Commentary: Arab and Middle Eastern COVID-19 Patients are Often listed as ‘Unknown.’ We must be Counted.
SOURCE: THE SAN DIEGO UNION-TRIBUNE
BY: RAED AL-NASER
San Diego County publishes a breakdown of COVID-19 cases, according to race and ethnicity that mirrors the U.S. census criteria. Unfortunately, the census does not identify Arab or Middle Eastern persons. Quite often patients from the Arab and Middle Eastern communities are listed simply as “unknown,” according to the National Arab American Medical Association. In San Diego County, the “unknown” category represents 1,256 of the 5,836 cases of the disease, or about 1 in 5.
I am a physician specializing in the health of the respiratory system. For many across the world, including myself, the last few months have been the most unprecedented of times. The images of COVID-19 are surreal with cities sleeping in the daytime, abandoned airports and vacant streets. There are also horrific scenes of sick patients lying on hospital floor hallways waiting for a bed, emergency rooms packed with patients, and overwhelmed intensive care units without enough ventilators.
In no time at all, people recognized that the world is facing a different kind of war in which the fighters are not in tanks or carrying guns. The armies of this war consist of doctors, nurses and other health care professionals wearing scrubs and putting their lives at risk fighting an invisible enemy, with limited resources.
Observing this pandemic as it approached our country, hospitals and organizations prepared to face the onslaught by implementing multiple protocols to address the safety of patients, health care providers and communities. Doctors obsessed over recent publications, seeking to acquire all possible knowledge and skills needed to fight this deadly and unknown disease. Personally, I felt I had reverted to my internship days, studying new information and, at the same time, facing an extreme workload from a situation that we have never before experienced. In the back of my mind, I also felt an overwhelming concern with becoming critically ill or disabled or bringing the disease home to my family.
Fortunately, having had firsthand experience during my training during the AIDS pandemic and the 2009 swine flu pandemic, I had some ammunition to fight this new disease. With each day’s reading of academic publications from around the world and consultations with my colleagues, I became more comfortable with anticipating the trajectory of this novel disease and ways to combat it. I focused hard on the well-being of our patients and community.
During this journey, however, I became greatly disturbed by a parallel observation: COVID-19 is affecting patients of color and minorities, particularly African Americans and Latinos, across the country in a disproportionate manner. I also witnessed a similar effect in our local ICU. In the hospital inpatient units in East County and the early waves of hospitalized patients, I observed a disproportionate number of COVID-19 cases from the Arab and Middle Eastern communities, especially from the city of El Cajon. Other physicians echoed similar observations and expressed their concerns.
Though epidemiological studies remain to be conducted, there may be several factors at play resulting in disproportionate effects in the Arab and Middle Eastern communities in East County. These are comparable to the factors observed in ethnically and racially diverse communities elsewhere: higher rates of underlying health conditions, such as hypertension and diabetes; smoking-related conditions, and limited access to medical care.
Members of these communities may hold “essential” jobs at grocery stores, restaurants and cleaning services where social distancing is difficult to maintain. Housing disparities and crowding further exacerbate the risk factors.
Arabs and Middle Easterners love to congregate and hold gatherings with relatives and extended family as part of our culture, so I know there may also be cultural factors that contribute to the risk of contracting this disease.
Such behavior, however, needs to be temporarily suspended when fighting a pandemic.
It is my firm belief that the availability of appropriate and accurate analysis of our population is of the utmost importance in the fight against this pandemic. We must correctly identify and categorize our COVID-19 patients.
This is critical in helping community leaders and physicians, under the guidance of San Diego County and its Health and Human Services Agency, to reach out to the community to deploy effective education, prevention and early intervention methods. These are the primary steps in combating our invisible enemy. Data collection is critical in moving forward in delivering effective and early health care to this subset of the population. Data moves people.
It is time to understand who our unknown population really is.