Limiting the Risk of COVID-19 Infection in African Americans

While wearing a mask in public, washing your hands, social distancing, and covering your cough/sneeze greatly decreases your risk for contracting COVID-19, there a some other less-proven approaches that also need discussion and consideration.

A good amount of theoretical approaches to minimize the spread and severity of COVID-19 have been published. Given this new coronavirus has limited confirmed supplement approaches to prevention and treatment, providers are using foundational knowledge regarding populations and viral infections, and hypothesizing (or guessing) what might be effective.

African Americans have been disproportionately impacted by COVID-19 with a much higher hospitalization rate and mortality.  At the core of worse outcomes in African Americans is poorly controlled chronic diseases like diabetes, hypertension, and COPD.  But there is also firm population data that points to trends in vitamin and mineral deficiencies that may also contribute to poor outcomes.  Using what we know about these trends and the fundamentals of infections (both viral and bacterial), and also keeping a keen eye on safety, here is what I have been recommending my patients consider.

Zinc (10 to 15 mg) one to three times a day when COVID-19 exposure risk is high

Zinc is an essential trace element that is critical for a variety of biological processes and proper immune function. Studies have consistently shown zinc deficiencies in African Americans and believe the dramatically increased rate of HIV and hepatitis C in African Americans represents an impaired immune defense linked to lower levels of zinc. Zinc’s antiviral activity has been confirmed against a variety of viruses and the science of how zinc either prevents infection or slows viral spread is well established.

There is also emerging evidence that zinc’s antiviral and antibacterial activities may help slow coronavirus spread and ease the complications that result from an infection. The improved antiviral immunity conveyed by zinc could be particularly impactful during the COVID-19 pandemic. Some suggest that the increased severity of COVID-19 in African Americans may reflect a low zinc status and the Mayo Clinic confirms that zinc is clearly more beneficial in populations that have deficiencies.

Vitamin D (2000 IU) once daily

The most dramatic vitamin differences by race or ethnicity relate to vitamin D levels which nutritionists agree is deficient in four of five African Americans. The widespread vitamin D deficiency is somewhat related to the melanin in darker skin, widespread lactose intolerance (also genetically driven) as well as urban living leading to decreased sun exposure.

The lack of vitamin D has been associated with an array of bad outcomes including increased stroke, heart disease, pre-term birth, and a host of cancers including lung, colon, ovarian, breast, and prostate. Low vitamin D has also been associated with a higher risk for lupus (SLE), multiple sclerosis, diabetes and hypertension.  African Americans have the absolute highest risk for diabetes, hypertension, stroke and the cancers listed.  The lack of vitamin D has also been linked to worse outcomes in COVID-19 infections, but its association may simply be a marker for the chronic diseases listed above.  Most African American patients, particularly the elderly and those with limited sun exposure and the potential for exposure to COVID-19 should consider taking vitamin D at 2000 IU daily.

Famotidine (20 mg) once daily

In a study at Columbia University, patients hospitalized with COVID-19 that had famotidine, the acid blocker also known as “Pepcid” within the prior few days had better outcomes.  They concluded that “famotidine use was associated with a reduced risk of clinical deterioration leading to intubation or death”.  This mechanism of action is not random.  Researchers note that famotidine is known to inhibit viral replication in some instances.  There are also first-hand accounts of rapid improvement after COVID-19 infection.  Given its safety (and over-the-counter availability), its use in a COVID-19 exposed vulnerable population can be justified.

While this information is far from confirmed, its science has a good foundation. Given African American’s well-established vitamin D and zinc deficiencies in the face of a “curiously high” infection rate, these largely safe measures, may make a difference. As always, check with your provider before starting any of these supplements or vitamins as your individual case may warrant a different approach.

Elizabeth Clarke, Master Teacher

Elizabeth Clarke, Master Teacher

While cleaning a closet I found this article from the Plain Dealer about my 6th grade teacher Elizabeth Clarke.  Mrs. Clarke was legendary in many ways. As the teacher of more than a generation of successful African Americans in Cleveland, her success with students was no accident.  As a teacher at Miles Standish Elementary School in the Glenville neighborhood where I grew up, she taught many of my family and friends including two of my brothers and my wife.  She also has taught a who’s who of African American success stories in Cleveland including TV personality Leon Bibb, prominent attorney Inajo Davis Chappell, Judge Ray Headen, former Mayor Mike White, and many others.

Elizabeth Clarke, Master Teacher
Miles Standish Elementary School (Currently Michael White Elementary School)

Mrs. Clarke demanded success and expected it of all of her students.  She was incredibly strict and ruled by intimidation and ridicule . . . which in my case was the perfect motivation. We were told we were better than the other students in the school and we needed to act like it, we were in “Mrs. Clarke’s class.”   Even within the class, she had her favorite students and everyone knew their status. I was one of her favorites as was Inajo, Ray, Miles Roach and others. My brothers and others were not so lucky.

The basics plus more . . .

Mrs. Clarke insisted we learn the educational basics of elementary school as fast as we could. Simply learning the multiplication tables was unacceptable, we needed to learn and recite them in lightning speed. Stuttering, or breathing for that matter, meant we had to see her exasperation and start again from the beginning. I can still recount those tables in my head when needed.

