25. How COVID-19 Has Impacted Minorities with Dr. Gary Puckrein

Published May 19, 2021

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Show Notes

The COVID-19 pandemic has been especially devastating for people of color. Minority groups are more likely to get severely sick and die from COVID-19. Additionally, Black Americans are getting vaccinated at a slower rate than whites. Here to talk about these disparities and how we can work to overcome them is Gary Puckrein, President and CEO of the National Minority Quality Forum.

Episode Transcript

Sue Peschin:

Hi everyone and welcome to This is Growing Old, a podcast from the Alliance for Aging Research. I’m Sue Peschin and I’m the President and CEO of the Alliance for Aging Research. The COVID-19 pandemic has been especially devastating for communities of color. Minority groups are more likely to get severely sick and die from COVID-19. Additionally, Black Americans are getting vaccinated at slower rates than whites. So here to talk about these disparities and how we can work to overcome them is Dr. Gary Puckrein, President and CEO of the National Minority Quality Forum. Gary, thank you so much for being with us today.

Gary Puckrein:

It’s my pleasure.

Sue Peschin:

Can you please, just for our listeners’ sake, tell us the mission of the National Minority Quality Forum and what you’ve been up to in the last year as it’s related to the COVID-19 pandemic.

Gary Puckrein:

So our mission is really about reducing patient risk. We started out with a focus on eliminating health disparities. And as we got deeper into the effort and looking at data, what we realized was what really what everybody expects when they come into the healthcare system, that the healthcare system is going to reduce their risk for hospitalizations or emergency room visits, disability or mortality while improving the quality of life. And it doesn’t matter who you are, that has to be the mission of the healthcare system. And so what we came to appreciate is that the conversation we were having was really about the broader healthcare system and making sure that it was treating everyone equitably and then it was on its mission. Because, no patient walks into the healthcare system expecting that the system was going to elevate their risk.

Gary Puckrein:

And what we saw with COVID was really sort of a breakdown of mission, right? Because part of, if you go back to the original contract, my Doctorate is in history, so I always go back to first principles and what it said was Conservation of Life. We shortened it to Life, Liberty, and the Pursuit of Happiness, but the actual language was Preservation of Life, and that’s why we get into the social contract. And sometimes it gets confused, or people think that what we’re really about is preserving an economic order, but that’s not what we’re about. What we’re really about is preserving life.

Gary Puckrein:

We want to make sure we do it, so everyone can enjoy liberty and happiness. And what we saw during COVID is that basic conversation about whether we are together to conserve life or to conserve an economic system, many thought that we were really about conserving an economic issue. And they were quite willing to put peoples’ lives at risk in order to do that, or unfortunately, minority populations, even because they were essential wokers, and not just firemen and policemen, but they work at the meatpacking factories and at grocery stores.

Gary Puckrein:

And transportation systems that have to keep on going. As well as the problem of access to quality care, elevating their risk in all kinds of ways. And the society didn’t do anything about it. It didn’t ramp up and say, “We have to be particularly careful for these lives because we’re asking them to do unique things in the middle of a pandemic.” And so we raised the alarm, but more than that, we started partnership with federally qualified health systems, with CEOs around the country to try to lower the risk of that for minority populations and it was going on in a lot of different ways.

Sue Peschin:

So, in April, the National Minority Quality Forum announced the launch of its COVID-19 index, a tool that’s designed to prepare communities for future waves of Coronavirus. Can you tell us a bit more about the tool and why it’s so important?

Gary Puckrein:

So the tool really came out as part of conversations that we were having with FQHC, Federal Qualified Health Systems, around the country. And one of the things that we really appreciated is that the virus is actually a slow moving train. Back in August, our scientists were projecting that, by February, if we didn’t make changes, 500,000 people were going to die from the virus. And when we hit February, 500,000 people died. But what we didn’t do was to show whnere, in small geography, zip codes and counties and congressional districts, state legislative districts, where those viruses were going to surge. So we didn’t provide communities with the predictive analytics. It’s almost like there’s a hurricane coming, and we know it’s coming, and we know where it’s going to hit, and we give you fair warning.

