City Councillors Ricardo Arroyo and Andrea Campbell offered a hearing order during Wednesday’s city council zoom meeting to discuss health inequities and how ventilators and ICU beds would be assigned in the event of a shortage during the COVID-19 pandemic.
“Dr. Anthony Fauci, the director of the National Institute of Allergies and Infectious Diseases, said that the medical community has known for a very long time that diseases like diabetes, hypertension and asthma are prevalent in communities of color.” said Arroyo, “and that COVID-19 patients with those underlying conditions often require ventilators and intensive care and have the highest likelihood of death due to COVID-19.”
In preparation for an expected influx of COVID-19 patients later this month, guidelines issued on April 7 by state health officials outline priorities for medical centers in distributing ventilators and ICU beds in the event of a shortage.
The Crisis Standards of Care Advisory Committee guidelines are not mandatory, but are offered to assist medical staff in establishing individual priority of care. Hospitals are encouraged to assign patients a score, ranking them based on likely long-term survival to determine priority for care. Underlying conditions would factor into those patient ratings.
“In Boston, information from the Boston Public Health Commission and all of the data we have supports that racism is the driving force behind health inequities,” said Arroyo.
“Communities of color— especially Blacks and Latinos— have the highest rates of asthma, diabetes, heart disease, and hypertension in the city.”
Arroyo, who also chairs the city’s Public Health Committee, said that the council should have an interest in ensuring that long standing health inequities do not play an intentional or unintentional role in deciding who gets medical care during the COVID-19 pandemic.
“If we deny ventilators and ICU beds based on underlying conditions it will impact people of color disproportionately and that would be a continuation of systemic racism,” he said.
“We need to ensure that racism does not play an intentional or unintentional role in deciding who gets medical care during the COVID-19 pandemic. The surge is coming now and frankly in the coming weeks, so we will move urgently on that hearing.”
Last week, the mayor formed a task force to focus on health disparities in the city. The task force is composed of 24 members including former state Senator Linda Dorcena Forry, former State Rep. Marie St. Fleur, Dr. Jean Alves of the Bowdoin Street Health Center, Chief Financial Officer of the Mattapan Community Health Center Guale Valdez, and Reverends Ray Hammond and Gloria White Hammond of the Bethel AME Church.
“At our first meeting we identified priority areas including testing, collecting more data, community action and understanding the economic impacts," said Mayor Walsh. "We’ve already started putting the ideas into action because we know this work is moving quickly and urgently."
There is incomplete data available about race and ethnicity related to COVID-19 cases. The race and ethnicity is only known in about 62 percent of the known cases in the city so far.
But, preliminary data released last week by the city's Public Health Commission indicated that of those in which race and ethnicity is known— 42 percent of Boston residents who have tested positive for COVID-19 are Black.
Campbell said that residents in District 4 and 5 have been seeing their “unfair share” of COVID-19 cases.
“In Boston, Blacks are only a quarter of the city’s population but we are already seeing they are over 40 percent of COVID-19 patients,” she said, “and because this data is not limited, I’m sure it will be worse when we get complete data.”
Campbell said that health disparities have always existed in communities of color as a direct result of racism.
“Health disparities that have long existed in communities of color did not happen by accident, they are the result of race and racism,” she said, “including periods of time when residents were explicitly told that because of their skin color they could not live in a certain neighborhood, could not get a certain job, and could not attend a certain school.”
She added: “As a result of this marginalization, oppression, and exclusion these communities have suffered tremendous devastation— including economic hardship, poverty, health disorders, and death.”
Campbell said that all of this is why the government’s response “cannot say it’s colorblind,” and must work to address health disparities while combating the coronavirus pandemic.
“These pre-existing conditions make people of color more likely to contract the virus and require lifesaving ICU beds and ventilators,” said Campbell. “One of the things we’ve been hearing in regard to these guidelines is that we’re not taking race into consideration- that’s a total mistake.”
“As uncomfortable as it might be for those in power to incorporate race into these conversations we must do so. We must use a racial equity and resiliency lens, we used it for a period of time to exclude people and we need to now use it to offer up solutions and to eradicate that exclusion,” said Campbell.
She added that hospitals should share their individual protocols with the public.
At-Large Councillor Annissa Essaibi-George urged her peers to rope in expertise from local community health center leaders, who could communicate the needs of the communities in the hearing.
“I would add to the makers that they should include our community health centers in the discussion because they have been doing so much of the work to care for so many of our most vulnerable residents, and they know the needs of our communities from a healthcare perspective,” she said.
Council President Kim Janey referred the hearing to the committee on public health.