COVID-19 and Health Disparities: Expert Q&A

[MUSIC PLAYING] COVID-19 has disproportionately affected Chicago's African-American and Latinx communities. In today's At the Forefront Live, community health experts will discuss top health concerns during the pandemic, including disparities in under-resourced communities, the medical center's response, and resources and opportunities that can help address these challenges.

Dr. Doriane Miller, Dr. Arshiya Baig, and Urban Health Initiative vice president, Brenda Battle, are here today to address this issue and take your questions. That's coming up right now on At the Forefront Live.

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And we want to remind our viewers that today's program is not designed to take the place of a visit with your physician. Let's start with each of you introducing yourselves and telling our audience what you do here at UChicago Medicine. And Dr. Miller, since you're actually in the studio with us, I do want to say that we are practicing social distancing.

Dr. Miller's clear down at the other end of the desk. And we've been very careful, wiping down surfaces and wearing masks up until right now. But tell us a little bit about yourself and what you do here at UChicago Medicine.

Thanks so much, Tim. I'm a primary care physician, internal medicine doctor, which are doctors for adults. And so I take care of patients with high blood pressure, diabetes, and a common variety of illnesses. I'm also the director of the Center for Community Health and Vitality.

Fantastic. And Brenda, let's go to you next.

[AUDIO OUT] --a registered nurse, and I am the vice president of the Urban Health Initiative. Our work is really working alongside community members, community partners, and other health care providers with the faculty and staff at UChicago medicine and across the University of Chicago to bring programs and initiatives in the community to improve the health of the communities, that we work alongside Dr. Miller, Dr. Baig, in supporting our community.

And Dr. Baig, let's go to you next.

Hi, Tim. Thank you so much for having me. So I am an internal medicine doctor like Dr. Miller. I'm a primary care doctor. I see patients in an inpatient setting in the hospital, also in the clinic. And I'm also a researcher. I'm interested in community-based interventions and improving health disparities with the focus on the Latinx community.

Great. And Dr. Miller, let's start with you as we kind of kick off the show. And I'm curious-- we're going to get right into some of the questions we have. But I wanted to go off script just a little bit because we were talking before we started about visits with your patients at home. And they just think this is such an important thing to chat about because you were telling me a story that was a little alarming about a patient that was afraid to come in. Can you relate that? And what are we doing to take care of situations like that?

So we've been involved in doing something called telehealth, which are either visits via the computer as a video visit or over the phone in the age of the coronavirus pandemic in order to make sure that our patients are still able to receive some health care but doing it from the comfort and safety of their own homes. But sometimes it's not safe for people to stay at home if they have a particular health need. I had a visit with a patient recently who was having a flare of one of her chronic health conditions, namely something called congestive heart failure.

I was able to see her over her daughter's smartphone and to take a look at her to see how she was breathing and decided that she really needed to come into the hospital for further evaluation and treatment. And, fortunately, she was able to do so. In many ways, I think of it, this is a little bit of Back to the Future in terms of the way that we've been delivering health care and that doctors used to do house calls. And so it's just a newfangled way of doing a house call.

And I love the way you put that because it really struck a nerve with me or struck a chord with me when you said that earlier. We've kind of come full circle. And now doctors are going back to patients' homes but in a virtual way. And, from a physician standpoint, I would imagine that's kind of helpful.

Extremely helpful because, oftentimes, in being able to see someone in their home, it's not just the patient that's involved with the visit. But there may be other family members who are there that may say, now, mom, you know, you forgot to tell the doctor about such and such. And, oftentimes, I don't see those people when they come into the office. And so being able to see a patient in their home, local circumstances, all of the things that they have to deal with on a day-to-day basis really makes a difference.

And Dr. Baig, I know you're doing these as well. And I'd love to get your input on video visits or telemedicine. And I think one of the things we want to stress to the audience is that it's so important to get the help you need. If you really need help, we have ways of delivering that care, not only through the telehealth visits but also here on campus.

Can you talk a little bit about, first of all, telehealth and then those situations where you need patients to come to campus?

