Science Friday - COVID-19 Inequalities. May 8, 2020, Part 1

Episode Date: May 8, 2020

Coronavirus is still hitting the U.S. hard. And breaking down infections by race shows a striking pattern: Black, Latino, and Native American people are hit much harder than other communities. National data shows black Americans account for nearly 30% of COVID-19 deaths, despite only being 13% of the population. In New York City, the epicenter of America’s epidemic, the death rate among black and Latino residents is more than double that of white and Asian residents. Coronavirus is spreading on tribal lands, too. If Navajo Nation were a state, it would be behind only New York and New Jersey in infection rates. Native communities are also often categorized in the racial category of “other” in statewide infection data —making it hard to know just how bad COVID-19 is for Native people. Joining guest host John Dankosky to talk about COVID-19 inequities are Uché Blackstock, physician and founder of Advancing Health Equity in Brooklyn, New York, Rebecca Nagle, journalist and citizen of the Cherokee Nation in Tahlequah, Oklahoma, and David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at UCLA’s medical school in Los Angeles. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

This is Science Friday. I'm John Dancosky, sitting in for Ira Flato. Just a quick note here, we won't be taking any calls for this pre-recorded hour, and Ira's just fine. He's just having a long-planned staycation week. Later this hour, we'll talk about how the coronavirus is disproportionately affecting some communities in the United States and the systemic reasons for why that is. But first, you may have seen the story. It looked frightening, to be sure. Two researchers at Los Alamos, National Laboratory, in New Mexico say that after studying the genome of the novel coronavirus in cases both old and new, the virus is mutating. And they say those mutations are making the virus more contagious. But there are reasons to be skeptical about that claim. Viruses mutate all the time, for starters. And there may not be

much evidence that these mutations are actually affecting how infectious the coronavirus is. Here to explain a bit more, plus other recent science news, is Ryan Mandelbaum. He's a science writer for Gizmodo. He joins me today. from Brooklyn, New York. Ryan, welcome back to Science Friday. Always great to be here, John. Thanks for having me. So I need to know, first of all,

what's wrong with this study about the mutating coronavirus? So a lot of this study is sort of thought work, you know, just connecting the dots on previously recorded data. And then the study was put on the bioarchive preprint server, which means that the study was not peer-reviewed. So that's important because it means that,

you know, these researchers are trying to get this research that could be important out quickly, but other scientists haven't been able to take the time to take a look and look for any potential issues with the work. So when we're reading something like this, we should be pretty skeptical and we should not necessarily start to get very, very worried. That's right. As a reader of science news, when you see a big, scary headline, I think the first thing that you really need to do is start looking for keywords in the news story, sort of saying whether

or not the study was peer-reviewed or perhaps saying where it came from, who did it, who funded it. So this is just a good example of a time where, you know, it is possible what the study is saying, but it's also possible that it's not. So we do have to be cautious when reading these kinds of stories. Are there any other plausible conclusions about whether this virus might mutate the way that the flu does, for example? Right. So it is possible that this virus can mutate. All viruses mutate, but a mutation doesn't necessarily cause it to become more contagious or more harmful. And in fact, this study might just be a case of correlation versus causation, which is that just around the time it took on this new mutated form was right when it was starting to spread in Europe

and there weren't a lot of measures in place to stop it. So it's possible that it's just the timing was what caused it to suddenly look more contagious than anything. Well, since we're talking about Europe, let's move to another story about a potential case in France And this, Ryan, was from well before anyone thought coronavirus was actually in France. What's going on here? That's right. So another paper suggests that COVID was around earlier than it was previously recorded.

So back in December, there was a man in France who reported pneumonia-like symptoms at a hospital in Paris. Swabs were taken and saved. And just recently, scientists reanalyzed these swabs, and they appeared to test positive for coronavirus. Now, the reason why this is worrisome is because the first official cases in France weren't recorded until January. And this man didn't have a history of traveling to China. So this immediately set off alarm bells that maybe the coronavirus was spreading earlier than previously thought.

Ryan, like in that first story, I've heard some criticism of this research, too. I'm wondering if you can talk more about that. That's right. Just like some of the other studies that we've seen is that these are quickly moving studies. This is a single case. We don't know for sure that these tests weren't false positives. And actually, Natio Science Editor, Ccan, Akpan on Twitter, said that there actually is some things that we need to be doubtful of. So, for example, France's death rates of the coronavirus aren't actually consistent with an earlier than expected start date to the pandemic.

It's felt like half the work we've been doing here on Science Friday is debunking coronavirus stories, looking at the stories exactly the way that we are right now. What is it about this virus, Ryan, that makes all this information just so slippery? I mean, how are we supposed to figure out what's true and what's not as things are coming out? So I think that there are some core truths that we know, which is that it's incredibly contagious and it can be incredibly harmful if we're not social distancing. But at the same time, we do need to be taking into account these most recent results, but with the knowledge that these are being done for scientists, and as new results are coming out, you know, scientists need to know these things.

