Questions of Bias in Covid-19 Treatment Add to the Mourning for Black Families

The Centers for Disease Control and Prevention have advised health professionals to be on the lookout for medical bias.

Ami Relf, right, holds a photo of her brother Reginald Relf alongside her mother, Cleona Relf, outside her mother’s home in Bellwood, Ill. Mr. Relf died there while quarantining in the basement after experiencing symptoms of Covid-19.Credit…Joshua Lott for The New York Times

The New York Times, May 10, 2020 By John Eligon and Audra D. S. Burch

Long dissatisfied with the doctor treating his diabetes, Reginald Relf decided to fight through whatever was causing his nagging cough. But then his temperature spiked and his breathing became so labored that he reluctantly took his sister’s advice to visit a doctor.

The staff at an urgent care clinic in suburban Chicago sent him home, without testing him for Covid-19 but after advising him to quarantine.

So Mr. Relf, a 50-year-old African-American engineer, settled into his mother’s basement. A week later, after he was found dead, his sister, Ami Relf, was left shaken.

“When I finally get him to go to seek help, he’s turned away,” she said. “If he was a middle-aged white woman, would they have turned her away? Those are questions that haunt me.”

The coronavirus has left tens of thousands of grief-stricken American families struggling to make sense of the seemingly random terror it inflicts, sickening many but only taking some lives.

But for many black families, mourning coronavirus deaths brings an added burden as they wonder whether racial bias may have played a role.

Decades of research shows that black patients receive inferior medical care to white patients. A long history of experimentation, exploitation and mistreatment has left many African-Americans deeply suspicious of the medical establishment. Now comes Covid-19, and the fear among many families, social scientists and public health experts that racial bias might be contributing to the disproportionately high rate at which the novel coronavirus is killing African-Americans.

Acknowledging a history of implicit bias in medical care, the Centers for Disease Control and Prevention recently advised health care professionals to be careful not to let bias influence their treatment during this pandemic.

Preliminary research by a Boston-based biotech firm suggests that treatment may not be consistent across the board. The study found that black people who visited hospitals with Covid-19 symptoms in February and March were less likely to get tested or treated than white patients.

Americans of all races may have experienced less than ideal care in recent months in an overwhelmed health care system, and it is not uncommon to hear stories of people who visited health professionals for treatment, only to be turned away.

But African-American patients enter the health care system with distinct disadvantages, experts say. There is less access to quality health care in many black communities, research shows, and black people are more likely to suffer from diabetes, hypertension and other underlying conditions that make Covid-19 particularly fatal.

So, should providers misinterpret or ignore coronavirus symptoms in black patients, there is a higher likelihood that the results could be grave, experts say.

The country’s largest professional organization representing black doctors is calling on federal health agencies to study the role bias may have played in the testing and treatment of African-Americans for Covid-19.

“I think what we will find is race is a factor,” said Dr. Oliver Brooks, president of the organization, the National Medical Association.

In previous studies, doctors have been found to have downplayed African-Americans’ complaints of pain, given them weaker pain medication for broken bones and withheld cardiac treatments from black patients who needed them. Research suggests that the decisions are the result of ingrained assumptions, cultural ignorance and hostile attitudes toward African-Americans.

The C.D.C. said in a statement to The New York Times that it did not have data to quantify the role of implicit bias in Covid-19 deaths. But the agency added, “Becoming aware of and reflecting on one’s own biases to help ensure they do not impact decisions is a potentially lifesaving step for clinicians to undertake.”

When Ms. Relf made an appointment for her brother at the Loyola Center for Immediate Care in River Forest, Ill., in late March, she said she was hopeful that the clinic would be able to test and treat him for the coronavirus. He had become extremely lethargic with persistent coughs and chills, she said.

Before Mr. Relf left the clinic, he called his sister complaining that the staff would not test him because he did not have a fever. He sounded defeated, Ms. Relf said.

“Quarantine at home for 7 days,” his discharge papers said. “Infection control will contact you regarding eligibility for testing.”

The family of Reginald Relf, from left, Kenneth Relf, Randolph Relf, Cleona Relf, Ami Relf and Randell Relf out side Cleona Relf’s home, in Bellwood, Illinois.Credit…Joshua Lott for The New York Times

The clinic set up an appointment for him to see his regular doctor 11 days later. Mr. Relf never made it. One of his brothers went to check on him after he stopped answering his phone and found his lifeless body crumpled in front of a couch. A posthumous test confirmed that Mr. Relf had Covid-19.

A spokeswoman for Loyola Medicine said in an email that privacy laws prevented it from discussing Mr. Relf’s case specifically, but that Loyola did not “discriminate based on race, age, gender or socioeconomic status.”

It is difficult to know if any individual medical decision was affected by bias.

Still, a 2003 report commissioned by Congress on racial and ethnic disparities in health care found that even controlling for income and insurance access, “Racial and ethnic minorities tend to receive a lower quality of health care.”

