KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5, welcome. Last week we held our third ever Kojo in Your Virtual Community event via Zoom, the topic this time, racial disparities in the pandemic. WAMU's Jeremy Bernfeld assisted me again by moderating and sharing the questions from the hundreds of attendees. A quick programming note, our next Kojo in Your Virtual Community will be Tuesday June 30th. Details on this event will be posted to kojoshow.org. So look out for that. And a reminder today's show is pretaped so we won't be taking calls or reading your questions or comments from social media during the broadcast.

KOJO NNAMDIThe coronavirus knows no boundaries. It has affected every community in the Washington region, but not in the same rates. Existing social inequalities in this country have increased the rate of COVID-19 infection and fatalities among communities of color and in communities already disadvantaged by poverty. The pandemic has also highlighted inequities in access to quality health and preventative care, which has fueled the racial disparities in the public health crisis. So how did we get here and how do we make sure vulnerable communities are better prepared if there's a second wave of the coronavirus? Let's find out.

KOJO NNAMDIWelcome to racial disparities in the pandemic. I'm Kojo Nnamdi. This Kojo in Your Community is presented by Sibley Memorial Hospital Johns Hopkins Medicine. We appreciate their support of this broadcast and of WAMU. Joining us now Maria Gomez, the President and CEO of Mary's Center, a clinic she founded over 30 years ago that initially provided prenatal and postpartum care to Latino women living in D.C.'s Ward 1. The clinic provides much more than that today, which we will discuss shortly. She is joining us from her office in D.C. Maria Gomez, thank you so much for joining us.

MARIA GOMEZGood evening, Kojo.

NNAMDIDr. Christopher King is an Associate Professor and Chair of the Department of Health Systems Administration at Georgetown University. He's joining us from his home in Ward 5. Dr. King, thank you for joining us.

CHRISTOPHER KINGThank you, Kojo. It's a pleasure to be here.

NNAMDIAnd Dr. Sherita Golden is a Professor of Medicine and the Vice President and Chief Diversity Officer at Johns Hopkins Medicine. She joins us from her home just outside of Baltimore. Dr. Golden, thank you for joining us.

SHERITA GOLDENThank you for having me.

NNAMDIDr. Golden, I'll start with you. Nationally black people account for 13 percent of the population. Yet we've accounted for 24 percent of COVID-19 deaths. That means that black people are dying at a rate about two times higher than our population. And some studies suggest the rate is even higher. And in D.C. where African Americans are 44 percent of the population, black people represent 75 percent of COVID deaths. Dr. Golden, how has this happened?

GOLDENWhen the pandemic first started a lot of the focus was on the fact that African Americans, other people of color have more co-morbidities, like, diabetes, cardiovascular disease, obesity and lung disease. But I think we really have to step back and ask ourselves why do those individuals have a higher risk of those co-morbidities, because the disparities that we're seeing in COVID-19 aren't really new. It's just that COVID is killing people at a higher rate. So it's just more visible, and so I think we have to really look at -- think of these things in three buckets.

GOLDENSo one is the medical and scientific contributors to disparities. So there has been a history of experimentation on communities of color without their consent that started during slavery and even continued in the post-Civil War era, and so that has led to a distrust in the medical system. So even those of color who have insurance, have access, you know, may feel uncomfortable coming to see the physician, because of how they're treated in the system.

GOLDENAnd in addition, there (unintelligible) of black doctors to care for our vulnerable populations, because following the Flexner Report in 1910 we had the closure of many medical schools, because medicine went from being a trade school to being more evidence and scientifically based. But what that meant for those medical schools educating black doctors that out of the seven that were there five were closed. So after 1910 there was only Howard and Meharry left at a time where we didn't have access to predominantly white medical schools. So there aren't enough doctors of color to take care of the population. And so all of those things have led to many African American patients having biased experiences in the healthcare system.

GOLDENAnd then I think about the social contributors. And so these are things like redlining, predatory lending practices, discrimination of federal housing loans that led to housing instability, a lack of investment in neighborhoods where, you know, African Americans were living and a lack of investment in schools systems. So consequently these neighborhoods then have very poor walking spaces. So it's very difficult to do physical activity. They have poor access to healthy food, and so all of those things increase the risk for chronic diseases as well.

GOLDENAnd then the third thing is that African Americans have been more exposed to COVID. And that's because it's not uncommon in our communities that we have had what are considered essential jobs, where we're working in the food sector, the transportation sector, the security sector. So those communities have had to go to work often without proper PPE using public transportation, which increased their exposure to COVID. And then, of course, many people are living crowded multigenerational housing. And then there's the overcrowding and representation of African Americans in our crowded prison system.

