Unfortunately, disinformation about and distrust in our medical system plays a significant role. Last monday i had the pleasure of speaking with dr. Lena wen, a visiting professor at the George WashingtonUniversity School of Public Health. She previously served as the Health Commissioner for baltimore, where she led the nations oldest continuously operating Health Department to fight the weed epidemic, improve maternal fight the opioid epidemic, improve maternal and child health. She has been a leading voice for sciencebased policy during the pandemic. We spoke at length about the impacts of covid19 on communities of color in the u. S. [no audio] video to playave here. Thank you so much for joining us. I would like to start off by asking you about data we are seeing in terms of disparities in covid19 infection rates and outcomes for people of color in the United States. First of all, i am glad to join you and thank you for focusing on this critical topic. We know this disease is not affecting people equally, that communities of color are bearing the brunt of this pandemic, and that this pandemic has unmasked many Underlying Health disparities that we have known for a long time have existed but are being brought out in the wake of this pandemic. Africanamericans, latino americans, native americans, Pacific Islanders, those who already bear the brunt of other health disparities, are experiencing the worst outcomes. They have many times the rate of hospitalizations and deaths due to covid19. When we look at the reasons why, it is several fold. Distancingnow social is a privilege not everyone has access to. People of color tend to be essential workers who, from the beginning of the outbreak, have not had the opportunity to practice physical distancing. Inple of color tend to live crowded, multigenerational housing where practices like isolation and quarantine are difficult. Already look at who has Underlying Health conditions that will make people more susceptible to adverse outcomes from covid19. You look at a city like mine in baltimore where one in three africanamericans live in a food desert compared to one in 12 whites. Is it any surprise that africanamericans disproportionately have heart disease, obesity, conditions that predispose you to poor outcomes because of covid19 . This is a reminder it is not the virus doing the discriminating. It is our health system. It is the conditions where people live, social determinants that we know influence health in many ways, but certainly influence Health Outcomes when it comes to covid19 very tragically. The same trends we see in adults are mirrored in children. Three quarters of the deaths that have occurred among children due to covid19 are among these same populations in black and brown children. Rebecca do you get the sense, looking at the data and trends on the ground, that we are improving over the course of the pandemic . Trends of the impacts on communities of color changed over the last seven months, or are we watching these be recapitulated over time . Dr. Wen it is a good question and one that i dont have the answer to, because we have been missing data all along. From the beginning, we had a big problem with data. Maybe you could understand because we were just getting started. We are still missing key data points when it comes to who is impacted, who are the individuals who have increased rates of hospitalization and death. Different states report the data in differentdifficult compariso. Also, you have different groups that may be classified differently. Some may classify asian americans, some would classify Pacific Islanders as differently and so we have a different collection of data overall. One would hope the disparities are improving over time, but aced on the limited data we have, it does not look like we are getting any better. Do you have any particular concerns about how information, particularly misinformation or disinformation about the virus itself are being received within Community Communities of color and impacting these communities . Question. Nother good i would say disinformation in general around covid19 has been a big problem. It has manifests in different ways. December in different ways. We have all heard these covid19 isnt real, even the data around who is dying, there was a cdc port put out looking at the conditions that are written ported that are reported, and that has been interpreted in different ways. We know death certificates may not contain one diagnosis. Somebody may have respiratory failure as a cause of death or may have an underlying condition in addition to having covid19. But that does not mean this person did not die because of coronavirus. Its like saying somebody who died from a car accident but also had cancer, somehow they butnot die from the crash, even Something Like that has gotten misinterpreted in so many different ways and it speaks to what has gone wrong in this response, that there has been mixed messaging. That instead of having Public Health lead in the response, weve seen Public Health experts and scientists being pushed under the bus. Between Public Health officials and that has led to a lot of confusion. Then you have a different problem in this case as well, which is that at ace line, you have communities that have had distrust in things like vaccines. Skeptics whocine may be antiscience as a baseline. Then you add on top of that that because of various political interference and fears of political pressure that also has interfered with Peoples Trust in science and now you have a whole group of people distrusting the process of regulatory approval, not because they distrust science, but because they fear political pressure and manipulation. Then you have a third group that has had