Black Doctors Work to Make Coronavirus Testing More Equitable

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

When the coronavirus arrived in Philadelphia in March, Dr. Ala Stanford hunkered down at home with her husband and kids. A pediatric surgeon with a private practice, she has staff privileges at a few suburban Philadelphia hospitals. For weeks, most of her usual procedures and patient visits were canceled. So she found herself, like a lot of people, spending the days in her pajamas, glued to the TV.

And then, at the beginning of April, she started seeing media reports indicating that Black people were contracting the coronavirus and dying from COVID-19 at greater rates than other demographic groups.

“It just hit me like, what is going on?” said Stanford.

At the same time, she started hearing from Black friends who couldn’t get tested because they didn’t have a doctor’s referral or didn’t meet the testing criteria. In April, there were shortages of coronavirus tests in numerous locations across the country, but Stanford decided to call around to the hospitals where she works to learn more about why people were being turned away.

One explanation she heard was that a doctor had to sign on to be the “physician of record” for anyone seeking a test. In a siloed health system, it could be complicated to sort out the logistics of who would communicate test results to patients. And, in an effort to protect health care workers from being exposed to the virus, some test sites wouldn’t let people without cars simply walk up to the test site.

Stanford knew African Americans were less likely to have primary care physicians than white Americans, and more likely to rely on public transportation. She just couldn’t square all that with the disproportionate infection rates for Black people she was seeing on the news.

“All these reasons in my mind were barriers and excuses,” she said. “And, in essence, I decided in that moment we were going to test the city of Philadelphia.”



Dr Ala Stanford and her staff on duty a coronavirus testing site in Pennsylvania. Stanford created the Black Doctors COVID-19 Consortium and sends mobile test units into neighborhoods.

Black Philadelphians contract the coronavirus at a rate nearly twice that of their white counterparts. They also are more likely to have severe cases of the virus: African Americans make up 44% of Philadelphians but 55% of those hospitalized for COVID-19.

Black Philadelphians are more likely to work jobs that can’t be performed at home, putting them at a greater risk of exposure. In the city’s jails, sanitation and transportation departments, workers are predominantly Black, and as the pandemic progressed they contracted COVID-19 at high rates.

The increased severity of illness among African Americans may also be due in part to underlying health conditions more prevalent among Black people, but Stanford maintains that unequal access to health care is the greatest driver of the disparity.

“When an elderly funeral home director in West Philly tries to get tested

Some U.S. doctors flee to New Zealand where the outbreak is under control and science is respected

Prime Minister Jacinda Ardern speaks to media at a press conference ahead of a nationwide lockdown at Parliament on March 25, 2020 in Wellington, New Zealand.

Hagen Hopkins | Getty Images

Dr. Judy Melinek knew it was time to make a change when she started fear for her health and safety.

While working as acting chief forensic pathologist for Alameda County in California, she read early reports about a virus in Wuhan, China. By June, after repeatedly sounding the alarm about the need for health workers to have sufficient personal protective equipment, she’d had enough. She also hoped for temperature checks, social distancing and masks, but she noticed that not all of the staff in her office were taking these steps.

And then an email appeared offering her the opportunity to relocate to New Zealand, a country that has reported less than 2,000 coronavirus cases and 25 deaths, drawing widespread praise from around the world for its science-led response. Melinek jumped at the opportunity. 

After a period of quarantine, she’s now living and working in Wellington City, New Zealand. She’s been impressed so far. “There’s a lot more respect for the government and for science here,” she said. 

Melinek is part of a wave of U.S. doctors plotting a move to New Zealand. A spokesperson for Global Medical Staffing, a recruitment group that helps doctors find short and long-term positions around the world, noted that inquiries have increased about relocating to New Zealand from the U.S. as more physician jobs have been affected during the pandemic. In addition, more physicians currently employed in New Zealand who already located are choosing to extend their contracts “because of fewer reported cases of Covid-19,” meaning that there’s a slight dip in open roles. 