So you as the general public really need to, if you're staying informed, you always need to just remember that, you know, science is a process and that there is a peer review for a reason. So just don't panic when you read a new headline. Just try and think like a scientist does and say, okay, well, you know, more scientists are going to comment on this. The story is going to develop and just try and keep those things in mind. It's also why we need more science journalists like you. That's right.

Thanks. So let's move on to some happier news here. Scientists think that they've solved one very perplexing space mystery. So tell us about the space mystery, Ryan. Yeah. So I think a lot of your listeners might have heard of fast radio bursts, but if they haven't, these are powerful blasts of radio waves that seem to originate from outside of the galaxy, which were first spotted by the Parks Radio Telescope around 20 years ago. So we've seen a lot more of these bursts since then, and we still don't really know what they are. A lot of people say, Oh, well, maybe it's aliens. But others suggest that maybe it's these really highly magnetic neutron stars called magnetars.

So what's exciting is that last week, telescope spotted a bright flash of x-rays from the direction of a magnetar, and then this special chime radio telescope saw a bright flash of radio waves right at the same time in its peripheral vision. So this could mean that we maybe just saw the origin of one of these fast radio bursts in our own galaxy, and that's really cool. It's really cool. What exactly does it mean, though?

What does it tell us? Well, it sort of would be telling us that the originator of these weird radio bursts are these magnetars. It would confirm it. And everybody loves the solving of an extraterrestrial mystery, but it's also an exciting opportunity to better understand these really weird magnetars, which are just strange objects. I mean, neutron stars are weird.

Magnetic neutron stars are weird. But, of course, with every science story, there's a kind of. caveat here, which is that they're still working on trying to interpret what this radio flash was. And it's unclear whether this radio flash would have been visible outside the galaxy, which would have confirmed it as a fast radio burst. So we're getting there, but we haven't solved everything just yet. We haven't solved everything just yet. And it's unclear as to whether or not this points to anything beyond the magnetar mystery about the evolution of stars or the overall logic of the cosmos. It might not be that big a discovery. No, I don't think we've sort of uncovered.

the core truths of the universe just yet. Well, let's move on to something that I know is very near and dear to your heart. Birds. The birds are in full migration right now, and there's a very weird bird that's been seen again in Southern California. Maybe you can tell us about this bird. Yeah, so this bird first showed up last fall, and the bird watching community went wild over it because it appeared to be the hybrid of two different families of birds.

So there's species, there's different species, there's different genuses, but this bird would have been different families. And scientists don't really know what's going on here. I mean, the one parent would have been a bird called a yellow-breasted chat, which is a hard to understand bird. Scientists have wondered where it belongs in the sort of ill-evolutionary family tree for a very long time and would have hybridized with an orio. Now, they're still trying to work out which kind of orio

and how distantly related these birds would have been. But I think a good sort of measure is that, you know, lions and tigers live, they diverged less than four million years ago, while the chat and the closest relative, the hooded Oriole would have diverged around 10 million years ago. So they are quite different. Are there any other hybrids like this in the bird world that you know of? Well, birds do hybridize. Interspecies hybrids are pretty common. Intergenus hybrids aren't as common, but they do happen. but inter-family hybrids are quite strange. And I think that what scientists, if they could ultimately take DNA evidence and then confirm that this is more than just a bird that looks like a hybrid, they might be able to honestly establish where exactly this yellow-breasted chat belongs in the family tree of birds.

And it might just belong in the same family as the Oriole all along. As a bird watcher and a bird lover yourself, how exciting is stuff like this to you? I love it. I've been following this. I mean, when the story first came out in September, I was all over it. And then just to hear that this bird has come back and it's now singing, which means that, you know, it survived the winter. And it's looking for a mate. You know, who's the mate going to be? It's just very exciting stuff.

Okay. So here's a story that I think a lot of people have been following along. And you've got a very small individualized piece of it. We've been reading about the murder hornet. And you've written about how you actually once ate a murder hornet? Explain what the heck happened here. Yeah, well, they are edible. I mean, in East Asia, there are countries that do eat this, but I guess what I want to stress is that it's, why is it so weird?

Well, I mean, people are scared about murder horn. It's the idea that you would be voluntarily eating one. I think maybe might give some people some pause. That's, it makes sense, but I think that there's an entire world of eating edible insects out there. And it just so happens that these murder hornets, as they're called, or actually Asian giant hornets, are eaten. And, you know, cooking them does denature the venom. So you don't have to worry about that. The flavor, I honestly don't quite remember it because it was on a night that I ate a lot of insects.

