When we decided to take a walk with our two African American college-aged daughters to escape the confinement of home and the all-encompassing feel of the internet, on the pretense of needing to mail a letter, we ventured out into the beaming sun warming the city of Portland, Oregon. Casually dressed with our masks on, appreciating the unseasonably warm weather and one another’s company, only four blocks into our walk, our family was affected by yet another consequence of COVID-19: COVID 1619 (America’s virus of racism that has been infecting society for over 400 years). An elderly white male stared at us as we moved up the street, smiled, then shouted from his upstairs deck: “Are you guys going to rob a bank?” followed by a laugh. We were taken aback by the stranger, and failed to find the humor. My entire family was shocked, angry, and offended. His words were reminiscent of a recent article in The New York Times describing the apprehension and experiences of African American men wearing masks, which while helpful in the face of COVID-19, identifies them as a threat.1 These protective coverings could not stop the droplets of racism that spewed from the man’s mouth and mind. As we continued our stroll, our family outing changed from a respite from internment to shared experiences of sadness, anger, and frustration followed by an intellectual discussion of racism, a disease (COVID 1619) which has and continues to contribute to widespread harm for African Americans, and other non-whites, even during a pandemic.
The pandemic of COVID 1619 is pervasive and it cares not that one of us is an English Professor/administrator and the other is an anesthesiologist/director, or that both daughters are college honors students. Nothing indemnifies us from stereotypes, myths, and inequities. We are not unlike the disproportionate number of black and Hispanic medical school graduates (7 percent and 6 percent respectively vs 50 percent white) who despite being subjected to many racist incidents this population manage to achieve entrance into the field of medicine.2
Unfortunately, despite our accomplishments, we are victimized by institutional racism. It is a deadly virus in its own right, founded on a social construct of white supremacy and fabricated to justify mass oppression of people of color, it plagues many of our lives.3 It is also pervasive in medicine, where practitioners double down, often insisting they are color-blind, and in education, where faculty and administrators find multiple reasons not to diversify colleagues or curriculum.
These protective coverings could not stop the droplets of racism that spewed from the man’s mouth and mind. As we continued our stroll, our family outing changed from a respite from internment to shared experiences of sadness, anger, and frustration followed by an intellectual discussion of racism, a disease (COVID 1619) which has and continues to contribute to widespread harm for African Americans, and other non-whites, even during a pandemic.
While the most vulnerable population for COVID-19 is the elderly, racism’s most vulnerable population is our youth. The damage to members of the black community begins as early as age five when black kids transition from associating photos of black children with good at age three to associating them with bad courtesy of society’s attitudes about race depicted in places like the movie screen, TV, and the classroom. From Disney, which has historically depicted darker characters as bad and white characters like Snow White as angelic, to the media’s constant categorization of drug abuse, welfare, and teenage pregnancy as activities endemic only to black and brown communities, white supremacy permeates our American life.4-6 These ideas help black and brown children generate self-hate that continues throughout elementary school. African American students are subjected to a Eurocentric education that glorifies Thanksgiving as overcoming hardship while omitting the truth of its inception and its ties to colonization and celebrates Independence Day as a liberation symbol for all Americans while willfully omitting the history of black enslavement and torture that ran parallel to it. 7 Frederick Douglass’s famous speech, “What to the Slave is the Fourth of July”, which exposes these contradictions, is never mentioned. By the conclusion of elementary school black and brown students will have endured being criminalized and all too often suffer an excessive rate of detention and expulsion compared to their white counterparts who are often given “the benefit of the doubt” and viewed as human beings. Black and brown youth, particularly the males, are so abused that high school may not be a viable option in their minds, thus limiting the number of future physicians or PhDs. Consequently, the systemically racist nature of higher education, a space where ideas and plans for careers should be formulated, tends to murder far too many black and brown dreams, rendering most aspirations unobtainable in their minds by the time they graduate—if they even graduate. Their educational experience lacks efficacy, as little confidence building is offered to these students during the most important stages in their development.