GOLDENSo all of these things have led to increased exposure. So if you have these preexisting conditions and then you end up with more exposure to COVID and you get the infection you tend to do more poorly and die at a higher rate. So really it's a structural racism that's contributed to the disparities that we're seeing.

NNAMDIDr. Christopher King, as I mentioned earlier black people in the District represent a staggering 75 percent of COVID deaths. You and your team recently released a report that looked at health disparities in the black community here in D.C. What did you find? And I should point out that this data is pre-COVID information.

KINGYes. Thank you for saying that. That's important to note. So overall when we look at the health of the District of Columbia we look really good. But when you stratify data by race and ethnicity there's a totally different narrative there. For example, African Americans in the District are seven times -- the rates for diabetes are seven times higher than whites, heart disease, two times higher than whites, obesity, three times higher than whites. Residents who live in wards with high volumes of African Americans, Wards 5, 7 and 8 are more likely to be hospitalized for preventable health conditions.

KINGWe also looked at data by ward. And I think one of the most stark disparities that we found was that there's a 15 year life expectancy between residents of Ward 3 and Ward 8. We looked at median household income. We know that median household income in residents -- excuse me in African Americans is three times lower than whites in the District. And when we look at educational outcomes, African Americans, who have an undergraduate degree or higher it's about 25 percent versus 90 percent of whites.

KINGSo it's important to know that. And I'm glad that we did release this data pre-COVID, because it will be important for us to look at data moving forward because we know that this has taken a significant toll on black communities not only in the District, but nationwide.

NNAMDICould you repeat the disparities that you found between residents of Ward 3 and residents of Ward 8?

KINGYeah, so a 15 year life expectancy difference.

NNAMDIBetween Wards 3 and 8. Ward 3, of course, being the most effluent ward in the city and Ward 8 being a low income ward. Maria Gomez, Mary's Center is one of the area's biggest frontline healthcare providers for communities of color and the disadvantaged. How did it begin and how does it serve these vulnerable communities today?

GOMEZSo we started with -- thank you, Kojo. We started with serving the immigrant population back in the 80s when the first wave of immigrants from Latin America came particularly for pregnant woman and their children. And now we are seeing people from all over the city. And the idea is to make sure that we are focusing not only on the healthcare, but we're focusing on the social supports and the education of individuals as we know that the structural inequities that Dr. Golden and Dr. King were just talking about have to do with poor health, poor education, poor justice systems that subjugate these populations to where they are today.

GOMEZSo today the immigrant population that we're serving, you know, has better insurance in the District of Columbia, but we're still struggling in other parts of the region. We are seeing that although they have health insurance accessing the health that they need, because of their language, because of the hours that they work is difficult at times.

GOMEZWe saw with COVID that they were either the first ones to be laid off or if they were not laid off, they were the highest at risk because the individual immigrants were subjugated. I can give you an example of someone who, you know, was in construction and was actually -- either you take the job with very little gear to take asbestos off of a building or you don't work.

NNAMDIHave the majority of your COVID-19 patients been people of color?

GOMEZYes, they have. They have been -- first we have a very large population of immigrants. About 65 to 70 percent of our population are immigrants, and we have right now more than half the population that we have tested has tested positive.

NNAMDIJeremy, we have a question?

JEREMY BERNFELDWe do have a question. This is from Jeni in Adams Morgan. She asks about, "The role of food deserts, poverty and racism can lead to limited food choices. That leads to chronic diseases and vulnerability to infectious diseases. What will it finally take to get healthcare providers including the Department of Health to realize that this is low hanging fruit and launch a massive public health campaign at least as a first step?"

NNAMDIDr. Golden.

GOLDENYeah. So that is an excellent question. And, you know, as a diabetes specialist one time someone asked me, what is the most important intervention to end disparities in diabetes? And I said it would be to fix the environment. And so I think that it's really important for us as physicians and for healthcare organizations to really advocate for legislation that directly addresses those disparities in healthcare. And in fact I was speaking with one of our Maryland legislators about that yesterday. And so we actually need to legislate if you will a lot of those healthy practices, you know, into neighborhoods.

GOLDENSo, you know, there should be -- like there's a fire hydrant every so many blocks. There should actually be healthy food choices every so many blocks that do not require someone to get on a bus to access healthy food. And we also need to make it so that healthy food is affordable to the community. And, you know, one of the challenges is often what's available in food deserts is less expensive. So you get more dense calories for less money, but those are unhealthy calories that lead to chronic diseases. And so I think it's really important that the cost of eating healthy is not so high that it's not accessible to the communities.

NNAMDIChristopher King, anything you'd like to add to that?

