Coronavirus in Context: Minority Communities Hit Hard by the Pandemic

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD.

Today, I have a very special guest, my good friend, the dean and president of Morehouse School of Medicine, Dr. Valerie Montgomery Rice. Dr. Montgomery Rice, thanks for joining me.

Thank you for having me. It's nice to see you again.

You and I have been talking about disparities for many years. And now, we see the impact of COVID on marginalized populations, communities of color. What has been the impact of COVID on minorities?

VALERIE MONTGOMERY RICE: You know, it's been significant. And, you know, I was sitting here. And I said, OK, let me go find the latest data. And one of the things that struck me is that the sources of where the data is is really becoming a challenge. You know, what we're seeing now is you think about African-Americans make up somewhere around 13% of the overall population. Dependent on the state that you're in though, they may account for 30% of the cases. And you and I know that that defines it as a disparity. But what's even more troubling, of course, that leads to about 2 to 4 times more-- higher death rates. And so we are seeing a significant impact on African-American communities.

We know it's access to the health care system. We know it's because of underlying hypertension, other underlying risk factors. But what about the social determinants of health, the access to food, the access to a safe place to-- to be active and-- and work out? You know, what are we doing about that?

You're-- you're in the city of Atlanta, where there is disproportionate impact on communities of color, people of brown and black skin. How do we address that? It's just not about coming to Morehouse. It's also about going to other-- you know, other aspects.

VALERIE MONTGOMERY RICE: So the first thing we do, we start with education, right? And so I tell people, first of all, this virus does not discriminate. So it doesn't matter that you are black or white. If you come into close proximity of someone with the virus, then you are going to catch the virus. If you're white, that's got to happen, black, or brown.

What we are seeing though are the challenges that occur when the person is infected with the virus. And so we then see the impact of all of those factors influencing-- first of all, you talked about the chronic diseases. We know this virus acts like an-- causes inflammation. You know, we talk about the cascade, the burst that you see of inflammatory cells, et cetera. And we know that is going to impact the heart, the kidneys, the lungs. And so if you have diabetes, and COPD, lung disease, or any of those challenges, you're going to have a worse outcome. So that's the first thing.

Now, if you couple, though, that with those social determinants-- when I am complaining of symptoms, can I get a test, first thing. And that is an access issue. Can I-- do I have the transportation means to go somewhere to get the test?

Yeah. If you don't have a car.

Can I get off of work? Right. Can I get off of work? So all of those things impact. And the most, though, the most impactful issue around the social determinants is that African-Americans and Hispanics tend to work in those essential jobs, those essential positions, right, where they are going to come into more contact with the public, whether it's you're driving the bus, or whether you are working in food service, or whether you work for one of our delivery services that have just been wonderful in keeping us safe but not necessarily themselves safe. So those are all issues that have influenced and impacted, cause the impact or the negative impact that we've seen this virus have on our communities of brown and black people.

You know, everyone's talking about the vaccine. But what they're not talking about is about the challenges in recruitment.

Yeah.

And we're seeing challenges in recruiting minority populations. And you and I have been conversing for years about the low number of Blacks and other minorities in clinical trials--

Right.

--especially in cancer trials. So how are we going to fix this? Is COVID going to show us the way to more equity? Or is it only going to, you know, exacerbate the current situation?

So you bring up a good point. You and I have talked years. When you were at the FDA, we talked all-- all the time about how we could increase the number of Blacks participating in the clinical trials. This was even before COVID.

I had the opportunity to serve on an FDA advisory panel for reproductive and neurological drugs for seven to eight years. And we talked about it then.

When I came to Morehouse School of Medicine, we actually have a clinical research center that has a really great track record for enrolling people of color in trials. And the reason that we can do that so successfully is because we are a trusted entity. We have worked really, really hard all of these years to build trust within the community. We work really, really hard to build a partnership with primary care providers so that we train them, and we train their nurses to actually participate with us in a trial. Because most of the patients that we want in a trial, or-- or subjects that we want in a trial are patients of primary care providers. So if you can build that trust network, it makes a difference.

Now, we also have to continue to educate. We all have heard the stories of the Tuskegee syphilis story. We've all heard the Henrietta Lacks story. But we know that the mistrust and distrust that occurs between a provider and a patient or the Black community and the health system started way belong that.

I'm reading this book again, Medical Apartheid by Harriet Washington. And I picked up this book and read parts of it several-- several times. And some of the information is so disturbing that it makes me have to pause. But it gives me and reminds me where that mistrust and distrust came from.

And it started way back in slavery, John, when Blacks were used for medical experimentation without their permission. And so stories were told over the years. And they were real stories.

And so I have to make sure that as we bring on the COVID-19 vaccine trials, which I'm very happy Morehouse School of Medicine and the three other historically Black medical schools will be enrollment sites, we have to make sure that we are educating our community, partnering with them, addressing their fears around participating in these vaccine [? stats. ?] And it starts with building trust.

OK. So it's trust. It's education.

VALERIE MONTGOMERY RICE: How has Black Lives Matter affected the discussion of health equity? Is it going to have a long lasting impact? Or is it going to be like other times, where there's been a blip, there's been interest, and then it's gone back to the way that it's always been? So what's different, Dr. Montgomery Rice, this time around?

