When I was 16 years old, my biological mother — whose very existence I had only learned of a month prior, due to her being incarcerated in the state of Texas for drug possession — died from complications of stage IV colon cancer. I later learned that before her diagnosis, she had complained of stomach pains for a long time, but rather than being screened for a health issue, she was repeatedly given Tylenol — despite having a history of colon cancer in her family. By the time my birth mother was given access to real care, the cancer had metastasized. The Bureau of Prisons granted her a compassionate release, and she returned home to her family in Louisiana to die. As the cancer slowly ravaged her body, she prepared her own wrongful death suit to be filed upon her passing; it would be almost 10 years to the date of her death before the Bureau of Prisons would admit to their role in my birth mother’s death and settle with myself and her remaining children. 

In my early adulthood, I too was impacted by incarceration, though only for one day. I was given no soap, due to lack of inventory, and a tube of a jelly-like substance that was supposed to double as toothpaste and gel; I watched women shower in open, crowded areas next to the living space; I saw no cleaning products being used to maintain the area. 

The same apathy toward the wellbeing of incarcerated people is being demonstrated on a much wider scale right now, during the COVID-19 pandemic. As both the Pfizer-Biotech and Moderna COVID-19 vaccines continue to be distributed to Americans, the glaring oversight of the approximately two million persons currently incarcerated in jails and prisons is both a moral and epidemiological mistake. Incarceration should not be an automatic death sentence.

By the beginning of summer 2020, the U.S. Bureau of Prisons reported that of the 2,700 inmates they tested for COVID-19, 70% had tested positive for COVID-19, though they stated that the figure “does not reflect the positive rates across the BOP system, which houses 146,000 prisoners.” At the end of December 2020, testing revealed that one in every five state and federal prisoners had tested positive for COVID-19, four times the rate of the general population. At least 2,400 incarcerated people have died from the virus. 

The environment we’ve created in American correctional institutions have allowed this deadly pathogen to surge nearly unimpeded. Due to the confined areas within prisons and jails and the ongoing problem of prison overcrowding, social distancing is virtually impossible inside. Moreover, those incarcerated in the prisons, jails, and even juvenile correctional institutions are not allowed to have access to hand sanitizer because, due to its alcohol content, it is considered illegal contraband. Even simple protective measures like washing one’s hands can be challenging; some incarcerated people don’t have easy access to soap and water. 

In light of the continuing severity of the pandemic, the U.S. criminal justice system has taken measures to alleviate prison overcrowding, such as releasing some non-violent offenders. In states like Ohio, some counties are holding criminal pre-trial hearings by telephone and lowering the cost of bonds. California, which houses the second-largest incarcerated population in the country, has allowed some violent offenders to go free if they suffer from a particular set of comorbidities. 

But thousands of other men and women remain in correctional institutions during the pandemic, and the conditions inside are literally life-threatening. Some institutions in states like Florida have required people who are booked into jails to quarantine for up to 14 days, during which time they may have no access to legal counsel; at one point in Palm Beach County, more than a third of the jail population was in quarantine. A report from the University of Texas as Austin showed that between April and September of 2020, nearly 80% of people in Texas county jails who died of COVID-19 hadn’t yet been convicted of a crime, and 58% of people in Texas prisons who died of COVID-19 were eligible for parole at the time of their deaths.

The handling of the COVID-19 vaccine offers another example of the public health negligence we have allowed to fester in American correctional institutions. Its distribution has been at best unmindful to the sensitive epidemiological threat ignoring incarcerated people’s care poses; in many cases, government officials have been purposely punitive. In early December while addressing the public concerning the rollout of the COVID-19 vaccine for the state of Colorado, Governor Jared Polis explicitly stated, “There’s no way it’s going to go to prisoners before it goes to the people who haven’t committed any crime.” 

Though his sentiment is shared by many, this statement is immoral and illogical. Inmates are wards of their individual states, and correctional facilities are required under the law to care for them. 

Further, 95% of those incarcerated in U.S. state prisons are coming home. The U.S. Department of Justice states that over 10,000 people are released from state and federal prisons each week. That means thousands of people who are possible carriers, being sent back into communities all over the country, spreading the contagious form of the pathogen and its newly emerging strains. The people who work in these facilities, including corrections officers, delivery drivers, and other staff, could also contribute to the spread. 

Many experts all over the world are calling for the vaccination of incarcerated populations to be a top public health priority. Though details about states’ vaccination plans are still rolling out, The COVID Prison Project, a nationwide watchgroup tracking the effects of the COVID-19 pandemic upon the incarcerated population and correctional staff in the U.S., has reported that around 24 U.S. states and territories (including Washington D.C. and Puerto Rico), have included the incarcerated population in their Phase 1 group for the COVID-19 vaccination distribution. Five of these states and territories, however, are prioritizing medically vulnerable incarcerated persons, such as people who are over age 65 or who have two or more chronic illnesses. As of the last COVID Prison Project update, around 15 states have incarcerated persons prioritized in Phase 2 or 3 of COVID-19 vaccine distribution, and 12 states have no distribution plan in place at all. The floundering of the nation’s vaccination effort cannot afford to spread to the prison systems unless the goal is to see cells turned into tombs. 