KINGObviously we're in an interesting moment right now in this country. What it's going to take, I think, is in addition to legislation is an investment in historically marginalized communities particularly communities of color. And what we're seeing right now is very very fascinating to me. We're seeing COVID-19 and how it's impacting communities of color locally and nationally. We have the killing of George Floyd and so many others. That's been magnified and that also is all part of this -- it's all connected. And then we have Donald Trump in the White House, right?

KINGSo these issues are being magnified in ways that have not existed in the past. And to me, I think that there's promise. I see that there's promise associated with where the country is and the conversations that we're having, but to go back to the question, it's going to take an investment in communities of color. And we're starting to see corporations, public and private sector, roll up their sleeves and actually do some heavy lifting in this space.

NNAMDIMaria Gomez, throughout this pandemic many people had to work. They couldn't have afforded not to. And they don't have the luxury of working from home. Who's coming to your clinic right now? And what situations are complicating things for them?

GOMEZYeah, so what we're seeing, I just want to go back to the food piece. One of the things that people are coming to us for is that they're hungry. They don't have a job and they're hungry. So that's a big thing. They also don't have a job, don't have money, and either have become homeless or about to become homeless. So those are the reasons that people are coming in is they need that cash assistance. For many of the immigrant populations and even people, who just because of their job situations they didn't get that stimulus check or it got complicated and didn't get it. So many many people were cash strapped for money.

GOMEZI think that the people that are also coming are people that the mental health, the stress for so many people that are poor and immigrant and people that are already had so much issues in front of them in regards to immigration, this has really doubled up. And what people are telling me and telling the providers is now that the streets are empty, they're even more scared, right, to walk in the street as an undocumented individual.

GOMEZSo those are the stresses that us as regular individuals don't realize, right? Just coming to the clinic on an empty bus, on an empty street is a fearful thing. And getting sick for some of our folks, you know, in the city many of the folks are insured so that's a luxury. For some of the suburbs they're not. And so they're scared to come to a doctor, because of the bill. What it -- how am I going to pay the bill?

NNAMDIJeremy, we have another question.

BERNFELDThis question is from Sarah, "What can your average citizen do to help address these racially based healthcare disparities?"

NNAMDIAgain you, Dr. Golden.

GOLDENSo I think there are many things. And so, you know, it depends upon what environment you find yourself working in. I think that there are certainly things, for example, around food insecurity, being able to, you know, donate to the local food banks. Many of the local food banks have been supporting the communities that have food insecurity during the pandemic that we've been talking about. And, you know, being able to provide resources for vulnerable communities to receive fresh fruits and vegetables. So, for example, farmer's market trucks that come into the community so that people -- if there isn't a place to set up garden, bringing those resources into the community.

GOLDENI think it's also really important if you are in a position to have access to resources or companies that really want to directly impact the community as Dr. King was, you know, donating money to actually fortify and build schools in a community and a neighborhood. And, you know, really having academic medical centers partnering with community based organizations and non-profits organizations to really begin to bring some of those resources to the community. You know, I think some other things that are important, because often the problem may seem so big you feel like there's not anything specific that you can do. And I know for me personally mentoring the next generation of, you know, future potential physicians, scientists, healthcare administrators is a passion.

GOLDENSo, you know, one of the things I've been very involved with in is a longitudinal high school student pipeline program that we have in Baltimore. And I know there are ones in the Washington area. And I've involved myself with their board and helped mentor students. So I think there's sort of small and large -- there are small things you can do. But certainly if you know people who have resources to invest in the community, I think that's important, and then using your voice to advocate to our legislators to put legislation in place that will result in investment to our communities.

NNAMDIJeremy, we have another question.

BERNFELDThis is a question from Jim. Jim says, "In my area in Maryland Hispanics have a much higher rate of cases than even African Americans. Deaths is a different story where the rate of African American deaths are higher. Any ideas why?"

NNAMDII'll start with you this time, Maria Gomez.

GOMEZI do think that there's this tendency to think that African Americans for some reason, their bodies are much vulnerable or something that allows them to die a much more than other communities. But I think that going back to Dr. Golden and Dr. King the years and years -- 400 years of racism has really taken a toll on the Afro American community that I think, you know, I want to say that it's the economic influences that makes this deficient, right? It's not that people's bodies are more vulnerable, but it's the environmental situations in which people find themselves. You know, the poverty, the years and years of limited quality education for communities. And we're starting to see that, us, immigrants stay here longer, right?

GOMEZThe amount of years that Afro American went uninsured without healthcare, right, the poor housing, the inability to get mental health services for so many years, yhe food insecurity and just the inhabitable housing if you want to call it that. That all has an impact on how the body really reacts to situations like this.

NNAMDIDr. Golden.

GOLDENCan I add ...

NNAMDIPlease go ahead.

