Our imperative to address health care disparities

We are data-driven. Although data will provide an accurate picture of a situation, it is empathy that motivates us to act on it. This week, the Iowa Department of Public Health (IDPH) began to report demographic breakdowns on which Iowans are being most affected by COVID-19. As has been reported for other parts of the United States, Europe, and South America, this pandemic has laid bare the impact of health care disparities and social determinants of health on disease outcome and prevention. As of this writing, the recently released IDPH data revealed that despite comprising just 4 percent of the state’s population, African Americans in Iowa account for 7 percent of the deaths from COVID-19 and 13 percent of the confirmed cases. Iowans of Asian or Pacific Islander descent are less than 3 percent of our population but account for nearly 9 percent of confirmed cases. Six percent of Iowans are Latinx, and although their reported 6 percent of the state’s virus-related death rate matches their population share, their proportion of confirmed cases is nearly quadruple that, at 23 percent of those in our state. I hope that it will not be lost on us that health equity is a goal that remains to be attained in our country, and the challenges ahead have only been magnified by the coronavirus.

There are many factors why minority groups in our state and elsewhere are bearing a disproportionate burden of this pandemic, and some of these social determinants may influence rates of non-communicable diseases such as diabetes, obesity, hypertension, kidney failure, COPD, and others. Our state received national attention as essential workers in meat-packing plants were part of workplace clusters of COVID-19. Their plight brought to the fore the value to society of many that we do not “see,” the importance of acknowledging their critical roles in our society, and the importance of ensuring that we provide safe working environments for those who do not have the luxury of working from home. Our institution has been touched by this, and faculty in our department have actively made a meaningful difference not only in the hospital but SanchezZoomin the community. The Tyson packing plant outbreak in nearby Columbus Junction rippled out into that town’s Latinx community and brought many of their members here. Dr. Rolando Sanchez was interviewed for this story in We Are Iowa, a Des Moines-based news outlet, in which he describes offering his native-Spanish-speaking skills to patients and their families. It is a moving narrative and shines a desperately needed light on an overlooked component of this crisis. Dr. Sanchez has not been the only member of our critical care team providing this extraordinary level of voluntary support. Pulmonary Division Director Dr. Joseph Zabner and division members Dr. Raul Villacreses, Dr. Alejandro Comellas, and Dr. Alejandro Pezzulo also stepped into this gap alongside Dr. Sanchez. They offered a familiar and culturally relevant beacon of hope and support to a patient population, who in many ways are more vulnerable to adverse outcomes or to challenges in fully accessing healthcare resources than many of those we usually treat. I want to thank our colleagues and the rest of the critical care team who gave them the space and time to directly contribute to addressing health care disparities by supporting community members in need. As we would say in Jamaica to Rolando and his colleagues, “Nuff Respect!”

MobileClinicTelehealthOn a related note, the University of Iowa’s Mobile Clinic, our medical-student-run free clinic, has put the call out for UIHC providers (physicians, PAs, NPs) who can serve as attendings in their Tele Mobile Clinic. An email solicitation was sent out to you earlier this week. If interested and available for even a two-hour shift, please complete this form: Tele Mobile Clinic Volunteer Interest Form. This is a terrific way to reach uninsured and underserved populations in our community.

Efforts like those outlined above are just two lights among many that show me the best of the Hawkeye spirit, how we as a community will come through this and how we are already moving to a place where we will be even stronger than before. We are all aware now that University of Iowa Health Care has been cleared to begin treating those we had to turn away when the COVID-19 crisis first began. I would like to echo our hospital leadership in reassuring you that we are doing this safely and in measured steps, while also following state guidelines that we preserve personal protective equipment and beds to maintain our COVID-19 readiness. It is now incumbent on all of us to invite our fellow Iowans back to our main campus and our clinics, to assure them that we are prepared to treat them safely, and to ensure that their necessary medical care is not delayed. As we evaluate their needs, we have deployed new tools such as telephone and video visits and a growing infrastructure to support them that make us nimbler than before. However, there may simply be no substitute for an in-person visit for many of our patients, and while some may be hesitant to come to our facility, I would encourage you to rely on the guidance our marketing and communications teams have developed that address some of their fears and concerns. Delayed care is delayed health and exposes our neighbors to greater risk. Thank you for your assistance in helping us build on the solid foundation of trust our community already has granted us.