Melinek has been open about her decision on social media, and has subsequently heard from half dozen of her peers considering doing the same. She expects the number to keep rising as the pandemic continues. “America will suffer an exodus of professionals to other countries that have responded better, with economies that have recovered faster,” she said. 

In the the United States, where the federal government has largely left the response for the pandemic up to the states, more than 213,000 people have died from the virus. Across the country, some states have largely reopened, despite recent surges in cases. An outbreak that tore throughout the White House has spread to at least 37 people, including President Donald Trump, according to a website tracking the infections. 

New Zealand, by contrast, recently declared victory over the virus after eradicating community spread for the second time. 

In addition, many public health workers and scientists based in the United States say they have faced online harassment and threats while sharing guidance to the public about measures to keep them safe, including masks and social distancing. New Zealand’s Prime Minister Jacinda Ardern has repeatedly praised scientists, and offered empathy to the public at the most trying times, including during the early lockdown. 

New Zealand

Doctors and nurses battle virus skeptics

MISSION, Kan. (AP) — Treating the sick and dying isn’t even the toughest part for nurse Amelia Montgomery as the coronavirus surges in her corner of red America.

It’s dealing with patients and relatives who don’t believe the virus is real, refuse to wear masks and demand treatments like hydroxychloroquine, which President Donald Trump has championed even though experts say it is not effective against the scourge that has killed over 210,000 in the U.S.

Montgomery finds herself, like so many other doctors and nurses, in a world where the politics of the crisis are complicating treatment efforts, with some people even resisting getting tested.


It’s unclear how Trump’s bout with the virus will affect the situation, but some doctors aren’t optimistic. After a few days of treatment at a military hospital, the president tweeted Monday, “Don’t be afraid of Covid. Don’t let it dominate your life. … I feel better than I did 20 years ago!”

After one tough shift in the coronavirus unit at Cox South Hospital in Springfield, Missouri, Montgomery went onto Facebook to vent her frustrations about caring for patients who didn’t socially distance because they didn’t believe the virus was real. The hospital later shared her post on its website.

She complained that some people demand the anti-malaria drug hydroxychloroquine and think the only patients who get really sick have underlying health problems.

“The majority of people don’t understand and can’t picture what we are seeing. That has been frustrating for all of us,” Montgomery said in an interview, adding: “It wears.”

Combating virus skeptics is a battle across the country.

In Georgia, at Augusta University Medical Center, visitors have tried to get around the mask requirement by wearing face coverings made of fishnet and other material with visible holes, something the hospital has dubbed “malicious compliance.” People also have shown up with video cameras in an attempt to collect proof the virus is a hoax, said Dr. Phillip Coule, the health system’s chief medical officer, who contracted the virus in July and has seen two staff members die.

“Just imagine that while you are caring for your own staff that are dying from this disease, and while you are trying to keep yourself safe, and you are trying to keep your family safe, and you are trying to deal with a disease that such little is known about, and then to have somebody tell you that it is all a hoax after you have been dealing with that all day,” he said. “Imagine the emotional distress that that causes.”

He said most skeptics — including some who have argued with him on Facebook — are converted to believers when they get sick themselves. And he is starting to hear fewer people dismiss the virus entirely since the president was diagnosed.

“It is unfortunate that the president has contracted the disease, but it is difficult for groups who support the president to be out there saying it doesn’t exist,” he said.

But he also said

Why Doctors Aren’t So Sure Trump Is Feeling Better From Covid-19

Standing on the steps of Walter Reed National Military Medical Center on Monday, with a phalanx of white-coated doctors behind him, the White House physician, Dr. Sean P. Conley, ticked off President Trump’s encouraging vital signs: no fever, only slightly elevated blood pressure and a blood oxygen level in the healthy range.

“He’s back,” Dr. Conley said later in the news conference.

But when reporters asked him for results of Mr. Trump’s chest X-rays and lung scans — crucial measures of how severely the president has been sickened by Covid-19 — Dr. Conley refused to answer, citing a federal law that restricts what doctors can share about patients.

Without critical data about his lung function, medical experts in Covid-19 and lung disease said they were struggling to piece together an accurate picture of how Mr. Trump is faring. They noted that while most patients with the virus do recover, it was premature to declare victory over an unpredictable, poorly understood virus that has killed more than 210,000 people in the United States.