GOLDENYeah. I wanted to add to that, because one thing that, you know, sort of early on in the pandemic it seemed to be, you know, it was older individuals and it was more, you know, that you were at high risk, because you had poverty. I think the other thing with African Americans is that, you know, there are many African Americans that have chronic diseases, you know, that put them at risk for a worst outcome with COVID. And they haven't necessarily been exposed to the lower socioeconomic status or the housing insecurities.

GOLDENSo, you know, what that really suggests is that this exposure, this long standing exposure to structural racism even if you're educated in a higher socioeconomic status, that chronic stress, you know, can alter the body's immune response. It can cause changes in your genetic architecture to adapt that environment that increases your risk for disease. So, you know, in addition to the social factors there are these other biological factors even independent of the socioeconomic status that likely are contributing as well.

NNAMDIThis racial and economic disparity, Dr. Golden, unfortunately is not unique to the D.C. region. Is it? Are the numbers are just about the same throughout the country?

GOLDENThey are unfortunately, and so if we look at like Richmond, which is just to the south of us. In Richmond, out of the COVID deaths about 62 percent of them are African American. If we look at Chicago, my son goes to college outside of Chicago, 72 percent of the deaths are in African Americans. And in Milwaukee, which was one of the first cities where this disparity was noted, 81 percent of the deaths are African American. So this is throughout the United States.

GOLDENAnd the other thing that's very compelling if you look at, you know, the 40 states in the District of Columbia where we have data on race that in the majority of those states and in specific cities where we have data it is not uncommon for the rates of death among African Americans from COVID to be anywhere from 20 to 30 percent higher than their percentage of the population. So this is really a national issue as Dr. King mentioned earlier.

NNAMDIAnd, Dr. King, you describe what you do as bridging the gap between medical care with what's happening in the community. Can you describe what you mean by that? And how are you able to bridge this gap?

KINGBridging the gap between the healthcare delivery system and public health. So I always talk about in this country, we have done a pretty good job providing medical care. We have not done the best around providing healthcare recognizing that my health is mostly shaped by the community in which I live, right? And so medical care to me is defined as did I get the right preventative health services. Do I have the medication I need to stay well. Do I have access to doctors? And that's important.

KINGBut what about the rest of my life? And do we have a system of care that is designed to meet the needs of patients holistically? And that requires us to bridge that gap between within the walls of the hospital or the healthcare delivery system and the community. So my work is around, you know, if we're looking at patient needs and we know that a patient, who is being discharged and they're going to a home in which they're socially isolated. They don't have support. They live in a community that does not have the resources to keep them well. Perhaps they've even had a surgery. How do you make sure that that patient when he or she is discharged has the resources that are necessarily to keep them from coming back to the hospital, and that requires a different way of thinking.

KINGIt requires a different way of how we organize and deliver systems of care. It requires us to develop partnerships with community based organizations. It requires us to rethink funding and how funding is allocated to support holistic needs of patients.

NNAMDIJeremy Bernfeld.

BERNFELDThis is a question from Heather in Ward 1. "What are two to three very specific programs, programs already funded by D.C. Council, and around which there's a consensus on effectiveness that can make a measurable difference if increased five or tenfold?"

NNAMDIMaria Gomez.

GOMEZYou know, healthcare really needs to be surrounded and embraced with social supports that really are meaningful. Like for instance when people come to Mary's Center like this where we have the healthcare, the social services that includes mental health and all of that. That we have dental health. That we have a charter school for both the parents and the children up to pre-K. That is meaningful.

GOMEZThat is why parents come and they take care of their diabetes, because when they come to Mary's Center and they get their medication for diabetes, they're also talking to their provider or talking to the social worker about things that may be mundane to us, but for a lot of populations that are really financially under-resourced, things like internet. Internet not just to watch movies, but actually to get their children the school that they need, right? We had people who had three kids, one computer and couldn't afford internet. So, they came to Mary's Center. How can you solve that problem?

GOMEZJobs, you know, we have to be centers like this where we can actually get people jobs where they can feel that they are doing something meaningful for their families and moving up that economic ladder, just like all of us. Learning English, assisting the family members with someone who's in the justice system. So, you know, how do I get a good lawyer, so that my child who did something really insignificant can get out of jail?

GOMEZSo, those are the kinds of things that I think that we need to multiply, programs that really surround and partner with each other. One agency can't do it all. But, for instance, at Mary Center, we have about almost 50 partnerships throughout the city with (unintelligible) from universities to law firms, to you name every other organization in the city, to make sure that we stretch that support for families when they come in and get their health care. That is exactly what gives us the best health offerings.

NNAMDIJeremy Bernfeld.