After high school the situation is even more dire. Haki Madhubuti’s landmark book Black Men: Obsolete, Single, Dangerous resonates the harsh truths of institutional racism and white supremacy for black males who suffer as victims of bias which often precludes suitable success in the job market alongside intense racial profiling. These factors work to ensure that black men are too often headed towards an inevitable introduction into our penal system or worse, death. Alas the fate of George Floyd, brutally executed by a white officer who kneeled on his neck for nearly nine minutes.8 His murder is akin to the COVID-19 virus death toll that disproportionately represents blacks in the United States (23 percent of United States deaths is derived from the black population that represents 13 percent of the population), compared to whites (who represent 53 percent of United States COVID deaths and 72 percent of U.S. population). These statistics are reflective of the health disparities associated with institutional racism.9,10
These casualties are difficult to reconcile for all physicians working diligently to improve patient outcomes. The stress and emotional trauma of being a front-line worker during the COVID-19 pandemic added to the tragedy of the aforementioned preventable deaths that are intolerable. Furthermore, structural racism for people of color in our society imposes another unforgivable harm in the form of microaggressions like the one my family experienced during our walk when we were branded a band of thieves. As an anesthesiologist, I am well aware that a face-covering alone does not guarantee protection from COVID-19. And, there is nothing that can shield black and brown bodies from the harm of explicit bias inflicted upon them in all facets of our society. However, it warrants serious discussion.
As an educator in a large university medical center, I am concerned about the risk of the emotional trauma consequent to the aforementioned preventable deaths and bias experienced by our brown and black trainees. What is superimposed on black and brown medical students is the impact of institutional racism experienced in training and during their practice. A 2017 survey found that 59 percent of responding physicians (mostly black and Asian physicians) had been degraded, belittled, or harassed by patients based on their social identity characteristics like race, religion, or ethnicity.11 During a workshop, I simulated racial disparities in medicine and a white male physician in attendance, after watching the video of a white patient refusing a physician of color, began to justify the patience’s blatantly racist behavior. The refusal to embrace truth hinders reconciliation and change. In a survey of over 7,000 surgical residents in the United States, 16.6 percent reported racial discrimination and 30.3 percent reported verbal or physical abuse or both mostly from patients and their families. It is heartbreaking to think these residents were more likely to have symptoms of burnout and suicidal inclinations.11,12 The consequent negative impact on learning and potential compromise of quality patient care is unacceptable.
What is superimposed on black and brown medical students is the impact of institutional racism experienced in training and during their practice. A 2017 survey found that 59 percent of responding physicians (mostly black and Asian physicians) had been degraded, belittled, or harassed by patients based on their social identity characteristics like race, religion, or ethnicity.
As African American professionals we encounter an astonishingly wide array of microaggressions and battle numerous policies that uphold systemic racism and differential treatment. It is distressing to note that whites are not the only perpetrators of these aggressions because the virus of racism (COVID 1619) is powerful and highly contagious. As an African American anesthesiologist, I understand that there is little I can do to change the minds of some patients and their families, and the elderly white man in my neighborhood. I am well aware of the importance of resources for teaching bias and reporting harassment in the workplace. While I applaud organizations that provide these resources, education, and diversity training for real institutional change will take time. Meanwhile, black and brown physician trainees continue to experience consequential harm from racial profiling and microaggressions in their respective institutions. In academe the threats are similar: teaching bias, subjective rules, and differential treatment regarding hiring practices and annual and tenure reviews.
The downward trend of African American male college entrants and male medical school matriculants, together with an impending shrinkage of our physician workforce, adds urgency to eliminating this dangerous societal construct.13 Perpetrators of these consequential micro- and macroaggressions must be removed from positions where they can affect more harm. This is the first step towards change and zero tolerance. Also, while white physician educators must necessarily move toward mitigating and eliminating the barrage of today’s stresses and strains superimposed on a legacy of abuse experienced by these students, some consideration must be given to a policy of zero-tolerance. It is the most effective way to mitigate and cure the virus of racism. Such a policy, we believe, will finally help ensure that brown and black learners are not subjected to continued harm while the white majority unlearns the disease of structural racism and our entire society can reap the benefits of a healthy community.