Less than a month from Election Day, Dr. Conley’s patient, Mr. Trump, is presenting himself as strong and unfazed by the coronavirus, and seems to have instructed his doctor to steer clear of disclosing health details that might puncture his image of invulnerability.

Dr. Conley said on Tuesday that Mr. Trump was experiencing no symptoms of the disease and doing “extremely well,” though he himself cautioned on Monday that the president was not “out of the woods” and that “we will all take that final deep sigh of relief” if he still feels well next Monday.

Far from having vanquished Covid-19, the outside doctors said, Mr. Trump is most likely still struggling with it and entering a pivotal phase — seven to 10 days after the onset of symptoms — in which he could rapidly take a turn for the worse. He’s 74, male and moderately obese, factors that put him at risk for severe disease.

“I don’t need to get in the president’s business,” said Dr. Talmadge E. King Jr., a specialist in pulmonary critical care and the dean of the UCSF School of Medicine. However, he said, “if their goal is for us to understand more completely what is going on, they have left a lot of very useful information off the table.”

Several medical experts said that based on the incomplete information Mr. Trump’s medical team had provided, the president appeared to have at least at some point experienced a severe form of Covid-19, with impairment of the lungs and a blood oxygen level below 94 percent, which is a cutoff for severe disease.

But again, Dr. Conley has not been fully forthcoming about Mr. Trump’s oxygen levels. He said that the president’s blood oxygen had dipped to 93 percent on Saturday. He was evasive about an earlier episode of low oxygen on Friday, though. When a reporter asked if Mr. Trump was ever below 90 percent, Dr. Conley said that his oxygen level had

Doctors urged to tackle malnutrition in obesity

A recent editorial calls on doctors to address the underrecognized problem of malnutrition among individuals with obesity to help prevent early death from cardiovascular events.

A study has found that malnutrition is common among people with acute coronary syndrome, which is the sudden reduction of blood flow to the heart that causes angina or a heart attack.

The researchers — at the University Hospital Álvaro Cunqueiro in Vigo, Spain — found that malnutrition in these individuals was an independent risk factor for all-cause mortality and major cardiovascular events, such as stroke or another heart attack.

Surprisingly, they found that malnutrition was common even among those with overweight or obesity.

The results appear in the Journal of the American College of Cardiology.

In an accompanying editorial, two cardiologists write that physicians commonly perceive malnutrition to be a problem that only affects people who are “undernourished” — in other words, underweight.

In fact, individuals with overweight or obesity are often malnourished as a result of their low intake of micronutrients and the poor quality of the foods that they eat.

“Malnutrition is a largely underrecognized and undertreated condition in patients with increased body mass index, as increased abdominal girth is too often mistaken for overnutrition rather than undernutrition,” says Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, CO.

Dr. Freeman co-authored the editorial with Dr. Monica Aggarwal, who is an associate professor of medicine at the University of Florida in Gainesville.

“It’s important to dispel the thought that weight is correlated with food quality and that [patients with obesity] are not at risk of malnutrition,” says Dr. Freeman.

The World Health Organization (WHO) estimate that 462 million adults have underweight worldwide, whereas 1.9 billion have overweight or obesity. However, they note that the term malnutrition can apply to both of these groups.

The researchers in Spain conducted a retrospective analysis of 5,062 people admitted to the University Hospital of Vigo with acute coronary syndrome.

They calculated the body mass index (BMI) of each person and scored their nutritional status using three standard measures: the Controlling Nutritional Status score, the Nutritional Risk Index, and the Prognostic Nutritional Index.

These measures use different combinations of values, such as BMI and blood levels of albumin, white blood cells, and cholesterol, to estimate the quality of the nutrition that a person is receiving.

According to these three measures, between 8.9% and 39.5% of all of the participants — depending on the specific measure — were moderately or severely malnourished.

Although those whose BMI labeled them as having underweight were the most likely to be moderately or severely malnourished, between 8.4% and 36.7% of those whose BMI suggested they had overweight or obesity fell into these categories.