BERNFELDThis is a question from Michelle. Michelle asks: So many immigrants lack health insurance. This has deterred many from seeking care. But even those that have sought it out now face large medical bills from the treatment of COVID-19. How can governments at all levels support both hospitals and patients with these financial debts?

NNAMDIDr. King.

KINGSure. So, there's dollars that have been made available to support hospitals, especially in the District of Columbia, to make sure that patients' needs are met. So, that's important. I think that we have to continue to advocate for immigrants and those who are uninsured to be sure that they have access to the continuum of services that are necessary to keep them well.

KINGWhen we're talking about COVID and COVID infection and given the -- it's such a highly infectious virus, that this is going to require us to look at how dollars are allocated and use emergency funds to meet the needs of patient populations. And we're seeing that in the District, and we're seeing it in other cities across the country. Because what has worked in the past will not work for what we're experiencing right now. This is a very, very unique situation that is requiring us to think outside the box and redistribute resources. Because it is a public health issue.

NNAMDIMaria Gomez?

GOMEZIn terms of this, I think that we need to make sure that we, again, be comprehensive in how we look at the person. There are people that qualify for Medicaid, and they don't think they do, right. We need to make sure that they do that. It's so many of our elderly who can qualify for Medicare, but the system can be complicated for them, at times, right.

GOMEZSo, we want to make sure that we -- in terms of those bills, we want to make sure that, as part of the health care system, that we advocate both at the city council and at the federal level, that we need to do something about this. Because many people have gone hungry and homeless because they're trying to pay their medical bills. And you're absolutely right, that is just -- it's unconscionable that that can happen in this country, at this time.

NNAMDIAnd Dr. Golden.

GOLDENYeah, and, you know, I would add I think it's really important to make sure we're taking full provision of the provisions of the Cares Act to make sure that, you know, again, patients are being inappropriately charged for testing. I think it's also important to think of providing the financial resources for the individuals who do test positive, you know, who perhaps don't have a way to isolate.

GOLDENYou know, I know that there are programs in the National Capital Region where there are hotels where people can isolate, where they don't have to pay for the time that they're there, but they're safe. And, you know, I know at Johns Hopkins Medicine, we've been working with our partners down in the National Capital Region to do similar things to what we've done in the Baltimore region, but trying to make sure we can get food delivery to those who are isolating, particularly like our immigrant communities who may not have access to, say some of the other public assistance that's available.

GOLDENSo, I think that we have to really think uniquely about how we can defray some of those financial costs by using the resources that we have available in the system.

NNAMDIWe're seeing massive sustained protests here and around the country against racial inequity and police brutality. What are your thoughts, each of you, about how inequality in health care fits into this moment? Starting with you, Dr. Golden.

GOLDENYou know, it's interesting. I thought a lot about that in the last week. And, you know, I think what's common is that the root of the inequities in health care and the inequities of the criminal justice system are the same. So, it's really like this 401 years of structural racism, you know, that perpetuates the way that people behave. So, the same biases that there are in the health care system that, for example, you know, Ms. Gomez mentioned earlier that, you know, African-Americans are dying at a higher rate.

GOLDENAnd part of that is because it was not uncommon that three times, somebody went to the EB and said, you know, I'm coughing, I'm out of breath, I don't feel well. And they weren't tested and they were turned away. And then when they finally got tested and came in, they were so sick, they passed away.

GOLDENAnd that's the same kind of bias that we have in our criminal justice system. It's the same bias in our educational system. So, again, if we can really begin to dismantle the root cause. And, you know, my father and my brother were at the 1963 March on Washington. And, you know, they were marching to get that legislation put into place. I feel like now, people are marching to change behavior and culture, because, you know, rules don't change behavior. You know, it's sort of like culture and really like rethinking, you know, how we deliver care, how we do criminal justice, how we do everything in our country.

NNAMDIMaria Gomez?

GOMEZYeah, totally agree with Dr. Golden. I think that I would also just add something different, and that is, this is the opportunity. This is the opportunity to really think innovatively, to really think out of the box, like Dr. King said, and to think about what are some of the things in the justice system, in the health care system that we can continue to fund.

GOMEZMaybe it's not defunding the police department, but maybe it's saying how much of that funding should go to community policing, as opposed to putting people in jail, right. And it's not necessarily just take it all to the Social Service Department, but how do we have a conversation that really talks about change.

GOMEZI think that this is one of those times where I am so passionate and I had said to our community here at Mary Center that we will make this our mission. We will change policies in this country that will enable everyone to be treated equally, and we're not going to let anything stop us from doing that. We're going to hold hands with the national organizations, with community organizations, with government, with, you know, foundations. And hold hands together to make sure that this does not end up like with the whole gun issue. This has got to change. Systems have got to change to break up this racism in this country.

NNAMDIDr. King.