Gary Puckrein:

So, in this case, you wear your mask, later on you get vaccinated, and there are these therapeutics. And if you, unfortunately, become positive with the virus, you have access to the therapeutics. So that people really understood that we could predict where the virus is going to be and we could mitigate a lot of that risk. And I think would have helped, tremendously, in the conversations about, “Should I wear a mask?” Or “Should I not wear a mask?”, but we didn’t do that. And so what we decided to do was to put those predictive analytics together. We worked with the CBOs and so we asked each of their community based organizations, and we asked them to give us the zip code of their service area. So we mapped their zip codes on the map, or we look for infusion centers in case for the COVID therapeutics in case they were positive.

Gary Puckrein:

And we also provided them with predictions. So we predicted where the virus was going to be surging or, at least, what the virus levels were going to be 30 days before they actually happened. And this way we empowered them with information that they could use in their community. We felt the government should have done that at the outset of the virus because I think it would’ve helped tremendously if we had a good sense of where the virus was surging.

Gary Puckrein:

And that way we could have taken steps to avoid the virus in terms of mastering. And also, would help us to figure out where we needed to put our interventions that could kind of helped out tremendously.

Sue Peschin:

Yeah. I remember, last year, on the CDC website, there is a whole tool kit about using by zip code. And we included that in some of the remarks we made to ACIP when they were talking about prioritization. And that was also a recommendation from the National Academy of Medicine. I’m sure you worked on that and generated a lot of that, but it didn’t seem like anybody was listening to your point. And it just blew me away. It just didn’t come up in discussion. I’m sure you’re not nearly as surprised about it as I was, because you’ve been doing this a lot longer, but it was really striking to me that we knew everybody, in the public health world and working on COVID, knew that this was happening in certain communities. There were spots that were identified, but it just wasn’t being talked about.

Gary Puckrein:

Some of it I would describe as old school. We think that we don’t have the power to intervene, that we have to be susceptible to the forces of nature. We throw our heads up and run around the circle and not do what we can do which is to use our science to be very effective and protect people which I think is what the role of government is. And I thought it was a tremendous failure of that.

Sue Peschin:

I agree. So the fact that, and you spoke to this a little bit already, but I just wanted you to detail it a little bit more, we know now, obviously knew throughout the pandemic as well, that people of color were making up a disproportionate number of total deaths from COVID-19. A lot of people older too, but not necessarily going to that 65 and older group, because things were skewing a bit younger. So why was that the case?

Gary Puckrein:

I think there’ve been a lot of things that contributed. You had multi-generational housing. And so the younger population was not wearing the mask. They’re getting infected and bringing it into the household, so that’s one. You have essential health workers, who were working in critical positions that society really needs them to work in, but they weren’t getting the protection at work. And so they were getting infected. We had the whole nursing home issue, and so there it was. We didn’t use any therapeutics.

Gary Puckrein:

FDA approved emergency use authorizations for a whole series of COVID therapeutics that would reduce hospitalizations and emergency room. And what happened is, the Federal Government bought all of those therapeutics and gave them to the states, the states didn’t distribute them. So in those high-risk communities, we ended up without the infusion centers and the education to use those therapeutics. So now you’ve got lots of people people ending up in the hospital, and you saw the privileged folks. Trump got them, Giuliani got it, Chris Christie got them, but down in the community, or where we really could have done some good, they were not available. So there were all these different causes that contributed to what we saw in this disproportionate high rate of infection, as well as mortality in those communities.

Sue Peschin:

So now we’re in the vaccine phase and seeing similar trends that Black Americans are getting vaccinated at a slower pace than whites. Why do you think the vaccination rate is lower among blacks? And how can we increase the vaccination rate?

