Health Disparities and COVID-19

On this episode, we are joined by Dr. Utibe Essien, Internal Medicine Physician and Health Equity Researcher to discuss COVID-19 updates and health disparities related to this disease. We specifically address how COVID-19 is disproportionately affecting Black Americans.

As the economic impact worsens and tensions are rising, we also reinforce some important guidelines for our fellow millennials.

If you have questions or comments feel free to reach out on Instagram @MillennialHealthDoc

Transcript

spk_0:   0:03
Hey, everyone! And welcome to the millennial health podcast. I'm Dr J. Cherie Allen, a board certified family physician who's passionate about the health of my fellow millennials. I know we're booked and busy, but your first well is your health. So I'm taking some of my most important health messages and bringing them here to you on this podcast. Today we have with us an internal medicine physician from the University of Pittsburgh to start us on a conversation about health disparities and cold ID 19. So, Doctor oughta be Essen is actually a front of mine going all the way back to New Rochelle, New York back in high school days, then through undergrad, then this medical journey, and we reunited recently at the 40 under 40 awards. Doctor SCN. Welcome to millennial health.

spk_1:   1:13
Thanks so much, Dr J. Sherry Alan. It's been a pleasure is the pleasure.

spk_0:   1:18
I am actually really looking forward to this conversation. I think it's so important that we start toe, have these conversations and set the record straight on a lot of these issues. So I really appreciate you taking the time to be here with us. But do you mind telling our audience a little more about yourself, your background in your current clinical role.

spk_1:   1:39
For sure, I would love to. So, as you mentioned, we heard from the same hometown before I got to Mira show my journey started in the greatest city in the world Brooklyn, New York, where I was born To my wonderful to Nigerian parents who made it across the ocean to the U. S. Back in 84. I have been here ever since. My father is a primary care doctor, and so he is really the inspiration for me to go into medicine. My medical school journey started in the Bronx, So I always represent the Bronx as well on. And I trained in internal medicine and primary care in Boston at Mass General Hospital, um, enduring residency, I decided that I wanted to do more than just clinical medicine and wanted to really impact population that a broader level and decided to pursue a career and research on. And so after residency, I did a two year general medicine fellowship at Harvard Medical School, where I got my masters of public health and have since been doing research focusing on cardiovascular health disparities. here at the University of Pittsburgh.

spk_0:   2:51
Oh, well, that's amazing. I've also read that you have a strong interest in health disparities too, and I've seen some of the other events that you have participated in. Could you tell us a little more about how you got interested in health disparities?

spk_1:   3:09
Yeah, definitely. I think like many of us, that kind of thinking about the communities we come from or we way take care of. So for me, it started back during medical school, and this is around 30 year of med school where we're going through rotations. I went to Albert Einstein and the Bronx like I mentioned, and we will take through several hospitals over that third year, and we would rotate through the private Academic Medical Center and then some of the more local community hospitals. And you can really see the patients almost shift, depending on where we were training and where we're doing. Our rotations and that shift look different depending on their clinical diseases. They're coming in with, even just depending on the person that they had at the bedside, whether or not they had somebody with them in the hospital. And I was really struck again by just that. This reported in amount of chronic diseases, that we're afflicting people who look like me, an African American man, whether it was diabetes, hypertension, obesity, Ah, lot of clinical diseases. And, you know, we learned about this in medical school slide after slide, which show that black individuals or more likely have this more likely to have that. But there never was really an explanation as to what the causes were, Um, And so you end up in the hospital as a resident of 30 or met student, kind of wondering again, what are some of those causes? Um, sadly, for me, it wasn't until residency, where I really started to see some of the social risk factors that were driving a lot of these disparities seeing how much poverty and how much access to insurance or just health care in general. Um, how much housing and food insecurity and a lot of these social determinants, as we now call them, really influenced people's health. And so that was what particularly drove me to think about health disparities and pursuing a research career. Matthew,

