Dr. Fauci on why coronavirus is wreaking havoc on Black communities

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Black, Indigenous and Latinx communities have been hit hardest by the coronavirus. Black Americans, according to the CDC, are 2.5 times more likely to die from COVID-19 compared to their White counterparts. Dr. Anthony Fauci, the nation's top infectious disease doctor, sat down with BET to speak about why minority communities have such a high number of infections, hospitalizations and death rates and what can be done to fix the disparity. View the full interview with Dr. Fauci on BET.com.

Marc Lamont Hill: The African American community has been hit particularly hard by the coronavirus. Can you help me, first of all, make sense of why that's happening?

Dr. Fauci: It's what I call a double whammy against the minority, but particularly the African American and Latinx community. You don't like to generalize, but as a demographic group, the African American community is more likely to be in a job that does not allow them to stay at home and do teleworking most of the time, they're in essential jobs. I mean, obviously, there are a lot of African Americans who are not, that could just as easily do that.

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But as a broad demographic group, you're outside, you're exposed. You may be in a financial or economic or employment situation where you don't have as much control over physical separation, which is one of the ways that you prevent infection. So the likelihood of your getting infected is more than the likelihood of someone not in your position.

The other side of the coin — and this has a lot to do with long-term social determinants of health — as a demographic group, African Americans have disproportionately greater incidents of the underlying conditions that allow you to have a more unfavorable outcome, namely more serious disease, hospitalization and even death. That is, diseases like diabetes, hypertension, heart disease, obesity, chronic kidney disease. If you look at populations as a whole, and you look at the demographic group of African Americans and the demographic group of the rest of the population, or Caucasian, what you see is a much greater incidence. So you have two things going against you: You are physically in a position that's more likely you're going to get infected, and if you do get infected, you're more likely to have a serious outcome.

So to me, the thing to do is we need to focus and concentrate resources in those areas that are overrepresented by African Americans. In other words, allow you to get tested more quickly, [get] results back quickly, and access to health care. We can do that right now, today, if we concentrate resources.

How do we get the most vulnerable people, particularly poor Black people, access to health care, access to preventative stuff? What kind of resources could we redirect?

First of all, a great awareness of the need that if you're African American and you get infected, it is more likely you're going to have a serious outcome. So we've got to just get a public awareness on the part of clinics and hospitals that you have to pay special attention to that, you have someone at a greater risk. And when you know you have someone at a greater risk, you make certain medical decisions. You may get them in the hospital earlier. So we've got to educate people on that.

The longer-term one is something that you're not going to cure overnight, and that is the economic and other conditions that African Americans find themselves in that they're not in a situation where they get a greater access to health care from a more of an economic standpoint.

But the other thing that I think we need to make a commitment that goes probably measured in decades. And that is, why do African Americans have a greater incidence of hypertension? Why do they have a greater incidence of diabetes? Why do they have a greater incidence of obesity? It's not genetic. It has to do with years and years of access to the right kinds of food, access to the right kind of health care. Those are the things that we've got to change. But that means that perhaps if there's one silver lining in this outbreak — which I hope there is always some silver lining in everything that's so challenging — is this, is to focus with a laser beam on the disparities in health that we've got to change, and it's got to change at the fundamental basic level. It's not going to be tonight or tomorrow or next week.

It's going to be over the next several years. So when people think about this outbreak, they say, "Hey, let's pay attention to this because it's another example." I went through the same thing early on in the early years of HIV, the disproportionate number of African Americans who get HIV infection. [They] are 13% of the population; 45% of all of the new cases of HIV are among African Americans. That's unacceptable. That's another example of the dis-- the unfortunate disparity of health.

There's a long history of skepticism of the American medical establishment in the Black community. Whether it's the Tuskegee experiment or our inability to access pain medications with the same pain levels as our White counterparts in hospitals and emergency rooms, we've had very bad experiences with American medicine. Some Black people are scared of the idea of it. How do you take that into consideration and what are the steps to recruit people for these trials?

We have a history that has gotten much, much better lately, recently, in the last few decades, but a bad news history going back to things like Tuskegee. I think it's good that you made that comment about pain medication. It's true. We have African Americans who have sickle cell disease who come into the emergency room in terrible pain. And, you know, there's sometimes a reluctance to give them the pain medication that they need. So those are the kinds of things that it's understandable why there's skepticism among African Americans regarding the typical, classical medical establishment.

So what are we doing about it? It's called community engagement and outreach to the community where we are leveraging the community relationships that we started years ago with HIV.

When I started the HIV program at the [National Institutes of Health], we developed relationships with community reps who were trusted by the African American community because they were reflecting the African American community. So I often joke, but it's the truth, you want to go into the African American community with people who look and think and act like the people you're trying to convince. You get a White guy like me with a suit like me and a tie on going in, talking to people who are people that you don't usually relate to every day. But if you get the community people on the ground to go in and say, "Hey, let me tell you, I've scoped this out. This is something for your own benefit," in addition to people like myself saying the same thing. So, when you see people in authority and people at the community level saying the same thing, hopefully, you can get the African American community to essentially do things for their own benefit because it's for your own benefit to protect yourself from this infection.

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