Gary Puckrein:

So again, it starts out with what happened in the beginning. So CDC released a guidance for prioritizing who was going to get vaccinated. If you recall, it was 75 plus is where we began with. Well, if you look at the age pyramid, African Americans, many do not survive to the age 75. Even at 65, it’s disparate in life expectancy. And so lots of African Americans were not eligible to receive the vaccine.

Gary Puckrein:

It’s not that they were hesitant. It was by the way it was being distributed, they would not available to get the vaccine. And so what it meant was we continue to expose them without giving them access to the vaccine. And, if you think about it, if we had prioritized those communities where the vaccine with the virus was surging, particularly in minority communities, and we got them vaccinated earlier, that would’ve helped the spread of the virus. And, typically, a good epidemiologist would say to you, “Those are the communities where you want to go in and tamp down on the spread of the virus by getting populations vaccinated.” But we chose a different metric. And so part of what we saw is that minority populations did not get vaccinated early and the numbers kind of showed that.

Sue Peschin:

The lack of vaccination is not due to hesitancy. And I think that’s a really important point because I think it’s something that’s kind of been a piece of misinformation that’s gotten spread that well, “people just aren’t getting, it in the Black community, because they just don’t want it.” And I’m wondering if you can just unpack that a little bit more and maybe talk a bit more about the access issues.

Gary Puckrein:

Yeah. So it’s not unusual, in our healthcare system, to blame the victim. To say, “The reason why you have poor outcome is because the victim is misbehaving.” And so that’s kind of standard there. So what we saw was, certainly the senior population, they were anxious to get vaccinated. There was lots of episodes around the country where we have those who are younger than 65, trying to get vaccinated and were not allowed to.

Gary Puckrein:

And what was intriguing is that sites were placed in African American communities, but the other population couldn’t get it. But folks from outside the community, who were eligible to get vaccinated, would come many times, for the first time, into the minority community to give vaccinated. Now, there are some that pretend like there’s no vaccine hesitancy in a minority community, or some of the younger population. We saw some of it among healthcare workers. When we started working with the FQHCs , some of their staff had some concerns about the vaccines.

Gary Puckrein:

And they said that that sort of dissipated as they started to administer the vaccine. And so by the time we got into mid-March or so, all of that hesitancy among those workers sort of disappeared. I think, quite honestly, when I look at the data, it’s more in sort of majority communities where the vaccine hesitancy, particularly with some politics mixed in it, hasn’t been seen as large.

Sue Peschin:

Okay. Interesting. What do you mean by that? With the politics?

Gary Puckrein:

So you have some who believe that, if you are a Republican, you don’t want to get vaccinated. I’m not sure why some are like that way, but there are some who have their political reasons that believe that they don’t need the vaccine.

Sue Peschin:

Oh, I see what you’re saying. Okay. Of course. Yes. So what do you take away from the COVID-19 pandemic in terms of what you hope people have learned about healthcare disparities in the United States? And how we can address those disparities?

Gary Puckrein:

Obviously, it made visible the disparities. And my hope is that it leads us to re-imagine our healthcare system. Let’s think about this for a second. The modern American healthcare system really begins to take shape during World War II where employers could not induce workers through salaries, so they use health insurance as a benefit to cash workers. Because obviously, during the war, workers were a scarce commodity. And, so it grew up in that period of segregation when inequalities were not frowned upon or accepted, both by practice and by law. All of the hospital systems were segregated and didn’t get the segregated until the late 1960, early 1970s. The American Medical Association did not stop discriminating until the 1970s and physicians, many physicians, in their practice, would not accept minority populations. And so that legacy system still exists. We got rid of the outward signs of segregation and the signs came down and the laws were removed.