Moreover, up to 57.8% of those with overweight or obesity had some degree of malnutrition, again depending on the index used.

During the median follow-up period of 3.6 years, 20.7% of the participants had a major cardiovascular event, and 16.4% of them

Doctors die by suicide at twice the rate of everyone else. Here’s what we can do.

That Monday when I asked Skip’s opinion — this time, on a troubling case of weight loss — I knew I would find him with his tie askew and his glasses crooked, which I did. He sat in his chair and listened, asking questions about food insecurity and other social determinants of health.

But that Monday was different. After we talked, Skip canceled his patients for the week, left the office and killed himself.

We were all blindsided. How did we not know? Was he depressed? Was he reaching out for help? If this could happen to him, who else could it happen to?

We would later learn about his struggles with other health issues, including possible dementia, but confusion still reverberated in our exam rooms and meetings. Administrators from the hospital met with us and talked of “making time for wellness” and “taking care,” but it rang hollow, and grief was soon swallowed up by the coming tide of the coronavirus pandemic.

I think of Skip often these days, as our community of Chelsea is one of the epicenters of the novel coronavirus in Massachusetts. He dedicated his 40-year career to the MGH Chelsea HeathCare Center caring for refugees and immigrants. I am certain he would have been the first to volunteer to see covid-19 patients in our respiratory illness clinic, or he would have been handing out food supplies. Perhaps seeing the worsening disparities in our community would have further depressed him.

Although suicide across the world is declining in some areas, this is not true in our country. Suicide rates in the United States are increasing, and now account for about 1.5 percent of deaths annually since 2000. Physicians, in turn, have the highest rates of suicide of any profession, with roughly one doctor dying every day. That is nearly double the rate of the general population.

Self-care has been increasingly difficult for patients and physicians alike during these unprecedented times. Some experts note a potential “perfect storm” of growing isolation, economic stress and decreased access to community support leading to a potential jump in suicide rates during the pandemic. For health professionals in particular, this warrants particular attention.

Last spring, I found myself poring over the story of Lorna Breen, an emergency room physician who killed herself in New York after treating countless patients with the coronavirus. I related to the overwhelming duty and guilt described in her obituary. Breen kept saying, “I couldn’t do anything.”

I’ve never been suicidal, but I felt despair in April. I remember coming home from hours on duty at the overwhelmed covid-19 clinic and I felt overwhelmed myself. I couldn’t really describe what I was feeling — we’ve failed to normalize talking about mental health. Breen’s family established a fund for mental health care in the wake of her suicide, noting the difficulty she had seeking mental health care in a system that often failed to acknowledge the deep burden of its providers.

At our hospital, a lot of time

What Makes Osteopathic Doctors Different

Osteopathic doctors are happy to share their techniques, but most could stand to receive a little more credit for their contributions. In recent years, M.D.s have gathered scientific evidence that supports osteopathic claims, but often without referencing those osteopathic origins. For example, D.O.s contend that the growing interest in fascia—tissue that sheaths and supports muscles and organs throughout the body—and the 2012 “discovery” of the glymphatic system, which drains waste away from the brain, both correspond to concepts Still described more than 100 years ago. Some osteopathic doctors feel validated by these developments. For others, the sense of disrespect runs deep. My D.O., whom I visited roughly every three weeks prior to the pandemic, teared up when talking about scientists who say that the glymphatic system was “previously unknown.”

In the past decade, professional organizations and academic institutions have begun to invest more heavily in osteopathic research. But at this point, the most compelling evidence for the continued practice of osteopathic medicine are the studies showing that, in certain cases, there’s no significant difference in patient outcomes, whether they’re managed by a D.O. or an M.D. It sounds like a low bar, but Gevitz argues it shows that different patients benefit from different kinds of care. Some people hate touch; for others, it’s restorative. “There are different paths to healing,” Gevitz says, and the opportunity to choose is itself important.


