In early April, the U.S. surgeon general called COVID-19 "our Pearl Harbor moment, our 9/11 moment." But data from New York City suggested another analogy: It had become our Katrina moment.
City health authorities released a report showing African Americans with the disease were dying at nearly twice the rate of whites—19.8 per 100,000 lab-confirmed COVID-19 cases compared with 10.2 for whites. The disparity was even greater for Latino victims, who were dying at a rate of 22.8 per 100,000 cases.
It's not surprising COVID-19 exacts a high toll on racial and ethnic minorities, who historically have suffered grievously from natural disasters. In 2005, Hurricane Katrina laid bare deep racial and economic rifts in New Orleans that left poor people of color stranded and without the means to reach safety. Even today, the storm's health effects linger for many poor residents who waded through toxic water and foul air as they waited for relief.
So, we could predict COVID-19 would wreak havoc on black and Latino populations in New York City and elsewhere. What should trouble all of us is how little we achieved these past 15 years and the price we again will pay in human lives.
Essential hospitals—those central to the safety net and now on the front lines of the COVID-19 crisis—see the ill effects of racism and disparities every day among the marginalized people they serve. Deeply seated inequities in our social fabric and the broader health care system manifest in ways that put people of color in the path of COVID-19: Substandard housing and food insecurity thwart social distancing and exacerbate chronic conditions. Minorities who fill jobs in transportation and other critical infrastructure cannot stay home and, instead, are exposed to the virus. Those furloughed from hospitality and other "nonessential" positions lose paychecks and insurance coverage and the health care access these bring.
These social risks are the ingredients of a perfect storm that has been with us for centuries and that we repeatedly fail to confront. That storm rages now in New York emergency departments, rural ICUs, Navajo reservations, and countless other settings across the country.
The question for us now is whether we learn from COVID-19 or accept the status quo. There will be a desire to pull back after this storm passes, to hunker down and avoid these tough questions. That will be the exactly wrong response; one guaranteed to lead to disaster again.
Our health systems must lead through action and example. They must lead collaboration with other necessary actors—communities, cities, states, and the federal government—in possibly new and untested partnerships. They also must address the social determinants that challenge good health in their community, particularly among racial and ethnic minorities. The list is long, but not insurmountable: poverty, food insecurity, housing instability, lack of transportation, low health literacy, language barriers, and others. These are the persistent, endemic hardships that put minority populations at the back of the pack before the race begins.
But we must not stop there. We also must commit to equity, internalize it, and make it our North Star. We must live it—starting at the top and ensuring diversity in our board rooms and executive offices. We must practice it, with culturally sensitive care and attention to race, ethnicity, and language data that can expose disparities as a first step to eliminating them. And we need a health care workforce that looks like America.
Our nation's leaders will need to do their part, too. Will they support a robust and sustainable safety net, based on equity, beyond just the next few months? Will they act decisively in the weeks and months ahead as millions of Americans turn to government for much-needed help? Fifteen years ago, we failed to heed the lessons of Katrina. Today, we can choose to take a different course. Our nation deserves nothing less.
