Excellent clinicians must think of creative ways to serve all of our patients during this time of crisis, and keep the most vulnerable at the front of our minds.
The novel coronavirus crisis before us is exposing so much about who we are individually as healthcare providers, and collectively, as a society. I have deep concern for my fellow clinicians on the front lines of caring for people with COVID-19, in many cases, with limited supply of personal protective equipment. I also am extremely concerned about those with clinical vulnerabilities, including people living with kidney diseases—my professional focus. But it is those with social vulnerabilities that animate my greatest worries.
Who are the socially vulnerable?
My mind turns first to the numerous groups lacking access to healthcare due to lack of insurance or “underinsurance,” who may not present for COVID-19 testing or care until it is too late. I am equally, though, cognizant that many individuals, including racial/ethnic minorities and sexual and gender minorities, have experienced such biased interactions with the healthcare system that, even with the provision of health insurance, they may delay seeking care. Worse still, is the situation for undocumented people who may delay seeking healthcare for fear of being targeted for deportation. This, of course, could endanger these individuals, and also those to whom they may pass the virus.
As social distancing interventions spread throughout the US, in healthcare (e.g. canceling of non-emergent procedures and appointments), and also via school and business closures, socially vulnerable individuals will face growing challenges that could impact their health status. For example, in Baltimore, we are already hearing of closures of food outlets in low-income neighborhoods that were already considered food deserts. We may therefore begin to see spikes in presentations for hypoglycemia, hypertensive urgency, and other conditions sensitive to changes in food access and quality of food.
The digital divide
Many healthcare clinics have moved to digital platforms for delivering healthcare, but the digital divide and disparities in health literacy will undoubtedly leave many unable to access these services. Because of this, such patients may present for in-person visits, potentially exposing themselves and others to risk of COVID-19.
We must think of creative ways to serve all of our patients during this time of crisis, and keep the most vulnerable at the front of our minds.