through quality improvement studies as well as qualitative and operational research, we must ease health access of Black communities and decrease inequities in care. Moreover, research on conditions that predominantly affect the Black community, such as sickle cell disease, remains underfunded. As one stark comparison, cystic fibrosis, a predominantly white disease, has 400 times more research funding than sickle cell disease. Such glaring discrepancies in research priorities must be addressed.
Black Lives Matter is more than a slogan, more than a rallying cry. It is a directive to eradicate the inequities that devalue the life of our Black brothers and sisters. In this defining moment, clinicians must provide support and offer our medical expertise and our privilege to these historic protests. Reform should not end with the policing structures of this country. Through unsparing self-scrutiny, clinicians must now concede, understand, and extirpate our own personal and institutional racisms.
Pranay Sinha, Karim Khan, Angela McLaughlin, Leah Harvey, Raagini Jawa, and Alison Nelson are infectious disease physicians.
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