KINGYes, Kojo. I'm calling for major reform in the practice of medicine. I say that because we still -- if you look at how physicians are trained in this country, there's still this focus on race. And you look at the person, the color of their skin, and you make all kinds of assessments that are inappropriate or ill-informed, right. And so what we have to look at is the socio context -- environmental context of individuals in the population in the communities in which they reside.

NNAMDIJeremy Bernfeld.

BERNFELDThis is from Laura, in Ward 1. She asks: what can we do to foster trust between communities of color and the health care system?

NNAMDIMaria Gomez.

GOMEZSo, the first thing, I think, trust between communities of color and the health care system, I think that I would just say -- I'm in the health care system, and I would say that it is up to us in the health care system to actually -- you know, we say that the patient is not complying. The patient is not complying because we're not complying with that patient. We are not open at the right hours. We are not giving them the time that they need to express if they have problems that are actually comprehensive.

GOMEZSo, we need to have a relationship -- I would say to audiences that are listening to this, do not go to a doctor that you don't feel like you can discuss anything and everything without being judged. As Dr. King said, you know, we need to make sure that we instill sort of a sense of opportunity for all children, all children to be able to choose health care as a choice of field that they go into. I think that it's not 100 percent, but if there were more people that looked like the people that they're serving, it would have a lot to do with the outcomes of individuals.

NNAMDIAnd, Dr. Golden, even today, you hear African-Americans refer to the notorious Tuskegee Study when it comes to trust in the health care system.

GOLDENYes. Yes. And that -- you know, it's interesting, for those on the listening end who may not be familiar, that was an experiment that was done in Tuskegee, Alabama, funded by the U.S. government, a public health service. It lasted for about 40 years, and basically black men who has syphilis were followed as a natural experiment to see what would happen if the syphilis was not treated.

GOLDENAnd the problem with that is that penicillin was known for years to be a treatment and cure for syphilis, and they were denied that treatment. And that not only happened in Tuskegee, Alabama. It also happened in Guatemala. It was the same physician that oversaw those studies. So, now we have communities that are afraid, because they feel that just given a flu shot, which they need to keep them healthy, is somehow an experiment.

GOLDENAnd so there is just cause for people to think that way. And I think that's why some important solutions are we do need to have more black and brown physicians who are a part of the health care system. It's been shown that race concordance and the doctor-patient relationship improves care. It improves participatory decision-making and engenders trust.

GOLDENAnd I think it's also really important that, you know, we actually teach patients how to be an advocate for their own health care and to ask the questions and teach our physicians how to receive that, so that our young physicians -- this is an exchange and not a paternalistic relationship. And I think that will really help to go a long way engendering trust.

NNAMDIDr. King, on the issue of trust.

KINGYes, absolutely. So, a lot of my work is around working with hospitals and health systems to address issues like this. Trust, what does it take? It's going to take a shift in power, right. It's going to require leaders of these organizations to shift their power into communities and allow the communities to find their way and not have this mindset that we can save the day for a community of color.

KINGSo, what does that take? Well, first, we've got to look at the board of directors of these institutions that are running health care corporations, right. And they do not look like me, many of them, right. And so what you have is you have people who are making decisions about communities of color, and they're so disconnected from the day-to-day lived experiences of folks.

KINGSo, if we're going to address the trust issue, we need to be at the table. People of color need to be at the table, and they need to know that they are part of the process, and not recipients of a system that's just there to benefit from them in the long run, right. So ,that's a big part of it.

KINGAnd one way that I've tried to help focus understand that is through this concept called learning journeys, in which we take board leaders into communities or color, historically marginalized communities. And they literally go into people's living rooms and sit down. And they look at the lived conditions of folks who live in apartment complexes that have not been kept up to par, and they have conversations with people.

KINGIt's one of the most powerful experiences that I've seen, actually, when it comes to helping people who really want to do the right thing, but just haven't had the opportunity to do something in such a powerful, structured way.

NNAMDIAs thousands march in the streets to protest the killing of George Floyd, as thousands flock the beaches and boardwalks, like Ocean City and the overall reopening of our country, a lot of people are concerned about a second wave. Jeremy Bernfeld, you have a question along that line.

BERNFELDThat's right. As we anticipate the second wave of the COVID-19 pandemic, are there some lessons from the last three months that we can apply to these underserved communities to reduce the impact of the second wave? We have others asking questions particularly in light of crowds here in Washington at the recent protests.

NNAMDIDr. Golden.

GOLDENYes. So, if it's one thing, I think, that we've learned is that, you know, sort of the public health preventive measures were actually effective. So, the social distancing and the hand washing and the wearing the mask. I mean, I remember, at the beginning of the pandemic in early March, when our hospital and their health system were thinking, you know, how are we going to manage the number of patients that we're anticipating? And are we going to have enough resources? And all of those things.

