Opinion: State must prioritize communities of color for COVID-19 testing

Opinion: State must prioritize communities of color for COVID-19 testing

June 8, 2020

Original article here.

By Guest Columnist

Susheela Jayapal, Alisha Moreland-Capuia and Smitha Chadaga

Jayapal is Multnomah County commissioner for District 2. Moreland-Capuia is an addiction psychiatrist who works at the intersection of cultural medicine, trauma, addiction and mental health. Chadaga is a hospital medicine physician and activist. They live in Portland.

The evidence is clear: Black, Indigenous, and other people of color are testing positive for COVID-19 at disproportionate rates and being hospitalized due to COVID-19 at disproportionate rates, across the country and right here in Oregon. Because of generations of systemic racism, they are more likely to work in frontline jobs; less likely to work in jobs with sufficient paid sick leave to allow them to stay home when ill or exposed to illness; and more likely to suffer from underlying health conditions that elevate the risk of complications. 

But BIPOC communities can’t get the testing they need. 

In Multnomah County, our most populous and diverse county, Hispanic people account for 28% of positive cases, compared to their population share of 10%; Black people account for 14%, compared to their population share of 7%; and Native Hawaiians/Pacific Islanders account for 3%, compared to a population share of 1%. Recent sharp spikes in certain immigrant and refugee communities further demonstrate the risks to our BIPOC communities.

COVID-specific evidence and general medical research make it clear that BIPOC communities suffer from institutionalized racism in health care and consistently experience bias that leads to worse health outcomes. 

Testing is the gateway to our public health response to COVID-19, and therefore to containing spread -- but BIPOC communities are having a harder time accessing it. Black patients are half as likely to get tested before coming to the emergency department as white patients. And they are sicker when they arrive. The recent story of Michael Lopez, turned away twice despite experiencing symptoms, further exemplifies the barriers faced by BIPOC communities (“Latino man twice rejected for coronavirus testing amid confusion over Oregon guidelines,” June 11).

We call on the Oregon Health Authority to immediately issue a clear, unambiguous recommendation that anyone who identifies as Black, African-American, Latinx, American Indian/Alaska Native, Asian, Asian-American or Pacific Islander be prioritized for testing, regardless of whether they are exhibiting symptoms.

Past statements made by the health authority have been vague and contradictory – for example, in the Oregonian/OregonLive article cited above, the agency spokesperson stated that it was not recommending routine testing for asymptomatic people of color. Not surprisingly, these conflicting guidelines are being interpreted in different ways across providers and across counties, creating additional roadblocks to testing for BIPOC communities. 

A clear, affirmative recommendation must be made. Further, it should be paired with culturally-specific outreach, including dissemination of information about existing testing sites, transportation to testing sites, pop-up testing at community events (including protests), options for mail-in testing as this becomes more available and assurance of wrap-around economic and social supports for those who test positive. Government, academic, health system, and philanthropic partnerships should support these efforts. 

These recommendations would increase the reach of testing and contact tracing in our chronically marginalized communities, and thus mitigate the impact of disparities inherent throughout our healthcare system. It would also benefit our entire community.   

Unimpeded access to COVID-19 testing for BIPOC communities is an important and necessary step to curb the disproportionate illness burden in these communities.  The current movement for racial justice has shown us that waiting to act costs lives.  We, on behalf of more than 100 physicians and community leaders, urge the Oregon Health Authority do what it takes to ensure justice and equity for those who too long have suffered.