The Biden Administration recently announced that it will buy 200 million more doses of the Pfizer-BioTech and Moderna COVID-19 vaccines by late-July, in the hopes of vaccinating the entire American population by summer’s end. It is not clear nor has it been explicitly stated where in the distribution efforts the incarcerated population will fall. 

In the interim, we as a community can aid those behind bars in surviving this pandemic by donating to community bail funds, which you can find using the National Bail Fund Network’s comprehensive directory. Lend your voice to grassroots efforts by sending officials such as your governor or local sheriff letters demanding the release of individuals who have less than a year of their sentence left or who are classified as medically vulnerable. When we stand in solidarity as one voice and one community, lives are saved. 

Today, I’m an epidemiologist with a focus on infectious diseases. I got my degree at the oldest and one of the highest ranked schools of public health and tropical medicine in this country. I have also been incarcerated. I have also been without a home. All of these things make up who I am. My life matters. And the lives of all imprisoned people do.

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On Monday, December 14, the U.S. officially commenced the largest vaccination effort of its citizens since the poliomyelitis outbreak of the mid-20^th century. On the same day, the nation officially surpassed 300,000 deaths attributed to the coronavirus pathogen. As the COVID-19 pandemic rages on, the Pfizer-BioNTech vaccine and the Moderna vaccine have both been approved for mass distribution in the United States. The vaccines have offered immense hope to many who have lost their loved ones, livelihoods, and quality of life due to COVID-19’s year-long destruction. But Black Americans are understandably wary of accepting the words of the medical community, public health officials, and the government at face value. 

From the very beginning of this pandemic, we have witnessed the glaring intersections of racial and social inequity in healthcare. We saw policies that could lead to the unequal distribution of dwindling hospital resources amongst Black patients; we heard from people who reported that medical professionals discounted their symptoms; this summer, there was fear that medical personnel might even refuse treatment for Black Lives Matter protestors. The phenomenon of medical racism has been amplified in the COVID-19 era, but it is by no means Black America’s first introduction to it. Ask almost any Black person in America of any age to quantify their distrust for Western medicine or the United States government, and they will immediately cite multiple infamous racial injustices. 

Medical racism is not just a talking point of the historical injustices perpetuated against people of color in this country. It is the bedside warnings from our mothers before we visit the doctor for the first time. It is the tales of our elders, regaled almost like ghost stories in their believability that such cruelty could be inflicted upon a person. My own biological mother, who gave me up for adoption at birth, was only given Tylenol for what was later diagnosed as Stage IV colon cancer; she was then given less than a year to live. These stories are not rare. Between the 1900s and 1970s, thousands of Black women and other women of color were sterilized without their consent and sometimes without their knowledge due to the forced sterilization authorizations that existed in more than 30 states. In North Carolina involuntary eugenics was practiced until 2003; the Eugenics Compensation Act of 2015 allowed the approximately 220 living victims to receive compensatory damages.      

In Washington, D.C., the theft of Henrietta Lacks’ cell line by Johns Hopkins’ Hospital researchers revolutionized medicine by creating immortal “HeLa cells”, but compromised its donor’s treatment for cervical cancer. Her family was completely unaware that her biological material was being used for unethical scientific research for over six decades, nor were they compensated. In Alabama, the Tuskegee syphilis experiments, a four-decade study on untreated syphilis conducted on illiterate Black male sharecroppers without their informed consent and under the deception that they would be given free medical care, irrevocably damaged Black Americans’ trust in the medical community. A research study from 1999 found that around 80% of Black men surveyed believe the men were deliberately injected with syphilis. 

These wounds will never truly heal, these sins will never be forgotten, and the hesitancy of the Black community to place a profound amount of trust in these same systems that have proven themselves untrustworthy time and time again is completely rational. Therefore, it is up to us as healthcare professionals to earn the public trust that this massive stride towards herd immunity against COVID-19 demands. 

As a Black epidemiologist, I have often said that the difference between the fields of public health and medicine is that public health is primarily focused on prevention. Prevention efforts require not only education but also coordinated efforts for the proper dissemination of information. In our nation’s history, when public health and medicine have come together as they are now, we have accomplished the seemingly impossible, like the elimination of measles and rubella in the early 2000s. How do we attempt to replicate these previous feats in the age of “fake news” and inspire the necessary public trust? 