26th February 1949: An osteopath treating a little girl who has trouble with her pelvic joints at the British School of Osteopathy clinic. (Raymond Kleboe / Picture Post / Hulton Archive / Getty)

My grandfather died of multiple myeloma in 2014, and a few months later, the meniscus in my jaw dislocated. Achy and tired, at one point I Ubered around Seattle looking for a TMJ specialist until, finally, my mom set up an appointment with an osteopathic physician. As the doctor’s big hands cupped the base of my head, I felt like a time traveler coming home.

Still defined the osteopathic tradition, from its inception, in opposition to the mainstream medicine of his day. It was only natural that mainstream medicine shunned osteopathic doctors in turn, relegating them to their own hospitals and refusing to refer patients their way. But today, osteopathic and allopathic doctors are difficult to distinguish, and the curricula at osteopathic and allopathic schools have largely synchronized, because D.O.s and M.D.s must ultimately pass the same licensing exams in order to practice.

“D.O.s are having an identity crisis,” Gevitz says. “Because who are they? What is the rationale for being a separate profession of medicine?”

The two disciplines are only growing closer. This spring, after years of negotiations, allopathic and osteopathic organizations agreed to sort their students into residency programs through a single, unified competency-based system, which evaluates all residents on six domains, including medical knowledge and systems-based practice. Although the majority of the programs are allopathic, some pursued a special osteopathic recognition, which signals their commitment to continuing education

Doctors disturbed after Trump removes his mask upon returning to the White House

“What White House staffer would still wanna go to work tomorrow???” Eric Feigl-Ding, an epidemiologist and health economist with the Federation of American Scientists, said in a tweet Monday night. “Epidemiologists just wanna vomit.”

Dozens of medical professionals and commentators echoed Feigl-Ding’s concerns Monday night, slamming the president for posing and then reentering the White House without a mask even though he is still suffering symptoms of covid-19.

Some medical experts were not just concerned for White House staff, but for the president himself.

Ilan Schwartz, an assistant professor at the University of Alberta’s division of infectious diseases, said the president appeared to be struggling to breathe in a brief clip that showed him standing outside the White House.

“This is a textbook example of increased work of breathing,” Schwartz tweeted.

A White House spokesman responded to Monday’s widespread criticisms, saying the White House is taking “every precaution necessary” to protect the president, his family and staff.

“Physical access to the President will be significantly limited and appropriate PPE will be worn when near him,” White House spokesman Judd Deere said in an email. “President Trump will continue to receive around-the-clock medical care and monitoring from his Physician and a team of dedicated physicians and nurses in the White House Medical Unit who function out of a state-of-the-art clinic, which includes many of the things a person would see in an urgent care clinic and much more, to ensure the Commander-in-Chief makes a full recovery and can continue to discharge his duties.”

The Centers for Disease Control and Prevention recommends people diagnosed with covid-19 wait at least 10 days after the onset of symptoms and go at least 24 hours without a fever before having contact with other people. Asymptomatic carriers who test positive for the virus but do not experience symptoms should wait 10 days after their positive test, the CDC says. And those who suffer a severe case of covid-19 may need to isolate longer, up to 20 days after getting sick.

Trump’s maskless moment at the White House and a short drive he took Sunday with several Secret Service agents to greet supporters outside of the Walter Reed National Military Medical Center appear to violate those recommendations.

CNN’s chief medical correspondent Sanjay Gupta was also among the doctors disturbed by the president’s actions on Monday.

“There is stuff that is pretty reckless, but at some point it’s just becoming absurd,” Gupta said, according to a tweet shared by one of his colleagues at CNN. “A person with known contagious deadly disease — without a mask on — is walking into the residence. Other people are around him.”

The heightened risk of coronavirus for people working within the White House has had many on high-alert as the virus spread quickly among individuals who had close contact with Trump last week. At least 10 people who attended a ceremony in the Rose Garden last week to mark the Supreme Court nomination of Amy Coney Barrett have since tested

Doctors skeptical of Trump’s health despite discharge from hospital

Allowing President Donald Trump to leave Walter Reed National Military Medical Center and return home to the White House while he remains in a potentially dangerous period of the illness is risky, some medical experts said Monday.