spk_0:   5:07
it's still interesting. You have that story. I think so. Many of us have similar stories like that that drove us to medicine. You know, I think of growing up in church. And I remember, you know, us praying for women who were trying to get pregnant and struggling with infertility or praying for leg God to heal the hypertension and the Diaby. Like I remember these prayers for people in the hospital. You know, I remember even my Sunday school teacher who had end stage renal disease and was on dialysis. Like I remember you know, him going to like, this is so crazy, you know, And I think to do similar to you. One of the things that inspired me to go into medicine was because I thought that my community was lacking positions. They were lacking doctors to address these problems. And it wasn't until medical school for me, ATM a Harry where, you know, I saw I mean a phenomenal doctors taking excellent care of the local population. That's when it clicked for me that the doctor was the missing doctor in the picture. Wasn't the problem here. There are a lot of other issues that impact your health outcomes and sometimes it goes way beyond just having a person, you know, with an m d. Looking after you. So I love that you share that story. I think many of us have these stories that originally brought us to medicine. Oh, well, speaking of which, you know, we're learning more now about how Cove in 19 is disproportionately affecting black Americans. You know, share a little more about that with us.

spk_1:   6:53
Yeah. So this has really been quite an interesting journey over the last few weeks. So we're chatting earlier, before the formal recording. But we first heard I finished my first my last rotation back in March 16th or so. So a little over a month ago Now, um, and just overwhelmed by the early news about Cove in 19. You know, I didn't want to see the news reports I was tired of hearing about. Conference is being canceled. And the fact that I was going to miss my friends and the fact that my cot might vacation had to be canceled. That couldn't travel anymore. I was really just fed up with the social aspects and for some reason, didn't appreciate just how serious this was going to be. It wasn't until kind of had my head back of afloat after being bogged out in my clinical work that I realized like, Oh, wow, this is a serious problem. And once that realization hit them further realization that this was going to be a serious problem in black communities. Um, and the biggest reasons I was thinking about that were related to the risk of developing the disease and people who both for risk of clinical diseases, that we just mentioned the higher rates of hypertension, diabetes and other cardiovascular and pulmonary diseases that increase their risk of getting the infection to again. Commenting on the social risk factors that put people at risk of not being able to social distance well enough or being considered an essential worker and not being able to actually take the time off of work. So I was really struck by how those were going to compound to really influence and impact minority communities in particular, then thinking about access. And I think, like, anecdotally the first, um, stories. We're starting here, where people being turned quote unquote turned away from testing right there were minority, and individuals were saying, Oh, well, I can't get a test. For some reason, my came in with a cough, a fever, etcetera. My doctor wasn't testing me on and some of that and holding true in terms of some early reports and data that we're seeing, and that was a really big concern to me. A or people going to feel like they're biased and being biased against testing, but be are they even going to have the access to a test? Are they gonna have a primary care doctor who they can call about their symptoms? Like literally, everyone of us are suggesting our patients do andan. Once our patients hit the hospitals, that was my even biggest concern. Was the treatment going to be as equitable and but and high quality as we hope that treatment should be? Even though we know that decades of research have shown us, Unfortunately, black and brown individuals do poor than our white counterparts, and that's whether it's related to chronic diseases like we've mentioned or even acute disease. If you put a black individual and I see you, there are less likely to get a cute I see you level critical care compared to non black individuals, and that's really striking to me. And so that's really what scared me the most about this infection. And unfortunately, as time has played out, we've really seen that the numbers have shown that whether we're looking in Louisiana or Michigan or New York City where we're from, we see that unfortunately, black and Hispanic Americans are dying and being infected at a disproportionately higher rate, and this is really a critical problem to think about.

spk_0:   10:31
So what can we do, right? What can we do about this? As health professionals, you know, who are members of minority communities? We have families, our parents, our cousins, brothers, sisters and friends, right? So what's in our power to that we could do about this?

spk_1:   10:52
Yeah, I think that's important question. You know, the first thing is the voice. I think we need to continue like we are having this discussion right now to continue to put our voices out there. And I've been on social media, kind of curating or collating the both essays that our colleagues air riding up that pizza pieces rather in their local newspapers, and that's what we need to do. We need to be the voice both in the national news media and our medical literature and forms like podcasts like we're doing here to really get the word out to our communities of color. You know, back three or four weeks ago, Idris Elba had to be the one to go on his Instagram live to tell black people that Corona virus is possible for us to have and and should not be, that it should be us who are at the forefront of those conversations. I think getting the message out, I think we need to support our health system leaders and advocate to really encourage the three teas is one of my colleagues puts it, which is testing, tracing and treatment. There needs to be universal testing. We right now have about 1% of Americans. Three million out of the 300 million in the country have been tested for Kobe 19. And that's a problem not just for the country but in particular for the minority communities that are disproportionately suffering. Talk about tracing. So right now, the big move is to go towards contact tracing. So who are you exposed to over the last 14 days? Let's go to them and talk about their symptoms and again etcetera center in. If we're going to do that, people are going to be concerned about privacy, about trust about security and need to make sure that the right people are helping support that initiative. And lastly, really helping support our colleagues and making sure that treatment is equitable. And a lot of us are kind of touting that conversation right now, making sure that whether it's thought thinking about rationing of ventilators, that equity is at the forefront of that conversation. Whether is thinking about the future Corona virus, vaccines or future like I'm compassionate care treatments, making sure again that each and everyone, um, of our colleagues, family members, friends, who is a fellow racial ethnic minority group has access to those treatments that, unfortunately again, history has shown that we tend to not have access to.

