Twitter fingers, health equity, and COVID-19

I’ve been on Twitter for a long-ass time, and I have a four-character username (@yode) to prove it, but In general, I lurk, passively consuming rather than broadcasting content. My relationship with Twitter began as a shiny new toy, but one I quickly lost interest in because I got to the party too early. When I came back, it became a way to stay up on pop culture: Drake’s infamous “Trigger Fingers turn to Twitter Fingers” line from Back to Back cemented Twitter’s place in Rap beefs. More recently, a particular political figure has used Twitter to issue government updates. Within the last month, Twitter has become, more than any other time in its existence, a centralized hub of medical information and epidemiological studies. Twitter remains an outstanding source of first-hand knowledge and real-time reporting, which becomes increasingly important in situations that are rapidly evolving, like that of COVI-19. Every minute of every day, we are getting new information that adds fidelity to our picture of what’s happening and how it’s playing out in our communities.

There’s been a lot written in the last few days on the disproportionate impact that COVID-19 is having on communities of color. The gist of every post I’ve read is that before this is all over, we will see black and brown people impacted at much higher rates than others due to our environmental conditions. What I’m a little surprised by is that the tone of these posts is that this is somehow “new” information, rather than part of the ongoing discussion rooted in Social Determinants of Health (SDoH) and their impact on residents of traditionally marginalized communities.

The fact of the matter is that People of Color have historically been victims of their geography — the same Social Determinants of Health that drive our health outlook overall, particularly in traditionally marginalized communities, are the things that make us more at risk for a fatal outlook should we test positive for COVID-19. Poor air quality that drives higher rates of asthma. Poor food quality that drives high blood pressure and higher rates of diabetes and heart disease. All of these conditions dramatically increase the risk of a COVID-19 positive test result resulting in a harder case and a longer and less specific road to recovery.

It seems pretty apparent looking through a lens of SDoH that People of color are at more, not less risk. Period. When this shit initially popped, there were all these memes about how POC weren’t getting “The Rona.” Shit was funny as hell for like half a minute (…Till I Literally, got “The Rona”). I’m seeing similar things begin to play out in Africa, with countries’ initially sanctimonious attitudes about COVID19 invulnerability giving way to a genuine fear of entire populations being decimated in geographies that don’t have the healthcare infrastructure to support a fraction of the volume of COVID-19 patients that the United States and Europe are seeing.

But tying conditions back to SDoH is only part of the challenge. Another piece of the puzzle is rooted in why People of Color, who know what their current state of health is, aren’t being more proactive in owning and addressing the preexisting conditions that paint larger targets on their backs for COVID-19.

Yes, part of this phenomenon is based on People of Color having less trust in healthcare professionals and having less access to health insurance. It’s a lot easier to default to “it’s just a cold, I’ll beat it at home” when you are worried about incurring the costs of healthcare if you are uninsured or under-insured. And part of it is based on our traditional role as front-line workers or participants in the gig economy; those that are unable to work from home during the pandemic and those that are living paycheck to paycheck and can’t afford to miss more than a few days under any circumstances.

But I’m convinced that as a community, we would be more proactive in addressing some of these things in a COVID-19 world if we understood how serious the underlying problem is. This is a problem of how we access information and, subsequently, what we do with the information that we receive. I’m not convinced that our most marginalized, most vulnerable communities have been ingesting, analyzing, and processing data in the same way that others have. I base this on conversations that I’ve had with various nodes within my network. When it comes to COVID-19, there’s a difference in how People of Color are ingesting, analyzing, and processing information. How they handle this ultimately determines how they are defining their risk of exposure. This is a significant challenge that I haven’t heard addressed, which I think accounts for some of the actions that we’ve seen in communities of color about COVID-19.

When Wuhan first started to pop, I ramped up my use of Twitter as a primary source, actively searching for first-hand information on Coronavirus. I have two business partners at humble who regularly consume vast volumes of Twitter content and share it in DM. I also have several friends that are avid blog and Twitter consumers, and they are all good at sifting and connecting the dots — frankly way better than I am at it. Collectively, these folks in my life saw my time on Twitter and contribution move from passive to active at a time when there was more of a premium being placed on having accurate information and being able to leverage it in real-time analysis. In short, I changed my behavior to get as close to the information sources as possible, mainly because the situation was shifting in real-time, and the only way to connect the dots and make the right decisions was with real-time information. I’m convinced that when it comes to Coronavirus, those in my community and communities like mine aren’t leveraging first-hand, accurate, high-quality data to inform their actions.

