Over the past two weeks, I saw 11 COVID-19 survivors in my practice—all long-term patients in New York City—six Latino and five African American. Two were on ventilators, for over two months. One is still severely disabled and fears job loss. The other fears loss of a home. Most of these survivors continue to have symptoms months after their initial COVID-19 infection. Several of them are essential workers. Nearly all reside in multigenerational homes and had multiple family members who were also infected. All reside in low-income communities.
After a terrible spring, New York City was able to suppress COVID-19 due to a mandatory lockdown, aggressive testing, and masking. As of this writing, much of the United States is still in crisis, with thousands of deaths per week and more than 200,000 COVID-19 deaths cumulatively. Additionally, we are facing an economic toll not seen since the Great Depression with high levels of unemployment, loss of health insurance, and an imminent eviction calamity. The racial and ethnic health disparities seen in COVID-19 shocked because of the terrible death toll. Clear causative social, economic, and political determinants were all telescoped into nine months.
Additionally, the COVID-19 disaster has been exacerbated by a federal response characterized by deceit, political gamesmanship, disinformation, and dismembering of the nation’s public health infrastructure. The mobilization of the Black Lives Matter movement against racist police brutality and murder via the largest political protests in United States history have added to our national sense of urgency. The extensive wildfires and other manifestations of climate change are yet more dire results of ignoring science.
For these reasons and more, the upcoming election will be crucial to all who are front line workers caring for Americans while risking our own lives to do so. Our experiences give us key insights into how politics affects all of our lives and how structural racism has affected politics.
In 2021, the new administration will have to think big—very big—and all policies should be approached with an anti-racist lens. Some priorities should include the following:
- COVID-19: The United States needs a national comprehensive testing strategy, universal masking, a fast and accurate data collection system, and vaccine development with exquisite attention to research ethics and scrupulously run clinical trials, and with a focus on poor and BIPOC (black, indigenous, and people of color) communities.
- Health Care: Millions lost their health insurance as they lost their jobs, and aggressive efforts to achieve universal health insurance coverage must move forward, especially as communities of color are disproportionately affected by lack of health insurance and poor access to care. The federal government should also expand programs that serve the underserved, including community health centers, migrant health centers, and workforce diversity programs.
- Policing and Criminal Justice Reform: The federal government should promote the redesign of policing that will redirect funds to appropriate social service, and mental health supports, especially as the mentally ill may be at extreme risk for fatal encounters with police. We must also reform drug laws to address mass incarceration, which has disproportionately affected men of color in particular, and promote the reentry of the formerly incarcerated into employment.
- The Economy and the Environment: The administration should immediately expand unemployment insurance due to our pandemic associated employment crisis, while expanding assistance for small businesses; and planning for infrastructure development, The administration should commit to anti-climate change initiatives that can also buttress economic development and create jobs, like the “Green New Deal.” Infrastructure development should include affordable housing so that we can eliminate homelessness in the United States. Communities of color are disproportionately affected by unemployment and underemployment, and chronic homelessness is much more likely to be experienced by people of color.
- Immigration: The administration must proceed with a plan for comprehensive immigration reform; path to citizenship; permanent status for Deferred Action for Childhood Arrivals (DACA) recipients; and reversal of family refugee and immigrant policies that separate children and families.
SGIM members have been at the forefront of documenting health inequities and the impact of racism on health, educating young doctors, and caring for the most vulnerable. We will do our part to help the United States recover and shape the way forward. We must fight for scientific independence and the strengthening of public health, and advocate for the most vulnerable. The stakes could not be higher.