What Covid Hath Wrought

The past year has been full of suffering, loss, and heartbreak. The coronavirus pandemic has wreaked havoc on the nation, and especially on Black and Brown communities. There is no silver lining to this incredibly destructive calamity, no way to fully capture the damage to families, to psyches, to work and economic security. But there are lessons to be learned. The first lesson is about this country’s system of public health. Long touted as one of the most modern and effective in the world, American healthcare has been revealed as fragile, disorganized, and practically leaderless. The pandemic has raised the curtain on an American public health system in shambles—a system riddled with bias, disparity, a disturbing amount of incompetence, and massive distrust in its ability to deliver timely, effective, and equitable care to all segments of the population.

As of this writing nearly half a million American deaths have been attributed to Covid-19; however it is widely assumed that this is a huge undercount. The number only includes people who receive an official cause of death related to the virus. Although huge numbers of people have been infected by the virus, with a regrettable loss of life, only a small percentage of victims have been hospitalized for treatment or reside in nursing facilities where an official “covid” cause of death can be easily determined and officially recorded.

The toll of hospitalization and mortality represent only a small fraction of the suffering caused by the pandemic. Most pandemic victims have weathered the illness at home, under the care of family and loved ones. With the health care system overwhelmed, the supply of protective equipment erratic, and shifting guidance on safety protocols, family caregivers have assumed a disproportionate burden of caring for both hospitalized and non-hospitalized victims of the pandemic. Nowhere has this burden been greater than in minority communities, where infections have been rampant, resources scarce, and related impacts such as job loss and financial disaster most devastating.

So what is the takeaway?

The American healthcare system did not get to this precarious state overnight. Always fraught with racial prejudice, the undoing of its boastful reputation has been decades in the making. Along the way, minority populations have experienced neglect and unequal treatment that the pandemic is now exposing in an unprecedented way. Rebuilding and reforming the system, restructuring its exclusionary design, its built-in biases and institutional practices, will be a slow process and mightily resisted.

The heroic performance of family caregivers, especially in Black and Brown communities where pandemic victims are concentrated and resources least abundant, deserves recognition. And the prime lesson to minority communities with regard to future health and welfare is to engage in aggressive advocacy for system reform, while innovating their own independent initiatives, methods, and unique supports intended to improve community self-reliance and outcomes going forward. Home and community-based care is the future of the American healthcare system. Black and brown communities must prepare themselves to gain in equity, responsiveness, and healthcare quality as this shift occurs. A focus on family caregiving must be a big part of this emerging awareness. That will continue to be the driving force of this blog.

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