I was in a small grocery store in my area (Westchester County, NY) and overheard two store workers arguing about whether the COVID pandemic was real or just some overblown hype being much exaggerated by the ‘fake news.’  One of them saw my hospital nametag and called me over to back up his viewpoint that this disease was very real, very bad, and if we didn’t get serious about it very fast we’d be very sorry.  The woman with whom he was arguing looked at me and asked with pleading eyes, “It’s not really that bad is it?”  This was April 8th as we at Montefiore in the Bronx were rapidly approaching the peak of our surge with almost 2,000 COVID patients in the Montefiore health system, over 1,000 COVID patients in our largest hospital division and the rate of new cases per day climbing rapidly.  The hospital system was being stretched well beyond its capacity and new COVID patient wards were being filled as fast as they were being built in unusual spaces, including the social hall, the cath labs and even the pediatric hospital.  The morgue was well beyond capacity and refrigerator trucks were in the loading docks to store the overflow of bodies. There were so many codes being called every day that the nurses pushed to also have something mark when patients were taken off ventilators and they chose Alicia Keyes “Empire State of Mind” (AKA New York).  Montefiore’s experience was captured by a news crew who spent a week there in April in a CBS News special.1

The community health center where I see patients is in the South Bronx – one of the communities hit hardest by COVID in both cases and deaths.  It is a largely non-white community with extremely high rates of poverty.  While New York City was the hardest hit city, the Bronx was the hardest hit borough2 with the greatest number of cases, hospitalizations and deaths occurring in those with the lowest incomes.  Predominantly white neighborhoods with higher incomes throughout the city had significantly lower rates of illness and death from COVID.3   While the numbers might be higher in the Bronx, these patterns repeat themselves all over the country.4 This is not surprising to anyone aware of the economic and healthcare inequities present in our society.  There is, however, another phenomenon taking place that is further hampering our ability to stem the tide of the pandemic, especially for those that are being affected the most.

In addition to a multitude of ways that the administration has failed to provide the appropriate response to this health disaster, the profound politicization of the pandemic and the public health response to it has made this country the single worst nation compared to all other first world countries in tackling this pandemic and getting it under control. 5 Public health physicians and scientists have been under attack and even threatened for the work they are doing based on science and data when the conclusions that are reached don’t support unpopular political views about opening up the economy again. 6  Even wearing masks, which has been proven to prevent transmission of disease, has become a political football.

In an article in NY magazine,7 a theory is described that might explain this phenomenon.  Based on work being done at Yale Law School,8 the theory of “cultural cognition” refers to the tendency of individuals to conform their beliefs about disputed matters of fact (e.g., whether humans are causing global warming; whether the death penalty deters murder; whether gun control makes society more safe or less) to values that define their cultural identities.  The author of the article describes that “when our beliefs are threatened, we find ways to minimize or dismiss that information. For example, we can question the source of that information (e.g., citing ‘fake news’).”

As a physician, I consider myself a woman of science.  So independent of my political views, it is enormously frustrating when I am confronted by those who wish to deny the science of global warming, or in this most recent case, deny the devastating effects that COVID-19 was having on my medical community. So in this local market, faced with someone who seemed to be choosing not to believe the data being reported daily about the enormous impact that COVID was having on our community, I decided to bear witness.  If the data wasn’t going to convince her than I would use anecdotal evidence.  I would tell her what we were experiencing in vivid detail with COVID-19 and that yes, her co-worker was right.  It is very real, it is very bad and if we don’t get very serious about it very fast and do what the scientists and public health officials are telling us to do, we’ll be very sorry.  Although even as I said that, I realized that this white woman in a market in the suburbs would likely be far less affected than my low-income patients of color in the Bronx.

-Felise Milan, MD Community of Practice Member

Felise Milan, MD is a professor of medicine at the Albert Einstein College of Medicine in Bronx, NY where she is the director of the Clinical Skills Center and the pre-clerkship clinical skills curriculum.  She is one of the founders of and recent past president of the Directors of Clinical Skills Courses (DOCs)

  1. CBS News. Bravery and Hope: 7 Days on the Front Line. 2020 May 15. https://www.cbsnews.com/video/bravery-and-hope-7-days-on-the-front-line/
  2. Almukhtar S, Aufrichtig A, Bloch M, et all, New York City Coronavirus Map and Case Count. The New York Times. Updated: 2020 July 27. https://www.nytimes.com/interactive/2020/nyregion/new-york-city-coronavirus-cases.html
  3. Schwirtz M, Rogers Cook, L. These N.Y.C. Neighborhoods Have the Highest Rates of Virus Deaths. The New York Times. 2020 May 18. Updated: 2020 July 22. https://www.nytimes.com/2020/05/18/nyregion/coronavirus-deaths-nyc.html#
  4. Centers for Disease Control and Prevention. Health Equity Considerations and Racial and Ethnic Minority Groups. Updated 2020 July 24. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html
  5. Felsenthal E. Front Line Workers Tell Their Own Stories in the New Issue of TIME. TIME. 2020 April 9. https://time.com/5850680/u-s-response-covid-19-worse-than-chinas/
  6. Weber L, Barry-Jester AM, Smith M. Public Health Officials Face Wave Of Threats, Pressure Amid Coronavirus Response. The Associated Press. 2020 June 12. https://khn.org/news/public-health-officials-face-wave-of-threats-pressure-amid-coronavirus-response/
  7. Singal J. The Theory That Explains the Politicization of Coronavirus. New York Magazine Intelligencer. 2020 May 8. https://nymag.com/intelligencer/2020/05/the-theory-that-explains-the-politicization-of-coronavirus.html
  8. Yale Law School. The Cultural Cognition Project. culturalcognition.net

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