Sure. That's a great question. I think telehealth is a fantastic way for patients and family members, their loved ones, to connect with their specialist, with their primary care doctors here at the University of Chicago. For me, it has been really wonderful to talk my patients, see my patients, and then, when I have questions like, oh, are you running out of your medications or what's that supplement you're taking, they can run over to their medicine cabinet and grab it and let me know, and then even having family members come and join the video chat, telling me about things that are happening in the home.

And, a lot of times, it's actually even important for me to see my patients who are at home, social distancing, but they have a smile on their face. They're doing OK. So I think that seeing folks in their home environment has been really great.

Of course, there are times when patients do need to come in. And I can do that assessment over the phone or video as well and let them know about the cautions we're taking at our hospital and in our clinics in terms of social distancing, having hand sanitizer. Some people need to come in to get lab work done, that they're social distancing in the waiting rooms. So letting patients know that the phone video visits work for many things, but sometimes we do need to bring you in for a physical exam, we need to bring you in for lab work, and that we, at the University of Chicago Medicine, are doing the best we can in terms of social distancing [AUDIO OUT]

Great. Brenda, could you talk to us a little bit about testing and how important that is, not only in general but specifically for the community that UChicago Medicine is part of, the Hyde Park community, and what are we doing to help with testing and increased testing for folks here.

Yeah, well, testing is clearly most critical to know who has been exposed to COVID or who actually has COVID-19. So we have expanded our capabilities for testing over the last several weeks. We started with capabilities for only testing around 200 patients.

But we're fortunate to be able to get enough tests to allow us to expand our testing capabilities to up to 1,000 tests a day. And not just to enable us to do that here at our Hyde Park campus, but to leverage our relationship and partnership with other community health centers and community hospitals on the south side of Chicago to enable them to be able to expand their testing. And I would say, up until the time when we were able to help support community health centers on the south side and also in the Harvey community where Ingalls hospital is, they were doing very few testing at that time.

We put together a team of nurses, and doctors, and community persons to work with other health centers and hospitals on the south side of Chicago to train their teams and testing to train them on how to properly use the PPE, to help them get supplies that they needed for testing. We even stood up-- along with a community health center that we partnered very closely with, we stood up a testing site in Auburn Gresham. That's one of the communities on the south side of Chicago that has been hit the hardest with COVID and has one of the highest number of persons who've been tested positive for COVID.

There is no community health center in that community nor is there a hospital. So a community member reach out and ask for that. And so we worked alongside with one of the community hospitals to get one up and going. And that one actually goes up tomorrow. And the response has been tremendous to our abilities to do that.

Brenda, as we talk about these numbers, 1,000 tests a day, which seems like a huge number, but there's so many folks that are worried about this and may be impacted by it. What do people need to do if they are worried, if they think they need a test? How do they go about getting the help that they need?

Yeah, so they can call. We actually have a COVID resource line that they can call and talk to a health care provider on the other side about what their experience is and actually get scheduled to have a test. And the testing is done either through a drive-by location, where there's actually tents and persons can stay in their car and ride through and get swabbed and tested through that process-- and there are some walk-up clinics. But, either way, a person needs to call and schedule. And that's really important because maintaining the practices of social distances are really critical. So calling and getting an appointment to come for your testing will ensure the safety of the persons who need to be tested and avoid the congregating of persons waiting in line for tests.

The process is incredibly quick. It's about two minutes. So just make the call real quick. You get an appointment. You come in. And the drive lines and walk-up lines have been really, really, really fast.

So it's not a lengthy time for people to do it. It's quick and easy. And the person on the other end can really help.

So we're already having some questions come in from viewers. And I want to get to as many as those we possibly can. Remind our viewers, too, if you do have questions, just type them in the comments section. We'll try to get those answered as quickly as we can.

The first one-- and this is a very good question-- how are you reaching out the people in the community who may need care but don't have access to the proper technology? Because we've talked about smartphones and that sort of thing. And I'm not sure who wants to take that, but it's a good question. How do we help those folks? And Dr. Miller, maybe I'll start with you.

