ATLANTA — Dramatically fewer Black and Hispanic adult outpatients were given the leading antiviral medication for COVID-19 than White and non-Hispanics — even as medical professionals knew they were less likely to get equivalent treatment because of long-pervasive racial and ethnic disparities.
Researchers studied those disparities in outpatient treatment for 692,570 adult outpatients around the country in the weeks of April-July 2022 and reported their findings in a recent weekly MMWR of the Centers for Disease Control and Prevention. In particular, the study focused on how the racial and ethnic groups were prescribed Paxlovid, the preferred therapeutic for high-risk patients.
The study came months after medical and public health professionals expressed concern that Black and Hispanic COVID-19 patients would not receive medical care equivalent to that received by white and non-Hispanic patients. Researchers said they hoped their findings would result in expanded programs to increase awareness of, and access to, available outpatient COVID-19 treatment.
“I’m sorry to say I wasn’t surprised,” said Daniel Dawes, executive director of the Satcher Health Leadership Institute at the Morehouse School of Medicine and author of “The Political Determinants of Health.”
“We’ve known throughout the pandemic that these groups have been disproportionately impacted by comorbidities, from asthma to obesity. We know that these older adults had the highest death rates and hospitalization rates. If that’s the case, why in the world do we continue to see the same results? Why have we not done a better job aligning the resources with the greatest need?”
Paxlovid is the most commonly prescribed outpatient COVID-19 treatment for those who have a high risk of severe illness. The series of pills can be taken at home after a person tests positive, within five days of symptom outset.
In the weeks studied, the number of COVID-19 patients older than 20 who were prescribed Paxlovid was 36% lower for Black patients and 30% lower for Hispanic patients than for White and non-Hispanic patients. The disparities were found in all age groups.
The researchers suggested multiple factors likely contributed to the treatment differences, with poverty one of the most serious by limiting access to treatment.
“Limited access to treatment is particularly detrimental when patients need timely services, as is required for COVID-19 medication,” the report said. Also cited is the known reluctance of minority patients to receive health care “because of previous negative experiences with health care services”; and “racism and implicit biases among health care providers.”
Other factors considered as possible factors contributing factors are the patients’ limited knowledge of treatment options, lack of internet access for telemedicine communication, limited transportation and language barriers.
“I go back to the root causes of these things… We know studies have demonstrated that [social and political determinants] play an outsized role in our health, in our well-being [and] in our life expectancies,” Dawes said. “[For me this includes] also thinking about why it is that people in our society are struggling to gain access to these health services.”
The CDC said in the report that majority Black, Hispanic or Native American communities in high-poverty areas have less access to places they can get treatment for COVID-19.
Researchers said there were signs between July and August 2022 that the disparities may be lessening. Data from pharmacies dispensing oral antiviral medication show the gap in care might be starting to narrow, but the researchers say more analysis is needed.
Dawes and other researchers see lessons learned from the COVID-19 pandemic as opportunities to provide more equitable care in the future. They include: prioritizing medication distribution and better communication with health care providers and residents of disproportionately affected communities.
Georgia health authorities have acted with listening sessions, vaccine drives and the federal Test-to-Treat efforts. That program allows patients to get Paxlovid prescriptions directly from pharmacies.
“Now we’re able to see where there were challenges and weaknesses,” Dawes said. “They’ve been brought to the forefront and we can no longer say we didn’t know because we do.”
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