Two weeks ago, I was pleased to share with you that our research activity is also as strong as ever. Our scholarly activity for the year is similarly resilient. A search of PubMed reveals that in just the first four months of the year, our faculty have published 185 articles, many in high-profile journals and many of which have multiple authors from within our department. This is across all divisions and from every rank, from senior faculty with research breakthroughs to residents landing their first published case reports. Our commitment to the academic part of academic medicine has not slacked, even in this new environment. Of particular note are 8 publications in some of the highest-impact journals that address multiple and diverse aspects of the coronavirus and the pandemic. Those publications are listed below and available for you to read. Kudos to all the authors, reminding our community of the vital role that research plays at the University of Iowa.

Moving Personal Protective Equipment Into the Community: Face Shields and Containment of COVID-19. Perencevich EN, Diekema DJ, Edmond MB. JAMA. 2020 Apr 29. doi: 10.1001/jama.2020.7477.

Current perspectives on Coronavirus 2019 (COVID-19) and cardiovascular disease: A white paper by the JAHA editors. Gupta AK, Jneid H, Addison D, Ardehali H, Boehme AK, Borgaonkar S, Boulestreau R, Clerkin K, Delarche N, DeVon HA, Grumbach IM, Gutierrez J, Jones DA, Kapil V, Maniero C, Mentias A, Miller PS, May Ng S, Parekh JD, Sanchez RH, Teodor Sawicki K, S J M Te Riele A, Ann Remme C, London B. J Am Heart Assoc. 2020 Apr 29:e017013. doi: 10.1161/JAHA.120.017013.

New challenges in the COVID-19 pandemic. Fiedorowicz JG. J Psychosom Res. 2020 Apr 22;133:110123. doi: 10.1016/j.jpsychores.2020.110123.

Caution Needed on the Use of Chloroquine and Hydroxychloroquine for Coronavirus Disease 2019. Fihn SD, Perencevich E, Bradley SM. JAMA Netw Open. 2020 Apr 1;3(4):e209035.

Insights from immuno-oncology: the Society for Immunotherapy of Cancer Statement on access to IL-6-targeting therapies for COVID-19. Ascierto PA, Fox B, Urba W, Anderson AC, Atkins MB, Borden EC, Brahmer J, Butterfield LH, Cesano A, Chen D, de Gruijl T, Dillman RO, Drake CG, Emens LA, Gajewski TF, Gulley JL, Stephen Hodi F, Hwu P, Kaufman D, Kaufman H, Lotze M, McNeel DG, Margolin K, Marincola F, Mastrangelo MJ, Maus MV, Parkinson DR, Romero PJ, Sondel PM, Spranger S, Sznol M, Weiner GJ, Wiggington JM, Weber JS. J Immunother Cancer. 2020 Apr;8(1).

Using Telehealth as a Tool for Rural Hospitals in the COVID-19 Pandemic Response. Gutierrez J, Kuperman E, Kaboli PJ. J Rural Health. 2020 Apr 11. doi: 10.1111/jrh.12443. [Epub ahead of print] No abstract available.

Public Health Interventions for COVID-19: Emerging Evidence and Implications for an Evolving Public Health Crisis. Hartley DM, Perencevich EN. JAMA. 2020 Apr 10. doi: 10.1001/jama.2020.5910.

When infection prevention enters the temple: Intergenerational social distancing and COVID-19. Hartley DM, Reisinger HS, Perencevich EN. Infect Control Hosp Epidemiol. 2020 Apr 1:1-2.

As a final thought, a reminder from me to you to take advantage of the COVID-19-related Grand Rounds recordings we have made available, including yesterday’s from Neurology’s Dr. Christine Gill and Nephrology’s Dr. Jonathan Nizar. We were also fortunate recently in the Fraternal Order of Eagles Diabetes Research Center to co-host with diabetes researchers at the University of Minnesota a talk from Dr. Anne Peters from the University of Southern California. Her presentation on the intersection of COVID-19 and diabetes is applicable to many of us. Give a watch.

About E. Dale Abel, MD, PhD

E. Dale Abel, MD PhD Francois M. Abboud Chair in Internal Medicine John B. Stokes III Chair in Diabetes Research Chair, Department of Internal Medicine Director, Fraternal Order of Eagles Diabetes Research Center Director, Division of Endocrinology and Metabolism Professor of Medicine, Biochemistry and Biomedical Engineering

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