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Brian Lehrer: Brian Lehrer on WNYC and by almost every metric the coronavirus has taken a disproportionate toll on Black Americans. Our report from the National Urban League, based in part on data from Johns Hopkins, found that Black people are twice as likely than white people to die of COVID and three times as likely to be infected. I'm joined now by Dr. Uché Blackstock, emergency medicine physician, founder, and CEO of Advancing Health Equity, and a Yahoo News medical contributor.

We're going to play two more clips from last night's debate that have to do with healthcare generally and with COVID in particular. We're going to talk about equity, disparities, and what seems to be the inevitable second wave of the virus coming in and how to prevent some of the horrible disparities that we've seen unfold before our eyes or experienced ourselves in the first wave. Dr. Blackstock, thank you so much for coming on and welcome back to WNYC.

Dr. Blackstock: Thank you for having me on again, Brian.

Brian: In last night's debate, the candidates were asked why voters to trust them to deal with issues of race. Joe Biden had this to say.

Joe Biden: This is a man who in fact you talk about helping African Americans, one in 1000 African Americans has been killed because of the coronavirus. If he doesn't do something quickly by the end of the year, one in 500 will have been killed, one in 500 African Americans. This man is a savior of African Americans? This man cares at all? This man has done virtually nothing.

Brian: Outside of Trump versus Biden, unless you want to go there, which of course you're allowed, are those numbers, numbers that you know and accept that one in 100 Black Americans have died of COVID and that may rise to one in-- I'm sorry, one out of 1000 and that may rise to one in 500?

Dr. Blackstock: Brian, we're getting close to that one in 1000 number. August actually was a pretty rough month for Black and Latinx communities. The actual mortality rates from coronavirus increased during August. We are nowhere in there out of the woods. I think those numbers that Biden mentioned last night by the end of the year are realistic numbers that we're looking at.

Brian: This month, the APM research lab released a report saying that the COVID-19 death rate among Black Americans and Latinos is rising sharply still. In New York City, the COVID test positivity rate is above 3% for the first time in months. We're also headed toward colder weather and flu season to boot. Given these trends and what looks to be on the horizon in terms of new wave of infection, how concerned are you about a repeat or a continuation of the disparities that the general public became aware of in the spring?

Dr. Blackstock: Brian, I'm definitely concerned. We always knew that they were preexisting health inequities. We know that Black and brown communities carry the highest burden of chronic disease. There are issues with access to healthcare. These communities are more likely to be uninsured or underinsured. Then there were specific factors that place these communities at increased risk for coronavirus.

We saw during the pandemic that depending on whether you were using public transportation, the type of job that you had. If it was a service worker or essential worker, or if you had lived in overcrowded housing, that you were more likely to be placed at risk for being infected. What we actually just saw from some recent data, is that over the pandemic Black New Yorkers were actually waiting the longest to seek care or waiting about seven days compared to Latinx patients were waiting five days and white patients three days.

We really have multiple factors converging to create the perfect storm for Black and Latinx communities to being disproportionately impacted by coronavirus. I know that H&H and the Department of Health have been working on strategies in these communities, such as focusing testing and contact tracing services on these communities, as well as working with community partners like churches, barbershops, and senior centers to engage communities around education and outreach.

Brian: Do you have any thoughts about the ways that the candidates last night, in general, talked about COVID?

Dr. Blackstock: Yes. I think they played it safe. I think that the conversation did not get to really bad-- I mean, Biden mentioned it, but we have been essentially seeing Black communities specifically decimated by this disease. What I really didn't hear is, what are the strategies that they're going to use to address this? We know that we need more federal funding for safety-net hospitals.

I think what we saw in the pandemic even here in New York City where that private hospitals were more likely to receive funding than even safety-net hospitals, and where patients went to get their care resulted in disparate outcomes. I think that any conversation between the candidates really should be addressing, what are they going to do to address these inequities.

We really haven't heard much from the CDC at all about any health equity strategy and that's incredibly disappointing. There really has been a complete failure on the part of the administration to address these disparities. I worry, as you mentioned, as we go into the cold weather that these disparities will worsen.

Brian: What can be done to minimize the disparities? You mention one thing adequate funding for safety-net hospitals, but how can doctors, public health officials, government at the city level, state level, federal level work against the systemic racism that has led to this disproportionality in phase one? We don't have to be resigned to it, despite some of the underlying conditions that we know can change in an instant.

We know who the frontline workers are, who even if we locked down again are going to go out and have contact with people. We know who has more underlying health conditions to begin with because of centuries of systemic racism, frankly. We can't reverse those things tomorrow, but what can we do to minimize the disparities if a second wave really hits hard?

Dr. Blackstock: I think that initially, it's starting out with tracking the data which actually was not done in an efficient manner earlier in the year, the racial and ethnic demographic data, and making that more transparent even to the communities that are being impacted. As I mentioned, equitably allocating testing, and contact tracing programs to these communities.

