A Collision of Crises

In the throes of COVID-19, with cases continuing to increase daily at my hospital, we are now further stressed with the brutal death of George Floyd, an African American whose death at the hands of law enforcement, while pleading that he could not breathe, is immortalized in a visceral video.

His death and those of others has spurred nationwide protests against systemic racism that are colliding with attempts to mitigate the COVID-19 pandemic. With these crises on multiple fronts, we face increased tensions, anxiety, and stress.

COVID-19 has resulted in myriad changes and heightened anxieties, especially for patients of mine who are among the hardest hit. With schools no longer open, their children are home – as often are their spouses, as their jobs are lost and wages scarce.

To add to this burden, we as a society are recognizing that we do not treat people equally, and just as the slogan “Black Lives Matter” says, we need to recognize that systemic racism and implicit bias are an issue and need to be addressed directly.

Furthermore, COVID-19 disproportionately impacts people of color, another blow we must mitigate.

Figure 1: Reported anxiety in last 7 days by race and gender in the United States.*

Nearly every professional society I belong to has launched campaigns and sent emails highlighting a zero tolerance policy of racism, for example:

• “The American College of Obstetricians and Gynecologists (ACOG) is committed to eliminating disparities in women’s health and to confronting implicit and explicit bias and racism. This means recognizing and examining our own prejudice and bias and addressing the way in which health care systems perpetuate inequality.”¹
• “The Society for Maternal-Fetal Medicine (SMFM) recognizes the impact of racism and is committed to working towards the elimination of the racism and health inequities that impact our members and the patients they serve.”²
• “The American Board of Obstetrics and Gynecology (ABOG) stands in solidarity with our health care community in opposition to the institutional racism, discrimination, and violence that has plagued the country for so long.”³

Figure 2: People of reproductive age (18-49 years) report higher anxiety in last 7 days.*

As healers, Alpha Omega Alpha (AΩA) condemns racism and bias in all forms, including police brutality. Racism, discrimination, and social injustice are barriers in the care of patients and public health.

AΩA stands with and cares for people of all races, ethnicities, and gender identities. In these times of crisis for our country and world, we must guide medicine to be unbiased, open, accepting, inclusive, and culturally aware in order to be worthy to serve the suffering.”⁴

In addition to stating their support and the importance of these issues, these professional societies are committing to action.

SMFM is educating their members and collaborating with other groups to promote policies to improve access to care and advocating for research.

AΩA, a medical honor society, has a new award for excellence in inclusion, diversity, and equity in medical education and patient care.

Both COVID-19 and racism have far-reaching impacts politically and medically. It is imperative that we as providers highlight these impacts, recognizing the serious consequences that may follow.

A household survey by the Centers for Disease Control and Prevention that was intended to monitor anxiety and depression in the setting of COVID-19 – an important metric given the social distancing and isolation – takes on new meaning now.⁵ Anxiety and depression have tripled in the last year, with US rates for anxiety around 8% in 2019 and over 30% in 2020 (Figure 1).

Importantly, the rates of anxiety vary notably across racial groups, and those of mixed race have the highest rates with the ongoing demonstrations and protests. During the pandemic, women are reporting more anxiety than are men.

In addition, people of reproductive age have the highest rates of anxiety (Figure 2). As the initial collision of crises passes, it will be vitally important to understand the impact going forward.

Critically, as the movement to raise awareness of social injustice and racism escalates, the rates of cases of COVID-19 continue to increase – the directionality of the interrelationship is unclear.

Unfortunately, they are not mutually exclusive, and the critical need to raise awareness clashes with the social isolation needed to quell the spread of COVID-19. Neither is more important, neither is less.

As I round on my antepartum patients, I have a new routine speech. It is hard to live in the world today, much less to be pregnant. Being hospitalized without visitors, juggling the media and messages of racism with the need for social distancing, does not easily allow for a healthy mental or physical state.

I listen, try to understand, and offer the services of psychiatry and psychology to provide some attempt at mental balance, although far from normalcy.

We discuss that this is situational, not specific to my patients, and they may benefit from external support. In truth, we all may.

Dr. Spong, editor in chief, is Professor & Vice Chair in the Department of Obstetrics & Gynecology and Chief of the Division of Maternal-Fetal Medicine at UT Southwestern Medical Center in Dallas. She holds the Gillette Professorship of Obstetrics & Gynecology.

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References

1. American College of Obstetricians and Gynecologists. Our commitment to changing the culture of medicine and eliminating racial disparities in women's health outcomes. Available at https://www.acog.org/about/our-commitment-to-changing-the-culture-of-medicine-and-eliminating-racial-disparities-in-womens-health-outcomes Accessed June 15, 2020
2. Society for Maternal-Fetal Medicine. SMFM issues a statement to its membership on racism as a publichealth crisis. Available at https://s3.amazonaws.com/cdn.smfm.org/media/2391/Racism_Statement.pdf Accessed June 15, 2020
3. American Board of Obstetrics and Gynecology. ABOG statement on racism. Available at https://www.abog.org/about-abog/news-announcements/2020/06/03/abog-statement-on-racism Accessed June 15, 2020
4. Alpha Omega Alpha Honor Medical Society. Statement on inclusion, diversity, equity, and service in the profession of medicine. Available at https://www.alphaomegaalpha.org/#gsc.tab=0 Accessed June 15, 2020
5. Centers for Disease Control and Prevention. National Center for Health Statistics. Household Pulse Survey. Available at https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm Accessed June 15, 2020