historical distrust in the scientific in scientific and medical community for good reasons. Were talking about black americans, native americans, and other groups that have had legacies of being experimented on, of unethical, illegal experimentation. Now we are asking the same groups to potentially be involved in vaccine trials because we do want to include everyone in vaccine trials but it is important to do Public Outreach and education in addition to make sure when the same therapeutics and vaccines come out that the distribution is such that these same communities that are the most impacted by covid19 also receive these vaccines and therapeutics first because otherwise we will perpetuate this concept that somehow we are experimenting on lack and brown bodies for the benefit of white and privileged individuals. A complicated, multifaceted issue, but we have to be attentive to it and recognize disinformation is rampant. That many communities have underlying distrust and we have to do our best to make sure science leads this process and we are overcoming the mixed messages that has been hampering our response all along. Would like to talk more about these potential solutions and you just described a very complex problem here. We have historical experiences, we have contemporary political actions and motives that are creating an environment of great distrust. If you were still a public Health Commissioner, whether at baltimore or anywhere around the United States, what are some concrete things you would want to put in place in this moment right now to try and help solve these problems, to deal with this complexity . I appreciate the question. So much we admire the problem and dont get to the solution and there are actually tangible toutions when it comes reducing the disproportionate impact of covid19 on communities of color. I had the opportunity to testify in front of comfort in front of congress twice about the utions urging Congress Talking about what we should be doing as Public Health officials which looking at my counterparts across the country, local health officials, state health directors, have been doing their best under extraordinary circumstances. They are already extremely Resource Limited and fighting disinformation every day and doing so much with extremely few resources while trying to do Everything Else because Health Departments are also the safety nets for their communities and also trying to work on food access and assisting with individuals experiencing homelessness, helping individuals with the opioid epidemic. I think they are doing as well as they can under these conditions but if i may reframe your question, what can we all do as in what is the role of congress and all of our elected officials who must answer this charge, there are specific, tangible solutions. First, we talked about the issue of data. Lets make the data known. When it comes to hospitalization, death from covid19, but also to testing, one really specific characteristic we should be measuring is around test positivity. We know test positivity should be below 5 . We should be making test positivity rates available throughemographics and specific zip codes and on the communitywide level. Positivitye a test in a state that is 5 or even 3 and it looks like its going the right direction, but if we have test positivity for latino americans and that test positivity in this group is at 20 , we know we need much more specific targeting to this particular group. If we know a particular zip code is testing at 20 or 30 and the rest of the state looks fine but this zip code need specific resources, that allows us to target testing, having mobile testing or partnering with groups that target those communities that need it the most and not just addressing the population as a whole. In addition, worker protection. We know essential workers tend to be people of color. Individuals working in Nursing Homes that dont have the right amount of ppe. Individuals who are home health plants,in meatpacking instituting strict Worker Protections on the federal level but also the state and local level is going to be really important for reducing the disproportionate impact of people of color as well. Housing is example something that very much influences health and Food Insecurity does as well. If we are telling our patients to isolate if they are ill or quarantine if they are exposed but summit who lives in a house and are literally unable to do that, what can we do as a society help provide them with the resources to do so. If people are afraid of losing their job, what kind of protections can we put into place to help with that . Finally, i want to touch on the issue of our educational divide and the disparities we are seeing at this time. It is such a complex issue to think about reopening schools and i know many schools have reopened in a way that may contribute to outbreaks among students, the staff, teachers, also communities around them. We also know keeping schools closed is going to further that educational divide and contribute to this covid slide we are seeing across the company across the country for most honorable children. The key is for us as society to reduce the level of Community Spread as much as we can, to invest resources into our schools, not just wealthy private schools but to schools that lack resources for their students so that we can as a as the have our schools most essential to help our children who are most in need. Rebekah could you tell me a bit more about some of your experiences talking to people on the ground, whether it is health care workers, patients, members of the communities themselves being affected, what have you been hearing from people on the ground . Need told you say they hear from us