But my friend and chef Joseph Yun said that it's got a very grainy, almost earthy kind of flavor to it. I had it on lobster, but he's sauteed it and put it on top of noodle dishes and in spring rolls. and it tastes great. And honestly, edible insects are having sort of a moment right now. And, you know, why not think about eating these murder hornets? And I do want to add that murder hornets are not quite a big a deal, as perhaps some of the headlines have made them seen. They've only been seen in the Pacific Northwest,

and they're not in any huge numbers. So this is not something people should worry about either coming to murder them or something that probably is going to be on the menu anytime soon at most U.S. restaurants. I don't think so. I think the number one thing I want to stress is that if you see a hornet in your backyard and you're not in the Pacific Northwest and it looks big, it's likely a native hornet that you should leave alone. Sounds good. Ryan Mandelbaum is a science writer for Gizmodo. Thanks so much for sharing all of these stories. I really appreciate it. Thanks for having me, John. I had a great time. Coming up after the break, we're going to talk about some of the inequities about who is getting and who

is dying of COVID-19. Latino and black communities are hit especially hard. We'll be with that story right after this short break. This is Science Friday. I'm John Dankoski in for Ira Flato. Coronavirus is still hitting the U.S. very hard. And while some say the virus doesn't discriminate, breaking down infections and deaths by race shows that black and Latino people are hit a lot harder than other communities. National data shows black Americans account for nearly 30% of COVID-19 deaths, and only 13% of the U.S. is black. In New York City, the epicenter of America's epidemic, the death rate among black and Latino residents is more than double that of white and Asian residents. Coronavirus is spreading on tribal lands too. Native communities

are grappling with fewer resources and a lack of data to even show how bad the problem is. Joining me today to talk about these inequities in COVID-19 are Dr. Uche Blackstock, a physician and founder of advancing health equity based in Brooklyn, New York. Dr. Blackstock, welcome to our show. Thank you for having me. Also with this is Rebecca. Rebecca Nagel, journalist and citizen of the Cherokee Nation in Talakwa, Oklahoma. Rebecca, welcome. Thank you so much. And Dr. David Hayes-Bautista is Director of the Center for the Study of Latino Health and Culture at the Medical School at UCLA in Los Angeles, California. Dr. Hayes-Bautista, welcome to our show. It's a pleasure. Dr. Blackstock, I want to start with you, and you work

part-time in emergency care in Brooklyn. Maybe you can tell us as best you can the racial breakdown of your patients coming in with COVID-19 symptoms. Sure, absolutely. So I work in central Brooklyn at various locations, and typically we have a very racially and socioeconomically diverse patient population. But starting in about mid-March, we notice a shift in the demographics. We notice mostly black and brown patients coming in with COVID-19 symptoms, and it was very apparent. It was even to the point where my organization actually had to close down certain urgent care sites that were in predominantly white and affluent neighborhoods because the patient volume, the number of patients coming in was so low and had to

shift some of our staffing to black and Latino neighborhoods because we had a surge in patients we needed to care for. My goodness. So how does this compare to patients that you see coming into the clinics normally? I mean, on a regular day pre-COVID? So on a regular day, you know, the volume is pretty low. We don't really see that many very sick people. but it shifted a few weeks ago.

We started seeing people coming in, fever, cough, shortness of breath, chest tightness, their oxygen levels were very low. And it was quite scary. And as someone who's been practicing for about 10 years, I've never seen such sick people. And even when I speak with my colleagues who've been practicing for about 35 years, they also agree. They've never seen anything like this. You said you saw some of this relatively recently. When did you realize that coronavirus was going to be really bad for the patients?

that you see? I think it was probably about the second week in March that we started seeing coronavirus patients and really appreciating how sick they were. But what's interesting was that although in the very beginning, we were given these CDC criteria to test because we had such limited testing supplies. We were only allowed to test people who had visited one of the areas where coronavirus is pandemic like Italy or China or you had to know someone who had been tested. So the patients I was caring for, the black and Latino patients I was caring for in central Brooklyn, they hadn't traveled outside the country recently. And they didn't know anyone who had been tested because at that point, it was really only politicians, celebrities, and athletes,

like the entire Utah Jazz team who got tested. Yeah, so essentially, the guidelines at the time, early on when you were seeing this, just mitigated against any of the patients you were seeing from getting any of the testing they could have needed. Exactly. And so while the criteria has evolved over the last four to six weeks. Initially, I know I'm certain that we missed a good number of COVID-19 patients because that criteria essentially was embedded with bias. So tell us more about that. I mean, why do you think that so many of your black and brown patients are disproportionately impacted by this disease? So many, many different factors. We talk a lot about the social determinants of health. So access to health care, not even just. health care, but access to quality health care, access to adequate housing, access to employment where you have sick leave and paid benefits. And so we know that all of those social determinants

