Of the 110,000 Americans who have died from complications of COVID-19, nearly a quarter of them were black: churchgoers, mourners, singers, school principals, police chiefs, public-transit operators, doctors and nurses, young and old.
I am a scientist who, for the past nine weeks, has been studying the respiratory virus that is disproportionately killing people who look like me. “I can’t breathe”—the way George Floyd pleaded for mercy as a white police officer in Minneapolis killed him late last month—has become a slogan for those protesting against police violence and systemic racism in America. But it also captures the deep inequities that have allowed the coronavirus to claim so many black lives, and neither the scientific community nor the public-health world is confronting the problem directly.
Black Americans are strikingly vulnerable to COVID-19. Since data collection began, black Americans have consistently died of COVID-19 at roughly twice the rate of any other group. At the same time, black Americans are villainized and brutalized for supposed offenses such as wearing a mask and not wearing a mask. While police gently hand masks to white people, black people are seldom given any benefit of the doubt.
I fully understand how viruses work. They exploit vulnerabilities, invading and quietly using their hosts’ cells to replicate, and then spread to other vulnerable hosts. As a black woman, I am doubly vulnerable—to COVID-19, and to the systemic racism that has always plagued my community. And at the moment, the coronavirus is attacking a major feature of America’s system—our profound racial divides. The nation’s public-health, medical, and scientific communities cannot address this pathway to infection without building trust among black Americans and giving black scientists a greater role in the fight.
I work in an infectious-disease lab that helps fight viral pandemics. Since 2013, I have overseen the genomic sequencing of viruses from patient samples collected during outbreaks of Lassa fever, Ebola, Zika, and hepatitis A. We started studying the novel coronavirus in January, after learning about the outbreak in Wuhan, China. Lately, my work has focused on, among other things, tracking the origin and spread of the outbreak in the Boston area, where our lab is based. (Through genomic sequencing, we believe that the virus was introduced to the region at least 30 separate times.) The overall goal of our work is to understand both the genomes of the pathogens and the ways they spread, including the social and cultural factors that contribute.
As I contemplate the spread of COVID-19 within my own community, those social factors look all too stark. Numerous studies have cited underlying health conditions and socioeconomic status as the main reasons black populations are shouldering greater burdens of infection and death during the pandemic. That may be a reasonable, albeit incomplete, scientific conclusion. But when I hear it, I also hear a sentiment hiding in it—something that isn’t being said out loud: Black people are to blame. You don’t merit the same compassion and dignity as white victims.
Our vulnerability does not earn us any special attention or public-health resources. For centuries, it has done the opposite, offering indifferent authorities an excuse to help us grudgingly or not at all. As the historian Vanessa Northington Gamble has documented, many leaders and health-care professionals during the 1918 influenza pandemic granted care and medical services—albeit limited and of low quality—to their black counterparts solely out of fear that disease-stricken black communities posed a public-health threat to white neighborhoods.
A century later, our needs are still routinely pushed aside. As the pandemic spread this spring, early triage plans for the expected surge in patients requiring intensive care included proposals to withhold lifesaving treatments from people with underlying health conditions such as lung and heart diseases—conditions that black people are more likely to have. Meanwhile, even experts who specialize in health disparities felt obliged to note that protecting the health of black patients also protects “all Americans.” We have been diminished as liabilities to the health-care system or as outright vectors for disease.
What research has been conducted to help black communities for their own sake? Even after years of efforts to reduce racial disparities in science and medicine, black populations are still dramatically underrepresented in medical and scientific data sets. Less than 10 percent of doctorate-level scientists are black. Black scientists are less likely to be funded by major organizations such as the National Institutes of Health, with one in 10 proposals by black researchers receiving support in 2019, compared with one in six proposals by their white counterparts. Studies of community health—which are more likely to involve analysis of health outcomes in black populations—are less likely to receive funding than studies focused on molecular and cellular science. (The former category also happens to be the type of study that black researchers are more likely to conduct.)
Making matters worse, the science, research, and medical communities have lost the trust of black communities after years of exploitation, abuse, and neglect—from the Tuskegee syphilis experiment to the infamous use of Henrietta Lacks’s cancer cells in research without her consent to the controversial approval of a “race-based drug” to our present awareness that health-care providers systematically underestimate black people’s physical pain. No wonder so many black Americans avoid participating in studies that might exclude us from the benefits or, worse, use science to link individuals to crimes they did not commit.
The pandemic has revealed still more official obtuseness about African Americans’ health needs. In recent testimony to the House Ways and Means Committee, the infectious-disease expert James Hildreth—the president of Meharry Medical College, a historically black institution in Nashville, Tennessee—shared the story of an effort by the Tennessee National Guard to offer free COVID-19 testing in public-housing projects in that state. Even as patients with the coronavirus died undiagnosed, many of the testing sites sat empty because residents were wary of the National Guard. “Not surprisingly,” Meharry said, “the people living [in the public-housing developments] were apprehensive, and they stayed behind closed doors.”
The pandemic will eventually peter out. But racism and bigotry have infected American institutions for centuries, and the public-health, medical, and science authorities are not immune. This infection is so familiar and normal to America that it has become endemic. Increased access to testing, contact tracing, and general efforts to expand access to health care are important, but they are not a cure: For black Americans, these interventions also increase our exposure to the pathogenic systems that were designed to oppress us in the first place.
What black Americans need is for leaders in the public-health, research, and medical communities to stand up alongside us—to engage us not as victims, but as leaders and problem-solvers. One way to do so is to collaborate with and recruit from the historically black health-care and scientific institutions that serve us and know us. As Hildreth put it, “Let us take our place in this fight.”
Scientists who seek to study and work with our community should be willing to create deep partnerships with us—and not just for the purpose of extracting data from us to advance their own careers. All members of the public-health, medical, and scientific enterprise should educate themselves about all vulnerable communities and try to understand history so as not to repeat it.
Simply treating all people as human beings and listening to and amplifying black voices will accomplish a lot—as will bringing more voices to the table. In the long term, efforts must continue to reduce the research-funding gap, invite more black Americans into the STEM pipeline, and provide appropriate support for both black health-care professionals and black students in medical and scientific fields.
During the pandemic, this agenda has become more urgent than ever. The emergence of a deadly respiratory virus has reminded us of just how precious the ability to breathe is. The words of George Floyd echo the systemic injustice and racist violence we have suffered for years. We can’t breathe. We need America’s public-health, medical, and research communities to mobilize not just for us, but with us—to recognize our needs as fellow humans, and to reinvent the systems that keep us all from advancing together.