LAUSR

C oronavirus disease 19 (COVID-19) is the condition caused by severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV-2) infections which is now prevalent in all 50 states with clustering of cases in major cities in New York, Michigan, California, and New Jersey. COVID-19 that was initially thought to be the great equalizer—no discrimination with who can become infected—now reveals patterns of disparities for low-income persons and racial and ethnic minority populations. This novel coronavirus which results in increased rates of respiratory failure and death among infected individuals 2 is found to disproportionally affect those with comorbidities such as diabetes, heart disease, and asthma. These conditions are known to disproportionately affect minorities who are already impacted by health disparities. Even before COVID-19, health disparities were pervasive in the USA. We define disparities as differences in healthcare utilization and health outcomes among distinct social groups. Emerging data show that racial/ethnic minorities and those from the working class have worse health outcomes due to COVID-19. In Chicago, Blacks comprise 30% of the city’s population but 70% of COVID-19 deaths. Based on our personal experience and data from our health system, COVID-19 is uncovering disparities embedded within our society. In this paper, we identify areas in which COVID-19 is exacerbating existing disparities and offer potential solutions to address these disparities. Structural barriers contributed to disparities in COVID-19 testing and diagnosis in the early weeks of the pandemic. One of the major issues with diagnosing COVID-19 is limited testing availability. Initially, testing was centralized and there were few testing sites. To control the number of patients presenting for tests, residents in New York were required to obtain a doctor’s prescription. Previous studies have shown that racial/ethnic minorities are less likely to have access to a primary care provider. Thus, this requirement may have served as structural barrier in obtaining COVID-19 testing. Then, the state implemented “drive-thru” testing to increase the number of patients receiving tests but this required access to a vehicle. Though the intentionwas to control the number of patients getting tested through prescriptions and “drive-thru” testing, patients without a doctor or without access to a vehicle were less likely to be tested. Controlling access to tests in this way likely disadvantaged racial and ethnic minorities and those who rely on public transportation. Furthermore, if a patient has a high clinical suspicion for COVID-19 infection but lacks a primary care provider or vehicle, their only recourse is to seek testing in an emergency room. Given the cost of emergency room copays, some patients have to decide whether to pay to get evaluated for testing or monitor their symptoms at home. Additionally, COVID-19 results are available 7 to 10 days after and during this time, patients again encounter a dilemma whether to quarantine themselves at home or go to work. Therefore, having an established policy for free and easily accessible COVID-19 testing would reduce the impact of the structural barriers to testing and, in turn, minimize disparities. We are witnessing unintended consequences of the COVID-19 outbreak; patients with non-COVID-19 medical conditions avoid healthcare to reduce the risk of COVID-19 exposure. As hospitals are filled with patients who test positive for COVID-19, COVID-19-negative patients with existing medical conditions are more susceptible to complications of those conditions. Cardiologists are noticing a reduction in the number of patients with heart attacks and those who are presenting with heart attacks are having worse outcomes. Surgeons also observe patients that require surgical interventions are presenting with gangrene or with increased risk of surgical complications. Patients from racial and ethnic minorities have an increased prevalence of common medical conditions compared to non-HispanicWhites, and a high percentage of them have undiagnosed common medical conditions. To reduce disparities arising from the management of both COVID-19 and non-COVID disease outcomes, it is critical to develop testing to rapidly assess COVID-19 status, isolate COVID-19 patients from non-COVID patients, and efficiently manage non-COVID-19 diseases. The views expressed in this article are those of the authors and do not necessarily represent the views of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes of Medical Research.