of health, which is what influence a community's health status, the driving force of those are the structural racism. And so my patients already had high burden of chronic diseases like diabetes, high blood pressure, and asthma, which we now know are. underlying factors that lead to very serious complications of COVID-19. Also, my patients, many of them are essential workers and service workers. So many of them here in New York City, they work for transit or their bus drivers. And so they still had to go to work. And a few of them had even told me they were scared to go to work, especially in the beginning because they were explicitly told not to wear masks in order to scare passengers. And so essentially, my patients were exposed in many

many different ways and put at higher risk of contracting the virus. They were told they can't wear masks. They were told they can't get the tests. All the things that could have helped them at the time early on they weren't able to get. Exactly. Let's move out to Los Angeles and see how it's going there. Dr. Hayes-Batista. I mean, what are you seeing amongst the folks who you're looking at, especially in Los Angeles,

the racial breakdowns there? Okay. Well, actually, the very first week of March, L.A. County Health Department released its first map of COVID cases. And they were all located in West L.A., which is the high-income area, Beverly Hills, Bel Air, Brentwood. And some people said, well, see, it's going to bypass minority communities completely. And I said, wait a minute. Who has the discretionary time and income to travel to Europe, to Asia? So they come back, they've been exposed. But what about the nannies, the gardeners, the cooks, the construction workers, the farm workers, those are largely

minority, particularly in Southern California, almost all Latino. So they're getting exposed. And it goes all the way back to farm workers, for Pete's sake, who plant the very food, tend it, and harvest that we all need so that the population can shelter in place and just go to the store once, one hour a week. The farm workers, first of all, are out there exposing themselves. And they are 100% Latino, 100% immigrant, between 50 and 80% undocumented. They are probably the most essential workers you can think of.

And yet, by the way, they can also be deported at any minute so much for essential workers, not supply personal protective equipment, have to work in gangs, et cetera. You have the truck drivers who bring the produce into the cities, grocery store checkout clerks. On an average shift, that clerk is within half of an arm's length of about two to three hundred people. And there was no personal protective equipment even offered until just a couple of weeks ago. Then you have the automobile mechanics, that's essential. You have the public transportation engineers. That's essential.

You have the attendance in the nursing homes, which again in California are largely Latino. So you have a population that was exposed as they want to support the population in West L.A. And as West L.A. population hunkered in homes, that other population, largely Latino and minority, had to continue their jobs. Now, within that, the second week of the crisis, the second week of March, both the local, the local, Los Angeles County and California Health Department said, and even said it in Spanish, you have a fever, you have a cough. Yami Asu Medical. Well, wait a minute.

We have a huge provider shortage here in California, particularly that speaks Spanish. In fact, the shortage is so great that it will take the medical schools in California 500 years to graduate enough Latino medical students so that Latinos have the same access as non-Hispanic whites. 500 years. So Signore de Gomez has a fever, a cough. She wants to see the doctor so she can get a test. And you say, well, yes, Signora Gomez, please have a seat. The doctor will see you in 500 years.

And you needed up until recently that doctor's recommendation to get testing. Testing used to cost quite a bit, and it still can depending on how you're getting it. And Latinos are still twice as likely not to have health insurance even after Obamacare. So you add the increased multiple exposure by the way of how they are working, to support those who can stay in-house, and then the lack of access to both medical care and the public health infrastructure, the weakness of the public health infrastructure,

the shortcoming of the private medical care system. And let's just go one step further. Latino households, because of high cost of housing and because of very low-wage work, farmers, workers don't earn very much, tend to live very densely, more people per household. That's an historic pattern. And also because of low wages tend to have more wages,

tend to have more wage earners going out every day. So you have more adults leaving the house every day. So even if the children are not going to school, they're sheltering at home, more adults can possibly bring this in. So what we're seeing here in California is that while the curve has pretty much flattened in the rest of the state, it is still growing in Los Angeles, largely increasingly Latino and African American because those folks are just now entering the data systems.

