What Does Implicit Bias have to do with Black Care Inequities in COVID-19 Clinical Encounters?
COVID-19 highlights unacceptable and avoidable systemic health inequities that are devastating African American communities and families. So, what I wanted to know was, “What if clinicians were contributing to excess COVID-19 death among African Americans?”
We already know that many employers put African American workers on the front lines, increasing the risk for contracting COVID-19. The threat associated with racism that is ingrained in racial bias is a source of stress for African Americans. Now imagine, going to the hospital as an African American with COVID-19. The threat is real.
We absolutely know at this time that many physicians demonstrate implicit or explicit racial bias in their interpersonal clinical encounters with African Americans. And, this is a part of systemic inequities and its relationship to health disparities. These racially discordant interactions within healthcare puts African Americans at a higher risk for COVID-19 morbidity and mortality (Milam et al., 2020).
In some cases, resuscitation is necessary for COVID-19 treatment. Hospitalized African American patients are less likely to be instructed by a medical staff member on end-life-care do not resuscitate (DNR) orders (Milam et al., 2020). Many COVID-19 patients inevitably need intubation to prevent symptoms from increasingly getting worse. However, African Americans are less likely to be offered early intubation, which increases the odds that they as patients are more likely to die (Beach et al., 2020).In fact African Americans are more likely to opt out of both treatments compared to Whites.
There are anecdotal stories about a family member being hospitalized due to COVID-19. His family members had to dress in business attire with a clipboard, paper, and pen to advocate their relatives. He was not receiving appropriate clinical care. His family members had to dress in their best to persuade the health professionals they were important. You see, implicit bias can cause you to marginalized Black voices and diminish the health needs of some. Other family members have talked about the late hospital admittance for African Americans. They mention how many times he went to the hospital and was told he could not get a test. By the time the person was admitted he died.
Now, it is important to note that African American individuals may experience poorer health care access and a greater burden of comorbid illness, which seems to be a particularly relevant factor in determining the outcomes of COVID-19. This, however, does not eradicate suspicions about a health professional’s implicit bias perceived with the consistent displacement and clinician distractions is what resulted in a higher mortality rate among African Americans (Golestaneh et al., 2020). Even noting the social and health barriers, implicit bias renders this community less self- advocacy vehicles than Whites. In turn, leaving African Americans with scarce and vulnerable resources during a COVID-19 hospitalization.
Now research is saying that race has nothing to do with disparities in ICU admission, mechanical ventilation, and death among the group hospitalized with COVID-19. This statement is supposedly similar to research on race and COVID-19 outcomes. Perhaps implicit bias has something to do with it?