COVID-19 is a respiratory disease caused by a coronavirus. That means it can affect your lungs, throat, and nose. For asthma sufferers, infection with the virus could lead to an asthma attack, pneumonia, or other serious lung disease.
One small study shows asthma doesn’t raise the chances of getting infected with the coronavirus that causes COVID-19. But if you do get sick, your symptoms could be more severe than other people’s because you already have trouble breathing.
Black Health Matters hosted a Facebook Live with Michael A. Lenoir, a San Francisco-area allergist and pediatrician with a special interest in asthma in the African American community, to talk about the confluence of coronavirus and asthma and the effects on Black folks. This is an edited transcription of that event.
Black Health Matters: Many people who have COVID and end up on ventilators stay that way for an extended period of time. I’ve spoken with people who had COVID and they say it’s incredibly difficult to recover, even after the cough has subsided. They feel they have to exercise their lungs because theres residual damage. Is that true?
Michael A. Lenoir, M.D.: Absolutely, it is true. It is like a battlefield. When the war is over, the battlefield still looks terrible. The body’s response to infections is to send a group of cells into the area and try to fight the virus. The byproduct of that fight is often scarring in the areas where the battle took place. That decreases lung volume available. Consequently, it may take weeks to months before they’re able to get back to the ability of oxygenation as quickly or significantly as they did before.
BHM: Is there anything you can do to help the lung heal?
Dr. Lenoir: It is very difficult. Like I said, it’s a battlefield. Until the battlefield is cleaned up in that part of the lung, you will have some problems. You can do respiratory exercises, but sometimes it’s not possible to speed up that process. It is like if you hurt your knee or your wrist—it just takes a while before the body is able to come back to its full function.
BHM: Could you also speak to us on why asthma is so unmanaged in the African American populations?
Dr. Lenoir: What is interesting to me is when the statistics started to come out about the impact of coronavirus on the African America community, America was surprised. As Black doctors, we were not surprised because from every condition—from the cradle to the grave, any chronic problem—African Americans are sicker and dying more often. You can take diabetes, hypertension, or any chronic disease.
Usually there are basically three principles that make it difficult for African Americans: One is pre-existing conditions. That means we have chronic diseases of all types—not the right diet and sometimes we don’t get the right care. Consequently, people with diabetes, hypertension or any other chronic pneumonias will have much more trouble with asthma and this virus.
The second thing is social determinants of health. [This includes] where we live, how we live. We [live] in areas of the country where environmental waste is a big issue, environmental injustice. We live around polluted areas, we live around factories, we live close together, we live where it’s impossible to get the standard social distance. How are you going to socially distance in the projects? My brother, who lives in New York, lives in a place on Columbus Avenue, 700 people in that building. How are you going to social distance in a situation like that? Also, when you talk about asthma and its triggers—dust, animals and other things in the areas we live in—we have a lot of environmental triggers where we live. People can’t avoid [those triggers].
Finally, it is how we are treated in the health care system. That is why Black Health Matters was founded. That is why we founded certain organizations because we don’t get the same kind of care other people get. We don’t get the same operations. We don’t get the same medications because we are Black. And there is no reason other than that. There is no genetic differences in how coronavirus impacts people. We just happen to be in worse shape in so many instances when the virus hits.
These three big issues issue: pre-existing conditions, social determinants of health and racism. These three elements contribute to not only coronavirus, but to asthma and every other chronic disease.
I don’t want them to try to decide between me, as an African American, and someone else about who gets the ventilator. If we (African Americans) get as mad about health care, inferior and poor quality treatment as we do when we get cut off in Safeway, we wouldn’t have this problem.
BHM: I understand people often ask about masks. There are variety of masks—paper, the N-95, even bandanas. What is most effective?
Dr. Lenoir: The studies have shown, [including] an article in Science about two weeks ago, the surgical mask is the best mask for you to have. If you can get a surgical mask, that is the best. The N-95 masks is a good mask. But basically, it is about how it fits. That is why cloth mask are pretty good and shields are good. The worst kind of mask is the one with the tube on the front of it so you can breathe in and out because it may protect you, but you’re breathing out into the atmosphere and it doesn’t protect other people.
BHM: What happens when you have a loved one who is hospitalized with COVID and you can’t have access? What do you do?
Dr. Lenoir: You talk to the doctor. Ask them specific questions and demand the answers. Doctors are sometimes intimidated when African Americans ask questions. Unless you ask these questions, I can guarantee you are not going to get the consideration you need to get the best possible outcome.
BHM: You were one of the first physicians actually recruiting people of color to be in clinical trials. What is your opinion about COVID vaccines? Do you feel enough African Americans will be in the clinical trials? What do we need to be aware of?