But they've been exposed. They just, they didn't know it. I want to ask you quickly, if you would, how much difference between the numbers that we've seen and reality do you think there is? I mean, the numbers that have been reported of the Latino population in L.A. County, in California, versus the number of people who you believe are actually infected. What's the disparity there, do you think? Well, I couldn't put a number to it, but it will be far greater and rolling in a little bit later. People have talked about a second wave of COVID maybe this fall, so we're looking at wave 1.0 here, 2.4.4.2. But I think for minorities, we're seeing like wave 1.5, not that they got it much later,

but rather they're entering the data systems and the care systems much later because of these problems and access to care. And I don't know, Uche, do you see sort of the same thing, this big gap between what the numbers really say and what the reality is? Yeah, absolutely. I wanted to comment on that because actually what we're seeing here in New York City is that as testing is expanding, we're seeing higher rates of positive cases, especially, you know, in black and Latino neighborhoods because those people were not being tested before. And so those testing rates are catching up with the cases and the hospitalization and mortality rates. And so it's making more sense now. And if I might add, John, one additional thing here is up until the second week

of March, ICE, Immigration Customs Enforcement was going into hospital. little here in Southern California and extracting folks to deport, which, of course, tends also then to depress someone's willingness to go into a medical facility for whatever reason. So we have all these structural things and then wonder why are Latino and African Americans having higher rates. Well, it's not that we're weaker. It's just that we are, this shows the structure of the system. We're more exposed. We have lexas to care. And just to piggyback on that, I would like to say, you know, structural racism has essentially made these communities. sick. So when you have a pandemic and a crisis like this is essentially a crisis within a crisis.

And so it's these most vulnerable communities that end up suffering the most, which is why we're seeing these incredibly high mortality rates in black and Latino communities. I'm John Dankowski, and this is Science Friday from WNYC Studios. We're talking about inequities in COVID-19. In coronavirus cases, we're talking with Dr. Uche Blackstock from Brooklyn, New York. and Dr. David Hayes-Bautista, who's from Los Angeles, California. I want to bring into our conversation Rebecca Nagel. She's a journalist and she's also a citizen of the Cherokee Nation in Oklahoma. So let's talk about the part of America that you're looking at. Rebecca, some tribal nations have

been hit very hard by coronavirus. Tell us about what's happening in Navajo and Puevlo lands. Yeah, so there are some tribal communities in the United States that have been hit really, really hard by this outbreak. So if Navajo Nation were a state, it would have the third highest rate of infection in the United States, only behind New York and New Jersey. It's important to note in that that they're also testing at a really high rate per capita. But right now in New Mexico, which is one of the states where their reservation is located, Native Americans are less than 10% of the state's population, but over 55% of the state's coronavirus cases. cases. There's also been a really, really disproportionate impact on Native Americans in Arizona. So a couple weeks ago, the Arizona Health Department released some data that even though Native Americans were less than 6% of the population in the state, they accounted for 16% of the state's COVID-19

related deaths. And are they being tested at a higher rate, not just testing at a higher rate, but are the tests being administered at a higher rate on the tribal nations? Within Navajo Nation, the testing rate is higher than across the United States. And so their testing rate per capita, I think, I believe that they're also third in the number of people that they're testing. But they've also had a really high death rate. So I think as of today, there are 79 confirmed deaths on Navajo Nation, you know, for an area that has a population of about 180,000 people. And so what we see in these pockets is an extremely disproportionate impact of coronavirus. And one of the reasons that, you know, the disproportionate impact in Indian countries

not being talked about on a national level is because across the country that data is not being collected and it's not being collected consistently. So we don't even have the numbers to have a conversation about what's happening across the country in terms of the impact on Native Americans. So we've been talking about some of the reasons why these disparities are happening across the United States and various communities. What do you think are some of the issues that are specifically affecting the Native American community here? Yeah. So when you look at the underlying health conditions that the CDC lists, you know, things like asthma and diabetes, Native Americans rate the highest. And, you know, that comes from years of racial and inequity and access to

health care. And so access to health care is actually a treaty right for Native Americans. It's not a handout. You know, we gave up billions of acres of land so that the United States could expand. And in exchange for that, our tribes were promised health care for our citizens, among other things. And so in the 1950s, the United States created the Indian Health Services to answer that promise. And it has been woefully underfunded, basically since the day it came into existence. And today, you know, Most health programs, like when we think about Medicare or Medicaid, they're what are called entitlement programs. And so they're funded based on need.

So if you qualify to get Medicare or Medicaid, you get it. Indian Health Services doesn't work that way. Congress sets aside how much money they want to give to it. And then if the place where you access health care as a Native American is out of money, you don't get that service. And so right now it's funded at about 16% of what tribal. leaders and Native health experts say it's needed. And so that's created this gulf of health disparities that leaves Native Americans more vulnerable to coronavirus. And you see this in the African-American

community and the Latino community where the resources needed in various communities aren't getting there from governmental agencies. But in this case, very specifically, the government just is saying, we're not going to fund the needed medical care. And the funding, since the epidemic has started has been woefully inadequate. You know, tribes don't have direct access to the national strategic stockpile. You know, there have been some really glaring mistakes that have been made, you know, in the first few weeks of the epidemic, IHS sent out a bunch of N95 masks to different service providers and centers that were expired, you know, telling people that they were probably still safe to use, but examined them before using them. And even the relief that was

passed that was supposed to specifically go to tribes, the $8 billion that Congress passed, it's been held up for a month by the Trump administration, and now it looks that a little over half of it will actually get distributed now a month later. We're looking at some of the inequities in who is getting and who is dying of COVID-19 across America. Stay with us right after this break. We're going to continue our conversation. This is Science Friday. I'm John Dankowski. We're continuing our conversation. We're continuing our conversation about why some communities have been hit the hardest by coronavirus in the U.S. Our guests are Dr. Uchay Blackstock, a physician and founder of advancing health equity in Brooklyn,

