Is tele-health the remedy for at-risk communities during COVID-19? | Opinion

April 20, 2020 6:30 am

Dr. Sanul Corrielus at work (Photo via Corrielus Cardiology)

By Sanul Corrielus

COVID-19, the clinical syndrome caused by the SARS-CoV2 has claimed the lives of about 100 thousand people worldwide. In the United States, the devastation has been much astonishing.  Data have shown that the case fatality rate is much higher with advanced age. Mortality is reported as high as 15 percent in those 80 years of age or older compared to less than 1 percent in those less than 50 years of age.

The presence of chronic conditions like diabetes, hypertension, chronic lung disease, and cardiovascular disease is associated with increased mortality. For example, heart disease alone is associated with a 10 percent mortality.  Seniors are predisposed to chronic conditions accounting for the higher mortality rate.

According to the U.S. Department of Health and Human Services Office of Minority Health, African Americans are 60 percent more likely to have diabetes and twice as likely as non-white Hispanics to die from it. About 42 percent of African American adults have hypertension, and they are dying at a higher rate of cardiovascular disease approximately 208 deaths per 100,000. African Americans and other ethnic minorities have higher disparities for chronic diseases irrespective of advanced age.

Minority communities are disproportionately affected by the devastation of COVID-19  rate of infection and death. These vulnerable communities are the most challenged with higher disease burden and complexity making it harder to meet their healthcare needs.

Social determinants of health like lack of basic resources and housing insecurities fuel those disparities.  Also, the lack of access to quality healthcare, compounded by institutional discrimination and mistrust in the healthcare system are also contributing factors.

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As elected officials are calling for racial and ethnic data surrounding the pandemic, there are reports as high as 70 percent death among minority communities in Louisiana and Illinois and 40 percent in New York.

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The coronavirus outbreak brings awareness to the state of minority health in America.

“It further shines a light on the long-standing inequities that exist in society,” said J. Nadine Gracia, executive vice president and CEO at Trust For America’s Health, a public health policy group in Washington, D.C.

In Philadelphia, cardiovascular diseases disproportionately affect minority communities particularly those below the poverty line.  According to an Oxford University National Health and Nutrition Examination Survey, from 2011 to 2014, about 16.5 percent of individuals at or below the federal poverty level had a 20% or higher risk for developing cardiovascular disease versus 9.5 percent of high-income individuals.

Comparatively in 2017, Drexel University’s School of Public Health summarized that every step down on an established disadvantage scale resulted in a 25 percent increase in the risk of cardiovascular disease in its report titled, “Neighborhood Disadvantage, Poor Social Conditions, and Cardiovascular Disease Incidence Among African American Adults in the Jackson Heart Study.”

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As the virus continues to spread, concerns are raised about the death rate among the minority communities in Philadelphia. Efforts to “flatten the curve” have resulted in practices of self-quarantine and social isolation as mandated by state and local authorities. The challenge remains how to provide adequate health care to that community while in isolation.

Telehealth has emerged as an intuitive solution. Using telecommunication technology with audio and video capabilities, individuals can visit with their doctors and receive the medical care that they need.

Telehealth is a great vehicle for healthcare delivery. It is most effective paired with a well-integrated patient-centered clinical approach delivered in a culturally competent manner while taking into account the patient’s state of mental health.  This requires providers to be open to new care approaches and willing to lean in and meet the patients where they are.

Providers must develop a great sense of empathy to allow for the optimal patient and doctor relationship. That connection is quintessential to our advancement towards conquering the devastation of chronic diseases in our at-risk communities.  Our vulnerable patients are more attentive to their health and more likely to follow a plan of care when developed with a provider they are comfortable and feel safe with.

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Telehealth will allow us to care for our vulnerable communities while developing more comprehensive mobile means to access those without access to the advanced technologies required for telehealth.  According to the Pew Research Center, nearly 35 million Americans do not use the internet majority of whom are seniors in minority communities.  We must account for everyone’s care.

Contrary to our community health outreach efforts, social isolation and stay at home policies have the tendency to encourage patients to bear their symptoms and not seek the care that they need in a timely manner. We must act now and build community-based culturally competent provider teams that embrace technology to connect with our at-risk patients and contribute in a meaningful way towards community health equity and empowerment.

Dr. Sanul Corrielus the founder of Community Cardiovascular Initiative, a non-profit organization that focuses on providing integrated cardiovascular health and wellness education to underserved communities. He writes from Philadelphia, where he maintains a cardiology practice

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