Black Women Have Long Faced Racism in Healthcare. COVID-19 Is Only Amplifying It.

Update: Rana Zoe Mungin died on April 27 due to complications stemming from COVID-19.

By the time Rana Zoe Mungin called 911 on March 19, she could hardly breathe. The 30-year-old social studies teacher had been at home in Brooklyn, sick with a fever, cough, and shortness of breath for nearly a week. Days earlier, she had gone to urgent care, worried she had signs of COVID-19, but the clinic was short on tests and treated her for an asthma attack instead. 

Mungin’s condition worsened, and because she was too weak to take the subway to the nearest hospital, she called 911. When the ambulance arrived, the EMTs were convinced it was a panic attack, not COVID-19. One of them sat with Mungin, who is Black, asking her questions to help her calm down. When he asked her about her long-term dreams and goals, she replied through labored breath, “My goal is not to die today.”

The EMTs left her to head to their next call. Still determined to get help, Mungin found her own way to the emergency room at Brookdale Hospital. There, she was placed in an area with people who had tested positive for COVID-19 but was not tested herself. Doctors said her lungs sounded clear. Terrified she would contract the virus if she hadn’t already, she went home. 

Less than 24 hours later, she was on a ventilator, fighting for her life in that same hospital. Mia Mungin said the attending physician told her that her sister “was the sickest patient they had.” 

Across the United States, Black women like Mungin have long faced significant social, economic, and racial barriers to receiving healthcare. Wage disparities, lack of access to hospitals and doctors’ offices, and the chronic stress of racism and implicit biases from providers all contribute to worse healthcare outcomes for Black women versus their white peers. Now, doctors and policymakers are concerned that those factors are compounding in the COVID-19 pandemic, creating greater gaps in care, and potentially increasing the virus’s spread.

My goal is not to die today.

Zoe Mungin Brooklyn teacher

Few places are tracking COVID-19 cases by race, but those that are show startling numbers of cases among Black people. In Milwaukee, where just over a quarter of the population is Black, data released on April 9 shows that Black people made up at least 45 percent of COVID-19 cases and accounted for 61 percent of fatalities. Other predominantly Black communities, like in New Orleans and Detroit, have become hot spots for the disease.

For many Black women, the trio of an elevated risk of exposure, lack of access to testing, and a higher likelihood of underlying health conditions make COVID-19 particularly threatening. 

The disease “spreads in places where folks are in contact with other people,” says Cicily Hampton, chief policy and programs officer at the Society for Public Health Education. “Who relies on public transport? Who are essential workers? Those women and men on the front line in grocery stores, or at the pickup counter in restaurants are Black and brown people.”  

Those low-wage, frontline jobs also tend to lack the kind of benefits that can help stop the spread of the virus, like health insurance or paid sick leave, Hampton explained. “If someone has a fever and a cough, but they have rent to pay and children to feed, they’re going to get up and go to work. They don’t have the luxury of a sick day.” 

She says fears about the cost of treatment also keep people away. “If you don’t know if your bill is going to be $100 or $1,000, and you don’t have that money to spare, you’re going to stay away.”

Even if someone who thinks they’ve been exposed can take time off to seek care, Black populations are more likely to live in areas where residential segregation has led to healthcare shortages, or lower-quality clinics and hospitals. Public institutions have been critically short on supplies in the pandemic—including test kits for the coronavirus. 

After her sister was admitted to the hospital, Mia tried to get tested, but the hospital told her they were short on kits. “Stars on TV with no symptoms get tested, no problem,” she said. “But if you’re poor, you can’t get tested unless you’re nearly on death’s door.”

The major risk factor that makes coronavirus more deadly for those who catch it is underlying illness, and Black Americans are at higher risk for chronic conditions, like asthma, cardiovascular disease and diabetes than their white counterparts. 

Those chronic illnesses can be caused or exacerbated by the toxic stress of racism, explained Jamila Taylor, director of healthcare reform and senior fellow at the Century Foundation. “We can’t have these conversations about racial disparities without centering them in racism, in both the healthcare system and broader society. The cumulative effects of racism cause wear and tear on our bodies, and make us more susceptible to chronic illness,” she said, pointing to a seminal research study on racism and inflammation.

A quality healthcare experience means a patient is listened to.

Jamila Taylor director of healthcare reform and senior fellow at the Century Foundation

Often the most pernicious obstacle, the one that affects Black women regardless of their income, education, or baseline health, is what Mungin faced in her attempts to get treatment: simply not being believed or deemed worthy of treatment. 

“A quality healthcare experience means a patient is listened to,” said Taylor. But for Black people, “their pain and discomfort are often ignored” by physicians, or assumed to be less severe than they describe. And providers often equate being Black with being poor, uneducated, drug seeking, pushy, or noncompliant.

This implicit bias affects Black women across socioeconomic strata, often with dire consequences. Donna A. Patterson, director of Africana studies at Delaware State University pointed to the pro tennis player Serena Williams, who tried to alert nurses to potential blood clots in her lungs after giving birth. “Serena Williams knew she had a blood clot and they brushed her off. She’s famous, she’s educated, she’s a multimillionaire, but she’s a Black woman, so they didn’t listen to her.”

Lawmakers are concerned that the number of COVID-19 cases in Black communities are being underreported and undertreated, leaving everyone more vulnerable. On March 27, five members of Congress, including Senator Elizabeth Warren and Representative Ayanna Pressley, both from Massachusetts, sent a letter to the U.S. Department of Health and Human Services, calling on them to monitor and address racial disparities in the nation’s response to the outbreak.  

“Any attempt to contain COVID-19 in the United States will have to address its potential spread in low-income communities of color,” the letter states, “first and foremost to protect the lives of people in those communities, but also to slow the spread of the virus in the country as a whole.”

But Hampton fears for the worst. “I think we’re going to see huge losses in low-income communities of color who are impacted by this,” she said. “People are losing their health insurance; public clinics aren’t getting tests. We are going to see huge inequalities when all the numbers are crunched on this.”

After a concerted effort by family, friends and alumnae from Wellesley College, where Mungin received her undergraduate degree, she was transferred to Mount Sinai to receive ECMO therapy, an advanced form of life support that can give her lungs time to heal. Nearly three weeks later, she is still on a ventilator in the ICU. 

Mia, who is a registered nurse, tweets daily updates about her sister’s condition intermixed with requests for prayers. “At this moment, we are all just praying for her survival. That’s all we can do,” she said.