There are different definitions of what “systemic” can mean, and what it can mean specifically in terms of “systemic” racism. I don’t think it is necessary for ordinary people to sign off on every possible meaning of those terms in order to acknowledge that, in some form or another, there appears to be a disparity in outcomes that (a) creates obvious divides on racial lines and (b) is not so much about individual acts of discrimination as it is some larger, harder-to-grasp phenomenon at work.
I want to share an example of how I think this sort of thing happens, and also an example of how Not Everything Is Horrible (Even If Some Things Are).
This summer my sixteen-year-old got sick. Sore throat, fever, dry cough . . . oh yeah.
In checking on her throughout the day (with masks for all, physical distancing, disinfecting, etc.), I observed her developing an alarming case of shortness of breath on exertion. This child is an athlete training intensively 4-5 times a week, and who does not have a history of asthma. I put a call into the nurse, and our pediatrician called me back personally. After a short conversation she told me she was calling ahead to the ER to let them know we’d be coming in shortly.
At our doctor’s request, we went to the inner-city major medical center that has a separate pediatric ER, and which would be the location where our daughter would be admitted if she needed to be hospitalized, as the other hospitals in the region did not have a pediatric COVID ward. Fair enough. Unfortunately, our experience there was not at all the level of care our pediatrician anticipated. Some of the things that happened:
- When we arrived at the hospital and immediately reported that my daughter had COVID symptoms, confirmed by the temperature check at the door, we were waved back to wander through the various waiting rooms and find a seat on our own.
- In the pediatric ER waiting room, there was no staff member on duty (someone popped in every fifteen minutes or so to check registration forms), and no one checking to make sure my child with unequivocal COVID disease symptoms stayed away from the other patients (there were seats taped off and signs encouraging physical distancing though). There was no provision at all for suspected COVID patients to wait in an isolation room.
- My daughter went through her initial assessment in the same triage room that every other patient used. Note here that the triage assessment requires the patient to be unmasked. I would not want to be the next patient coming into that room.
- The staff were variable about using their minimal PPE. Some seemed to show no real regard for using PPE at all. Others were more diligent. None of them were protected at anything near the level of self-protection the physician at a different hospital system had used during an urgent care visit I’d made the week prior.
- Over the course of the evening, the level of care offered to my daughter was laughable. Our pediatrician provides a more thorough assessment before a routine vaccination. I have never seen a pediatrician perform such a cursory non-examination in my life. I was astonished. (They did, however, do a chest x-ray, and God bless the tech who let me look at it myself.)
- They declined to do a COVID test, citing a shortage of available tests. We were referred for drive-through testing the next day at the same hospital. So they have tests, except that they don’t, except that they do. If you come back the next day.
- There was no follow-up plan. We were, however, instructed to return if she showed the exact same symptoms she was currently showing. In fairness we were given a packet that said, somewhere deep inside, to make an appointment with your doctor. Nobody ever said with their mouths to us personally, “Make an appointment with your doctor.” We were supposed to find that in the packet, I guess.
Fortunately my child rapidly improved on her own. I left that evening resolved, given the choice, never to visit that ER again. I also left enlightened as to why there might be significant demographic disparities in COVID-related complications.
What made me come to that conclusion? The hospital that was so careless about preventing the spread of a sometimes-fatal illness, and that was so astonishingly unhelpful in ensuring a patient with potentially life-threatening symptoms be fully evaluated and treated is the hospital serving the minority community in our state that had experienced the most serious COVID-19 outbreak at the start of the pandemic.
Gosh? Could the two facts be connected?
Now let’s be very clear: This is not racism as you or I tend to think of it. I have every reason to believe that all patients at this hospital are treated equally, regardless of race or income.
(–> I do think there must be stark differences in outcome based on education and social networks, though, for simple fact that if you don’t have Medical Twitter and personal connections as a resource, you’re stuck with just the help offered by your local provider.)
Furthermore, everyone at the hospital was kind and respectful. They just provided very, very little in the way of medical care, and were absurdly uninterested in keeping patients and care providers from infecting one another.
I’d also like to say right now that lousy medical care is not a defining ‘burbs vs. inner-city thing. Years ago we left a pediatric practice serving an affluent suburban community because the staff were so condescending and unhelpful, and switched to an inner-city sliding-scale-fee practice that came well-recommended, and where we’ve received far better care and where the staff are just nicer people.
All I am saying is that: In my state, like many others, COVID-19 outbreaks have had a disparate impact based on racial lines . . . and also, having sampled the care that is offered by the major medical center serving one of the hardest-hit communities along that demographic divide, there’s a rather glaring probable cause-effect relationship.
And if, furthermore, this situation appears to be echoing around the country, one begins to think there is something wrong with our system.
And that’s it.
We have a warning sign that there’s a problem we need to deal with, and that people are being hurt by allowing the problem to persist.
Update: This post edited to fix the most glaring and egregious pair of typos I can recall committing in a very long time. My apologies to the readership, and profound thanks to the kind soul who spoke up with a please tell me you didn’t mean to say . . .? intervention. FTR, usually it’s pretty obvious when I’m intentionally saying something appallingly stupid vs. when I do it by accident. But not always.