spk_0:   13:16
And I think there's an additional challenge in the midst of this pandemic and that word not allowing family members into the hospitals or emergency rooms with their loved ones at this point in time. And so I think it's even more important that you know those of us on the front lines. Those of us still working. Take that extra step to truly be advocates for our patients and really ask Right? Is there something else I can be doing to help you know and taking that extra time to just call that family member and give them that update? You know, because even if the outcome is going to be poor, if they can appreciate that the care given along the way was optimal, right? That kind of changes the dynamics, even in the poorest of outcomes. So I think that's another huge one without a set the bedside to advocate, You know, we've got to step in and fill the gaps.

spk_1:   14:24
Yeah, no, that's exactly right. And I think I appreciate your practical tips as well, because that's that's what's happening in real life. The New York Times two days ago published an article about the Lost in translation. It was the title and out, um, right now in Mass General Hospital, where did residency? Almost 40% of the patients with Cove in 19 are Spanish speaking, and we know that 5.5% of physicians in the U. S. Are Hispanic like we know that there are not enough doctors out there to speak to the true issues that these patients who are scared, who are alone, like you mentioned, have as related to this disease. And if we don't think about people actually taking that extra time, unfortunately, people are going to be in a tough space. So that's a great point.

spk_0:   15:10
And I think I hold that one a little more dear to my heart because, you know, I lost my grandmother four weeks ago in New York, and the very last time I was ever able to speak to her when she was able to speak was when the doctor who was running on her used her personal cell phone. Teoh, return our call and put my grandmother on speaker so that we could explain to her that we weren't there at the hospital with her simply because of the virus and the restrictions that had been put in place. That's the last time I ever got to speak to her. I saw her once after what? At that time she couldn't speak anymore. So I think from the patient perspective, I usually think of this as a doctor. But from the patient perspective, I have a little more appreciation for us, kind of really stepping in the shoes there and going that extra mile for the families who need us most, you know?

spk_1:   16:06
Yeah, I'm sorry to hear then that's such a touching story. And I think your experience is probably you not unique to her many of our colleagues who are not just thinking about their family members or the last patient that they saw, but also thinking about themselves, like we are also at risk of this infection. Back in just a couple weeks ago, we're still begging for personal protective equipment to be able to go into the safely, go on to the front lines toe, make sure we can hold the hands of the patients who are at at who are in need. And so I'm sure that rings true for a lot of listeners to.

spk_0:   16:42
But that actually brings me into our next point that I wanted to touch on. So bringing it back to us as millennials, you know, early in this disease course, there was a lot of a younger people are, you know, elderly and co morbid conditions, and and I think we're seeing a lot of cases that are proving to not be the case. We're all at risk at this point, you know? And so we had issues with kind of younger people taking this seriously and really staying home, especially before some of the social distance and guidelines Really, you know, were handed down to us, but I think we're in a different place now. You know, we had a nice conversation with Dr Jasmine Marcellin, whose infectious disease out of Nebraska. And so we were addressing this on the front end of the pandemic. But now that we're in the midst, I think with Millennials, we're facing another issue. So now we've been home. Many of us have been home for quite some time, right? We have to think we're not necessarily the demographic that has savings lined up to continue to support ourselves throughout the midst of all of this. Right? We're in that career building phase. We're pursuing educational endeavors that are now on hold or have been changed significantly. Right? So what are some points that you'd like to highlight for especially us as millennials in the midst of this crisis where we currently stand today?

