Most physicians have stories to tell, some of success and happiness, and some of extreme despair. My story is that of a 19-year-old undocumented immigrant from Mexico, who was diagnosed with an aggressive type of lymphoma of the head and neck, NK/T-cell lymphoma.
Initially, we found a way to treat him with grueling radiation and a chemotherapy regimen. He did well for a few years, and our team felt pretty good about ourselves -- we managed to find a way around the infamous issue of access to healthcare. However, a few years later, he developed a recurrence of his illness that required a more advanced treatment. We couldn't administer the treatment unless he had insurance or the means to pay, neither of which he had -- this is where we hit a wall. As cruel as it sounds, our only success at this stage of his disease was to let him die with dignity, thanks to charity hospice care.
When the COVID-19 pandemic unraveled in March 2020, many were shocked by the disproportionately high hospitalization and death rates in communities of color. Sadly, as a physician taking care of the inner-city poor for years -- first as a medical student, then as a resident, and finally as an attending -- it was hardly surprising to me.
As an otolaryngologist-head and neck surgeon, I routinely see a higher incidence of advanced cancers among patients with lower socioeconomic status. I am not alone in this observation, and this has been well documented . Such delayed presentation is, in part, due to a higher number of uninsured and undocumented individuals who have limited access to healthcare. They tend to lack primary care physicians, or, if they have a primary care physician, the wait time for a visit is unacceptably long. Meanwhile, as head and neck tumors grow, they tend to interfere with vital functions that define us as humans, such as speaking, swallowing, and breathing. As a result, our patients frequently present to the emergency room when tumors are so big that they cannot speak, swallow, or breathe. At this stage, tumors fall into the category of "barely resectable and barely curable." For these patients, the odds of doing well are meager. Moreover, when mainstream treatments fail, our patients are less likely to be offered clinical trials or more expensive molecular biologic therapies. But all of the above goes unnoticed by the public and is mostly observed by grieving family members, treating physicians, and reported in specialized journals read by few.
That is until the COVID-19 pandemic. It acted as a magnifying glass exposing systemic healthcare inequalities that have been present for decades. Minority ethnic groups and people living in areas of higher poverty generally have a greater number of medical issues. Now we know that these same medical issues are that increase the severity and mortality of COVID-19. Compounding the problem, this population was not in a position to properly isolate. While wealthy Manhattanites could afford the luxury of lockdown in the Hamptons and such, many poor New Yorkers had to stay behind, continue to work their essential jobs, ride public transportation, and reside in overcrowded quarters, thus risking exposure. Moreover, as the New York Times, as rich New York hospitals secured the help of private donors to acquire ventilators and personal protective equipment, hospitals serving poor communities, such as SUNY Downstate Medical Center where I work, had to set up a GoFundMe page. Therefore, it's not surprising that poor communities were not only hit hard by the pandemic, but also, that the healthcare institutions serving them were less equipped to save them.
Undeniably, our society was shaken by the COVID-19 pandemic and its disproportionate effect on communities of color. If we are to recover from the consequences of this pandemic, we must not only use science to eradicate the virus, but also, implement policies to improve the health of underserved populations. As we move forward, we must commit to improving equal access to high-quality healthcare. Perhaps we should revitalize the idea of universal healthcare, as the U.S. is the only industrialized country that does not provide some form of universal health coverage. We must improve access to healthy food and safe water, promote physical activity, improve access to safe housing, and invest in education. May this become our "new normal."
Despite the extraordinary cruelty of the ongoing COVID-19 pandemic, I stay positive because it has drawn attention to healthcare inequalities and created a progressive agenda to improve equity. In what world is it fair to refuse any hope of a cure for a 19-year-old? We can do better. We must not only win the enduring battle with COVID-19, but also, win the war against the health inequalities brought to the forefront by the pandemic.
Natalya Chernichenko, MD, is an attending physician and MPH student at SUNY Downstate Medical Center in New York City.