First, bring everyone to the table, and I do mean everyone. Answer every question. Educate. Don’t ask minority communities, especially ones scarred by generations of trauma at the hands of medical racism, to come to us. Go to them. Work with trusted leaders within that community. An example of this is how my city of New Orleans, a predominantly Black metropolis, has handled the COVID-19 pandemic this year. Once on track to become a COVID-19 epicenter, New Orleans was able to lower both its incidence and prevalence rates by holding nightly COVID-19 informational sessions on the local news with Black doctors and healthcare providers, disseminating testing availability information through the city’s Department of Health, and asking local community leaders, such as the two deans of the two largest Historically Black Colleges and Universities (HBCU) in the city, to explain and solicit participation in the COVID-19 vaccine clinical trials at the state’s best hospital. When people are not only educated but also included in decisions about their health and safety, the community is safer. That is community health. 

Fortunately, we are seeing these approaches replicated on a national scale. Back in April, the world met Kizzmekia Corbett, PhD, the Black viral immunologist at the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases, via a CNN interview with Anderson Cooper. She informed us that help was on the way and a COVID-19 vaccine was on track for December of this year. She kept her promise. In December, vaccines created by both Moderna and Pfizer were granted emergency use approval. Americans even watched as a Black intensive care unit nurse in New York City became one of the first in the country to receive the Pfizer vaccine, which was administered by another Black healthcare professional. 

That visual will live forever, as it is so indicative of how we as Black people have been at the forefront of every health-based fight that bears upon our community. Per the CDC, 60% of issues that lead to premature death in the U.S. are caused by social and environmental factors; only 10% of those factors are caused by faulty clinical care. As a result, concentrated efforts by public health officials and the medical community to engage and partner with minority communities in addressing our questions, concerns, morbidities, and mortalities — and training and community members to be part of their own community’s frontline defense — have long been a vital part of our path forward.

That is how diseases and ailments that have disproportionately affected the Black community in recent decades all the way to the present day have come to be addressed. That is how the HIV-1 virus, once a death sentence in the U.S., has now become widely acknowledged in the medical community as a treatable, chronic condition with a life expectancy into the 70s. That is how successful strides in decreasing viral hepatitis C transmission, and, in turn, intravenous drug usage within the community, have been made. That is how the creation of a human papillomavirus virus (HPV) vaccine in 2015 that specifically targets and stops the “high grade” strains that lead to increased cervical cancer diagnoses in Black women and girls came about. From the vaccine booster shots of your childhood as you sat in your mama’s lap to the groundbreaking medical advancement we have just witnessed at the hands of a Black woman, I can see no better time than the present to rely upon our community. 

With 49% of Black Americans polled refusing to be vaccinated even if it’s deemed safe and is free, it is my sincerest hope that Black healthcare providers and epidemiologists like myself use this time to speak to the communities around us and dispel fact from fiction. Like Dr. Corbett, we have dedicated our lives to science and the healing of our communities. Explain to your loved ones that it takes approximately two weeks for the body to establish immunity to a pathogen upon vaccination. Explain that you still need to practice social distancing and wear a mask after vaccination, because so far we only know that the vaccines prevent you from contracting the virus or developing severe symptoms, not whether it keeps you from spreading the virus. Explain that vaccines are not created out of thin air, but are constantly being developed, so the brevity of the COVID-19 vaccine production doesn’t have an effect on its effectiveness in any way. 

It’s like the elders always say, “We all we got.” Stopping a pandemic that has been bolstered by ineptitudes in leadership, societal apathy, and systemic medical racism has been the perfect storm of destruction upon our community, which has not even begun to heal from the transgressions of this nation’s past. With 2021 quickly approaching, nothing will change unless we as a community help to facilitate that change. Because by January 1, it is projected that 1 in 500 Black Americans will have died of COVID-19. We truly are all we got. 

Gabrielle A. Perry is an infectious disease epidemiologist based in Louisiana 

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The insidiousness of racism is not only that it is enduring, but that it is ubiquitous. Right now, hundreds of thousands of us mourn in the streets for Breonna Taylor and George Floyd, as we protest a pattern of police brutality toward Black Americans. At the same time, we enter another month during which we’ll be fighting COVID-19. This pandemic has revealed all the ways in which racism infiltrates our medical systems, too. 

While training to become an epidemiologist, my colleagues and myself were taught about medical racism in an abstract way, despite it being a very tangible threat. Science and medicine are considered by many to be pure, and immune from “qualitative” biases. However, Black Americans, who make up around 13% of the total United States population, represent a full 23% of COVID-19-related deaths in the United States, reports the Centers for Disease Control and Prevention. That is not a coincidence. 

From the beginning of the SARS-CoV-2 pandemic, racism has been at the forefront of the national conversation. We watched as the world rendered Chinese people the culprits and carriers of a global plague. Their culture and humanity were placed on trial. The Asian community in America is still reeling from this dangerous attack, and likely will be for some time.