I’m born and raised in NYC, Harlem, and the Bronx to be specific. My circle transcends many types of people; I have the crew I grew up with, my college friends, and the collective work/ business school crew. Regarding Coronavirus, I met varying responses to sharing information, depending on which subgroup I was speaking to in my network. In February and early March, when I talked to my “Day Ones” about “The Rona,” I was met with complete disbelief. They looked at me like I was making this shit up. In speaking to my college and work crew, we were much more in sync and seeing the same things. Still, I found that among my networks of People of Color, we were all having similar convos with those in our lives that weren’t consuming and analyzing the first-hand information. This has far-reaching consequences on how we react to external threats like Coronavirus.

Here’s what I saw- particularly during the run-up before NYC shut down: there was a stark dichotomy in communities of color between the “information elite” and the “information impoverished.” The information elite were on Twitter early, tracking event cancellations (core to many business sectors) and were seeing and discussing patterns in what was happening in other parts of the world and what we could expect to see in the United States. We shared this information among our various circles as best we could-but what I noticed was a level of disbelief in some nodes of my network that was truly mind-boggling.

In early March, I can vividly recall sharing information on Italy as they began to experience the effects of Coronavirus on their society, and getting blank stares when I tried to explain that what they were seeing was what we were likely to see, except on a much larger scale. One friend told me, “Black people can’t get The Rona.” Another said to me that “it was all a ploy to bilk us for a high-priced vaccine.” My Ex started calling me “Covi’’ because of the steady stream of COVID-19 info I was sharing… It took weeks for folks in my Day One PoC network to acknowledge what others knew; we were early, but not wrong, as the information in other parts of their systems caught up.

I don’t necessarily think this is a phenomenon tied to formal educational achievement. I think it is more closely related to how we get our information. If you consume information from first-hand sources like Twitter and medium, you are at a clear advantage in being able to paint a higher-fidelity picture of how something like Coronavirus might play out in our communities. Consuming information from secondary sources or traditional media resulted in a much fuzzier picture of what was happening and what might happen next, and it is this piece that I think accounts for some of the behaviors we see in communities of color. Behavioral change is hard, particularly in the face of more questions than answers. In communities of color, imperfect, lower fidelity pictures based on the information being ingested accounts for the reluctance to change behaviors, in the face of the necessity and obligation to work, and also the reluctance to advocate for our health at a time when Coronavirus is running rampant through our communities. We all make tradeoffs, but regarding Coronavirus, the mental calculus didn’t suggest that the risk of Coronavirus transmission trumped work, daily routine, or an alteration instance regarding preexisting health conditions and health equity. Some networks only aren’t getting high-fidelity information and are consequently making decisions based on less than perfect info. Over time we will see the same things that are playing out today in Communities of Color concerning Coronavirus in all vulnerable communities, whether in Appalachia, the deep south, the midwest, or other parts of the world.

This strategy has the potential to help black and brown communities make better decisions when it comes to assessing their risk and changing their behaviors regarding Coronavirus. Still, it’s not without its own set of risks. Consuming information from primary sources (Twitter, Medium, other social channels) requires people to be discerning consumers and engage their bullshit meters, because how can you tell right from wrong when it’s all wrapped in the same packaging? Bullshit is bullshit, and the ability to discern real from fake is nothing new, it’s just applying a known skill set to a new set of media. The more you do it, the better you become at it.

My advice for people in our communities is if you are unwilling or unable to tap first-hand sources like Twitter and medium, then try to keep people in your network and in your life who do use these sources and have access to higher-fidelity information. Right now, There are PoC subject matter experts who are embedded in our communities and have been engaged in the health equity conversation for years. Still, these are not the voices the traditional media has tapped in their reporting. We need to find these voices and tap into their knowledge and understanding. In essence, they can serve as not only analysts and filters of primary sources but also as translators between our communities and the larger world. As the situation with Coronavirus continues to evolve, the ability to connect the dots with what’s going on around the world and relate it to what may or may not be happening in our communities becomes invaluable.

There’s light at the end of the tunnel if we just look for it. When the WU gets active, you know it’s serious…but in the right way.

Special thanks to the Institute for the Future for the epidemiology explainer video.

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