White americans. Unfortunately, this information about distrust and medical systems like a significant role on these outcomes. Last monday, had the pleasure speaking with the doctor, an emergency physician visiting professor of health, policy and management and the George WashingtonUniversity Institute school of Public Health. The doctor previously served as the Health Commissioner for the city of baltimore. She led the nations oldest operating Health Department to fight the Opioid Epidemic and print child health and treat racism as a Public Health issue. The doctor has been a leading voice call for policies and practices during this coronavirus pandemic. On monday we spoken with about the impact of covid19 on communities of color in the u. S. [silence]. I believe we have video to play here. Thank you doctor for joining us. I would like to start off by asking you but the current data but the disparities in the covid19 rates. In the outcomes people of of color around the United States. First of all, glad to join you and thank you for focusing on this really critical topic. Because we know that this disease, covid19 is not affecting people equally. That communities of color are bearing the brunt of this pandemic. In fact, this pandemic has unmatched any Underlying Health disparities that weve been dealing with a long time have existed. Literally being brought out in the wake of this pandemic. So we have seen africanamericans, native americans and latino americans in native highlanders are ready have so any other Health Disparities are experiencing and disproportionately rates of hospitalizations and tragically due to covid19. And when you look at the reasons as to why, several fold. First, is that we know that social distancing is a privilege and not everyone has. So people of color tend to be essential workers. From the very beginning of the outbreak have not had the opportunity to practice physical distancing. In addition we also know that people of color tend to live in a multi generational housing where even basic precautions like isolation and quarantine are difficult. And you also have who has already Underlying Health conditions that are then makes people more susceptible to outcomes from the covid19 read the look of the city here in baltimore where one in three africanamericans any food desert or two bites. Is it any surprise than that africanamericans also disproportionately have diabetes, Heart Disease and hope obesity in these conditions that they also predispose severe outcomes to the covid19. All of this is a reminder than that it is not the virus in this case. The stop doing the discriminating. It is our health systems, the social determinants of this conditions of People Living. We know that in the ways, but certainly the influence the Health Outcomes when it comes to covid19. Very tragically. Perhaps most tragically adulterated the same thing so we see in adults, they mirrored. Three quarters of all of the deaths that occurred among children are among the same populations. There in the black and brown children. Rebekah do you get the sense looking at the data in the trend on the ground, the mayor improving over time over the course of the pandemic itself. How theyre impacting the communities of color. How they are changing over the course of the last seven months. Are we simply watching them being restructured over time. This really good question when they dont have the instant. And thats because we have been missing data all along the pandemic. From the very beginning, newman big problem with data. Maybe in the beginning you can understand because you were just getting started. Who we are still missing keep data points when it comes to for example who is impacted. Who are the individuals who have increased rates of deaths and hospitalizations. Different states report the data different ways making it a difficult comparison also you have different groups that classified differently for example some states record on asian americans. Others with separate pacific islanders. So we have a big issue of Data Collection of our all. One hopes the disparities are improving over time based on limited data that we have, it does not look like were getting any better. Do you have a particular concern about how information and particularly misinformation ravens disinformation. About the virus itself are being received within the communities of color and ultimately impacting the communities. Dr another good question. I would say disinformation in general around the covid19 has been a big problem. Its manifest in different ways. So first, theres just like disinformation about how weve all heard these like covid19 is not real. Even the data around who his dying from covid19. There is a report that was put out looking at the conditions that are reported and even that information has been misinterpreted and 70 different ways. Somebody may be dying from covid19 but also has respiratory failure is a cause of the death. Or they have no underlying condition in addition to having covid19. They have Heart Disease and have covid19. But it doesnt mean that they didnt die because of coronavirus. Sky like saying the somebody who died from a car accident also had cancer. Somehow they didnt die from the car accident because it also had cancer. Even Something Like that is gotten misinterpreted 70 different ways. I think it really speaks to also what is going wrong in this response. And has been mixed messaging. Instead of having Public Health lead in this response, so often we see Public Health xers and scientists being pushed under the bus. At the message between the Public Health officials and elected officials adjustment different. That is led to a lot of confusion. Then i