Detroit. The history of my city is racially-charged and rooted in the effects of structural and individualized racism. #COVID19 exposed that. As a #SickleCell physician who cares for black patients with #chronicpain and #chronic disease, I have known that for a long time 1/n

#Detroit has the largest black community in the country (84.3%). In 1910 it was 98.7% white, but by 1930, due to the Great Migration the black community grew. The increase in diversity was perceived as a threat to the way of life and the isolation of black people began. 2/n

A terrible example of this comes from 1925, an African American physician #OssianSweet, found his home on surrounded by an angry mob; a neighborhood where he was the most affluent, the resentment from his neighbors that a black man had infiltrated, caused hate and violence. 3/n

By 1940, 80% of Detroit deeds contained restrictions to keep African Americans from property ownership. As a second wave of black people moved here in search of a better life to escape the Jim Crow laws, they found that they weren't welcome to pursue liberty or happiness. 4/n

As this city swirled into the riots of 1967, and then never found a road to recovery, the city headed towards bankruptcy, the privatization of Detroit’s public health with full time staff of 5, and 37 percent of the population living in poverty. 5/n

The effect of this chaos resulted in a healthcare infrastructure that was ill-suited to care for an entire population of minorities in #Detroit. This is borne out in the mortality rates of this community in our city.

Look at the number of dying babies. More than double.

6/n

The result of structural racism in the community is also apparent in the differential in how #COVID19 caused destruction in the black community. This differential was worst in Michigan. 7/n

The city of Detroit has less pharmacies and grocery stores combined than it does marijuana dispensaries. The black community is more exposed, and less protected from this infection. But I keep hearing the narrative that race is a risk factor in poor outcomes. 8/n

Do Black communities experience-

Disproportionate preterm births? YES.

Do they have more diabetes? YES. More likely to have a limb amputation? Kidney disease? YES.

3x more likely to die from asthma. YES.

Develop hypertension earlier? YES.

Higher cancer death rate? YES. 9/n

But is it only race? No, there is an entire system suppressing the health of a minority community based on their color.

So, stop calling race a risk factor.

The only risk factor that ever mattered was #RACISM.

And there is no clearer example of this than in #SickleCell 10/n

See this thread by my friend @acweyand - breaking it all down for us as only she can. https://twitter.com/acweyand/status/1288453545633734660?s=20

A disease of 100,000 individuals (more than #cysticfibrosis and #hemophilia combined) - mostly black, largely ignored because of their color. Perhaps the biggest failure of the American healthcare system. Check out this graphic from @SickCells. 11/n

So, one more time - for whoever needs to hear it.

You cannot change someone's race -

You can fight #racism.

Stop approaching #SickleCell patients with an accusatory tone. Stop saying "sicklers", "frequent fliers" and "drug seekers." These are victims of our system. 12/n

So while #COVID19 has just reminded everyone about how we cannot care appropriately for the black community...

The #SickleCell provider and patient community has known for a long time.

Time to stop letting #SickleCell disease be a 'back of the bus' disease. 13/13