Note from BW of Brazil: We’ve all seen the headlines and read the reports. In the United States, the coronavirus is having a devastating effect on the black community. A recent Reuters reports says that African-Americans are more likely to die of covid-19 than any other racial group in the United States. As the New Yorker says, the way the pandemic has played out, it has become “an object lesson in racial and class inequality.”
In Brazil, a recent spike in Covid-19 cases and deaths has raised concerns that the pandemic could actually take a much bigger toll on the country that was originally imagined. I’ll cover that in an upcoming article but even not knowing the full effects of the crisis at this point, what we can say as of right now is that, in Brazil, whites are more likely to contract coronavirus, but blacks are more likely to die from the disease.
I know that no one likes to discuss the racial elephant in the room, but it’s hard to ignore such data. Maybe there will be people who will react to the racial issue coming up in the discussion of the coronavirus crisis in the same way that they react to any other subject when race comes up, you know, ‘race has nothing to do with this’, ‘I don’t see race’, or ‘we’re all suffering equally’, but not acknowledging the racial disparities in this crisis or why they exist, in some way, also says that the well-being and lives of people who don’t look like ‘their kind’ really don’t matter. I know when I came across the data, I was definitely intrigued and puzzled by the normal question: why?
Dr. Rosane de Souza had some very interesting things to say on the topic of race and the Covid-19 pandemic. She is part of Brazil’s first collective of black doctors, which is worthy of report in itself. Check out an interview with de Souza below.
Racism hinders efficient fight against coronavirus, says doctor
By Antonio Junião
“They wouldn’t talk about economics if disease didn’t kill more black people,” says Rosane de Souza, from Coletivo NegreX; for her, racial data on the pandemic is still insufficient
The dissemination of the first Epidemiological Bulletin of the Ministry of Health from a racial perspective of registered cases, hospitalizations and deaths due to the new coronavirus in Brazil is an important first step for the analysis of the real impacts of the pandemic on the Brazilian population. But it is still far from sufficient. The accuracy of the information on race and color of people with Covid-19 comes up against structural problems in the fight against the pandemic as a whole in the country, especially the low rate of testing and the inefficient process of reporting cases of Severe Acute Respiratory Syndromes (SRAG), including Covid-19. And, in the specific case of the black population, the effective fight against the pandemic also comes up against structural racism in the country.
The evaluation is by the physician Rosane de Souza, specialist in infection control and neonatologist at the Pedro Ernesto University Hospital, of the State University of Rio de Janeiro (UERJ). The doctor, who is part of the NegreX collective, the first collective of black doctors in the country, formed in 2015, affirms that the dissemination of data from Covid-19 with from a racial perspective is an achievement of black movements.
“We had a very important victory, as a result of the request of the Working Group on the health of the black population of the Brazilian Society of Family and Community Medicine. Epidemiological bulletins released from April 10 also include information on race and color. It’s easier to analyze how Covid-19 impacts the black population,” she said, in an interview with Ponte.
However, the doctor stated that the information in the Epidemiological Bulletin itself demonstrates underreporting in terms of race and color. One of the graphs that make up the document shows that, of the total of 19,638 cases of Covid-19 confirmed in Brazil until April 10, 1,942 did not contain race and color information.
Data updated on Saturday (4/11) show that numbers have increased, but the proportion of the absence of racialized information on death and hospitalizations remained. According to the document, the number of confirmed individuals without race identification rose to 2,206 for more than 20 thousand cases.
“There are 10% of confirmed cases without registration of race and color”, points out Rosane de Souza. “Health professionals think that this data is not important. And I say more: those that are computed are, for the most part, heteroidentification. In other words, it was not the patient who informed of his race and color, but the person who filled out the form with his own impression.” In many health units across the country, the doctor recalled, filling out care records is still done by hand, which leads to a delay in the transfer of information to the Unified Health System, e-SUS.
When it comes to deaths, the number of cases without race information is 405 for a total of 1,124, as of April 11.
According to the Worldmeter website, which gathers data from the Covid-19 pandemic around the world, Brazil has a very low testing rate. There are less than 300 tests performed per million inhabitants. In South America, Chile performs more than 4,000 tests per million inhabitants, and Venezuela, more than 6,000 per million.
The lack of tests was a problem prior to the new coronavirus, as the Epidemiological Bulletin also shows. In the graph that shows hospitalizations caused by SARS according to the causative agent, it is possible to note the large number of cases in which the virus that caused the disease is not known. The unknown rate was high throughout 2019 and increased further in 2020, especially from the tenth week of the year, that is, mid-March.
The doctor highlights the need for an accurate panel of which portions of the population are being tested for an accurate notion of the racialization of the disease, its distribution and lethality by race. “The impression is that underreporting occurs preferentially in the black population, in the most underserved population, that has less access to health services and less information about what the warning signs are,” said the specialist. “We don’t have data, we don’t know where the infected people are. It’s practically impossible to build strategies and policies without knowing where we are going. ”
In an interview with Ponte, the specialist also analyzed the political discourse on the Covid-19 pandemic and the international situation of black men and black women in the face of the disease.
Ponte – Why is the racial profile relevant in the current pandemic?
