Midway through an ED shift in early April, I sat at my computer, mentally running my board of patients, reviewing labs and imaging, figuring out dispositions for my growing list of patients to make room for those in our socially distanced waiting room. I quickly realized that my entire list of patients was made up of only two chief complaints: suspected COVID-19 and gunshot wounds.
Black Americans are disproportionately experiencing the deadly effects of two compounding public health crises—the global coronavirus pandemic and our national gun violence epidemic—and I was observing this disparity in real time in my Chicago ED.
The racial makeup of Chicago is 30.1 percent Black, 49.4 percent white, 6.4 percent Asian, and 14.4 percent other. (World Population Review. https://bit.ly/3ajzonu.) Black Chicagoans, however, are dying from COVID-19 at a rate nearly four times that of white people, and account for 56 percent of COVD-19 deaths recorded in April while 15.8 percent of those deaths were of white people. (Health Educ Behav. 2020;47:509; https://bit.ly/3ammEfE.) In the thick of the pandemic, gun violence not only persists in the city, but is increasing: Chicago recorded 232 shooting incidents in July 2019 compared with 406 this July, a 75 percent increase, with the majority of victims being young Black men. (Chicago Tribune. July 29, 2020; https://bit.ly/31NRJFj.)
A 2019 study by researchers from the department of population health at the NYU School of Medicine found life expectancy in Chicago's affluent and mostly white Streeterville neighborhood to be 90 years. (NYU. June 5, 2019; https://bit.ly/3ixburo.) Yet just nine miles south, the life expectancy in Englewood, a mostly Black neighborhood on the South Side, was 60 years. This 30-year gap in life expectancy is estimated to be the most significant health disparity in America, and that was before the COVID-19 pandemic. According to the CDC, ED visits in March and April 2020 were down as much as 42 percent relative to 2019 across the country as a result of the COVID-19 pandemic. Yet those hospitals that serve a majority of Black and brown patients in Chicago, including mine, saw no change in the steady stream of victims of gun violence.
We are witnessing the impact of a long history of structural racism and persistent social and economic injustices on population health in Chicago. Yes, higher coronavirus deaths in Chicago's minority communities may be due in part to a higher prevalence of comorbidities such as heart disease, respiratory disease, diabetes, and obesity. These comorbidities, however, are directly linked to decades of socioeconomic disadvantage, contributing to COVID-19 susceptibility and, ultimately, poorer health outcomes. Increasing levels of unemployment, poverty, and social isolation as a direct result of COVID-19 have also compounded the Black and brown communities' socioeconomic stress.
COVID-19 is also increasing the risk of firearm injury in Chicago's minority communities. Gun violence prevention efforts have been mostly paused as violence interrupters stay home due to lockdown orders. In July, 107 people lost their lives to firearm violence, twice as many as the number in July 2019, and at least 570 people suffered a firearm injury, an increase of about 250, placing an additional burden on already stretched hospitals, including mine. (Chicago Tribune. August 3, 2020; https://bit.ly/3ivUmCu.)
Chicago's Mayor Lori Lightfoot said in April, “To be blunt, if our ICUs are filled with gunshot victims, our ability to respond to this COVID-19 crisis will be unnecessarily compromised.” (Chicago Tribune. April 8, 2020; https://bit.ly/33UqN9C.) Meanwhile, this also comes at a time when hospitals like the historic Mercy Hospital, which serves the South Side of Chicago, will be closing its doors. Mercy currently serves an area with 62 percent of Chicago's African American population and 37 percent of the Hispanic population. For these populations already bearing the brunt of two epidemics, access will become even more limited.
Since the race riots in Chicago nearly 100 years ago, study after study has called for more robust funding for education, expanding social services, ending discriminatory housing policies, and eradicating racism in policing minorities in Chicago. Today, the consequences of this sustained neglect and disinvestment in minority communities across the country are excess death in record numbers at the hands of gun violence and COVID-19. To prevent these unnecessary deaths, we need to change the way that we think about community health and adapt our hospitals and organizations to combat the epidemic of gun violence and structural racism with the same vigor and urgency that we are fighting COVID-19.
Thanks to Tracy Hauver, MPH, the director of firearm injury prevention education and programs of AFFIRM, for researching and providing the statistics for this article. Follow her on Twitter@hauver_tracy.
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Dr. Royanis a third-year emergency medicine resident at the University of Chicago and an advisory board member for the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM). Follow her on Twitter@ReginaRoyan. Follow the foundation on Twitter@ResearchAffirm. Find more information about AFFIRM athttps://affirmresearch.org.