UNMC working to address COVID-19 health disparities

According to the Centers for Disease Control and Prevention, current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups in the face of the COVID-19 pandemic.

Where racial demographic data is reported in Nebraska, this also is the case, said Jasmine Marcelin, M.D., assistant professor of infectious diseases.

“Demographic data from Douglas and Lancaster counties show disproportionate numbers of cases in the Hispanic and Asian populations,” she said. “In Douglas County, over 50% of reported cases are among Hispanic persons, 8% among African Americans, and 13% of reported cases are among people of Asian descent (that includes large Nepali, Burmese and Vietnamese immigrant/refugee communities). In Lancaster County, Asian and Hispanic people each account for 30% of cases reported and African Americans account for 8% of cases reported.”

UNMC is working to address these disparities through outreach to underserved communities.

Athena Ramos, Ph.D., of the Center for Reducing Health Disparities, has been working with colleagues on outreach efforts to the state’s Latino communities since March, helping arrange virtual meetings, creating bilingual infographics and working with organizations such as the Latino Center of the Midlands to get COVID-19 information out, especially through Spanish-language media outlets, on websites and through virtual meetings.

“There has been a lack of information to underserved communities,” she said. “We’re starting to catch up now with some language-appropriate resources, but that has been a struggle, too. And if you look at who the essential workers are in our state, I’m sure overwhelmingly that the demographic profile is mainly racial and ethnic minority individuals – people working in agriculture, meatpacking, in the grocery stores.

“There’s a concern community members have raised to me about potential further stigmatization of racial and ethnic minority communities, beyond just COVID, but long-term economic consequences that may hurt the viability of these communities for the long term,” Dr. Ramos said.

Dr. Ramos also compiled a survey of workers at Nebraska’s meatpacking plants to examine how the plants have responded and what safety measures were put in place, an effort she said will provide a “ground-level view” of companies’ responses.

“We have been holding discussions with family support workers, community advocates, non-profit organizations, staff and the folks who have contact with workers all across the state,” she said. “The survey grew out of our engagement.”

Language barriers are something UNMC can address, Dr. Marcelin said, pointing out that the Nebraska community has many Spanish, Nepali, Karen and Arabic speakers, and UNMC should work to provide informational materials in a wide range of languages.

“In Nebraska, we have several immigrant populations whose first language is not English,” she said. “Therefore, as health care professionals and an organization, we must ensure that we are helping to provide communication/education in a culturally congruent manner. If a language does not have a reliable written component or most people cannot read, we must be innovative with videos, television, and social media outreach in the language that people understand.”

Dr. Marcelin pointed to a Spanish-language information page on the Nebraska Medicine website, which includes a series of informational videos by Armando De Alba, M.D., as an example.

In North Omaha, UNMC has been partnering with a group of community leaders and organizations who are putting together multi-media information about COVID-19 safety measures for dissemination to the community in a culturally appropriate manner, said Dele Davies, M.D., senior associate vice chancellor of academic affairs. These leaders and organizations have also combined their own personal resources and leveraged others to support hard hit segments of the community by providing much needed cleaning supplies and food staples.

UNMC also is collaborating with the COVID-19 Community Task Force — Protect the Village in North Omaha on a masking and social distancing campaign, said Sheritta Strong, M.D., interim director of inclusion, not only to provide masks but to provide education on managing the pandemic using local influencers in the community.

Dr. Strong emphasized the importance of diversity among the people at UNMC who are providing information, as well.

“UNMC has an essential role in getting this information out there,” Dr. Strong said. “And it’s important, and much more effective, when individuals see these messages coming from people who look like them, as well.”

UNMC members of the North Omaha Community Care Council have partnered with community leaders to provide informational sessions via Facebook Live to help answer questions and ensure safety during COVID.

The UNMC Office of Community Engagement is working on establishing a rapid response communication network with community leaders to make sure communications are collaboratively created, tested appropriate for each community, timely, and that the community has open channels to provide reaction and feedback to the information.

In addition, UNMC has worked with Douglas County Medical Director Adi Pour, Ph.D., to help set up and expand COVID-19 testing capacity at Omaha’s two federally qualified health centers, the Charles Drew Health Center in north Omaha and OneWorld Community Health Center in south Omaha.

“We communicated about testing volume and need, supplies, and methods of reporting to their clientele,” said Steve Hinrichs, M.D., chair of the UNMC Department of Pathology & Microbiology. “We were happy to help expand testing capacity at these health centers.”

In another outreach effort, UNMC infectious disease experts also have been working with the health administrator of the Oglala Sioux Tribe, who reside on the Pine Ridge Indian Reservation in South Dakota.

Tribal health officials have sought counsel on things ranging from modifying burial practices to the safety of well water, tap water and with the warmer weather coming, pool and lake water.

Most recently, UNMC experts made a site visit to the reservation to learn more about the challenges facing the tribe, and provide guidance on testing sites tribal officials are considering using when they test tribal members more widely.

Rohan Khazanchi, a medical student at UNMC and a Community Outreach Coordinator for the UNMC COVID Relief (CoRe) program, who authored a forthcoming paper on the relationship of social vulnerability with COVID-19 cases and death in the United States, said some amazing initiatives have come out of the UNMC student body.
Those initiatives include efforts to target disparities, he said, such as UNMC CoRe’s community sewing project to create and distribute 45,000 cloth masks and multi-language COVID-19 educational materials to Omaha Public Schools families who may not otherwise be able to access them. An initiative called “The MUNA Box Project” aims to distribute information and essential resources to refugee and immigrant populations in Nebraska. A “Period Product Drive” is collecting personal hygiene products for women at the Stephen Center and the Women’s Center for Advancement.

“From the perspective of a student, we are the leading institution in this state when it comes to both health care and providing health information,” he said. “Our physicians and faculty members have been on the leading edge as voices to state and national government officials who are trying to navigate how to approach this pandemic.

“We need to make the structural drivers of health inequity, especially structural racism, part of every conversation,” he said. “Equity has to be embedded in every approach that we take to addressing the pandemic, because if we aren’t helping our most vulnerable populations, it will only prolong the downstream negative consequences.”

Dr. Marcelin agreed.

“It has become clear in the United States, and indeed here in Omaha, that we need to begin and continue conversations relating to the disturbing racial/ethnic disparities we are seeing emerging from cases, hospitalizations, and death due to COVID-19,” she said. “Black people in this country specifically, have been subjected to what is being called a dual pandemic: Black people are dying more from COVID-19 than any other reported racial groups nationwide, yet simultaneously are being harmed and killed because of their race at equally alarming rates. It is time to address the generational inequities and structural racism that have allowed these conditions to exist.”