Health Lead Story West Edition

Hospital guidelines may make blacks less likely to receive COVID-19 testing

LOS ANGELES — Are more African Americans dying under the current COVID-19 triage system of health care treatment?

Based on the disproportionate percentage of African Americans with coronavirus symptoms being turned away from hospitals, the answer may be yes. Family members in coronavirus hotspots throughout the country describe loved ones with the virus symptoms dying from the disease after being sent home by health care workers.

“Experience has taught all of us, if you’re poor, if you’re of color, you’re going to get services second,” said Dr. Georges Benjamin, executive director of the American Public Health Association.

According to Benjamin, even for those African Americans who are symptomatic, it appears doctors are less likely to refer them for testing.

Rubix Life Sciences, a Massachusetts-based health research and development firm, used patient billing information from seven states to analyze the number of African Americans who were referred for COVID-19 testing. Results indicated that African Americans with COVID-19 symptoms, such as a cough and fever, are far less likely to be tested than white patients. 

The word triage is derived from the French word “trier,” meaning to separate out. The current definition originates from the early 20th century military system of assessing the wounded to determine who would best benefit from medical treatment and be returned to the battlefield. 

The system of triage prioritized healthier soldiers, the ones most likely to survive, for treatment while severely wounded soldiers received little or no treatment. Limited medical resources could not be squandered on dying soldiers.   

Dr. Richard Allen Williams, founder of the Association of Black Cardiologists and past president of the National Medical Association, recalls being trained in the principles of triage in the 1970s at Martin Luther King Hospital in South Los Angeles.

He said the same triage system used in wartime was also used in disaster training and has now evolved into a way of prioritizing the treatment of African-American patients suffering from COVID-19. 

Most recently, Italy, the country with the second highest number of COVID-19 deaths in Europe, developed a detailed triage system to decide which patients would receive life-saving ventilators.

The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care developed the country’s triage protocol. The guidelines are based on the utilitarian belief that “actions are right if they are useful or for the benefit of a majority.”

The Italian system “puts a value on human life. It gives a number to a person’s life and it establishes a rank order as to who is going to live and who is going to die,” Williams said.

The underlying health conditions that many African Americans suffer from, also play a major role in doctors’ triage decisions throughout the United States.

“The fact is that black people have always received inferior health care delivery and have been at the short end of the stick when it comes to health care decisions,” Williams said.

In response to how to begin addressing African American health care disparities, the Center for Disease Control and Prevention’s (CDC) provided general guidelines including the standardization of protocols especially in facilities that serve large minority populations; Identifying and addressing implicit bias that could hinder patient-provider interaction and communication; reducing cultural barriers to care; connecting patients with community resources; and learning about social and economic conditions that may put some patients at higher risk for getting sick with COVID-19.

According to Williams, the fact that doctors and administrators making life and death decisions on COVID-19 care are white and the majority of the patients are African American, makes the remedy to the disparity in care difficult.

“A white doctor looking down at a black patient and a white patient, you have to wonder who he’s going to choose to live or die. I think studies have shown in the past, doctors make selections like that based on implicit bias or unconscious bias,” Williams said.

He concludes that the solution lies in having more black involvement in the treatment process in the front lines at the point of care where it really matters. African Americans also are needed behind the scenes in back office in administrative positions where policy decisions are determined.

“That’s what health care systems ought to do now.  They need to be developing equitable policies, which will deal with issues such as the negative triage situation facing African Americans.”