Others suggested that the move seems reasonable, given that the White House is very well equipped for medical care, with constant physician attention and resources available.

Full coverage of the coronavirus outbreak

“Right now there’s nothing that’s being done that we can’t safely do at home,” Dr. Sean Conley, the president’s physician, told reporters at a briefing.

Some medical experts disagreed with Conley’s assessment.

“There is a lot of concern about safety,” said Dr. Kavita Patel, a primary care physician in Washington who is managing director in the Center for Health Policy at the Brookings Institution, on MSNBC Monday.

Conley said: “While he may not be entirely out of the woods yet, the team and I agree that all our evaluations and, most importantly, his clinical status support the president’s safe return home, where he will be surrounded by world-class medical care 24/7.”

Trump is receiving several medications, including the antiviral remdesivir and the steroid dexamethasone. Both are given intravenously, which can be done at the White House. He also received a single infusion of an experimental antibody treatment Friday, the White House said.

Trump’s oxygen levels dropped twice, prompting doctors to give him supplemental oxygen.

Experts say the first seven to 10 days of the illness are key.

“We know that patients with severe Covid have symptoms hit this little honeymoon period where their symptoms look better,” said Dr. Ken Lyn-Kew, a pulmonologist in the critical care department at National Jewish Health, a hospital in Denver. “Coming out of that honeymoon period, they either continue to get better or they have a decompensation.”

Given the timeline of Trump’s illness and the medications he is on, “most of us would not anticipate him being discharged in that setting,” Lyn-Kew said.

“When we look at the president, you know, how he looks on the outside is only one indicator of how well he’s doing,” he said. “There is some element of disconnect between how you look and feel and what’s going on inside you with this disease.”

One phenomenon Lyn-Kew noted is referred to as “happy hypoxic, where the patient does not feel as sick as their vital signs indicate.” When patients are hypoxic, their oxygen levels are low. “So for the purposes of a short video or a picture, the president can look just fine but still be doing poorly, and we wouldn’t know it.”

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Other factors that are not obvious from the outside include levels of inflammation and blood clotting.

Dr. Hugh Cassiere, director of critical care services for Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell Health, on Long Island, New York, agreed.

“The real question that we do not know is

All the president’s medicine: How doctors are treating Donald Trump

The leader of the free world is now fighting his own battle with a virus that’s laid global siege — and a concoction of some experimental treatments is helping him do it.

Uncertainty and fear for the president’s well-being plunged a nation already in chaos into further crisis, amid a pandemic that has already killed more than 209,000 Americans.

Over the weekend, Trump’s personal physician, Dr. Sean Conley, said the president is “receiving all the standard of care and beyond,” doctors are “attacking the virus with a multi-pronged approach” and he has “continued to improve.”

PHOTO: A car with US President Trump drives past supporters in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020.

A car with US President Trump drives past supporters in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020.

A car with US President Trump drives past supporters in a motorcade outside of Walter Reed Medical Center in Bethesda, Maryland on October 4, 2020.

Some experts have raised questions about the uniquely robust drug regimen now being administered to the president. Dr. Lew Kaplan, president of the Society of Critical Care Medicine and a surgeon at the University of Pennsylvania, saying that these types of “non-standard processes” can ” invite error.” This exact combination of medications has not been tested together yet in large-scale studies.

NIH treatment panel guidelines member Dr. Mitchell Levy insisted that there is no “miracle” drug yet available.

“If you look at our guidelines, we just don’t think there’s enough evidence to recommend one way or the other,” Levy, chief of pulmonary critical care at Warren Alpert Medical School of Brown University, told ABC News. “So little is proven. It’s like the Wild West, and he’s the president of the United States, and so you feel like, I want to do anything I can to prevent the disease from progressing. That often drives us to do things outside of the normal standard, and that is never a good idea. There’s a standard of care for a reason. With COVID-19, part of the problem is we’re never really sure what the standard of care is.”

Other experts are more optimistic

“All of these treatments shift the odds in your favor,” Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center, told ABC News. “None of them is a magic wand that suddenly makes you feel better,” he said, explaining