Coronavirus Exposes Inequities. Now, Let’s Address Them.

By Brett Lewis

This article was originally published in the online magazine In-Training on March 20, 2020. The original article can be found here.

I am a medical student in Oregon, and the novel coronavirus is just starting to take hold in our hospitals. Before the school cancelled clinical rotations for all medical students late last week, my team already had one confirmed case of COVID-19. I walked by the patient’s room in the ICU on my way to see another patient. A nurse inside the room was gowned up from head to toe in personal protective equipment (PPE), miming to another nurse through the glass. I stopped to make it out: “DNR (Do Not Resuscitate),” the patient’s code status should things go further south.

Unfortunately, at least with regards to the broader COVID-19 pandemic, things have certainly gone further south.

Last year, I spent nine months in Botswana. I repeatedly saw patients die of potentially treatable diseases because of systemic breakdowns: their diagnostic tests were delayed or the only available CT scanner in the country was 90 minutes away, unreachable in time. Now, 10,000 miles away, I am seeing similar breakdowns in our own health care system. This week, I’ve heard countless stories of suspected cases of the novel coronavirus across the United States not being diagnosed due to unavailability of testing services. Testing is even being denied to front-line health care workers who are left in fear of unknowingly transmitting the virus.

From a public health perspective, we in Oregon have nowhere near the number of cases as our northern neighbors in Washington, although with delayed testing it is hard to tell exactly how many people are infected. But as we continue to follow the pattern of disease spread that has been demonstrated in Wuhan and Italy, we can presume that things will only escalate from here. And with it, inequities will be laid bare.

As a student, I am often humbled by the field of medicine. I am humbled by science, and the ability to discover and invent treatments that target pathologies on the molecular level. I am humbled and inspired by our health care providers, who everyday go the last mile to deliver quality care to their patients. Above all, I am humbled by my patients, who, in addition to managing their illnesses, take time off work and childcare to navigate the maze of our health care systems. In the face of illness, my patients often find strength and humor that I cannot believe.

I am also humbled by the limitations of medicine, especially when it comes to treating the broader determinants of health, including poverty, structural racism and houselessness to name a few.

Perhaps the biggest lesson to be learned right now, amidst the COVID-19 pandemic, is not about social distancing, although that is important. It’s about global inequities and the need for true solidarity and system change. Looking back on prior crises, both global and local — the earthquake and subsequent cholera outbreak in Haiti, the Ebola epidemic, the aftermath of Hurricane Katrina, and the separation and detention of families at our Southern border — I often find myself wondering what it means to be in true solidarity as medical professionals and as individual citizens of this interconnected yet structurally segregated world.

In an age of growing nationalism and xenophobia and racism, what will bring us together as human beings who are both a part of and have the power to overcome systems? And I continue to wonder, at what point do we choose to override our systems before they crumble before us? What would I do if I were in the shoes of Dr. Chu, the infectious disease doctor in Seattle who started testing flu samples for COVID despite orders not to?

Strangely enough, the novel coronavirus is forcing us to realize that, despite the artificial borders we have created around ourselves, the United States is still a part of the broader world. This morning, I got a WhatsApp text from a friend from Uganda. She was reaching out to our multinational cohort of medical trainees who took a course last year in Uganda and Rwanda focused on addressing global health inequities: “Having all of you in mind amid COVID pandemic … how are we doing wherever we are?” I smiled despite myself as people’s responses flooded back from all over the world.

While certainly for a solemn reason, it was heartwarming to feel connected on such a global scale, unencumbered by power structures and national borders. That conversation illuminated a global truth: after several weeks of increased xenophobia, we must move beyond the point of discrimination. And with that, we must begin to question our established privilege here in the United States. We also must open our eyes to the limitations of our own health care system, the very health care system my peers and I are about to inherit.

Before this pandemic, I worried about my patients with multiple chronic conditions who struggled to find employment but at the same time stressed about making too much money that they wouldn’t qualify for Medicaid. With the novel coronavirus, I can only imagine the types of difficult decisions people are making in attempts to balance their health and the health of their families with the amount of food they are able to put on the table and keeping the lights on. Now, houseless patients are being asked to quarantine themselves, undocumented families are trapped in crowded detention centers and our prisons and jails are still filled.

We are no longer the country with all the resources and all the answers, if we want to claim we ever were. The good news is we are finally forced to stare in the face the fact that we have vulnerable populations within our own borders — communities who face extreme poverty, unemployment and limited access to health care. We are forced to realize the limits of our own health care system that is largely dependent on private insurance companies and patients who can afford to pay their medical fees. We need to take care of our most vulnerable populations. We need increased public health spending. We need Medicare for All. Maybe the novel coronavirus will be the tipping point.

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Brett Lewis is a third year medical student at Oregon Health & Science University in Portland Oregon class of 2021. In 2014, she graduated from UC Berkeley with a Bachelor of Arts in public health with a minor in anthropology. Before medical school, she worked as Program Coordinator of the UCSF HEAL Initiative, an organization that trains fellows from or who are dedicated to serving communities in Navajo Nation and countries such as Liberia, Haiti, and Mexico. She enjoys reading, running, and racing cyclocross in her free time. After graduating medical school, Brett would like to pursue a combined career in family medicine and psychiatry.