Anti-Asian bias brought out by pandemic

Some physicians have fought discrimination along with the virus.

Hospitalist Audrey Sue Cruz, MD, had heard about increased discrimination against Asian-Americans resulting from the COVID-19 pandemic, but a patient encounter really brought the problem home to her.

“I'm a hospitalist, but I also do primary care and so we've been doing a lot of telehealth visits, and I did one visit over the telephone with a new patient,” said Dr. Cruz. “At the end of the visit, she asked me what my nationality was. . . . I answered her, ‘I'm Filipino and Asian.’ She responded by saying, ‘Wow, I can't believe what your people did.’ And then she said, ‘I typically wouldn't choose an Asian doctor, but you seem nice.’”

Screenshot courtesy of Dr Cruz
Screenshot courtesy of Dr. Cruz.

Dr. Cruz, who practices at Loma Linda University Medical Center in California, was left shocked, uncomfortable, and glad the visit was near its natural end. “I asked her if she had anything else she wanted to talk about medically, because that's what I'm here for. . . . She didn't have any other questions, so we ended the visit.”

Recent incidents like this, and concerns about even more explicit racist attacks in the community, have motivated Dr. Cruz and other physicians to speak out against anti-Asian bias, individually and collectively.

Elisa I. Choi, MD, FACP, an internal medicine and infectious disease specialist and chief of internal medicine at a multi-specialty practice in the greater Boston area, said she started hearing about this type of bias right as the COVID-19 epidemic began in China. “I had started seeing reports on Twitter and social media that there were cases here and there of biased language or racist speech that were directed at the origins of the virus,” she said.

It's gotten even worse since, despite the efforts of health care leaders to avoid the problem, for example, by not naming the virus geographically, she added. “As the pandemic has continued, the anti-Asian racism has really only picked up steam.”

Whether the racism is occurring within health care or outside, Dr. Choi believes it's important for physicians to respond to it. “Our job as medical professionals and practitioners of evidence-based medicine is to also make sure that our patients understand what's actually authentic truth and medical facts, and not to help perpetuate some of that false narrative,” she said.

Among other problems, biased beliefs about the virus may actually impair patients' understanding of their health, she said. “This has happened to numerous colleagues that I've had the chance to speak with, and I've certainly seen it in my own health care practice: Some patients, when they're asked, ‘What's your risk factor for COVID-19 exposure?’ will start to mention, ‘Well, I was surrounded by a group of Asians.’”

Dr. Choi tries to educate such patients on an individual level with a response like, “That has no bearing on whether you have a risk for COVID-19.” But she worries about how such attitudes could be dramatically more detrimental to the health of those subject to the bias.

“This false view that anyone of Asian descent is somehow to blame or somehow a carrier can have a tremendous impact on an individual's desire to even seek medical care,” she said. Dr. Choi is concerned that some members of the Asian community might be reluctant to seek care if they do develop COVID-19, but “We don't know if that's happening because it's really hard to measure.”

They might even be nervous to leave their homes. “Being of Asian-American descent, we think about our parents and our grandparents and how helpless and innocent they are, and we worry about them when they go out,” said Dagny Zhu, MD, an ophthalmologist in Rowland Heights, Calif. “I think it's important, for those who are able, to speak up for those who are normally voiceless and have less of a say in society.”

Dr. Zhu and a group of colleagues, including Dr. Cruz, used an online video to speak up against the hate. The two-minute video, posted on YouTube and shared widely on social media, features Asian-American doctors, some holding signs with anti-Asian statements, others holding responses such as, “But I'm on the frontlines risking my life to save yours.”

“We really just want to spread a positive message to promote kindness and unity so that we can, instead of tearing each other apart, unite and fight this pandemic together,” said Dr. Zhu.

Dr. Choi and her ACP colleagues, meanwhile, highlighted the issue in medical publications. She was the lead author of a March 18 article on the Annals Fresh Look blog titled “Respiratory Disease and Racism Have Reared Their Ugly Heads With COVID-19,” which reminded physicians that “promoting empathy, mutual respect, inclusion, and equality can be as important as accurate communication, diagnosis, and treatment.”

That was soon followed, on March 31, by an official ACP statement condemning harassment, violence, and discrimination based on an individual's race, ethnic origin, ancestry, or nationality. “We are deeply concerned about reports of harassment against individuals of Asian descent, including physicians and other clinicians,” said the statement from Robert M. McLean, MD, MACP, then President of ACP.

Dr. Choi, who is the Governor for ACP's Massachusetts Chapter, had advocated for this statement and was also involved in the College's endorsement of a congressional resolution condemning anti-Asian sentiment related to COVID-19. “It definitely makes me very proud to be part of the organization that recognizes things like hate crimes are not separate and distinct from caring for our patients,” she said.

This pandemic is not the first time that a disease has led to racial or ethnic discrimination, she noted. It's been a problem from the plague centuries ago through the early days of the HIV/AIDS epidemic. “When [AIDS] first emerged, there seemed to be some epidemiologic association with individuals of Haitian background. And so there was some element of racialization and targeting,” which led to both stigma and psychological trauma, said Dr. Choi.

Anti-Asian bias has also been a longstanding problem in the U.S., the physicians noted. “I think the first law excluding a group of immigrants was against Chinese immigrants, and so we've had a long history,” said Dr. Zhu.

Racism is a health care issue on multiple levels, noted Dr. Choi. “That has so many downstream effects, ultimately, not just in physical health for lack of seeking care, but we're starting to also recognize the mind-body connection, and having an ongoing sense of psychological stress likely has effects on physical health.”

That stress is also the last thing that clinicians need for themselves right now. “As a hospitalist, we don't get to choose our patients, obviously,” said Dr. Cruz. “What I want people to know is that we all are working as hard as we can, and our main focus is the health and safety and well-being of our patients.”

For some Asian-American physicians, there is a second battle, noted Micah Yu, MD, a rheumatology fellow at Loma Linda and participant in the video. “On top of the coronavirus that we're all fighting as health care professionals, some of our colleagues might be fighting the racism virus at the same time,” he said.