Spotlighting Stigma and Disparity in Care During the COVID-19 Pandemic

Spotlighting Stigma and Disparity in Care During the COVID-19 Pandemic

“We had known that minority groups had worse mortality and infection rates, but black Michiganders also reported more severe symptoms, longer hospital stays, and worse treatment.”  – Dr. Nancy Fleischer

The COVID-19 pandemic has been characterized largely with numbers – how many positive cases are there in a county? How many deaths were there this week? How few ICU beds are remaining? All important and telling of how things were proceeding in the pandemic response in our nation, but there were questions that weren’t initially being asked and were harder to quantify: Is access to quality healthcare the same for everyone? Which of our communities are being impacted the most by COVID? With funding from MIDAS, Dr. Nancy Fleischer, Associate Professor of Epidemiology, sought to find the answers to these questions and came up with alarming results.

When the pandemic first began looming large in the United States, MIDAS pivoted rapidly to assist data science researchers in their efforts to address the pandemic. With a 30-day turnaround time from call for proposals to award announcement, the special round of the Propelling Original Data Science (PODS) grant program funded 7 data science projects on COVID. One of the projects was “The Michigan COVID-19 Recovery Surveillance Study” (MI CReSS). A collaboration with the state of Michigan’s Department of Health and Human Services (MDHHS), MI CReSS developed a survey to collect information from Michiganders both about their experiences being diagnosed with COVID-19 and about the wider effect the pandemic had on their lives.

In January of 2021 MI CReSS released a report of their findings regarding racial disparities between black and white Michiganders in relation to their experiences with the COVID-19 pandemic. “The group I work with are social epidemiologists.” said Fleischer, “We care about not just the population as a whole but also the more vulnerable communities – and how those communities are often disproportionately affected. One of the ways those communities are affected is based on race and because of racism. This study falls within the framework of public health surveillance but most of the current public health surveillance engine was based on case counts, hospitalization and mortality and less focused on identifying and understanding these experiences. Our findings show a sharp difference in severity of cases between white and black patients, with black patients reporting more severe symptoms, a higher rate of hospitalization, worse experience seeking healthcare, and increased stressors due to the pandemic (i.e. unable to pay bills).” Their work also provides insight to the impacts of “Long COVID” and shows that, again, marginalized communities are more likely to experience longer lasting effects stemming from a COVID-19 diagnosis due to lack of access to healthcare. “People are often focused on hospitalizations and deaths but our work and other’s work are showing that people can have symptoms many months after their initial diagnosis and this is really debilitating even after the acute phase.”

Fleischer and her team have been working closely with the State and the Michigan Coronavirus Task Force on Racial Disparities, sharing their population sample data with these agencies to inform and enact meaningful changes. They are continuing to interview new cohorts of Michigan residents affected by the COVID-19 pandemic. “We’re starting to plan to follow up with people we interviewed a year ago, we’re planning to continue our data collection.” When asked about what she anticipates over the coming months, Fleischer said, “From our perspective, the pandemic is not over. With vaccination rates not at the level we would like and continuing circulation of new variants we expect cases to go up again.”

MI CReSS expects to publish more results over the coming months including a report examining the experiences of the Hispanic/Latino population akin to the recently released study on the black community. Another report will more closely analyze how individuals working in different industries and occupations have been impacted. ”We have a lot in the works.” says Fleischer. She credits the PODS grant award to jumpstarting the study, “…it was enough to get the work started, provide research incentives to our participants and support the interviewers. We were able to launch the study and collect data from about 600 people over the summer.” The initial results from the first sample of MI CReSS gave Fleischer and her team the motivation to write other grant proposals which have led to multiple rounds of funding from the Michigan Public Health Institute and MDHHS.

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