“Significantly,” the report added, “these differences are associated with greater mortality among African-American patients.”

A pilot study by Rubix Life Sciences, the biotech research firm, compared the severity of Covid-19 symptoms exhibited by more than 27,000 patients during hospital visits in seven states with the treatment they received.

The study, which has not gone through peer review, showed that black patients were six times less likely to get treatment or testing than white patients, said Reginald Swift, the founder of Rubix.

Dr. Brooks, medical director at Watts Healthcare in Los Angeles, explained the issue this way: “When we walk into an E.R., what they sometimes see is not a patient who is suffering from respiratory illness, they see a black man here who needs something.”

Gary Fowler’s family believes that the minimizing of his symptoms by doctors ultimately cost him his life.

Mr. Fowler, 56, who is black, had developed a deep, worrying cough, a fever and labored breathing, said one of his sons, Keith Gambrell. Over the course of five days, Mr. Fowler was sent home by three hospitals in metro Detroit, Mr. Gambrell said. A week later, Mr. Fowler died sitting in a blue recliner in his bedroom. He tested positive for the coronavirus after his death.

The three hospitals where his family said he sought care disagreed with the family’s account. A spokesman from one of the hospitals, Detroit Receiving Hospital, said, “there is no record of this individual coming to Detroit Receiving Hospital for any type of treatment.” The other two hospitals disputed that Mr. Fowler was denied care.

Mr. Fowler’s death added to the grim tally of deaths in Detroit, a city with a majority African-American population that has come to tragically symbolize the virus’s devastation of black America.

Kaila Corrothers mother, Deborah Gatewood, turned to the hospital where she had worked as a phlebotomist for decades when she got sick. She was sent home four times with nothing more than Tylenol and cough medicine.
Kaila Corrothers mother, Deborah Gatewood, turned to the hospital where she had worked as a phlebotomist for decades when she got sick. She was sent home four times with nothing more than Tylenol and cough medicine.Credit…Brittany Greeson for The New York Times

Kaila Corrothers believed that her mother, Deborah Gatewood, did not have to be part of that tally.

Ms. Gatewood, 63, developed a high fever in mid March. But in four visits over six days, she was sent home with nothing more than Tylenol and cough medicine from the suburban Detroit hospital where she worked as a phlebotomist for 31 years, her daughter said.

Days after that last visit, Ms. Gatewood became so weak at home that her daughter insisted she go to the hospital again.

“No, they’re not going to take me,” Ms. Corrothers recalled her mother saying.

But Ms. Gatewood collapsed and an ambulance rushed her to a different hospital, where she tested positive for the coronavirus and was placed on a ventilator.

On April 17, three weeks after being admitted, her heart, kidney and lungs failed, and she died.

Ms. Corrothers said she could not say whether the fact that her mother was African-American played a role in her treatment.

In her visits to the emergency room of her employer, Beaumont Hospital in Farmington Hills, Mich., Ms. Gatewood never presented with symptoms severe enough to warrant admission, a hospital spokesman said in a statement. Given the shortage of testing supplies, patients with mild symptoms were not tested and told to quarantine at home, but return if their condition deteriorated, the statement said.

The lack of resources in some hospitals and the overwhelming number of cases likely have played more of a role than bias in the negative outcomes for African-Americans, some public health experts said.

But, in another case that has raised concern of medical bias, the family of Robert Johnson Jr. cannot help but think that doctors could have done more for him.

He seemed to embody many coronavirus risk factors: 49 and black, he had diabetes, hypertension, a low-functioning kidney and a double amputation.

The day before Easter, he woke up too weak to leave his bed, eat, or tell his mother what precisely hurt.

The next morning, Mr. Johnson’s fever soared to 103.3 degrees. He was rushed to the emergency room at Yale New Haven Hospital. His mother, Gloria Johnson, 71, called the hospital hours later and was told her son had been given “the green light” to return home after receiving a chest X-ray that showed signs of pneumonia. The hospital did not test him for the coronavirus.

Ms. Johnson brought her son Easter dinner that night after his discharge. He had no appetite but she insisted he taste a few spoonfuls of yams. When she called the following morning to check on him, he didn’t answer.

She hurried to his apartment only to find him unresponsive in his bed. Ms. Johnson watched as emergency responders tried to revive him.

“I thought, ‘Oh my God, what if they had given him the Covid-19 test or even kept him overnight for observation? What would the outcome be?’” she said.

The medical examiner confirmed that Mr. Johnson had died of complications from the coronavirus and diabetes, Ms. Johnson said.

A spokesman for Yale New Haven Health said in a statement that they “understand the family’s concern.” The hospital was confident in the care provided to Mr. Johnson, but his case was under review, the spokesman said.

After Mr. Johnson’s burial in a graveside service in New Haven, his mother was preparing to have his old apartment packed and cleaned when she received one last call from the Yale hospital.

They were calling, she said, to schedule Mr. Johnson’s Covid-19 test.

Sheelagh McNeill contributed research.

Read the original article on the New York Times website.