Black Doctors Work to Make Coronavirus Testing More Equitable

6 years ago

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 indicating that Black people were contracting the coronavirus and dying from COVID-19 at greater rates than other demographic groups.

鈥淚t just hit me like, what is going on?鈥� said Stanford.

At the same time, she started hearing from Black friends who couldn鈥檛 get tested because they didn鈥檛 have a doctor鈥檚 referral or didn鈥檛 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 鈥減hysician of record鈥� 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鈥檛 let people without cars simply walk up to the test site.

Stanford knew African Americans were than white Americans, and . She just couldn鈥檛 square all that with the disproportionate infection rates for Black people she was seeing on the news.

鈥淎ll these reasons in my mind were barriers and excuses,鈥� she said. 鈥淎nd, in essence, I decided in that moment we were going to test the city of Philadelphia.鈥�

Stanford visits a Black Doctors Consortium testing site in Darby, Pennsylvania, on Sept. 9. Stanford has largely self-funded the testing initiative.(Nina Feldman/WHYY)

Black Philadelphians contract the coronavirus at 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鈥檛 be performed at home, putting them at a greater risk of exposure. In the city鈥檚 jails, sanitation and transportation departments, workers are , and as the pandemic progressed they .

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.

鈥淲hen an elderly funeral home director in West Philly tries to get tested and you turn him away because he doesn鈥檛 have a prescription, that has nothing to do with his hypertension, that has everything to do with your implicit bias,鈥� she said, referring to an incident she encountered.

Before April was over, Stanford sprang into action. Her mom rented a minivan to serve as a mobile clinic, while Stanford started recruiting volunteers among the doctors, nurses and medical students in her network. She got testing kits from the diagnostic and testing company LabCorp, where she had an account through her private practice. Fueled by Stanford鈥檚 personal savings and donations collected through a GoFundMe campaign, the minivan and open tents on busy street corners in Philadelphia.

It wasn鈥檛 long before she was facing her own logistical barriers. LabCorp asked her how she wanted to handle uninsured patients whose tests it processed.

鈥淚 said, for every person that does not have insurance, you鈥檙e gonna bill me, and I鈥檓 gonna figure out how to pay for it later,鈥� said Stanford. 鈥淏ut I can鈥檛 have someone die for a test that costs $200.鈥�

Philadelphians live-streamed themselves on social media while they got tested, and word spread. By May, it wasn鈥檛 unusual for the to test more than 350 people a day. Stanford brought the group under the umbrella of a she already operated that offers tutoring and mentorship to youth in under-resourced schools.

Tavier Thomas found out about the group on Facebook in April. He works at a T-Mobile store, and his co-worker had tested positive. Not long after, he started feeling a bit short of breath.

鈥淚 probably touch 100 phones a day,鈥� said Thomas, 23. 鈥淪o I wanted to get tested, and I wanted to make sure the people testing me were Black.鈥�

Many Black Americans seek out Black providers because they鈥檝e experienced cultural indifference or mistreatment in the health system. Thomas鈥� preference is rooted in history, he said, pointing to times when white doctors and medical researchers have exploited Black patients. In the 19th century American South, for example, white surgeon J. Marion Sims performed without anesthesia on enslaved Black women. Perhaps the most notorious example began in the 1930s, when the United States government enrolled Black men with syphilis in a study at Tuskegee Institute, to see what would happen when the disease went untreated for years. The patients did not consent to the terms of the study and were not offered treatment, even when an effective one became widely available.

鈥淭hey just watched them die of the disease,鈥� said Thomas, of the Tuskegee experiments.

鈥淪o, to be truthful, when, like, new diseases drop? I鈥檓 a little weird about the mainstream testing me, or sticking anything in me.鈥�

Brothers Tavier Thomas (left) and McKenzie Johnson were tested for the coronavirus at a Black Doctors COVID-19 Consortium testing site. Tavier, who studies history, says he feels more comfortable getting treatment from Black medical providers because of past abuses of Black people by white doctors and medical researchers in the U.S.(Nina Feldman/WHYY)

In April, Thomas tested positive for the coronavirus but recovered quickly. He returned recently to be tested again by Stanford鈥檚 group, even though the testing site that day was in a church parking lot in Darby, Pennsylvania, a solid 30-minute drive from where he lives.

Thomas said the second test was just for safety, because he lives with his grandfather and doesn鈥檛 want to risk infecting him. He also brought along his brother, McKenzie Johnson. Johnson lives in neighboring Delaware but said it was hard to get tested there without an appointment, and without health insurance. It was his first time being swabbed.

鈥淚t鈥檚 not as bad as I thought it was gonna be,鈥� he joked afterward. 鈥淵ou cry a little bit 鈥� they search in your soul a little bit 鈥� but, naw, it鈥檚 fine.鈥�

Each time it offers tests, the consortium sets up what amounts to an outdoor mini-hospital, complete with office supplies, printers and shredders. When they do antibody tests, they need to power their centrifuges. Those costs, plus the lab processing fee of $225 per test and compensation for 15-30 staff members, amounts to roughly $25,000 per day, by Stanford鈥檚 estimate.

鈥淪ometimes you get reimbursed and sometimes you don鈥檛,鈥� she said. 鈥淚t鈥檚 not an inexpensive operation at all.鈥�

After its first few months, the consortium came to the attention of Philadelphia city leaders, who gave the group in funding. The group also attracted funding from foundations and individuals. The regional transportation authority hired the group to test its front-line transit workers weekly.

To date, the Black Doctors COVID-19 Consortium has tested more than 10,000 people 鈥� and Stanford is the 鈥渄octor on record鈥� for each of them. She appreciates the financial support from the local government agencies but still worries that the city, and Philadelphia鈥檚 well-resourced hospital systems, aren鈥檛 being proactive enough on their own. In July, wait times for results from national commercial labs like LabCorp sometimes stretched past two weeks. The delays rendered the work of the consortium鈥檚 testing sites essentially worthless, unless a person agreed to isolate completely while awaiting the results. Meanwhile, at the major Philadelphia-area hospitals, doctors could get results within hours, using their in-house processing labs. Stanford to share their testing technology with the surrounding community, but she said she was told it was logistically impossible.

鈥淯nfortunately, the value put on some of our poorest areas is not demonstrated,鈥� Stanford said. 鈥淚t鈥檚 not shown that those folks matter enough. That鈥檚 my opinion. They matter to me. That鈥檚 what keeps me going.鈥�

Now, Stanford is working with Philadelphia鈥檚 health commissioner, trying to create a rotating schedule wherein each of the city鈥檚 health systems would offer free testing one day per week, from 9 a.m. to 9 p.m.

The medical infrastructure she has set up, Stanford said, and its popularity in the Black community, makes her group a likely candidate to help distribute a coronavirus vaccine when one becomes available. Representatives from the U.S. Department of Health and Human Services visited one of her consortium鈥檚 testing sites, to evaluate the potential for the group to pivot to vaccinations.

Overall, Stanford said she is happy to help out during the planning phases to make sure the most vulnerable Philadelphians can access the vaccine. However, she is distrustful of the federal oversight involved in vetting an eventual coronavirus vaccine. She said there are still too many about the process, and too many other instances of the Trump administration putting on the Centers for Disease Control and Prevention and the Food and Drug Administration, for her to commit now to doing actual vaccinations in Philadelphia鈥檚 neighborhoods.

鈥淲hen the time comes, we鈥檒l be ready,鈥� she said. 鈥淏ut it鈥檚 not today.鈥�

This story is part of a partnership that includes , and KHN.