Also, as I mentioned, I think the community engagement is a very, very important piece. There is a trust that is essentially missing between Black communities and other communities of color and to the healthcare system. This is where engaging with community-based organizations, with community partners is incredibly important. I will also add that the part of the contact tracing strategies is to help people and communities with social services. Whether that is making sure that people are fed, picking up prescriptions, or addressing other social needs, that would be part of a strategy really to ensure that these communities are not disproportionately impacted as they were before.

I think there are other issues like ensuring maybe emergency health coverage, putting moratoriums on medical debt collection, and really providing financial assistance for patients when they arrive to the hospital and are seeking care. I think those are a few of the short-term strategies that don't really seem that complicated but really need to be organized in an efficient manner.

Brian: My guest is doctor Uché Blackstock, emergency medicine physician, founder, and CEO of Advancing Health Equity, and a Yahoo news medical contributor. We can take your phone calls for her on reducing the disparities in COVID outcomes as we head into at least a period of rising infections in the New York area. We know that's already going on. (646) 435 7280, (646) 435 7280.

When we come back from a break as we also talk about aspects of last night's debate as it relates to this, I'm going to play what I thought was one of the most newsworthy moments from the debate. It's not getting all that much attention because of what President Trump did in refusing to denounce The Proud Boys and other violent white supremacist groups explicitly, but I'm going to play what I think deserves a little more attention than it's getting from last night's debate on this topic. Stay with us.

Brian: Coming up at noon on All of it with Alison Stewart, Alison is going to take your calls today on whether you're ready to eat inside restaurants again. We know indoor dining has already been allowed for a while at certain percent capacities around the area. Today New York City restaurants can open for indoor dining at 25% capacity. Today's the day. New York City eaters, Allison is going to take your calls on whether you're ready to eat inside restaurants again and she'll talk about it all with Grub Street staff writer Chris Crowley. So that and more on all of it coming up at noon here on WNYC 93.9 FM, AMA 20, or ask your smart speaker to play WNYC.

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Brian: Brian Lehrer on WNYC with Dr. Uché Blackstock. Here's one more healthcare exchange from last night. Moderator Chris Wallace puts it to the President that he is against Obamacare continuing to exist but has never proposed an alternative.

Chris Wallace: Over the last four years you have promised to repeal and replace Obamacare but you have never in these four years come up with a plan, a comprehensive plan to replace Obamacare-

Trump: Of course, I have. I got rid of the individual mandate.

Chris Wallace: Well, I'll give you an-

Trump: Excuse me.

Chris Wallace: -opportunity

Trump: I got rid of the individual mandate which was a big chunk of--

Chris Wallace: That is not a comprehensive plan.

Trump: That is absolutely a big thing. That was the worst part of Obamacare.

Chris Wallace: I didn't ask it, sir. You're debating him not me

Trump: Chris, that was the worst part of Obama--

Chris Wallace: Let me ask my question.

Trump: Well, I'll ask Joe. The individual mandate was the most unpopular aspect of Obamacare, I got rid of it and we will protect people with pre-existing conditions.

Chris Wallace: Mr. President, I'm the moderator of this debate and I would like you to let me ask my question and then you can answer the question.

Trump: Go ahead.

Chris Wallace: You, in the course of these four years have never come up with a comprehensive plan to replace Obamacare. Just this last Thursday you signed a largely symbolic executive order to protect people with pre-existing conditions five days before this debate. My question, sir, is what is the Trump healthcare plan?

Trump: Well, first of all, I guess I'm debating you not him, but that's okay, I'm not surprised. Let me just tell you something. There's nothing symbolic. I'm cutting drug prices, I'm going with 'favored nations' which no president has the courage to do because you're going against big pharma. Drug prices will be coming down 80 or 90%. You could have done it during your 47 year period in government but you didn't do it. Nobody's done it, so we're cutting healthcare.

Brian: President Trump and Chris Wallace from last night's debate where Joe Biden snickering a little bit there in the background. Dr. Blackstock for you as an emergency room physician, first, can we fact check the claim that the President made at the end there? Are drug prices coming down 80 or 90% or do you see that on the horizon?

Dr. Blackstock: No, we definitely don't see that on the horizon. I speak to a lot of my physician colleagues. We do have concerns about what is happening or going to happen with the Supreme Court nomination of Dr. Amy-- Sorry, Judge Amy Coney Barrett. I think that we are concerned about what the ACA is going to do in terms of millions of Americans losing health insurance and then especially in the midst of a pandemic and those with pre-existing conditions, so we were very worried.

Brian: I thought it was astounding. That's why I thought it should have made more news than it has so far, that in the answer to that very straightforward direct question from Chris Wallace, "If you want to abolish Obamacare and you think it's so bad and you claim that you're going to protect pre-existing conditions and make insurance cheaper, well, where are the details of that plan? You've never issued a plan." The President had no response. All he did was continue to criticize Obamacare.

Dr. Blackstock: Right, yes, no. He doesn't have a plan and what we need to know is what would happen if the ACA gets struck down and we're going to have millions without health insurance in the midst of a pandemic. That could be a crisis within a crisis.

Brian: Here's the follow-up question that I would like somebody to put to him or any of the advocates for declaring the Obamacare individual mandate unconstitutional and thereby having the Supreme Court undo the whole structure of Obamacare which ensures millions and millions of people.