GOLDENAnd then the idea was by, you know, sort of closing things down for a period and socially distancing, that we would bend the curve and flatten the wave. And that actually happened. We never reached a point where we didn't have enough resources and we were able to care for everyone that we needed to. So we know that those measures work.

GOLDENAnd so I think that we need to do those measures, but I think in terms of protecting our vulnerable communities, we're still going to be more susceptible. I think with the second wave we need to actually look and see are the rates of infection -- like, that trajectory, is it higher in those vulnerable communities? And do we need to, you know, actually have them start re-putting these measures back in place sooner? And, you know, really looking at those things closely.

GOLDENSometimes I feel like there's almost a tale of two Americas. So, there's sort of the privileged America, where the rates of COVID are going down and the hospitalizations are going down. And then there's a tale of vulnerable America, where that may not actually be happening. So, very similar to Washington and to what, you know, Marie Gomez has described in our Latino population, immigrant population in Baltimore, they're still getting quite sick, and half of those tested are positive.

GOLDENSo, I think that in order to prepare I think that we need to put measures in place for our vulnerable communities sooner rather than later, and making sure that we not only have mobile testing capacity ready to go to those communities in a second wave, but that we have the personnel to help do the medical follow-up and to also do the contact tracing. I think that we can prepare now for what we would need to do in that situation.

NNAMDIMaria Gomez, from a perspective of someone in charge of overseeing multiple health centers in this region, what do we need to do to prevent this from happening again?

GOMEZSo we need to do a lot of education. We need to spread the word. We need to -- you know, one of the things that we did just within our own health center is the virtual introduction of how to wash your hands properly, right. So, basic education. I think we assume that everybody knows how to do that. I think that the other is make sure that people understand the things that Dr. Golden just talked about, about the masks, about the distancing, how important that is and to show, you know, very pictorial, how that is happening, compare ourselves to other states that actually were in trouble.

GOMEZI think that the other is that we need to really focus on making sure that we advocate for the affordability of PPE, right. Because that is not affordable, and it's not accessible to everybody. So, we have patients that come here that are saying, you know, I can't return to work because I don't have a mask. Well, you know what? We need to really advocate to make sure that those construction companies, that those restaurants, that those places that people are doing (word?) and the cooks, that those places actually provide the PPE.

NNAMDIDr. King, what do these communities need so they're better equipped to take on the next wave, or the next pandemic, for that matter?

KINGSo, I think we've heard PPE, that's really important. And, I'll tell you, when this all started, you know, Dr. Fauci and so many were saying, wear your mask, wear your mask. And I went to places where you would think you could find a mask. I went to a Target, I went to a CVS, I went to Walgreens. No masks to be found. I couldn't find any masks. And the whole world was telling me to wear a mask, right. So, those masks need to be ubiquitous. They need to be everywhere, because we know they're very effective. So, that's one.

KINGThe other piece is around surveillance and looking -- making sure that we are collecting data in real time and making that accessible. So, it took us a while to report data by ward. Now we're doing that. I think we even need to go more granular than that. We need to pinpoint cases as quickly as possible so that we can have the necessary targeted interventions. So, go as granular as we possibly can, so we know where cases are. Contact tracing is going to help us do that.

KINGThe other piece is around emergency funds to support public health innovations that are led by organizations that do work in communities of color. Again, this goes back to being creative in how dollars are dispersed to address and support those individuals or those organizations that do work on the ground each and every day. They're very knowledgeable about what's happening in their local communities. That goes back to the shift in power, right, and making sure that those dollars go into the pockets of the organizations that can do meaningful work on the ground.

GOMEZHey, Kojo, can I mentioned one thing really quick? I would be neglectful if I don't do this. I think that it's really, really important to make sure that we also push for internet that is accessible to everyone. Because tele-health is the way that we have learned that people actually can access health care, but without the internet, people cannot do tele-health. And so I think that that's something that we are trying to push in the city.

NNAMDIWhat about young people, Jeremy Bernfeld? We have a question about that.

BERNFELDThis one's from Bernard, in Washington. I'm a 23-year-old black man, and I can say I know how serious COVID is and how dangerous it can be. There are many young adults and teens who do not take it as serious or see how their actions affect others, especially during these trying times with protesting and being quarantined for quite some time. What message can you put out there to motivate the younger generation to take this COVID issue more seriously?

NNAMDIDr. Golden, a lot of what we were hearing is about how people who are at risk are people who are older or people who have compromised immune systems, which may have led some young people to believe that they themselves are immune from coronavirus.