Rosane de Souza – The little importance that some representatives of the Brazilian State have been giving to the Covid-19 crisis shows the little value that black lives and peripheral lives have. Because it is not a matter of disinformation: they know who is most at risk of dying. When a public figure proposes mass contamination so that large contingents of the population will soon acquire immunity, they know that this will also lead to a massive illness and collapse of the public health system, with a large number of deaths. In a poor, black country like ours, deaths are poor and black. They are bodies seen as disposable, replaceable. They would not raise the flag that the country’s economy cannot stop if the most numerous deaths were not of black bodies.
Ponte – In the United States, the pandemic has affected blacks the most. Why does this happen?
Rosane – In many ways the situation of the majority of the black population in the United States in the pandemic is similar to that of the black Brazilian population. But, as black men and black women are a minority there, racial determination in health is evident, or better, as a barrier to the right to health. Here, as we are the majority of the population, and the majority of the population is poor, the economic issue masks ethnicity. In Chicago, for example, where 30% of the population is black, just over 70% of the deaths by Covid-19 are of black people. The same is true in the state of Louisiana, where black people make up 32% of the population, but 70% of deaths by Covid-19. There are several reasons, none of them biological. There is nothing in the black race that increases presence, that attracts the virus. Arterial hypertension and diabetes are risk factors for more severe forms of the infection, and are conditions of high prevalence among black people in the United States and in Brazil, but not only due to physical factors: they are also a consequence of the difficulties for a balanced diet, strenuous working hours. Who can be quarantined? What is the color of street sweepers, supermarket workers, public security and transport personnel, delivery personnel, cleaning and maintenance personnel for gas, electricity and sanitation networks, delivery personnel? Among health professionals, what is the color and race of nursing technicians, who make up the largest portion of this essential service, where they work under enormous risk of contamination and with difficulty in accessing personal protective equipment, all over the world? If we doctors are getting sick, nursing technicians are much more. It is estimated that there are 11 million people living in favelas (slums) in Brazil. We, black men and black women, are the majority among these 11 million. In the United States, although there is no such degree of housing “stacking”, blacks also live in worse conditions than the white population.
Ponte – In general, what influence do racial issues have in the practice of medicine?
Rosane – Preliminary data from some states in the United States showed that for black people showing the same symptoms as white people, test collection was offered less often. That is, even if you have the symptoms, being black you have less chance of being tested against the new coronavirus, less chance of protecting your family and getting a certificate of absence from work. It is structural racism at work. A black person is more likely to have their complaints minimized, or to consider himself strong and to “take it”. Medicine in general is not ready to talk about this. The American Academy of Pediatrics (AAP) recently published a study talking about what we already know in practice and the World Health Organization itself has already said: racism is a determinant of health. It has an impact on the physical and mental health of black people, including children. But that’s when an institution like AAP says that people stop to listen. If not, it looks like “mimimi” (whining). The change that the profile of doctors and medical students has undergone in recent years is causing this eye patch to be taken out by force. There are a lot of people in health, medicine and other areas willing not to let their eyes close to this.
Ponte – Recently, the Federal University of Maranhão (UFMA) approved the discipline of Health of the Black Population, on an optional basis. How does this type of discipline work? Are there other similar initiatives?
Rosane – This awareness that there are different ways to get sick and that race, as well as gender and sexuality, interfere in health perspectives is not new. In 2009, the Ministry of Health launched the National Policy for the Comprehensive Health of the Black Population, which establishes guidelines, concepts and strategies for promoting the health of the black population, understanding their specificities and needs. The discipline aims to analyze this specific policy, but also how the health structure affects or does not affect our population. As far as I know, this is the first time that this slant has become a discipline in the curriculum at UFMA. Generally, the discussion on health of the black population (SPN) is conducted in undergraduate courses in the scope of teaching family and community medicine, comprehensive health care or medical psychology. As I said before, it is the black students and professors guiding the theme and opening space from the inside out. And there are also academic health leagues for the black population at some universities. Academic leagues are spaces where students get together to research and discuss topics of interest, under the supervision of professors. There are a lot of people from NegreX doing this, like the cohort from Santa Marcelina, of São Paulo, who have a very active SPN league. Or the classes at UFRJ and UniRio, which managed to implement discussions on the topic at various moments during their undergraduate studies. I mention only what I know best because of geographical proximity, because there are movements like this in several medical schools across the country. UFMA has taken a huge step and opened a path for everyone.
Ponte – Is the typical profile of the Brazilian doctor still very white and elite or is this changing? How faster and more effective changes in this area be promoted?
Rosane – Yes, it still is. We are a white and upper middle class profession. But that has been changing a lot. I graduated in 1989. My class had 3 blacks, but the other 2 were negros de pele clara (light-skinned blacks). We were few in any university where we were. We were not a threat to anyone, we did not represent an opposition to expectations, to the concepts absorbed by our colleagues and present in medical institutions about the place reserved for blacks. On the contrary, I think that we served to justify stereotypes, as exceptions that justify the rule. Or as examples of successful meritocracy. In a country with the population composition of Brazil, nobody was surprised that a class with 130 students had only 3 blacks. With the quotas, things started to change, and the scenario I see now, more than 15 years after the program started at UERJ and about 10 years later at other universities is quite different. Classes are much more diverse, not only racially, but also in socioeconomic terms. Of course, we are far from representing the reality of the Brazilian people. Of course, we face the serious problem of quota fraud and we need the installation of heteroidentification banks to minimize this problem. But there is no doubt that this is changing. Today we have the potential to train doctors capable of professional practice much closer to the reality of the majority of the Brazilian people, because they live or lived that reality, they have parents who lived it, or had their exchange with colleagues who lived it.