The question that I'd like to hear is, well, okay, then what's your funding mechanism for getting everybody insured at relatively low rates? He says the price for insurance would go down but the point of the individual mandate was to keep the younger healthier people who might not feel they need insurance today in the system paying some kind of rates so that the older or sicker people don't have to foot so much of the bill just to insure themselves at what would be much higher rates.

That's how insurance works in general. That's why car insurance is mandatory for everybody who's going to own or drive a car. Because then everybody's in the pool and then when you have that small percentage of crashes, there's enough money there to cover the damages without charging people an arm and a leg for insurance.

What would the funding mechanism be that would keep insurance premiums down if you throw out the individual mandate? I haven't heard anybody answer that question.

Dr. Blackstock: No, I haven't heard any answer to that either, Brian.

Brian: Let's take a phone call. How about. Let's see. Donald in Douglaston, Queens, you're on WNYC with Dr. Uché Blackstock. Hi, Donald.

Donald: Hello.

Brian: Hi, Donald, you're on the air.

Donald: Okay. I just wanted to say that in Japan only 1000 people died from COVID and there was no downturn in the economy because as soon as they were aware of COVID everyone wore a mask. If we can have a local law in New York City that requires everyone to wear masks, perhaps we can also work on reducing our infections from COVID.

Brian: Donald, thank you very much. Dr. Blackstock, should masks be mandatory and how effective do you think they actually are? You may have seen the news coverage in the last day. This is a debate within the Trump administration where one of his health care advisors, who is extremely controversial and in a minority position in the science community, this Dr. Atlas says masks are overrated for COVID protection. I guess your laugh is the beginning of your answer.

Dr. Blackstock: I have to say last night on the debate, it was just incredibly disappointing but not surprising to see a leader actually joke about people wearing masks when we know that we have overwhelming data, and we've had even more data come out over the course of the pandemic, that we're in that is incredibly effective, and that the more people who wear masks, that that is even better, and that decreases the transmission of coronavirus.

What we know is that we have these very basic public health measures that we can use to mitigate the spread of this virus. All we need is for people in leadership really to endorse those views, endorse those practices because we know that it works. I don't know necessarily about having a law. I think education is critically important having people understand, "Why do I need to wear a mask? How does this mask help?" Also, understand that the data is evolving, but the data that we have now shows that masks work and that we need as many people as possible to wear them.

Brian: In fact, there is something of a mass mandate to the caller's question in New York. This is from Cuomo in April that my producer just put in front of my eyes to be really specific. "Amid the ongoing COVID-19 pandemic Governor Andrew Cuomo today announced he will issue an executive order requiring all people in New York to wear a mask or a face covering when out in public and in situations where social distancing cannot be maintained such as on public transportation." At least to that degree, there is a mask mandate.

I heard the White House Chief of Staff Mark Meadows the other day, who seems to be a mask skeptic, responding to the head of the CDC Dr. Redfield, who had said that mask-wearing if it's really universal could reduce COVID spread by 80%. He said, "Oh, yes? Well, if mask-wearing can reduce COVID that much, then we can open up the economy." Does he have a point in a certain way? If Dr. Redfield is right and mask-wearing really does reduce COVID spread 80%, then it gives the businesses more leeway to be open, and have people have more contact?

Dr. Blackstock: I think that's what we saw over the last few months in different parts of the country, and more specifically in New York City. When people are wearing masks, when they're physically distancing, that the positivity rates and transmission rates in the community go down and we can start reopening business. I think that because there's never been a universal national strategy around mask-wearing or even coronavirus mitigation, we haven't seen that and we keep seeing hotspots.

I think it's important to accept that we are going to have spikes. It's going to happen. We're humans, there's going to be pandemic fatigue, but I think that if people are wearing mask consistently, practicing physical distance when they can, we can actually create an environment where businesses can reopen and the economy can improve. Until we have a unified strategy, that's not going to happen across this country.

Brian: I'm going to take one more caller that I'm going to label in advance as 'I think it's disinformation," but the reason I'm taking it, is because I think it's also out there and probably needs to be addressed. Jack, in Brooklyn. You're on WNYC. Jack, we have about 20 seconds for you. Hi, there.

Jack: Hi. I live in one of those Orthodox areas and my community, most of us have like 80%, 90%, we have antibodies and if we have antibodies, we can't give the virus and we can't get the virus.

Brian: Why is the virus spreading faster in the Orthodox communities than anywhere else?

Jack: Because the ones that are being tested are the ones that did not get it in the beginning.

Brian: Jack, I'm going to leave it there. Dr. Blackstock, you'll get our last 30 seconds just to clarify.

Dr. Blackstock: What I will say is that I don't think that the antibody rate is that high in those communities, one, but I know that the Department of Health and H&H are focusing their strategies on those neighborhoods in terms of rapid testing and contact tracing, which will hopefully get those spikes to go downward.

Brian: It's Dr. Uché Blackstock. Thank you so much for joining us, a CEO of Advancing Health Equity, a Yahoo News contributor on medicine, and an emergency room physician.

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