GOLDENRight. So, no, I think that that is true. And so there's a couple of things we know. So, one is that even if you are a young person and you get coronavirus or say you have it asymptomatically, just remember that you can transmit that, even without symptoms, to your grandparents, to your aunts, to your uncles, so those who are at risk. So, you can become a vector. That's important to remember.

GOLDENAnd then we're now seeing in children this very unusual, like, Kawasaki-like syndrome where, you know, they have blood clotting and a vasculitis. And it's a very, very serious illness. So, you know, with the experience in the United States, we're actually finding that just because you're young doesn't mean, you know, that you are completely immune from COVID and its complications.

GOLDENBut I think it's very important to remember that, as a young person, you could be a vector to an older person who is at high risk. So, we all need to exercise our, you know, responsibility. And it's difficult. It's summer. I have a 20-year-old. I know how that is, but, you know, it's really, really important that we all have to take this as a social responsibility.

NNAMDIDr. King, reading from your report now, findings of this report will inform policymaking, advocacy of genders, appropriation of equitable resources and education for the general public. What are your hopes for this report, and how do you think it might be able to change policy?

KINGYeah, my hope for the report is that it gets into the hands of -- especially now that we have this awareness of systemic racism and the impact that it has on society. I'm going to go big picture, on society, right. And so, my hope is that the findings and the recommendations -- there are recommendations in the report -- will stimulate conversation and action within the clinical systems of care, in the health care delivery system, as well as the broader community.

KINGThrough those recommendations -- and, again, this is the second report -- we've had so many organizations reach out to us because they have been informed as a result of the report and its findings. So, the goal for us is just to continue to refresh the data and provide information that will help organizations think differently about how they are organized, how they deliver services, how they're structured, who they actually partner with in the community, and that they are applying a racial equity lens in everything that they do.

NNAMDIDr. Golden, I see you nodding in agreement. Is there something you'd like to add?

GOLDENYes. I mean, I think I like the statement Dr. King made about, you know, a health equity lens and how we deliver health care. And, you know, I remember at the start of the pandemic, you know, I sort of felt like, you know, one of my important roles as a chief diversity officer is not just thinking about workforce diversity and inclusion. But our office also oversees health equity operations for our whole health system, which includes Sibley and the other hospitals in the region.

GOLDENAnd it was really important to me that in everything we were doing in responding to the COVID-19 pandemic, that we approached that with a health equity lens, that we made sure we were implementing the class standards. We were providing interpretation. You know, we were providing all of our education materials in all of the languages that are spoken in our health system, just really making sure that we were giving those vulnerable communities the best experience.

NNAMDIMaria Gomez, we haven't discussed mental health. Mary Center offers mental health services. Have you been seeing a rise in mental health patients?

GOMEZOh, we can't keep up with the demand. It's just tremendous. From just basic, you know, I'm scared, I'm concerned, to I'm suicidal, to children who -- of staff and of clients -- who are saying to their parents, mommy, am I going to get killed? Am I going to die? What happens if you die? What happens to me?

GOMEZAnd so with all the protests in the African-American community and children that are mixed, right. We have many, many children that are mixed in our community here. And just feeling the burden of being an immigrant, but also being black is really, really overbearing, just too much. Our staff is feeling the same way. And so we have staggered the staff so that they can do a lot of this by tele-medicine, having them to take time off.

GOMEZBut the resources are not there in terms of, you know, the capacity to be able to see all the people that we want to see. We're very concerned about the people with substance abuse and their treatment and how they're coping. So, yeah. So, there's a lot of need, but I think one thing that I can shine a light on is that tele-medicine has really, really, really allowed us to, like, tenfold do the services that we did before. But even with that, we need services.

NNAMDIAnd I'm afraid that's about all the time we have. Dr. Christopher King is an associate professor and the chair of the Department of Health Systems Administration at Georgetown University. Dr. Sherita Golden is a professor of medicine and the vice-president and chief diversity officer at Johns Hopkins Medicine. And Maria Gomez is the founder, president and CEO of Mary's Center. Thank you all for joining us.

NNAMDIWe've heard a lot tonight, and thank you all for showing up and participating. We hope you'll continue to engage with us on this topic. Our next virtual town hall will be June 30th, so please watch out for details on that. Check back for more information at kojoshow.org. Before we go this evening, we'd like to say thank you to our wonderful engineers, the Kojo Show team, especially Monna Kashfi and Kurt Gardinier, marketing and events, and to the rest of our colleagues at WAMU for taking this show on the virtual road.

NNAMDIWe're especially grateful to WAMU's general manager J.J. Yore, as well as Andi McDaniel and Diane Hockenberry for their support. This Kojo in Your Community was presented by Sibley Memorial Hospital, Johns Hopkins Medicine, and we appreciate their support. I'm Kojo Nnamdi.