New York, Rebecca Nagel, a journalist and citizen of the Cherokee Nation in Oklahoma, and Dr. David Hayes-Bautista, who's director of the Center for the Study of Latino Health and Culture at UCLA's Medical School in Los Angeles, California. Dr. Blackstock, I want to go back to you. A recent poll of New York City voters found 70,000. 25% of white residents don't know someone who has died of COVID, but half of black and Latino voters say that they do know someone who has died. Does this discrepancy sound right to you? Yeah, no, absolutely, it sounds right. And I think in terms of the disparities in hospitalizations and mortality rates that you mentioned earlier in the other segment, I think that sort of confirms

that, you know, one thing that I, you know, did notice not only were we seeing more black and brown patients, starting in mid-March, but less white and affluent patients. And many of those patients had the luxury of working remotely from home. Another phenomenon that I've noticed, and this is anecdotally, is that a number of white New Yorkers actually had second homes outside of the city, whether it's upstate New York or out on Long Island and actually went to their second homes, so we're able to leave the densely populated city to less dense areas. And so right now in New York City, we don't even have all of the data. We only basically have a small percentage of the data that's showing these trends. I think that as we go further along, we're going to see these disparities widen even further.

One other thing that I wanted to mention is that on an average day, about 20 New Yorkers die at home. Now we're seeing about over 200 New Yorkers a day dying at home. And I think that when you look at that demographic data racially and ethnically, it's probably going to be black and Latino. And I think it's for several different reasons that we already discussed. But I also wanted to bring up this issue of distrust between, especially the black community and the health care system. That distrust, as you talked about before, Dr. obviously is happening in the Latino community as well. I'm wondering if you could follow up on this. The numbers that we talked about of people feeling like they know somebody in their community who's died of COVID or has gotten sick from it, do you feel like those numbers kind of hold up in the community you're looking at in L.A. too?

Well, in fact, I would like to take it one step further. Even though people in West L.A. again, the affluent for UCLA is, Beverly Hills might know very few people personally have died of COVID. They depend upon those who are dying. Let's talk about the farm workers just for a second. They plant the food. They tend to the crops. And if work for the farm workers, we wouldn't have the food that people need to shelter at home. Now, in the early days, when the markets first started to close down, you remember there were fights and the dials over toilet paper.

Just imagine when there were fights over food, over meats. That is going to be very, very serious. And because of largely immigrants, largely undocumented farm workers, slaughterhouse workers, et cetera, they keep us all fed. So while maybe somebody in West LA doesn't know somebody personally with COVID, the people in West LA are very much dependent upon that person out there. They don't know personally because of their. willingness to expose themselves to COVID, everyone else can eat. I'm just very, very glad that Rebecca really alluded to the history of these things. You know, this situation didn't just pop up overnight. We have the history of what happened with Native Americans and the lands. Here in

California, medical services have been provided in Spanish for 251 years. California came into the union as not only a free state, but also a bilingual state, and Spanish is not a foreign language in this state. Yet it is treated as if it were such, and there are very, very few providers that can speak Spanish. These are historic things. They just didn't pop up since the first of the year. And there's an African-American story as well, and I'm sure it can fill us in on. Well, David, I wanted to go to something else that you've been studying for a long time that I think really links into this, a type of a health paradox in the Latino community. Maybe you can explain exactly what this is. We've been studying the Latino epidemiological paradox for about 35 years.

And the paradox is this. Latinos have very low income, very little education, horrible access to care. So normally you expect Latinos to have really super elevated mortality for heart cancerous growth. But in fact, we see just the opposite. Paradoxically, Latinos have 30% lower mortality for heart compared to white, 32% lower cancer. In fact, as you look at all causes of death, Latinos have overall a 30% lower mortality rate, which leads to a three and a half year longer life expectancy. see, very good infant mortality, and actually far less likely to drink, smoke, or do drugs than non-Hispanic whites. Now, this with lower income. So I've had some people say, well, then COVID's not going to affect them. But we don't see that same curve for communicable diseases. Latinos consistently have had much higher rates for communicable, hepatitis, you name it,

which for me is an indication of the weakness of the public health infrastructure. With COVID, we're getting the worst of all possible world because it will affect Latinos. populations, the way other communicable diseases do, very high. But while you don't die of TV anymore, you will die of COVID. That's going to be really different, the worst of both possible worlds. Dr. Blackstock, do you have a thought on that? It's such an interesting idea. Yeah, no, that's so interesting. Actually, what I was thinking in terms of black communities is that, you know, we know that there's a mortality crisis among black mothers. We know that black babies have the highest infant mortality rate. Actually, the rate is almost higher than that during,

