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GeriPal - A Geriatrics and Palliative Care Podcast

Alex Smith and Eric Widera

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GeriPal - A Geriatrics and Palliative Care Podcast
46 MINJUN 5
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This was a remarkable podcast. Eric and I were blown away by the eloquence of our guests, who were able to speak to this moment in which our country is hurting in so many ways.

Today's topic is the impact of COVID19 on minority communities, but we start with a check in about George Floyd's murder and subsequent protests across the country. Our guest Monica Peek, Associate Professor of Medicine and Director of Research at the MacLean Center of Clinical Medical Ethics at the University of Chicago, notes right off the bat: COVID19 and the reaction to Floyd are related. The covid epidemic has created an economic crisis, a heightened level of worry, and a disproportionate number of deaths among the African American community. When we add COVID on top of the long history of police brutality that has been heightened over the last several years that has been ignored by the federal government - in that context, it's not surprising that we're seeing protesters put their lives on the line to stand up for what they believe in. These protesters are putting their lives on the line due to the twin risks of reprisals from police or national guard, as well as the risk of acquiring COVID during a protest.

As we turn later to the topic of COVID19 and impact on minority communities, Alicia Fernandez, Professor of Medicine at UCSF and Director of the UCSF Latinx Center of Excellence, notes that so many people reach for a biologic rationale for the excess exposure and mortality among minority communities - it's a genetic factor, it's racial/ethnic differences in ACE receptors, or it's the higher rates of diabetes and kidney disease among minority communities. How is it then that Latinos, and immigrants in particular, who tend to be younger and healthier, have higher mortality rates? What COVID19 is exposing are the underlying disparities in social determinants of health. For example, Africans Americans and Latinos represent a disproportionate share of essential workers, are more likely to live together in multigenerational households, and may reside in areas with less access to testing and high quality hospital care.

We turn finally, to what we can do. As Monica says, "This is the fight of our lives. And this may be our last fight." Alicia notes that we need better reporting about detailed race, ethnicity, and language of people impacted by COVID for public health reasons. We talk about the need for professional interpreters for all goals of care conversations with patients (and Yael Shenker and Alicia's must read article for all clinicians on this topic). And we return to Doug White's framework that persons who reside in areas with a high Area of Deprivation Index score get a boost in their chances of obtaining scarce treatments for COVID.

Finally, I encourage you all to watch this YouTube video of the song Seriously (song choice for the Podcast), sung by Leslie Odom Junior (Aaron Burr in the original Hamilton), about how Barak Obama might have reacted aloud to the 2016 election. It's speaks to this moment as well. The link is https://www.youtube.com/watch?v=hI8TCA3fJcs

-@AlexSmithMD