VALERIE MONTGOMERY RICE: You know, so for so many years, we've been nibbling around the edges, right, of this problem of health inequities in the United States. But Black Lives Matter has done a couple of things. It's asked us to look at the drivers. What drives the entrenched inequities in this country, the structural inequities, the institutional inequities? Only when we address those issues will we really be able to say that we're making a difference. Because it's systemic.

And so Black Lives Matter has said, we've got to get-- do a root cause analysis of what has been causing these problems. And then we have to have interventions along the way that break down the systemic barriers.

At Morehouse School of Medicine, we've recently been talking about the political determinants of health. And clearly, I don't want to get into--

JOHN WHYTE: The political determinants, OK.

VALERIE MONTGOMERY RICE: --the political determinants of health.

Right.

One of our professors, Dr. Daniel Dawes, has this new book, The Political Determinants of Health. And he's going to be our convocation speaker. But what he talks about there is what is it from a policy perspective that has allowed these inequities to continue. And we know that, whether it's housing laws that cause redlining, where people are forced to live in communities, and then the tax base doesn't necessarily allow, right, for there to be the amount of taxes contributed to those communities so you can have better schools, et cetera. There have been systemic public policies that have influenced health outcomes.

And Black Lives Matter is asking us to do some root cause analysis. So I'm excited.

And you think it'll make a difference this time.

I think it's going to make a difference. I am a-- I am a person who believes in advocacy. And so what I say to everyone who's out there being in the marches and all of those places is to continue to do three things-- wear your masks, wash your hands, and watch your distance, but use your voice. Use your voice.

Now, we've also been talking about the importance of having more minorities in medicine.

Mm-hmm.

And I want you to share your personal story. And I know you're modest that here you are, Harvard Medical School, a woman dean, a Black woman dean and president of a medical school. That, you know, doesn't happen very often. And your portrait hung in the National Portrait Gallery. Wait. We're going to have a picture of this on the screen.

OK, thank you.

Dr. Montgomery Rice, tell us your story and how you can inspire people of color, women, to go into medical school, become a dean, become a world expert physician, yours in infertility and women's health. What was your key to success?

VALERIE MONTGOMERY RICE: So first of all, I've always had this wonderful village that supported me. I was raised in a single parent household with three other wonderful sisters and a mother, a mother who had resilience and grit. And she built that as a part of our character.

We are people of faith. That was a-- she allowed us, and forced us initially, to have a strong foundation. But you know, it's kind of like osmosis. It comes back to you. And when you need it the most, OK, it's there. It's a part of you. And so when there have been times of challenge, I relied on my faith and my village.

And I came from a small town in Macon, Georgia. That is correct. And then I went to Georgia Tech, and I went to Harvard Medical School.

And I didn't know I always wanted to be a doctor, right? So I thought I wanted to be an engineer. And when I decided I didn't want to be an engineer, I wasn't afraid to change my mind. And again, I think that ability to be confident in that decision was really based on the strength that I had gathered from my mother.

Now, I saw you on the day in Washington, DC, that you went to the portrait gallery where your picture hung. Tell us how that made you feel. Here you are. You said you grew up in Macon, Georgia.

Mm-hmm.

And now, your picture is in a Smithsonian in the nation's capital.

You know, it was-- it was a-- a-- a-- a-- a opportunity that was really significant for me. And uh, it was-- several people have been featured. But they went looking for individuals who had a life story that would resonate and inspire. And-- and I've just been very fortunate that my story resonates with other young people who believe that if they didn't come from a two-parent household that whatever they want to achieve is not achievable. I think I've shown that that's not the case.

But I think I've also really kept in mind that it really takes a village. And one thing that I've never been afraid to do is to ask for help and to actually open myself up to, uh, reasonable, constructive advice and followed that advice.

And so what I would say to young people is that you have a story. And your story is important. And first of all, not to be afraid to tell your story. But also equally important, share your story in ways that inspire others, and because everybody can resonate with something else in somebody else's life. And that is what actually builds that village. That's what actually builds that village.

Well, Dr. Montgomery Rice, I want to thank you for sharing your story today, for your leadership, for your advocacy in helping us try to find a road map as to how we address these issues of disparity.

VALERIE MONTGOMERY RICE: And, you know, thank you, John. And this is-- this is important. And the only thing that I would add to our conversation is that as we think about this comprehensive strategy that when we're trying to really beat down this virus is that I hope that we would consider really what it means to have a national testing strategy in this country such that we can ensure that we know who is infected, and then that we cannot appropriately quarantine those persons, support them so that we can mitigate the spread of the disease. That is something that we're working on here at Morehouse School of Medicine. And I hope that, with all the science that's coming out about asymptomatic carriers, all the data that's coming out about the different testing that is available, whether it's point-of-care testing, whether it's testing using a saliva kit, or whether it's testing using different types of swabs that we would actually put all of that information together, and partner, and develop a national testing strategy so that we can not let this virus continue to beat us in the way that it has.

That's a great reminder and one that we have to work on in terms of this strategy.

Yes.

But thank you again.

Thank you.

And thank you for watching Coronavirus in Context.

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