think you also have a different problem in this case as well. Patients that have baseline, you have communities that have had distressed and things like vaccines. There are for example, vaccines skeptics made the antiscience. Another top of that, because of various political interference in fears of political pressure. That also has interfered with Peoples Trust in science. Know you have a whole group of people were distrusting the process of Regulatory Approval not because the distrust science because they are political pressure and manipulation. And you have a third group that has historical distrust in the scientific and medical communities for good reasons. Because these are the groups were talking about black americans native americans, and other groups that have had legacies of being experimented on and of unethical and illegal extermination. Never asking the same people also be involved in a vaccine trials. We want to include everyone in the vaccine trials. I think it really is important for us to Public Outreach and education. In addition to also make sure that when these things are repeated the vaccines come out, that the distribution is such that the same communities that are the most impacted by covid19 also receive these vaccines and therapeutics first. Because otherwise we will perpetuate this concept and somehow we are experimenting on black and brown bodies. Benefits of whites and privileged individuals. So this is such a complicated multi faceted issue but we have to be attentive to it and recognize that this information is rampant. Any communities already have underlying distrust that we have to do our best to make sure that science leads the process number overcoming the mixed messaging is been hindering our response all along. Rebekah i would like to talk more about the potential solutions. He just described very complex problem here. Extraordinary circumstances. These Health Departments are already resource limited. They are fighting disinformation every day. They are doing so much with extremely few resources while also trying to do everything else. House departments are also the safe net for their Community Also think about food access and asked individuals the looking at homelessness for their the Opioid Epidemic and other factors will theyre doing this too bring their doing as well as i can under these conditions. But if i may reframe your question is what can we all do what is the role of congress . What is the role of our elected officials to answer the charge . Theres simple tangible solutions. First of the issue of data. Lets make the data known on these demographic breakdowns when it comes to hospitalizations, to death from covid 19, but also to testing. One really specific characteristic that we should be measuring is the test positivity. We know that the test positivity should be below 5 predicates above 5 we are not testing nearly enough. We should be making test positivity rates available across demographics and through specific zip codes in communitywide level. You may have a test level in a state 5 or even 3 its the right direction. We also have tests on for like the latino group is that 20 , we know that we need much more specific targeting to this particular group. We know a particular zip code is testing at 20 or 30 , on the rest of the site looks fine but this zip code need specific resources. Mimicking target testing like having bubble testing or partner with churches and Community Groups so that we are targeting the resources to those communities that needed the mos most. Not as a dressy population as a whole. Thats a key principle of equit equity. In addition Worker Protections. They tend to be people of color individuals working in nursing home not have the right amount of ppe. I developed who are home workers or in meat packing plants. As a drink strict Worker Protections on the federal level from the state and local level enforcement on these levels is going to be really important for reducing the disproportionate impact on committees of color as well. We also need to look at these other social determinants. We know housing for example is also something that very much influences health and Food Insecurity very much. We are telling our patients too isolate if they are ill or quarantine if they are exposed. But somebody lives in a house where they are literally unable to do that, what can we as society provide them the resources to do so. Our people are afraid of losing their jobs if they test positive or are exposed, what kind of protections, he also put in place to help with that. Finally want to touch upon the issue of the edge of occasional side. The educational disparities we are seeing at this time her to such a complex issue to think about opening schools. I know many schools have reopened, potentially in a way that may contribute to outbreaks among the students, the staff, teachers, the families of the communities around them. The same timing of keeping schools close is going to further that educational divide and contribute to the covid slide we are seeing all across the country with our most vulnerable children. They key here is for us as society too reduce the level of Community Spread as much as we can. Too invest resources into our schools. Not just wealthy private school schools, but to all schools in particular schools that are already lack the resources so we can, as a society prioritize schools is the most essential to help our children who are most in need. Doctor could you tell me a bit more about some of your experiences talking to people on the ground . Whether it is healthcare workers, patients, members of the communities themselves are being affected. What have you been hearing from people on