15 years before slavery. And we know black men have the shortest life expectancy. And I think what that speaks to is, you know, this legacy of essentially legal discrimination, you know, against black people in this country where, you know, our communities have been disinvested in and disenfranchised. And, you know, there's even this notion of epigenetics where the chronic stress of living with racism, you know, actually influences gene expression to the point where that's why we're seeing, you know, higher rates of diabetes in black communities or higher rates of autoimmune diseases. Rebecca, I want to bring you back into the conversation. You wrote an article for the Guardian about Native Americans being left out of coronavirus data. Tell us about some of what you learned in

reporting this story. Yeah, so we looked at how states were reporting racial demographic data, and we found at the time about 80% of states had published at least some demographic breakdowns, And over half of those didn't even list Native Americans and have a category for Native Americans. And most of them put us into what's called an other category, which statistically doesn't mean anything. We found that this was also happening in places with high native populations. So over half of all Native Americans in the United States live in only 10 states, according to the U.S. Census Bureau. and four of those states had put Native people in the other category. Also, while there's the stereotype that a lot of us live on reservations,

actually about 70% of us live in urban areas with the highest numbers, not surprisingly, because they're big cities in L.A. and New York City. And in the racial demographic data that is being published by both of those places, Native Americans aren't included. We're put into the other category. And that's a huge problem because, one, it's something that happens in public health data all the time that we're not included. And then what happens often is that when we're actually pulled out of the data, it shows really, really stark disparity. So I'll just give one example. Just

this past January, the CDC released a very detailed study on the rate of maternal mortality by race in the United States. It didn't include Native women. And a separate study done by the Urban Indian Health Institute found that Native women living in the United States, it didn't include. cities were four and a half times more likely than white women to die during pregnancy and childbirth. And so basically what happens to our communities over and over and over again is we are experiencing these public health crises, but because the data isn't being collected, they're not being named. You know, the other big problem that's happening right now with the data collection is, you know, I mentioned Indian Health Services before as the federal health system set up.

to service Native Americans. You know, IHS serves two and a half million tribal citizens and some family members in 37 states. And the data reporting system that they have, you know, which you would think could at least provide a snapshot, is woefully inadequate. So one thing about IHS is that it's a health system that is mostly primary care. And so critically ill patients are transferred out to non-IHS facilities. And the data does not follow that patient. So if a patient, is tested at an IHS facility but goes on to be hospitalized. And even if that person goes on to pass away from COVID-19, that data doesn't come back to IHS. So IHS can really at this point only publish testing data, which we know when we're talking about racial disparities,

rates of hospitalization and death are one of the really important ways that people are talking about the disproportionate impact of coronavirus. I just want to ask each of our panelists, before we run out of time here, about something that's been really important to following and understanding this pandemic. How much worse COVID seems to be on elderly populations and the elderly play such an important, very specific role in each of the communities that you follow and that you're your parts of, Dr. Blackstock, maybe you could start here. I mean, how do you see the elderly African-American population being disproportionately affected by COVID? Right. No, this is such a great question. I will say that, I've been emotionally affected by this, as many of my patients who have come in and been very

sick from COVID have been elderly black patients. And some of them are even close to retirement. And they are essentially the stalwarts of our communities. And so it's especially painful that, you know, in the twilight of their lives, when they're supposed to be retiring and really enjoying life after many years of working very hard, that they have to really suffer from this very dangerous virus. Dr. Hayes-Bautista. How about you? What are you seeing in your community?

Well, we see a couple of things. One is that there has been a tendency for generations for Latinos elderly to stay in place with the rest of the family rather than being put out to a nursing facility. So on the one hand, they missed that exposure within nursing facilities, although their adult children will wind up being the assistance in that nursing facility, then you can bring it back into the house. Also, because of the strictures placed on Medicare and Social Security, a lot of Latino elderly today, because of when they were active workers back in 60s, 70s, and 80s, certain industries were excluded from Social Security Medicare. So it's just farm work where you get people that have been nannies or gardeners off the record all this time, so they never had accounts.