Dr. Lenoir: For years I was working on the NMA (National Medical Association) project, called Project Impact, which was to increase the number of African Americans in clinical trials. Sometimes, we as a cultural group respond differently to medications.
As far as this vaccine situation is concerned, I would tell people that you are probably at more risk now than when it all started because all of the things that have happened. Certainly, the opening up of the society and the marches around the issue we are faced with recently. The virus will spread more rapidly than it has over the last two or three weeks because all these people coming together. So the only time I think we will be safe is if we have a vaccine. A safe vaccine is the only thing that will stop this pandemic.
But the vaccine has to go through certain steps before African Americans will feel comfortable with it. It has to be looked at for not only efficiency that it works, but for safety. Until a safe vaccine is available, none of us will be comfortable. And I think we’re going to have to plan to stay in place, plan to wear mask, plan to be careful with our washing our hands and doing things until there is a vaccine.
Once there is a vaccine, there will be a great debate in the African American community. We are already dying of diseases that long ago could have vanished in our community if vaccinations were part of the solution. Vaccinations work. I think most people have not been able to face the reality of what happens when we don’t have a vaccine until COVID-19 came along. We had the luxury of not getting the flu vaccine, but now we see what happens when the society in not vaccinated and gets an infection.
BHM: I want to travel. I miss not being able to take a vacation. What are your thoughts about going to the Caribbean or Mexico during this pandemic?
Dr. Lenoir: I think you are stuck in place. I don’t think there’s a safe way to travel. As bad as it is here, if you go to some of these other countries, they are not reporting the cases. They are not sheltering in place. They are not standing 6 feet apart. They are not doing any of those things. I think the places we love to travel are going to be difficult. It will be a long time before I get on a cruise ship. It will be a shorter time before I get on a plane. But I think for right now, traveling Is not going to be a real option. You’d better learn what’s in your area and try to do those things—state parks and things you passed over. I don’t think we will travel safely until there’s an effective vaccine
BHM: What gets you excited about advances in caring for people with chronic pulmonary diseases or asthma? What can patients look forward to in 2021?
Dr. Lenoir: I think there is so much out there we are not taking advantage of. Too often what happens is when we get a condition, there are usually a series of treatments doctors know about that we don’t get. For instance, with asthma, most of our patients use albuterol. Albuterol is a dangerous drug if you use it as your only treatment for asthma. It is a rescue medicine. It is not a maintenance medicine.
The reason people have asthma is because there are cells that move into the lung, set up shop and release chemicals. These chemicals cause the airways to close. What albuterol does is to open up the airway regardless what closes it, but it does nothing for what we called pathophysiology of the problem. There are a number of effective ways we can reduce the inflammation in the lungs. But too often, because of the fact that we are not prescribing these medicines, or we are not adherent to the medical regiment given for these chronic problems or it falls by the wayside after a while, we are not getting the kind of care we need.
There is treatment out there for any degree of asthma that can reduce the significance of the symptoms you have. Nobody should be in hospital from asthma these days. Just days off work and African Americans are at the top of the list. And certainly nobody should die. But every day 10 people die from asthma, largely in the African American community, because we don’t follow the regiment, or we don’t get it.
New treatments for asthma are coming out every day. We call them biologics, drugs that you can take for serve and retractable asthma. Most of us with asthma don’t get to that point. Because we don’t do the things that would build us to where we could take advantage of these drugs if other drugs don’t work.
One of the first things I have to ask patients when they aren’t doing well is, ‘Are you taking the medicine I gave you in the first place?’ Too often, before you make a change in medication, you’ll find medications are not being used properly.
BHM: You work to help educate other physicians about diseases prevalent in the African American community. Can you speak to us about that work?
Dr. Lenoir: My parents—my mother was a social worker in Rosewell Hospital in New York City, and my dad was a YMCA executive—so being involved in the community was expected of us as we grew older. As a doctor it enraged me to see African Americans treated differently than other people. Sometimes, it is so subtle people don’t even recognize it.
Look, obviously there are health disparities—hypertension, diabetes and other things that impact us uniquely because we are African Americans. So we decided to put together an organization that gave people the tools to deal with the health care system. Really quickly, you’ve got to have an advocate when you go into the hospital or the system. But it shouldn’t be your brother or sister or cousin. It should be someone who knows something about health because when they start asking questions about the health system, the health system responds much more effectively. If you don’t have an advocate in the health system, you are done for.
You stay ready so you don’t have to get ready. You stay healthy and put your best foot forward … so you can have the ability to fight whatever comes.