Well, I've been doing visits with many of my patients just over the telephone. And, as long as they have either a landline or a cell phone that's not necessarily a smartphone-- so it's not internet-enabled-- available, I talk with them in that way. I also ask them for our telephone visits if there are certain pieces of equipment, if they can get them, things like a blood pressure cuff where they can take their own blood pressure and heart rate. For some of my patients who may have breathing problems, they can actually pick up a machine called a pulse oximeter which will measure the oxygen saturation in their blood.

You can get it at a local drugstore. Having those things available, a weight scale. Patients who have diabetes should have a way to check their blood sugars. And so there are different ways in which I can get that information and have my patients to report back on it without necessarily having a connection via the internet in ways that I can see them over the phone.

Well, and I like what you said earlier, too-- and I think it can be done safely as long as people are careful. But if they have a son or a daughter with a smartphone or somebody that they can trust and rely on that would have something like that, there are options there as well.

Absolutely. And, for a lot of my older patients who may not necessarily be as tech savvy as their younger family members, I will ask them to have a niece, a nephew, a grandson, or a granddaughter to join them on the visit and to download the information via Zoom app so that we can see their loved ones over the phone.

So Brenda, if we can--

Go ahead. I'm sorry.

We were fortunate to get funds from a donor that wanted to support one of our high-risk populations, our children with asthma, to be able to continue to see their providers, to see community health workers who work with them, to help them to manage their asthma from their home.

Typically, a community health worker can go out to the home and work with the family. In this case, we've got our community health workers making phone calls and Zoom Video calls. And this donor really helped us-- foundation, as a matter of fact, helped us to fund our ability to purchase phones that, when we determined that there are families who don't have technology, there are these I'm going to call them burner phones. I think that's the lingo.

to actually be able to stay in touch and to video Zoom for those calls. So we'll be rolling that out soon. And I'm really grateful to the donor that supported that as well as some of the needs for persons who, because they're sheltering in place, don't have the ability to go out to the store to get food and the things that they need, to actually help get food to them in the home and help them with some of those other determinants, those needs that people have that are not directly health care needs.

I tell you, you all just constantly amaze me. Brenda, you and your team and the physicians also that work here just constantly amaze me with this kind of stuff because you're always looking for ways to care for people that may, oftentimes, be forgotten. And I think that's so important. And it just impresses me so much.

So hats off to you again because that's fantastic. So let's talk a little bit about why we think that the rates for COVID infection and death is so high. Let's start with the African-American community, Brenda, if we can, and let's discuss that for a moment, some of the efforts underway-- well, we're already hearing some of the efforts. But let's talk about that a little bit. Why are we seeing such high rates?

Yeah, so there's a number of reasons that we're seeing high rates, not just in the African-American community but the Latinx community. Both of these communities are experiencing really high rates of COVID. And some of the reasons are the general proximity.

In Chicago, the density of where people live is really close. People live close. They live in apartments, condos. Even houses and communities are really in close proximity to each other. So some of that has to do with it.

Some of the persons that are in low-income communities are still working. And many are catching the bus. Many work in environments where they're constantly out and sometimes are being exposed. Some of the places where they work don't have enough PPE and masks and the things that they need to protect them.

And, in general, when you're looking at low-income communities, marginalized communities, communities that have been marginalized for a long time, they're already sick. I mean, that's where you see the highest amount of disparities as it is already, so disparities with diabetes, and cancer, and heart disease, asthma, those sorts of things that are happening in these communities.

And, when they're already sick, then COVID just compounds that. And so these individuals are even sick. I'm going to let Doriane and Dr. Baig maybe contribute to that discussion as well. I think their input is helpful.

Yeah, and Dr. Baig, if we can go to you next, we haven't heard from you in a few minutes. Could you talk a little bit about the Latinx community and some of the challenges that you're seeing? And how are we addressing those challenges?