Later, when enough epidemiological data became available for states to see the demographics of COVID-19 morbidity and mortality, it became clear that Black Americans were being inordinately affected. While the blame for this was quickly placed back on their own shoulders, this disparity highlights many of the ways Black people are harmed by the medical system. 

The American Medical Association estimates that 56.2% of active U.S. physicians are white and 17.1% are Asian; just 5% are Black. As such, the majority of Black Americans receive their healthcare from non-Black people. It’s naive to ignore the implicit racial biases that these providers take with them into physician-patient relationships. 

Black women with white physicians are less likely to be educated by their providers on preventative care, less likely to be preventatively tested for maladies, and less likely to be referred to “state-of-the-art” specialty facilities like their white female counterparts, according to a 2013 meta-analysis performed by sociological researchers at Texas A&M University. A dual study that was part of the meta-analysis, published by the National Institute on Minority Health and Health Disparities and Columbia University, found that, “Black patients with problems comparable to whites got less attention from nurses, fewer tests, and less sophisticated or no heart treatments.” 

Despite this empirical evidence, growing bodies of research aimed at answering why racial biases permeate medicine have found that white and white-adjacent healthcare providers view medical racism differently — if they acknowledge it at all. White physicians find Black patients, and low-income patients, less intelligent than white patients and patients of higher income, found a study performed by the University of Albany School Of Public Health. When doctors and nurses were given an anonymous survey asking them to explain racial inequalities in healthcare, most providers saw Black patients as “passive” and unintelligent, and blamed them for not making pointed care requests of their providers, reports the Journal of Ethnic and Racial Studies. 

Americans were shown a blatant example of this phenomenon when the U.S. Surgeon General Jerome Adams received immense backlash for publicly lecturing Black Americans for not adhering to stay-at-home policies. Many felt that the implication was that the Black community had only itself to blame for its disproportionate rates of COVID-19 deaths and hospitalizations. Never mind that Black Americans are the demographic that make up a disproportionate amount of American essential workers, are the most likely to use public transit, and are the most likely to suffer from comorbidities while having less access to healthcare. Medical racism kills you and blames you for your own demise. 

We’ve seen this type of reframing for generations. We’re seeing it now, even as we continue to mourn the deaths of those killed by police in America. Black women and men are 1.4 times and 2.5 more likely to be killed by the police, respectively, than their white counterparts. Yet, no matter what, the blame is placed on the deceased for the end of their life. 

After Breonna Taylor was shot in her own home, law enforcement tried to justify the killing, pointing to a search warrant they’d obtained — though it didn’t include Taylor’s name, and she had committed no crime. After George Floyd was asphyxiated, preliminary results from an autopsy conducted by the state’s medical examiner pointed fingers at “other significant conditions,” besides a police officer’s knee on his throat. When Ahmaud Arbery was shot while jogging, neither of his assailants were charged for more than two months.

As we enter the second week of protests, and the middle of the two- to 14-day COVID-19 incubation period, many are concerned that the recent uprisings will manifest into nationwide spikes in COVID-19 cases, hospitalizations, and deaths. Los Angeles County, CA, Lee County, FL, and multiple testing facilities across the states of Pennsylvania and Illinois have suspended COVID-19 testing. Each municipality has cited the recent uprisings against police brutality as the reason for the suspension of testing. 

The Huffington Post reported that 2,000 masks, paid for by The Movement for Black Lives, that were destined for protestors in Oakland, Washington D.C., St. Louis, Minneapolis, and New York City were seized by federal authorities. 

I’m a physician and I agree with this. I’ve experienced medical racism as a patient and I’m a physician! I’ve also been the target of anti-black acts from my physician colleagues. Medical racism is not a joke y’all.

— Dr. Monifa M.D. (@DrMonifaMD) May 31, 2020

With the suspension of affordable COVID-19 care access and the blatant dismantling of organizational efforts to keep communities safe from viral transmission, Black communities will continue to bear the brunt of the virus’s impact. All because Black Americans dare ask that our humanity be recognized and that police be brought to justice for our unlawful murders. 

In the midst of an unprecedented public health crisis, medical racism has been bolstered by police interference and systemic violence perpetuated by public health leaders.

Because numerous scientific studies over decades and hundreds of years of human history have shown us that internal biases create macrocosms of deadly consequences, we must contend with how all these forms of oppression work together with the pandemic. Nurses are already publicly speaking out about how they feel the actions of protesters affect the lives of healthcare workers on the frontlines. 

But how do we teach people that racism is as deadly as any pandemic? When it comes to George Floyd, one little fact remains stuck in my mind:  The Hennepin County Medical Examiner’s Office revealed that Floyd had tested positive for COVID-19 in April — only to die at the hands of systemic racism just one month later. 

Gabrielle A. Perry is an infectious disease epidemiologist based in Louisiana 

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