Going Forward . Dr. Wen i am hearing from patients and Community Members that they want to do the right thing. I think people are recognizing in the areas where i live and the communities i speak to that they absolutely understand covid19 is a pandemic. It is something affecting each of us, and i think there is a great deal of frustration. But i think there is a great deal of frustration that people can be doing all the right things and there is this mixed messaging coming from our elected leaders that is making the sacrifices people are making every day in vain and thats very difficult for people to hear and to conceptualize because people are giving up so much and people are not seeing their grandchildren, older adults are not able to safely gather in Senior Centers that have been their lifeline. Kids have not been able to go to school. Individuals have lost their livelihood because of this pandemic. And had theo much opportunity early on to contain this pandemic but we havent and we are continuing to sacrifice so much and lives continue to be loss and that is one thing. Another thing is quarantine fatigue, which is that we cannot be isolated for the foreseeable future and its important to figure out which risks we are willing to continue to take on and which are the risks we really need to cut down on, understanding we need to figure out how to live with this virus and one of the trends we are seeing is the many new infections are not so much do to congregate settings or formal settings but rather informal settings, that people are getting infected through gatherings with their loved ones, through extended families and friends. One message thats important for all of us to keep on distributing is the need for continuing to be on our guard. Foro 50 of the spread is people who dont have symptoms. Haveoved ones dont coronavirus. And we love our loved ones. Somehow strangers are carrying this. Its critical for us to keep in mind that if we are doing all these things to keep kids physically distanced at school, if they are coming together for play dates or celebrations afterwards and are not going to be abiding by these restrictions, we are still going to have out rakes and these out rakes are going to lead to schools being closed for longer. If we are doing everything we can at Grocery Stores and at work, but still getting together for dinner parties indoors, thats going to eliminate all of the good work we are doing. So use an abundance of caution. Think about all those things that are important to you. Out wearing, gathering doors rather than indoors, avoiding crowds, these are things we can do in order to protect ourselves at loved ones and allows us to get as much back to normal and not be isolated as we can. Thank you so much for taking the time to speak with us today. Thank you for all the work youre doing and please be safe and to be well. Dr. Wen thank you very much. Rebekah joining us now to continue our discussion, we have dr. Amanda castille, a tenured professor in the department of epidemiology at George Washington university. Cdcs a physician and trained epidemiologists Whose Research focuses on hiv and related Infectious Diseases. She has worked domestically and internationally on hiv aids surveillance, prevention, care and treatment. Since the start of the covid19 pandemic, she has been providing support to local Health Department and serving as part of the Public Health team, leading gw cost reopening efforts. In q so much for joining us. Thank you so much for joining us. Thank you for having me. Rebekah i would like to begin our conversation by asking you wens remarks. R. She started by noting that africanamerican, native american and other communities feel distrust toward Public Health institutions largely because the history of illegal and unethical experimentation. Could you tell us a bit more about this and how this history might be shaping coronavirus outcomes in the u. S. Now . Certainly. We have seen histories of these types of Unethical Research and experimentation among committees of color. If you think back to the native americans, it started with the colonization of the United States, bringing Infectious Diseases these populations had never seen before, systematically stripping native americans of their right, their land, their heritage, and even in the 1990s, we have seen research that has been done. There was a Diabetes Project done among a native american tribe where these individuals agreed to share information and to donate led for Research Study that was supposed to be focused on diabetes only to then find out the information and their blood was being used for other purposes. Examples such as these are unfortunately pervasive throughout our culture. In the African American community, the tuskegee experiment is still in the back of many peoples minds. This was a study that took place for decades among africanamerican men who were being followed for syphilis infections. Even though in the late 1940s, even though treatment was available, they were not able to access this treatment and the study went on until 1972. All of these are examples where because of the way these communities have been treated, there is understandably people are mistrust, scared in these communities, and unfortunately, covid didnt create the situation. Covid has reminded us of this unhealed wound and how yet another pandemic, another situation has impacted these communities. We have seen that because of these longstanding historical inequities that these communities of color are more at risk and have a higher prevalence of comorbid conditions. Ofy constitute the majority essential workers and we have seen from the data that those are risk factors for worse outcomes. Thats why we are seeing these