Sure, I echo a lot of what Brenda has just said, that what we're seeing with COVID is really looking at what is already happening in these communities in terms of high rates of diabetes, especially in the Latinx communities in Chicago. We're seeing that people are making tough decisions regarding going to work or not. Many in the Latinx community are essential workers.

They're out. They're working at the grocery stores. They're doing deliveries. And, if they don't have the appropriate equipment, masks, gloves, hand sanitizer, that they're getting exposed. But it comes down to an economic question, do I go out and work or stay home and not be able to buy food or pay rent?

I think we have seen great efforts from the city of Chicago and even University of Chicago Medicine in terms of trying to increase testing in his community, especially in Little Village, and trying to let people know that you should come in to get tested if you're having symptoms, if you're having exposures, and that don't fear accessing the health care system. Sometimes there's fear of costs as well.

What's going to happen if I go get tested? Am I going to pay for it? What's going to happen if I am positive?

And then the second issue is also social distancing may be challenging, especially if you live in a multi-generational home in an apartment. How do you have a separate bathroom and a bedroom just for the person who is COVID positive? So I think there's many challenges in these communities, especially in the Latinx community. I was just on a Facebook live event in the city of Chicago last night. And they're actually putting forth a lot of testing in these communities, knowing that we need to be more present in these communities to get testing done.

So that's what I would say. And I think University of Chicago also has a great partnership with Saint Anthony Hospital. There's the community hospital in Little Village. So I think encouraging our patients to go get tested, and that's an opportunity to tell them about social distancing, the actions we should be taking. But I think COVID is really unveiling the disparities that we've all already have seen in the Latinx community, unfortunately.

And Dr. Baig, you mentioned some of the essential workers in those specific professions. Oftentimes, you deal with a lot of people, so you're around a lot of people. If you're in a position like that and you need to go to work every day, what are some of the things that you can do to help protect yourself and your family?

Yes, I think that working with your employer to make sure that you have access to the PPE, so be it masks or gloves-- I do some grocery stores are even putting up glass shields so there's limited contact between customers and employees. I think that good handwashing is always important, so either hand sanitizer or just little soap and water, I think that taking the precautions when you come home, about washing your hands and decreasing exposure to your family members who you live with and, then just being conscious of any symptoms. If you come down with symptoms, contacting your primary care provider and probably staying away from work until you get tested.

And Dr. Miller, one of the questions that just came in from a viewer that I'd like to ask you is-- because I know you've been working on this project. Actually, all three of you have. But how are local churches and the community involved with testing and prevention? And I know we did some public service announcements just recently. But I'm sure there are other efforts as well.

The local churches are working closely with our leadership, through the Urban Health Initiative and University of Chicago Medicine, to make sure that their congregations know about some of the things that they can do in order to try to slow down or stop the spread amongst their parishioners. And so being able to get tested if their parishioners become positive, having a social distancing but still engaging, particularly, in services, and having those streamed over the internet for their parishioners is important. And it doesn't necessarily have to be over the internet.

I know of some of my patients who have been able to get on what's called a prayer circle in which they have of the minister from their particular congregation to call at a particular time. And they worship over the telephone. Being able to drop some of those messages in as public service announcements around, why is it important to wear a mask? What should you do in terms of washing your hands? If you're in a situation in which you're not able to have a separate bedroom or a bathroom, if somebody becomes sick in your home, how to set that up in your home? All of those things are very important messages for people to hear.

And one of the things that, again, I just-- I want to keep stressing this throughout the program. I think it's so important. If you are sick, if you do need care, there are options. And the hospital is a safe place as well.

This is probably one of the safest places you can come to. And I don't know if you want to talk a little bit more about that. But I think it's important.

One of the things that we've instituted at the University of Chicago Medicine is that all of our staff is being asked to attest to the fact that they are healthy when they come in the institution. We're not wearing masks right now. But it's something that is required across the board. We have something called universal masking.