Gary Puckrein:

But the inequality in outcomes that existed during that period were never dealt with. Were never really addressed. And now what’s happened is, because of the growing diversity in the political system, there’s pressure being brought to bear to make sure that we have a more equitable provisioning of healthcare. But I don’t think you can do that in the existing system. I don’t think it’s built to do that. And that’s why we talk about managing patient risk. Because we think the future health care system, that’s what it ought to really be about. It really ought to be about managing patient risk. And if we focus on that, I think the inequalities go away. I think it will energize our healthcare system because its purpose will be clear. And even more importantly, we can get on with looking for innovative therapies that really reduce risk. And that’s really where our future lies.

Sue Peschin:

Interesting. What does a system that looks at managing risk look like? What does that mean? What would happen when you went to the doctor?

Gary Puckrein:

So there’s still a part of medicine that believes that medicine is an art. We’re saying, “No it’s a science.” And that you can use the numbers, not only clinically to improve risk. Think about it, you’re going to Las Vegas, we’re all subject to the same thing. We’re all at Las Vegas. We don’t get a choice. We got to play the game. And you want to go into the booth and gives you best chance of winning. And the best chance of winning is by the science. Not the guy who’s doing the art form over there. And there are going to be a lot of guys that can do magic and it’s entertaining, but that’s not going to get you where you want to be. And you want to do it by the science. It’s measurable.

Gary Puckrein:

And that’s the point. And so if we use the numbers, if we fly by instincts, we get better outcomes for patients. And it drives the system. Right now, for example, is Medicare really being driven by the numbers? Is its purpose to lower risks for beneficiaries? Absolutely not. Is the Medicare program willing to lower risk for the 90 million people that are now in the Medicare program? No. And so that’s what we’re talking about. That’s what we’re talking about reimagining. And we think that it will have a powerful impact because as we get invested in each other’s health, as we are working towards that end that creates the common purpose that binds us. That goes back to that first mission of conserving life. That’s the social contract. That’s all we’re doing is bringing social contract into healthcare and saying, “This is what we ought to be committed to.”

Sue Peschin:

Okay. I like it. So here’s when I’m going to switch gears and ask you a question we ask all of our guests. When you were a kid, what did you imagine growing older would be like?

Gary Puckrein:

That’s a great question. So, when I was a kid, it was Halley’s comet that comes around, I think I read 70 years. And I realized that I would be around, if I survive that long, for observing Halley’s comet. And so that was my great wish, to survive long enough to see Halley’s comet come.

Sue Peschin:

Were you one of the kids with the telescope? That’s cool. One day, I have to introduce you to my uncle. He is an astrophysicist.

Gary Puckrein:

Oh, wow!

Sue Peschin:

And an astronomer.

Gary Puckrein:

I love that.

Sue Peschin:

And a lot of fun to talk to. So what do you enjoy most about growing older now?

Gary Puckrein:

So, I think of growing old as being on the Vanguard? Because really what we’re trying to do now is to push the boundaries of life expectancy. And those around us who get old are at the Vanguard. We are trying to move that frontier, not just for ourselves, but for the next generation. And that’s what I think about. We don’t want the next generation to have to deal with the issues that we have to deal with. And that’s the investment. That’s the infrastructure building. And that’s the way to think about what we’re investing in healthcare. Because it is that older generation that needs to help. Because we were pushing back on those forces of nature. And the only way we can push back is through science and investment and the deep collaboration that it takes for all of us to achieve those goals. So that’s what I think about it.

Sue Peschin:

That’s awesome. I love it. All right. And we get to be partners on some things, which I really enjoy. Gary, thank you so much for joining us today.

Gary Puckrein:

Well thank you for everything.

Sue Peschin:

Thanks everyone for listening to This is Growing Old. Our intro and outro music is “City Sunshine” by Kevin MacLeod. Please stay tuned for new episodes. Every other Wednesday. You can subscribe on Apple podcasts, Google podcasts, Spotify, or anywhere else you listen to podcasts. And please rate and review us, if you’re enjoying this show. Thank you for listening to This is Growing Old, and have a great day.