Flu, Colds, and RSV: Do Doctors Discriminate Based on Race?
It’s cold and flu season again, and we desperately seek to remain healthy and avoid the bug that can linger for two to three weeks. Over the past month, there have been six daily absences in my daughter’s class, with some children confined to home with the flu for an entire week. Our pediatrician’s office recently announced extended hours in an effort to keep up with the demand. According to a recent CDC report, the flu arrived early this season — December, as opposed to January or February. As a result, doctor visits to treat influenza-like symptoms are high for half of the country. The last time flu season hit so early was during the 2003—2004 season.
The effects of the flu, and similar illnesses, are not only physical, but monetary. During a typical season, the flu costs our country approximately $10 billion, not counting the relative severity of this flu season and the full implementation, and added costs, of health care reform.
For minority communities, the impact of the flu is even more severe. Low flu vaccination rates within the black and Hispanic communities have led to higher hospitalization rates for these groups. The CDC estimates that Blacks 65 and older lag behind whites in getting annual flu shots by approximately 21 percent. Hispanic Americans 65 or older lag behind white, non-Hispanic Americans in flu immunization by 19 percent.
Children, of course, constitute our most vulnerable population. Children are at risk for diseases if adults are not vaccinated, which unfortunately means that children with black and/or Hispanic parents or guardians are more susceptible to catching things like the flu, or worse.
With these facts in mind, I question a decision made by the American Association of Pediatrics (AAP) that’s been in the news recently. Respiratory Synctial Virus (RSV), a disease that most children catch before their second birthdays, is a leading cause of pneumonia and infant hospitalization. In 2009, the AAP changed its recommendations for the treatment of RSV, both shrinking the pool of eligible infants and reducing the dosage of medicine used to treat infants infected with RSV. Since there is no vaccine that one can take to prevent an RSV infection, the best defenses against the virus are education (of parents and guardians) and a treatment to prevent catching the virus in the first place – something that is essential for very high-risk children like premature infants and those with chronic lung or heart conditions.
The education component seems to be sticking — many pediatricians urge new parents to be aware of RSV and to take proper precautions, since RSV is often mistaken for a cold, but is much more devastating to infants. The treatment, however, is another story.
Under the auspices of “cost cutting,” the number of premature babies who can be treated to prevent RSV was intentionally reduced – so in effect, the AAP has increased the exposure of at-risk infants to the damaging effects of RSV. According to the Centers for Disease Control, infants of non-Hispanic black mothers are more than 1.5 times more likely to be born preterm compared with infants of non-Hispanic white women – which means this policy change has hurt the minority community particularly hard. In addition, those few infants who are still eligible for treatment face another hurdle, as the AAP has increased the health risks for these infants by reducing the number of doses the infants can take to below FDA-approved levels. Such an act by the AAP seems misguided and tone deaf in light of information that other professionals have contributed to the debate on this issue.
The National Medical Association, a professional association of black physicians, and the National Black Nurses Association have expressed concern about these guidelines and the impact on black infants and other minority children. They recommend additional research aimed towards maximum protection to infants and children at risk of RSV and would like to see the inclusion of more minority children in clinical trials.
Cost is always a consideration when it comes to healthcare, as it is with every other major decision in our lives. The decision of a board of physicians to reduce dosages for babies in at-risk communities, however, does not always produce the best outcome, especially when the outcome equals increased hospitalizations. There needs to be a thoughtful, cost effective method which will protect our most vulnerable children, while allowing parents the ability to make the best health decisions for their families.