And then, wherever possible, where there's a hand sanitizer station, making sure that you clean your hands, and so good hand hygiene. In addition, as I said before, we've implemented many of our telehealth visits for people who don't necessarily have to come in. But, if, for people who need to come in and to be seen by either one of our primary care doctors or one of our specialists, this is a very safe place to be. And people should come in for their health care.

Yeah, I can attest to the fact that I've got my mask right here. I wore this up until the show. I know you were wearing your mask. I saw that. And, when we do come in, you're 100% correct.

They ask us to show our identification. They ask us to wash our hands or use the antibacterial, the foaming in, I guess, is what they call it when we come in. And they're very careful. And they're also asking people to social distance even in the facility, which is what we're doing right now, so very, very important.

Another question from a viewer, how can we access providers within the University of Chicago network? And I think there's a couple of different ways to do that. But I don't know if anybody wants to talk about that. We'll put the phone number in the web address up on the screen as well. But if one of you want to handle that?

Doriane?

Certainly, so it depends upon what kinds of services you'd need. I'm always a big advocate for coming through primary care because, in many ways, I think that we're the front door to care here at University of Chicago Medicine. The number is up on the screen right now to make an appointment, 888-824-0200.

But give us a call. We are open for business. And we are making appointments for people to have new patient visits as well as established patients for return visits. And so we're open. We're here. We're available. And we would love to see you either in-person or virtually.

Brenda, we just have, I think, about three minutes or so left in the program. And I've got kind of a big question for you. So I'm curious about this one. So what kind of a long-term impact do you anticipate the pandemic will have on under-resourced communities? Because I think this, as Dr. Baig mentioned ago, this really shines a light on an issue that needs to be addressed and dealt with.

Yeah, so there are a few. I'll start with just the overall health of persons in underserved communities. These individuals have started with kind of historical lack of access to health care, lack of just knowledge about how to support health and manage their own health. And so I think, to Dr. Baig's earlier point, COVID has just uncovered the deep disparities that these communities have experienced. And so there has to be a real concerted effort across health care, city-state, federal to really address these health disparities and get to those. So that's going to be a long-term effect.

I think the other thing is the impact that COVID has had on individuals from an economic standpoint. Many of the individuals in low-income communities, those are the ones, many of them have lost their jobs. And the impact of losing your job in communities, particularly the south side, where 43% of the people on the south side are already below the federal poverty level-- so losing jobs due to COVID will further compound that.

And so that's going to be a long-term effect, the ability to get jobs up to boost the economy and help people to get back into work. Those things are going to take a while to get to help stabilize that community. So there are many other impacts. But I think, from a health and economy standpoint, those are the two things that are going to-- that's really going to impact our communities even worse.

And Dr. Baig, we've got about 30 seconds to a minute left. Is there a message that you want to get out to the underserved community or the community in general?

Yeah, I want to emphasize what Brenda was speaking about. So nationally, only 60% of Hispanics or Latinx people can work from home. So that says a lot about decisions that folks are making in terms of exposing themselves to COVID, having to go to work versus staying at home and sheltering in place. I think that this is the wonderful opportunity for us to reach out to these vulnerable communities, increase testing, allow them to feel safe in the health care system without having a fear of accessing health care, especially in this time of need.

And I think supporting patients and managing their chronic conditions like diabetes is essential at this moment as well. So making sure that health care systems providers, community organizations are reaching out to our most vulnerable population, I think this has been a wonderful time for innovation and home visits and video visits.

I hope that we can continue that because it gets across-- it addresses some of the fears that some patients may have in coming in. But, if they can just call in and talk to their provider to answer their questions, that is a great advantage. And that is something that has really come out of this COVID epidemic.

Fantastic. You all were great as always. And it's important information.

That's all the time we have for the program. We'll have another At the Forefront Live next week. Please remember to check out our Facebook page for our schedule of programs coming up in the future. Also, if you want more information about UChicago Medicine, please take a look at our website at UChicagoMedicine.org.

If you need an appointment, give us a call at 888-824-0200. And, remember, you can schedule your video visit by going to the website or calling that number. Thanks again for being with us today. And I hope you have a great week.

Thank you, Tim.

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