the ground . How are they reacting . And what would you say they need to hear from us Going Forward . Cnet well, i am hearing from patients, from Community Member members, that they want to do the right thing. I think people are recognizing in the areas where i live at least, and the communities that i speak to, that they absolutely understand that cove 19 is a pandemic. It is something that is affecting each of us. And i think theres a great deal of frustration of quarantine fatigue is something that is very real. I think there is a great deal of frustration that people can be doing all of the right things. But then there is a mixed messaging, this confused at messaging from our elected leaders. That making the sacrifices people are making every day. That is very difficult for people to hear and to conceptualize. Because people are giving up so much. People are not seeing their grandchildren, they are older adults on are not safely able too gather in Senior Centers that have been there a lifeline. Kids have not been able to go to school. Individuals have lost their livelihoods because of this pandemic. I am hearing that we gave up so much. And we had this opportunity early on to contain this pandemic and we havent. We are continuing to sacrifice so much and lives continue to be lost. That is one theme. Another theme is of quarantine fatigue which is that we cant be isolated for the foreseeable future. And it is important for us to figure out which risks we are willing too continue to take on. And which are the risks we need to cut down on right understanding that we need to figure out one of the what trends were seeing as many new infections are not so much due to how that its settings or to formal settings but to informal settings that people are getting infected through gatherings with their loved ones through extended family and friends. One message its really important for all of us to keep on distributing is the need for continuing to be on our guard. At the 50 of the spread is from individuals who dont have symptoms. And there is a level of magical thinking that many of us have their loved ones do not have coronavirus. Because we know them. We love our loved ones. But that somehow changes caring for this. Thats truly critical for us to keep in mind that if we are doing all of these things, if kids physically distance at school they are wearing masks. Theyre only going to be coming together for play dates or birthday celebrations after words. Its not going to be abiding by these restrictions that we still will have outbreaks. And in fact these outbreaks will lead to schools being closed for longer. By the same token, we do everything we can at Grocery Stores and it works, but were still getting people together for dinner parties indoors, that is also going to be eliminating all of the good work we are doing. Remember to use an abundance of caution. Think about all the things that are most important to you. And remember that mask wearing , gathering outdoors rather than indoors. Eliminating or avoiding crowds. These are all the things that we can do in order to protect our self and our loved ones. It also allows us too get as much back to normal and to 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 you are doing. And please be safe and be well. Thank you very much. Joining us now to continue our discussion, we have doctor amanda kissed del who was tenured professor in the department of epidemiology and George Washington university. Doctor casale is a physician and cdc trained epidemiologist who focuses on hiv and related Infectious Diseases. She has worked domestically and internationally on hivaids surveillance, frenchman, care and treatment. Since the start of Covenant Team pandemic, she has been providing help to local Health Departments in serving as part of the Public Health team during the reopening efforts. Thank you so much for joining us. Good morning and thank you for having me. So i would like too begin our conversation by asking you about one of the doctors remarks. She noticed that africanamerican, native american and other communities of color, often feel significant distrust towards medical and Public Health institutions. Largely because of the history of illegal and unethical experimentation. Could you tell us a bit more about this . And about how this history might be shaping coronavirus outcomes in the u. S. Now . Certainly, certainly. The doctor said we have seen histories of these types of research and experimentation among communities of color. Everything back to the native americans, really started with the colonization of the United States, bringing Infectious Diseases that these populations have never seen before. Systematically stripping native americans their rights, their lands, their heritage. Uneven in the 19 90s we have seen a research that is been done, there is a Diabetes Project that was done among the native american tribe where these individuals agreed to share information and to actually donate blood for Research Study that was supposed to be focus on diabetes. Only to then find out that the information and their blood was being used for other purposes. And so, examples such as these are unfortunate pervasive throughout our culture. In the average American Community the experiment is still the back of many peoples minds. This is a study that took place for decades with africanamerican men and are being followed for syphilis infections. Even though in the late 1940s, treatment was available. These men were not able to access this treatment. The study went on until 1972. All of these are examples where because of the way these communities have been treated, they are certainly understandably skepticism, missed trus