Respiratory Disease and Racism Have Reared Their Ugly Heads With COVID-19

As physicians, we affirm the view articulated in a recent Annals article, penned in support of the ACP’s New Vision for U.S. Health Care, that “achieving health equity … necessitates intentionally addressing underlying structural drivers, such as individual and structural racism and discrimination" (1).

This belief—in the need for the medical community to address discrimination as a driver of health—is particularly salient amid the uncertain times in which we find ourselves. In the United States, a growing number of schools and universities have cancelled in-person classes and activities. Hospitals and health care organizations have implemented policies to restrict or completely ban domestic and international business-related travel. Professional societies and trade groups have cancelled large meetings and conferences domestically and globally, including our very own annual meeting of the American College of Physicians, despite the economic implications they create for multiple stakeholders. Numerous states have declared a state of emergency, and the stock market has been in steep decline, signaling wide economic fallout.

The source of these developments: a novel coronavirus that first appeared several months ago in Wuhan, China, before snowballing into what has now become a global pandemic of respiratory disease widely known under the heading of COVID-19. In the heaviest hit countries, such as China and Italy, the economy in many sectors has ground to a halt and unprecedented national “lockdowns” have been implemented.

COVID-19 presents a major medical and public health challenge for the global community, with a looming but unknown mortality risk understandably creating fear, uncertainty, and panic among groups around the world. Unfortunately, its emergence has been accompanied by another “viral epidemic”: anti-Asian racism and discrimination. As Asian American physicians, we are deeply concerned about the consequences of this parallel epidemic. Individuals of East Asian descent have been denied hotel reservations, ride shares, and other services, while others have been subjected to hateful racist epithets, condemnation, and even violent assault. Fear of the virus has also created negative impacts on many Asian-owned businesses.

This racial profiling and targeting stems from the false notions that East Asians are to blame for the emergence of COVID-19 and/or are viral carriers by virtue of their ethnicity. Sadly, there is a long and ignoble narrative of Asian scapegoating in U.S. history. Individuals of Asian descent were designated as “The Yellow Peril” in the late 1800s, and Chinese immigrants in particular were denied U.S. entry with the enactment of the Chinese Exclusion Act of 1882—the only time a specific racial or ethnic group had been targeted by law for exclusion from entry into the United States. In the 1940s, Japanese Americans were forced into concentration camps due to racial hysteria during World War 2.

These dynamics underscore the importance for all of us in the medical community to do our part in championing accurate information and for cogent thinking about COVID-19. Our collective effort is critical not just to overcome misinformation about such topics as quarantine and isolation and to support efforts to mitigate population-level disease burden. Our voices and advocacy are also vital to repudiate racially motivated discrimination and xenophobia that can rear its ugly head in the setting of disease outbreaks—a dynamic that has played out before in history (e.g., persecution of Jews amid the Black Death) and is sadly not limited to the current COVID-19 pandemic.

As clinicians, promoting empathy, mutual respect, inclusion, and equality can be as important as accurate communication, diagnosis, and treatment. COVID-19 presents an opportunity for us to rise to the challenge on all of these fronts and to reaffirm that our best chance to stand against a global threat is together, united in solidarity.

References

1. DeSalvo KB, Gracia JN. Health is more than health care. Ann Intern Med. 2020;172:S66-7. doi:10.7326/M19-3895

Elisa Choi, MD

Dr. Choi is dual Board-certified in internal medicine and infectious diseases and serves as a Chief of Internal Medicine of her practice and faculty at Harvard Medical School. Her expertise includes infectious diseases as well as health advocacy and health care disparities affecting the Asian American Native Hawaiian and other Pacific Islander (AANHOPI) populations. She received the Unsung Hero Award from the Annual Asian American Pacific Islander Civil Rights Forum in Massachusetts for her contributions to Asian American Native Hawaiian and other Pacific Islander populations there. Dr. Choi is Governor of the ACP Massachusetts Chapter and current member of the Executive Committee of the ACP Board of Governors.

Tammy Lin, MD, MPH

Tammy is an internal medicine specialist and a Voluntary Assistant Clinical Professor in the Department of Medicine at the University of California, San Diego, Health Sciences. She has strong interests in wellness, mentorship, and strengthening the pipeline for underrepresented groups in medicine. Dr. Lin is the Governor-Elect Designee of the ACP California Southern Region III Chapter and a member of the ACP Diversity, Equity, and Inclusion Subcommittee.

Tiffany I. Leung, MD, MPH

Tiffany is an internist and Assistant Professor at the Faculty of Health, Medicine and Life Sciences at Maastricht University in The Netherlands. She completed her MD, MPH, and internal medicine residency training at Northwestern University. She also completed an Advanced Fellowship in Medical Informatics at the Department of Veterans Affairs Palo Alto Health Care System and Stanford University. Dr. Leung is is Chair-Elect of the ACP Council of Early Career Physicians and a global member of the ACP's Global Engagement Committee.

Joshua M. Liao, MD, MSc

Josh is a faculty member of the Department of Medicine at the University of Washington School of Medicine, where he is also the Associate Medical Director of Contracting and Value-Based Care. He is also an Adjunct Senior Fellow at the Leonard Davis Institute of Health Economics in the Wharton School at the University of Pennsylvania, where he obtained his health services and policy training. He obtained his MD from Baylor College of Medicine and trained at Brigham & Women's Hospital, where he was also a Clinical Fellow in Medicine at Harvard Medical School.