Black Docs Work to Make Coronavirus Testing Extra Equitable
By Nina Feldman, WHY, Kaiser Health News
When the coronavirus hit Philadelphia in March, Dr. Ala Stanford at home with her husband and children. As a pediatric surgeon with her own practice, she has employee privileges in several suburban hospitals in Philadelphia. For weeks, most of her usual procedures and patient visits were canceled. So she found herself, like many people, spent the days in her pajamas and glued to the television.
And then, in early April, she saw media reports suggesting that blacks contracted the coronavirus and died more often from COVID-19 than other demographics.
“It just hit me like that, what’s wrong?” Said Stanford.
At the same time, she heard from black friends who couldn’t be tested because they didn’t have a referral or didn’t meet the test criteria. In April there was a shortage of coronavirus testing in numerous places across the country, but Stanford decided to go to the hospitals where she works to find out more about why people were turned away.
One explanation she heard was that a doctor had to register in order to be the “doctor on record” for anyone seeking a test. In an isolated healthcare system, it could be difficult to manage the logistics of who would communicate test results to patients. And in order to protect healthcare workers from the virus, some test sites did not just let people without a car walk to the test site.
Stanford knew that African Americans were less likely to have general practitioners than white Americans and were more likely to rely on public transportation. She just couldn’t balance all of that with the disproportionate black infection rates she saw on the news.
“All of these reasons were obstacles and excuses for me,” she said. “And essentially that was when I decided to test the city of Philadelphia.”
Black Philadelphians are almost twice as likely to get coronavirus as their white counterparts. They are also more likely to have severe cases of the virus: 44% of Philadelphians are African American, but 55% of those hospitalized for COVID-19.
Black Philadelphians are more likely to work in jobs that cannot be done at home, which puts them at higher risk of exposure. In the city’s prisons, plumbing, and transportation departments, workers are predominantly black, and they have contracted COVID-19 at high rates as the pandemic progressed.
The increased severity of the disease among African Americans may also be partly due to underlying health conditions that are more common among blacks, but Stanford claims that unequal access to health care is the biggest driver of inequality.
“If a senior funeral director in West Philly tries to get tested and you turn them away because they don’t have a prescription, it has nothing to do with their high blood pressure, it has all to do with your implicit bias,” she said, referring to to an incident she encountered.
Before April was over, Stanford took action. Her mother rented a minivan as a mobile clinic while Stanford recruited volunteers from among the doctors, nurses, and medical students on their network. She received test kits from the diagnostic and testing company LabCorp, where she had an account through her private practice. Powered by Stanford’s personal savings and donations raised through a GoFundMe campaign, the minivan stood in church parking lots and opened tents on busy Philadelphia street corners.
It wasn’t long before she faced her own logistical barriers. LabCorp asked her how she would deal with uninsured patients whose tests were being processed.
“I said for any person who doesn’t have insurance, you’ll bill me and I’ll figure out how to pay for it later,” said Stanford. “But I can’t let anyone die for a test.” that costs $ 200. “
The Philadelphians streamed each other live on social media as they tested and spread the word. Until May, it wasn’t uncommon for the Black Doctors COVID-19 consortium to test more than 350 people daily. Stanford brought the group under the umbrella of a nonprofit it already runs, which provides tutoring and mentoring to young people in schools with limited resources.
Tavier Thomas found out about the group on Facebook in April. He works in a T-Mobile store and his employee tested positive. Not long after that, he felt a little out of breath.
“I touch probably 100 phones a day,” said Thomas, 23. “So I wanted to get tested and make sure the people who test me are black.”
Many black Americans seek out black providers because of cultural indifference or abuse in the healthcare system. Thomas’ preference is rooted in history, he said, pointing to times when white doctors and medical researchers exploited black patients. In the American South of the 19th century, for example, the white surgeon J. Marion Sims performed experimental gynecological treatments without anesthesia on enslaved black women. Perhaps the most notorious example began in the 1930s when the U.S. government enrolled black men with syphilis in a study at the Tuskegee Institute to see what would happen if the disease was left untreated for years. Patients did not consent to the terms of the study and did not receive treatment even when an effective one became generally available.
“They just saw them die of the disease,” Thomas said of the Tuskegee experiments.
“To be honest, when new diseases fall away? I’m a little weird when the mainstream tests me or when I get something inside. “
Thomas tested positive for the coronavirus in April but recovered quickly. He recently returned to be retested by Stanford’s group, even though the test site that day was in a church parking lot in Darby, Pennsylvania, a solid 30-minute drive from where he lived.
Thomas said the second test was only for safety because he lives with his grandfather and doesn’t want to risk infecting him. He also brought his brother McKenzie Johnson with him. Johnson lives in neighboring Delaware, but said it was difficult to get tested there without an appointment and without health insurance. It was his first time he was wiped off.
“It’s not as bad as I imagined it to be,” he joked afterwards. “You cry a little – they look a little bit in your soul – but no, it’s okay.”
Every time it offers testing, the consortium sets up an outdoor mini-hospital that includes office supplies, printers, and paper shredders. When they do antibody tests, they need to power their centrifuges. These costs, plus the lab processing fee of $ 225 per test and compensation for 15 to 30 employees, are estimated by Stanford to be around $ 25,000 per day.
“Sometimes you get reimbursed and sometimes you don’t,” she said. “It’s not a cheap operation at all.”
After the first few months, the consortium became aware of those responsible for the City of Philadelphia, who provided the group with approximately $ 1 million in funding. The group was also funded by foundations and individuals. The regional transport authority hired the group to test their frontline transit workers weekly.
To date, the Black Doctors COVID-19 consortium has tested more than 10,000 people – and Stanford is the “doctor on record” for each of them. She appreciates financial support from local government agencies, but she still worries that the city and Philadelphia Well-equipped hospital systems alone are not proactive enough. In July, waiting times for results from national commercial laboratories like LabCorp were sometimes longer than two weeks. The delays essentially rendered the work of the consortium’s test sites worthless unless a person agreed to completely isolate while waiting for the results. In the major hospitals in the Philadelphia area, doctors were able to get results in their in-house processing laboratories in a matter of hours. Stanford urged local health systems to share their testing technology with the surrounding community, but she said she was told it was logistically impossible.
“Unfortunately, the value that some of our poorest areas have is not being proven,” said Stanford. “It is not shown that these people are important enough. That’s my opinion. They are important to me. That’s what keeps me going.”
Now, Stanford is working with Philadelphia’s health commissioner to try to create a rotating schedule in which every health system in the city offers free tests one day a week from 9 a.m. to 9 p.m.
The medical infrastructure she has in place, Stanford said, and her popularity with the black community make her group a likely candidate for distributing a coronavirus vaccine once one becomes available. U.S. Department of Health officials visited one of their consortium’s testing sites to assess the group’s potential for vaccination.
Overall, Stanford said she’s happy to help during the planning phase to ensure the most vulnerable Philadelphians have access to the vaccine. However, she is suspicious of the federal oversight associated with the review of a possible coronavirus vaccine. She said there were still too many unanswered questions about the process and too many other cases of the Trump administration putting political pressure on the Centers for Disease Control and Prevention and the Food and Drug Administration for them to stand up May now require actual vaccinations to take place in Philadelphia’s neighborhoods.
“When the time comes, we’ll be ready,” she said. “But it’s not today.”
This story is part of a partnership that includes WHYY, NPR and KHN.
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KHN (Kaiser Health News) is a non-profit health news service. It is an editorially independent program of the KFF (Kaiser Family Foundation) that is not affiliated with Kaiser Permanente.