spk_1:   18:16
Yeah, that's a great question. and Dr Marcellin is amazing. She's a fellow out Hamilton fan and stand probably so like drops, um, Hamilton quotes along the way. But I think that's a really important point, right? Like like you mentioned, There's a lot of us who have not are not used to this life. We're used to being on the go, whether it's brunch on Sundays traveling on. But whenever we get our latest vacation I remember was until residency, we realized like, Oh, exactly, exactly, I realized, Wow, all of my friends are going abroad during residency like I'm not doing this job right. But I think the really the first thing is to stay aware that this disease does kill. Just yesterday we saw that there is another 25,000 cases and another 2000 deaths from holding 19. And as you mentioned that range of ages from his youngest in their twenties, all the way through Teoh, eighties 90 year olds and the 20 year olds, everyone asked, Well, what were their chronic conditions? Whether they have what was their problem, so to speak, almost trying to present like well, it can affect me. But again, any hear story after story, whether anecdotally or through the early research data, to see that young people, whether they're healthy or not, young women who are pregnant or coming in with asymptomatic infections as well. And and they're really a lot of people who are at risk. And so staying again, ready and aware of just of how risky this diseases and scary it is and how it can come on all of a sudden we hear about, you know, make sure your social distancing for, you know, for 14 days or self quarantining, depending on who you been in contact with. But in a matter of days, you're the life can change. You're gonna end up sitting at home with a little tickle in your throat, a little cough and all of a sudden the next day be in the I C U. As you mentioned to cut off from your family, not able to speak to them because you have a breathing tube down your throat and having a very different life. And the realization is being an icy you isn't just like a Grey's Anatomy moment, where they just pull the tube and you're back to normal being in I C. U involves your kidneys all of a sudden not acting normally. And we have to have doctors considering whether we need to be placed on dialysis for some time and you're a liver function, not were being appropriate. And there is a recent data to show that the effect on the cardiovascular system is really significant. So these are things that yes can start off kind of, You know, if you're starting off younger and healthier and a good place you may not experience but things that we all need to be thinking about him staying aware of. So again, I think I wouldn't advise everyone to stay ready. Whether it's washing of hands is constantly as you can. The six feet social distancing. We're all fortunately living in a country where we still can go for a run and we can go for a walk. Our dog getting a parking as best as you can wear the mask when you're outside, really do your part to make sure that we can keep our fellow citizens. Are fellow come healthcare professionals as healthy as they can? That would be the first big tip for me.

spk_0:   21:26
What about another big tip as we're closing out the segment. Another Biggs, if you want to share with our views tonight

spk_1:   21:34
Yeah, I think the biggest other big one would be Teoh. Quote unquote. Stay woke. I'm gonna try and get my listeners are You know, the opportunity that we have as millennials is to use our voices. People listen to us. People want to hear from the young train Me who's a medical student who now is not ableto work on the floors because they are not wanting to expose themselves to cove it. 19. So what can they do? How does the former law student who has now been furloughed from classes going Teoh respond to this? And I will just continue to say to use your voices, get out on your social media platform of choice, get out and write those essays and those thought pieces and op EDS And really advocate for the people who are less fortunate than we are. If you are thinking about your avocado toast, um, vacations like I still am right now, that means you may be in a position of privilege on, And if you're not, definitely use your voice as well. They are so few stories from people who are from more, um, difficult situations that we're hearing. We're hearing a lot about the celebrity who got cove it in Australia on vacation, but we're not hearing about. The mother of two is trying to home school trying to work her essential job. Is the bus driver etcetera? Eso I would think on both and sharing as many stories as we can to get through this together.

spk_0:   23:02
I love that I absolutely love that. Another major one You know, Instagram live is all the rave now. I mean, this Teddy Riley and Baby Face had, like over 500,000 live viewers, right? So Instagram live is another way to to kind of just get out there and get like a quick story that you want to share with friends with family, you know, and even good things too, because I think this is also taking a mental toll on a lot of people. So if you have ah, story that brings a ray of hope. That's also another really good thing to share too Well, Dr SC and thank you so much for joining us on the millennial help podcast. This'll

spk_1:   23:49
was amazing. Thanks So much history for having me. And thank you for bringing the word out in your own very special, important way.

spk_0:   23:56
Thank you. So thank you everyone for joining us today. I hope this information was beneficial to you If it Waas please subscribe to the millennial health podcast and share with your friends and family. If you have questions or comments, feel free to reach out to me on Instagram at millennial health, Doc Now actually so millennial health, Doc, You know, I dabble on Twitter. I doubt a little facebook or really Instagram's were all right. So thank you guys until next week Fine.