Covid, race and inequality: why it's time to hold tight to human rights

In Episode 2 of Series 6 Attorney Dominique Day, founder and Executive Director of the Daylight Collective which seeks to fill the space between the status quo and substantive justice with creativity, diverse voices, and multi-sector approaches and understandings talks to Todd about how COVID is negatively and unequally impacting the lives and human rights of Black Americans of African descent.

00.00 – 02.20

Todd begins by asking Dominique to comment on the dis-proportionate impact of the Covid19 pandemic on people of African descent. She points to significant racial disparities in terms of:

• Who becomes infected
• Who has access to health care
• Differences in outcomes in terms of severe illness and death

This is seen as an outcome of policies, which exemplify systemic racism at a global and local level.

02.20 – 05.30

Todd asks Dominique which factors she sees as playing a key role in the impact of the Covid19 pandemic. 

• Whilst racism is not intentional she sees it as being ingrained into the presumptions and actions of individual decision makers
• In emergency departments this translates to medical bias when doctors are working under stress
• As evidence she points to research which suggests that medical bias disadvantages people of African descent (and which she discusses in a related webinar)
• Although the data is widely known her concern is that the issue of systemic racism is embedded in decision making even at the level of the individual clinician

05.30 – 12.40

Todd summarises and points out that the reality is that people of African descent in the USA have a markedly higher mortality rate, which is linked to a long history of systemic racism.

• Dominque points to “social conditioning” in deciding which lives matter. By way of example she points to the decision to withhold the distribution of the Pfizer vaccine on the African continent and argues that it suggests that this is a decision made along the lines of race
• In terms of the impact of the pandemic, there are parallels within the fields of education, the economy and health where individuals make decisions on the basis of a bias which reflects systemic racism within society
• She references an email circulated within NYU hospital in New York where the onus to make rapid life and death decisions was placed on doctors working in the emergency department, without supervision and review. Given the intense stress doctors were under, those decisions were more likely to be influenced by bias (unwitting or not) 
• Health care providers showed no willingness to discuss the research data,
• • predicting the disproportionate impact on black and brown communities
  • identifying systemic racial bias 
  • individual doctors were prevented from commenting publicly
• Warnings of racial bias were ignored and continue to be ignored

12.40 – 20.50

Todd moves on to examine differences of outcomes for black and white communities in relation to encounters with the police and references the killing of Michael Brown in Ferguson a suburb of St Louis in the US in 2014.

• The Ferguson killing follows a common pattern of outcomes for the black community
• A parallel is suggested with respect to the security preparations made for the Black Lives Matter protests in 2020 in Washington
• Comparisons have been made between this protest and the insurrection staged by pro- Trump militants. Todd argues that any move to suggest the two events were similar creates a false equivalence

Dominique points out that:

• In terms of policing there was a higher level of perceived threat and a heavier response during the Black Lives Matter protests than for the recent march on the Capitol in Washington
• Dominique argues that the former was a racialised response conditioned by acceptance of white supremacy and a long history (in the USA) rooted in slavery and exploitation.
• She references the origins of racial policing in the USA as being to protect property from the actions of slaves.
• She identifies a “legacy mindset”, a baseline of white supremacy, where white people expect to be treated differently (better) than black people, a mindset which is a major barrier to progressing racial justice and equality.

20.50 – 23.45

The conversation returns to the pandemic and vaccination programs in the USA. Dominique has a number of concerns.

• Distribution is a major issue
• More thought needs to be given in terms of prioritising who gets the vaccine first. The role of essential workers, drivers, home helpers who have been disproportionately infected needs to be acknowledged when prioritising vaccination programs.
• There is also a need to talk about racial equity in the delivery of vaccination programs

23.45 – 26.00

Todd asks why significant numbers of African Americans are resistant to taking the vaccine.

• In Dominique’s view there is a distrust in black communities which in part dates back to the infamous Tuskegee experiment, where black people were exploited in the name of medical science
• In order to increase the uptake of the vaccine in black communities their must first be an understanding that there is a legitimated scepticism based on historical fact

26.00 - end

Todd ends by asking Dominique what she is hoping to see from the new government administration in terms of the issues she has discussed in this episode. In terms of the response to the Covid19 pandemic, she would like to see a critical re-evaluation of responses to the pandemic, and in particular the role of systemic racism and its impact on African American communities.

Useful links

1. Racial Bias in the time of Covid19, the Time is Now  A webinar hosted by Dominique Day
2. Millions of black people affected by racial bias in healthcare alogorithms Heidi Ledford in Nature October 2019
3. NYU Langone tells doctors, “Think more critically” about who gets ventilators Shalini Ramachandran and Joe Palazollo in Wall Street Journal 31/03/ 2020
4. 40 years of Human Experimentation in America: The Tuskegee Study Ada McVean, McGill University, January 2019

Additional references

Assessing differential impacts of COVID-19 on black communities; Gregorio Millet et al, Annals of Epidemiology, July 2020

Implicit Bias in ED overcrowding, is there a connection? Loner and Rotolli i EM Resident October 2018

The effect of race and sex on recommendations for cardiac catheterization Schulman Berlin et al, New England Journal of Medicine February 1999

Implicit racial/ethnic bias among health care professionals and its influence on health-care outcomes: a systematic review  Chapman et al, Journal of Public Medicine December 201