Diagramming Sentences

We also had to learn to diagram sentences which apparently had been a long abandoned approach to grammar, but not in Mrs. Clarke’s class.  We all strove for her complimentary comments on our homework: “Very Excellently Done!” I’ve embedded a video of diagramming sentences for those of you unfamiliar.

“What does Africa mean to me?”

Most important in her class was to learn a deep appreciation for the continent of Africa.  As the PD article describes, she won a paid excursion to Africa as a Master Teacher and continued to go whenever she could. Because of her stern nature, she didn’t smile much, but when she did, Africa was likely the topic of discussion. Annually, she would put together a student performance that educated students at other schools about the rich culture, values, and contributions of our African heritage. Like everything else, that performance had to be perfect every time . . .and it was. We were also the children of Africa and needed to represent that continent impeccably.

Elizabeth Clarke, Master Teacher
Mrs. Clarke’s students would chant “What does Africa mean to me?” between giving education facts about the great continent.

47 years later, here I am writing about a truly masterful teacher who made an indelible mark in the lives of many. Her approaches to teaching would surely not be allowed today. Her deviation from the standard 6th grade curriculum, blatantly “having favorite students”, discounting other students as not as good, and using fear as a primary motivation to learn, would all draw stern criticism from today’s educational leaders.

But the fact remains that Elizabeth Clarke, the Master Teacher, set a path for our success that was deliberate and incredibly impactful. She laid the foundations for learning and the expectation for excellence that many of us carry to this day. There may have been other students that needed a different method for learning, or a more loving approach, but that was never her intention. She unapologetically demanded superiority of her students and accepted nothing less.

For my life, and the lives of a few others, Mrs. Clarke was exactly what we needed to build our self-confidence, to gain appreciation for our heritage, and to carry and exemplify that pride and expectation of more, to the next generation.

For that, we say “Very excellently done, Mrs. Clarke.”

Elizabeth Clarke Master Teacher
Plain Dealer Article by Margaret Bernstein from February 16th, 1992.

Cleveland State University Urban Health Program

Channel 5 did a short piece on the program that Dr. Hall leads at Cleveland State University.  Dr. Greg Hall splits time between patients and a two-year program where he teaches students at Cleveland State. Dr. Hall is co-director of the NEOMED-CSU Partnership for Urban Health, a program that aims to educate and support more black doctors.

 

African American Healthcare Negatively Impacted by Bias-Driven Data

Hospitals across this nation use protocols and algorithms aimed at improving outcomes in their patients, but because of nuanced differences in the care of African Americans, those protocols have now been shown to negatively impact African American healthcare. A recent article in Science, “Dissecting racial bias in an algorithm used to manage the health of populations” reviewed outcomes data and found that “Black patients assigned the same level of risk by the algorithm are sicker than White patients.” Essentially the computer “assumes” that African Americans are healthier than they are because of their decreased use of certain medical care services.

African American Healthcare By Greg Hall

The predictive model uses, among other things, cost of care as a marker for health.  Because of bias in providers, less interventions are ordered and completed, less referrals to specialty providers, and less orders for a number of counseling opportunities.  African American patients, across the population have less successful follow up with physicians, fewer prescriptions filled and refilled, and more missed appointments.  These combine to produce an outcome that mathematically would suggest better health, but instead bias on both the patient and providers’ part is driving worse outcomes.

African American Healthcare By Greg Hall

Large hospital and hospital systems spend a significant amount of money trying to save money. There are a  number of “risk-prediction tools” that are used to target “high risk” patients that would get more attention, added studies, longer stays, increased follow up, and more.  Knowing the significant health disparities impacting African Americans, one would assume that added attention would improve these rock-bottom outcomes, but the “predictive model” does the exact opposite and suggests less interventions.

The study also found a difference in healthcare-related spending with African Americans having “fewer inpatient surgical and outpatient specialist costs, and more costs related to emergency visits and dialysis.”

The take-home message is bias on almost everyone’s part (provider, social worker, discharge planner, patient, hospital, etc.) negatively impacts African American health and healthcare outcomes.  Systems and algorithms designed to improve outcomes and save money are actually driving up cost and decreasing quality outcomes in African Americans.  Bias-driven outcomes can easily be tracked, considered and corrected.

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To learn more about purchasing Patient-Centered Care for African Americans, click the book.

In addition to bias, there are other African American healthcare differences that impact hypertension, diabetes, stroke, diet counseling and more. These differences, by and large, are also being ignored by hospital systems, medical schools and providers.

The good news is the first textbook addressing the patient-centered clinical care of African Americans was recently released.

 

 

Cleveland Clean Indoor Air Committee 2004

Early in Dr. Hall’s public health career, he was chosen to chair the Cleveland Clean Indoor Air Committee under Mayor Jane Campbell.  At the time, the issue was very controversial, but as time passed, people have accepted clean indoor air as a way of life. And the smoking rate has drooped from 42% in the 1960’s to an all-time low of 15% currently with more planning to quit.

Here is an article in the Toledo Blade in 2004.

Cleveland Clean Indoor Air Page 1Cleveland Clean Indoor Air Page 2