So that they're now aging, 30% of Latinos in the survey we did 15 years ago, Latino elderly did not have Medicare. And you normally assume, you got 65, you got coverage, about 20% of. did not have Social Security, they do need to live with their adult children, but their adult children are the ones who are going out and being exposed and then bringing it back. And that's been a concern in the Spanish language press. How do we protect our elderly, given the structure of the situation? And Rebecca, how about you? Yeah, I think that's the aspect of the disease that is really, really scary for Indian country. You know, I think that our elders, they hold a really, really important role in our communities. A lot of times they're in leaders. In leaders,

leadership roles. They do a lot of caretaking for their family members. And they also often hold a lot of cultural and language knowledge, you know, just to talk about my own tribe. Basically, the last generation of fluent speakers are mostly over the age of 60. You know, we have less than 10 people who speak our language fluently under the age of 40. You know, we're already in a place where we're losing speakers at a rate that we don't know what we're going to do with this crisis. And when I get really emotional about coronavirus as I think about that increasing. It's a really, really scary thought. And so I think that that's one of the ways that the impact on coronavirus in Indian country is going to be disproportionate because some of what is important to us about our elders and some of the knowledge that they

hold is irreplaceable. We cannot afford to lose elders, you know, like what we saw happen in Italy. I'm John Dankowski. This is Science Friday from WNYC Studios. all three of you, I think, have referred to this earlier in our conversation. But I'm wondering quickly if you would. And Rebecca, I'll start with you, this idea of just having more black, Latino, native people in medicine, whether or not this would change in some way the outcomes that you've been reporting on. I mean, Rebecca, do you have a strong feeling on that? Yeah, absolutely. I mean, I think that we need to be represented across the board. You know, I mean, I think that even though the funding that we've been,

gotten from coronavirus has been inadequate, it wouldn't have been possible without our greater representation in Congress. And so even just seeing our numbers in Congress double in the last election and having more leaders on both sides of the aisle made a huge impact. But yeah, absolutely. I mean, I think that even just having health care providers, you know, for those speakers that can speak their language, you know, so that they can talk to somebody that they can understand, you know, I know a lot of elders that maybe do speak English when, you know, they're seriously ill, struggle more with their second language and are more comfortable in their first language. And so we absolutely need people from our communities in those roles,

both on the ground and at the national level. David, how about you? Not really is important for patients. It's important for everybody. It's important for science. I'm a researcher. And I've been studying the Latino epidemiological paradox. Yet when I present my data to even the National Institute of health, people shake their heads because we don't fit what we're supposed to do. They say, where do you get your data? And I say, well, they're your data. They're NIH data. Now, here's the situation. If non-Hispanic whites had the same epidemiological profile as Latinos for heart, cancer stroke, et cetera, we would save 250,000 lives a year. And they would be white baby boomer lives. But because we have not invested, the researchers that are there, have their, if you will,

narrative about what Latinos and minorities are like. So we haven't done the research, so we don't know how Latinos managed to reduce the risk for heart disease. And white baby boomers are ones who are going to pay the price for our negligence of medical education of Latinos and minorities in medicine. And Dr. Blackstock, I'll give you the last word. I know this is something you've written about and thought about substantially in your career. Yeah, absolutely.

Especially being a black woman physician. So we know from the data that one of the solutions to addressing racialized health disparities is having a diverse health care workforce. And so as Dr. Batista mentioned, you know, we're doing the research to address these health disparities. We're more likely to work in underserved communities. And we also know that our interactions with patients have more positive outcomes and affects after the interaction. So it's really important that we be here. And I also want to say that the reason why our numbers are so small are due to structural issues. So it's pipeline issues. It's due to practices and policies of structural racism.

So this is definitely not a mistake that we're not there. And so we need intentional and explicit efforts to address diversity in the health care workforce. Dr. Uche Blackstock is a physician and founder of advancing health equity in Brooklyn, New York. Dr. David Hayes-Bautista is director of the Center for the Study of Latino Health and Culture at UCLA Medical School in Los Angeles, California. And Rebecca Nagel is a journalist and a citizen of the Cherokee Nation in Oklahoma. I want to thank you all for the work that you do, and I want to thank you all for spending some time with us here on Science Friday. Thank you. Our pleasure.

Thank you so much. Charles Bergquist is our director. Our producers are Alexa Lim, Christy Taylor, Katie Feather, and Kathleen Davis. B.J. Leatherman composed our theme music. If you missed any part of our program or you'd like to hear it again, subscribe to our podcast, or you can ask your smart speaker to play Science Friday. We're working on a story about how the pandemic is affecting children and their mental health, and we want to hear from you. go to our Science Friday VoxPop app and record your questions or have your kid record their story. That's on the Science Friday Voxpop app wherever you get your apps.

You can also email us. The address is SciFri at ScienceFri.com. Ira is back next week. I'm John Dankoski.