Enhancing data collection, investing in research, and building trust can help mitigate the disparate impacts of the COVID-19 pandemic on Black and Latinx seniors, witnesses told members of the Senate Special Committee on Aging during a hearing on Tuesday.
The pandemic’s impact on minority and ethnic groups appears most acute in young people and seems to taper off among community-dwelling older adults, Mercedes Carnethon, PhD, an epidemiologist and preventive medicine specialist at Northwestern University in Chicago, told the committee.
Nevertheless, disparities persist for seniors living in congregate care settings such as nursing homes.
In fact, nursing homes with a higher proportion of Black and Latinx residents have double the rates of COVID-19 infections than facilities with a greater share of non-Hispanic whites, Carnethon said.
Current policies don’t require universal reporting of race or ethnicities of individuals affected by COVID-19, she said.
“We really need the data … of who’s contracting COVID in order for us to stop this transmission,” she said.
While seniors would stand to benefit from reopening the economy, like most other age groups, Carnethon warned against “prioritizing the economy over the people.”
The shadow of vaccine hesitancy looms over the COVID-19 solution in which policymakers and clinicians have put much of their faith.
Only 25% of African Americans and only 37% of Latinx individuals say they are willing to take a vaccine, Sen. Tim Scott (R-S.C.) noted.
At a minimum, researchers suggest that 70% of the U.S. population would need to either be vaccinated or have contracted the virus at some point to achieve herd immunity.
Asked how to overcome these odds, Carnethon, who is Black, suggested building partnerships between academic institutions and community leaders, and spending time listening to the community and understanding their needs and concerns.
“What we really need to do is put ourselves in the shoes of community members to try to understand what those barriers are to wanting to engage in preventive health behaviors, to wanting to accept these vaccines,” she said.
Rodney B. Jones Sr., CEO of East Liberty Health Center in Pittsburgh, argued that vaccine hesitancy proves the need for more diversity among providers, suggesting that people respond best to others who look like them.
Lingering suspicion of the medical establishment and the government in general is also a problem for contact tracing.
For contact tracing, Carnethon said she’s not surprised that minority individuals are reluctant to respond when a government agent asks about their whereabouts.
Jones said community health centers can play a key role in the messaging, having already established relationships and built partnerships with churches and other groups. “The trust is there,” he said.
Carnethon also advocated for “implicit bias” training in medical school to help improve trust between patients and clinicians.
She suggested that “experiential learning” can be very effective. For example, inviting community members who had negative experiences when receiving medical care to share their stories with clinicians or recording clinicians to make them aware of how they sound when speaking with patients.
Improving Telemedicine, Investing in Research
Another way to enhance care for older adults now is to expand the telehealth infrastructure and provide training for seniors, Carnethon said.
The CARES Act included provisions and provided grants to support expanded use of telehealth services.
While telehealth can be done through telephone calls, Carnethon argued that using video would enhance social connection between clinicians and patients, as well as give clinicians “visual cues” enabling them to determine whether an in-person visit or other home-based supports are needed.
About half of older adults have access to smartphones, and ownership is similar across different races, she said. But access is just the first step, Carnethon said, as “technology-naive” adults need help learning to use video conferencing.
Carnethon also called for Congress to increase funding for research at the National Institutes of Health.
Researchers have also found that adults with obesity or diabetes have some of the worst outcomes from the virus. For that reason, Carnethon asked that other institutes — those that study the relevant organs and under-represented populations — be on “equal footing” with NIAID, which received most of the new NIH funding appropriated in the CARES Act.
Similarly, Dominic Mack, MD, director of the National Center for Primary Care and a family medicine professor at the Morehouse School of Medicine in Atlanta, called on Congress to provide another $100 million to the NIH’s Office for Minority Health (OMH) to target minority-health serving institutions.
Morehouse has partnered with OMH to create a National COVID-19 Resiliency Network to identify vulnerable communities; use technology to link these at-risk communities with community health workers; and disseminate culturally and linguistically relevant information about SARS-CoV-2 to residents.
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