Crisis as Opportunity: Let’s Rise to the Challenge of COVID

The coronavirus surge is likely to get worse over the coming weeks and months. The U.S. has a long history of taking on challenges and leading by example. We still have a chance to seize this unique moment to completely change the way we care for the health of our citizens.

The Pandemic Politics of Reproductive Health Care

This piece is part of “Women on the Frontlines: COVID and Beyond,” an online symposium examining the political, economic, social and legal status of women.

Sponsored by the Cornell Law Review with the Center for Biotechnology and Global Health Policy and co-hosted by Ms. and others, the symposium brings to light the ways women labor and lead at the forefront of society, constituting the foundation of essential workers, and performing critical services from child to medical care. But during the pandemic, women (especially women of color) suffer persistent economic constraints; health and death disparities; obstruction of rights; and the troubling perceptions of expendability. Watch “Women on the Frontlines: COVID and Beyond” for a discourse about the role of women and pathways toward a more just society.

I see a theme emerging during this pandemic and it is one well-known to me: Illness, crisis and “hard times” tend to “unmask” seemingly unrelated problems or issues that previously we had ignored.

As a surgeon, I see this daily as patients undergo procedures for one issue only to realize—either before surgery or during their recovery—all the other issues they had ignored and now have to deal with to get back on their feet. But I also notice, in most of my patients, that these challenges are typically met with grit and resilience they otherwise didn’t know they had.

The lovely patient who has to get their diabetes under better control or their weight a bit lower before surgery finds the strength to do it when “the time comes.” Frequently, challenges bring out the best in us.

Our Country in Crisis

Crisis as Opportunity: Let's Rise to the Challenge of COVID
A sailor screens a patient in their car at Naval Medical Center’s COVID-19 drive-through screening in Portsmouth, Va., in March. (Official U.S. Navy Page / Flickr)

In a similar way, our country is now profoundly ill with the COVID-19 pandemic, and as we try and fail to battle it, we are seeing in stark relief all the inequities and wrongs we have too long ignored.

While this challenge could have brought out the best in all of us, to date, too many have selfishly bought into a culture of personality that encourages deeply irresponsible behavior: Many of our current leaders are actively ignoring or even opposing basic health measures like wearing a mask. Their only reward is political gain. While they distract us from doing our best and being the incredible nation we can be in the face of this pandemic, the fissures in our society continue to expand, exposing those at greatest risk and those who have been ignored far too long. 

To name a few of our long-ignored problems:

  • Our health care is twice as expensive as most other high-income countries, yet many Americans don’t benefit at all from that excess spending.
  • We have the highest prevalence of diabetes and heart disease as compared to countries that spend less. 
  • Asthma rates also rise every year especially in low income areas. 

These chronic conditions and others disproportionately affect communities of color. Without access to reliable comprehensive health care not tied to employment, many Americans—especially Americans of color—have little access to preventative care, which results in poor health. As they become sick and access what care they can, perhaps in emergency rooms, they may face crushing medical debt. 

Add to all this structural racism experienced through a lifetime of discrimination. The National Urban League’s 2020 State of Black America report, “Unmasked,” examined the economic, health, civic and other social systems impacted by COVID-19. The report rightly concluded the pandemic “unmasked” the face of racism in the country by exposing inequalities: high rates of unemployment, poor access to housing and technology, and health disparities—just to name a few.

All three chronic conditions previously mentioned—diabetes, heart disease and asthma—raise patients’ risk for developing severe and deadly COVID-19 complications driving the racial disparities we see in mortality rates.

Yet, even well-meaning legislation may fall flat—as was the case for the CARES Act, meant to pay for COVID related treatment. We aren’t investing in public health messaging or educating our citizens. So, few know this relief exists and many avoid seeking care out of reasonable fear for hefty bills. These compounding failures result in unnecessary death and suffering and are the result of a society that does not prioritize access to care for all. 

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“Unmasked” Sexism

During “Women on the Frontlines: COVID and Beyond“—an online symposium examining the political, economic, social and legal status of women—we heard how the pandemic has also unmasked sexism in our country. As we search for better treatments and a vaccine for COVID, we are confronted yet again with our history of inadequate research into women’s health.

Crisis as Opportunity: Let's Rise to the Challenge of COVID
Jennifer Romero, a registered nurse with the Florida Department of Health, explains the process of the specimen collection to a nursing home resident in Northeast Florida on May 1. (The National Guard / 8)

As a surgeon who specializes in women’s health care, most of the diseases I treat receive relatively little to no NIH research funding, as compared to how many women are affected daily. This long-standing issue is brought into focus by the continued failure to include equitable numbers of women in research studies during this pandemic. The American College of Obstetrics and Gynecology has called for greater inclusion of women, including those who are pregnant.

While women have not been included in representative numbers in research, they are the unlucky recipients of excessive legislative attention when it comes to contraception and abortion. Some states were quick to designate abortion an “unessential” medical service during this pandemic, severely limiting access.

Seen in juxtaposition with states’ failures to enact mandatory mask legislation, this seems an overtly sexist attack on women’s rights with not even a hint of a public health purpose. Access to safe comprehensive abortion and reproductive care is always time sensitive. Especially in a pandemic when risks to pregnant persons are higher than if not pregnant, access to contraception and abortion services should not be curtailed.

Crisis as Opportunity

We have the opportunity as a nation to rise to this challenge and to make lasting change to improve the health of our citizens. Adhering to the status quo as is seen when we fail to include women and pregnant persons in research squanders this opportunity. Politicizing public health measures through intellectually dishonest legislation as when states declare abortion services “unessential” makes a mockery of our political system. 

The U.S. has reported more than one million new coronavirus cases since the start of November. (The New York Times)

As we face a second surge that is surely upon us, we must come together and support drastic changes in the way we see our duties to each other and to our country.

Some form of national health care has to be our first step—and it should be taken now, while so many in our country are in need.

Any plan for comprehensive national health care must do away with gender disparities in reimbursement for services, in funding for and participation in research, and in access to care for persons of color. As an example, gynecologic surgery—surgery for women, my specialty—reimburses at two-thirds the rate of comparable surgeries performed for men. There is no reason for this disparity and equalizing the playing field can naturally lead to better access and better outcomes for all, including for people of color.

While the steps we have to take are daunting, they are not insurmountable. We have a long history as a nation of taking on challenges and leading by example. We still have a chance to be an international leader and to seize this unique moment to completely change the way we care for the health of our citizens. Let’s hope we don’t waste it.

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Louise P. King, MD, JD, is the director of reproductive bioethics at Harvard Medical School Center for Bioethics.