 Well, good morning, everybody. I think it's just at seven o'clock now, so we're gonna go ahead and get started. Welcome, I'm Donna Prosser with Two Clinical Officer with the Patient Safety Movement Foundation, and we're here to bring you another COVID-19 update. Today, what we would like to discuss is social disparities in health. And this is not a new topic. We've been talking about this for a long time and just to talk about what we mean when we say social disparities is that there are higher rates of illness and death experienced by certain groups. And you can see here, healthy people of 2020 has identified these groups as at risk for social disparities. But the reason why we wanted to talk about this today is because we have seen that communities of color have been disproportionately affected by this pandemic. And we wanted to examine this, and we thought a great way to do that would be to examine what's happening in one particular city. And so we're gonna talk with our panelists today who are all, they're all gonna tell us about what's happening in Chicago, how did we get to where we are in Chicago and what are some things that we can do differently moving forward. So I'd like to go ahead and have the panelists introduce themselves, and we'll start with Dr. Robinson. Oh, I think you're muted, Dr., there you go. Yeah, I'm Marcus Robinson, thanks. Chicago, I'm living in the neighborhood of Inglewood that has the distinction of being the lowest income, highest poverty rate in Chicago, and it's a body of work that we're trying to work here to help the community find dignity and meet in the challenges of the day. Excellent, thank you, Dr. Robinson. And Patricia, that. Mary Weather Argus, executive director of Project Patient Care. And I collaborate in Chicago with many different organizations, including Marcus's organization. And I'm on the board of St. Bernard Hospital as well as working with Cook County Health. So I'm very familiar with the issues and I truly think that the disparate populations, the populations of a color have been adversely affected and I think this is a wonderful opportunity to share but also to bring to action. Excellent, thanks for joining us, Pat. Dr. Terrell. Good morning, I am Daria Terrell. I am Dr. Robinson's working neighbor. So I work at St. Bernard Hospital and Health Care Center. I'm the chairman of the Department of Surgery and vice president of the medical staff. And I have been working here for almost 10 years now. So the health disparities that have been highlighted by COVID-19 are not new to me. But I am glad that this has kind of put a microscope on what we've been seeing all along. And hopefully this will help bring about change, very needed change. Excellent, and then Dr. Wyatt. Yeah, hi, good morning everyone and glad to be here. I'm an internist by training. My experience with Chicago started in 1988 when I did six weeks as a medical student at the Old Cook County Hospital. Then I was patient safety officer for the Joint Commission that was out in Oak Brook. And latest was chief of quality and patient safety with Cook County Health System. And during that time I lived in Illinois Medical District just off of Western Avenue, a few blocks west of United Center, which gives me several unique perspectives about Chicago. And my daughter lives and goes to school there. She lives in Oak Park. So that'd be here and hope I can offer some insights. Thank you. Thank you, thank you all for being here. Well, let's go ahead and get started because we have a lot to cover and we wanna make sure that we have plenty of opportunity for questions at the end. And so we'll start with Marcus if you would take us back to the history behind what has happened in Chicago and how we got to where we are today. Oh, you're muted, Dr. Robinson. The history of racism and segregation and disparity amongst the racist in Chicago, amongst people that should be racist. As long and deep since the beginning of the foundation of this great city, Chicago is a kind of a shortened phrase of a first people's word Chicago, which is about the naturally growing onion that used to be so prevalent here in the prairies here. And since the founding, we pretty much erased the first peoples from the area of the march of marginalization and white supremacy and all the things that go along with that kind of oppression has straight out over the last few hundred years, a couple hundred years of Chicago and stuff. So we find ourselves now after redlining and all kinds of other interesting tools that have been used by the system to sort people into different neighborhoods. Let the think of ourselves as 72 great neighborhoods. But we're also strategically designed to move populations of people into certain corners. And as you know, zip codes can inform everything from longevity to quality of life to what kind of experiences that you might have over a lifetime and say, my neighborhood, well, the average lifespan is in the low 60s. And just eight miles away, couple of zip codes away, that number is closer to 80, 85. And we live and breathe the same air, we walk the same streets, we do the stuff. And you can see the evidences of how structural racism acts as a primary driver on the experience of black indigenous people, people of color that we now call VIPLC in this part of the country. And we see that in health and wellness, justice, education, housing, economy, just the entire ecosystem of being human. And so I'd like to kind of explore a little bit about both of all four of these areas, three or five of these areas. Please, next slide. So as it relates to health and wellness, black indigenous people of color neighborhoods have reported a prevalence of household food insecurity three times the national average. Food insecurity, that's our first medicine. You're getting great high quality food into your system, green, colorful, beautiful, fresh, organic, if you can get it. Your life's gonna be, gonna have better outcomes, but here, most people are just not buying calories at the cheapest they can get. You can buy a honey bun for 50 cents with 400 calories in it for God's sake. And if you're trying to make it through the day on five or 10 bucks, a couple of honey buns fit the bill. And but it deteriorates your health in ways that we all see playing out in our hospitals and health centers are a little bit of a place. And many of the residents on the South side live in what we call provider pharmacy deserts. And after this last ramp inflection point, or shall I say intensity spiked with mass protesting mass demonstrations in Chicago, a person has to drive at least four or five miles out of the neighborhood or catch a bus or get an Uber if you can afford one just to get to the pharmacy, like to get the Walgreens. And then when you do, you got to walk through a battery of armed associates, armed police officers, just to walk in the door. So all of these things have a deleterious impact on one's overall health and wellbeing and sense of self and sense of wellbeing and stress is high. So if we can move on to the next slide, we'll talk about how it plays out. And again, that next could Chicago's make up 29% of the population, but 48% of the COVID cases, 30% of the deaths, same as, you see that with African-Americans as well, where appropriately 30% of the city, nice balanced city, yet we're 45% of the deaths. And that's a fluid number. It may even be worse. Somebody else may come on and share with us numbers that are even more accurate than the ones that I'm showing here, because it changes every day. But we know it disproportionately impacts blacks and indigenous people, people of color, not because of their genetics or race, but rather because of the structural disparities that are in place like river banks guiding us into what we can get and away from what we can't get so that it changes the way something as ubiquitous as COVID-19 has an even more impact because of the segregation and structural racism in Chicago. Going forward, next one. And of course, the intensity spike of the last week, Black Lives Matter movement and all of that that we saw in the last 10 days or so, and still going on and expanding, I would say, it's because young black people are 14 times more likely to be assaulted by a police officer, if I could say it that way. Use of force against black, 14 times. That means like, I have a 29-year-old son. I think about him every time he leaves the house. I'm a very well-educated, well-rounded African-American man and I tell you something, every time a car pulls up behind me or drives around me, I pause with some concern because I don't know how that interaction would go, no matter what I say or do. And it's a fear, which makes it based on the statistical relevance potential of me having a bad erection with a cop is pretty low. But if I do have one, the intensity of that thing is pretty high. So even though the risk of individually being impacted by this is low, the reality of it is if you are, it's difficult to thrive. Surviving it is an issue. Moving on, please. I try to say this in the most provocative way possible so that folks can have something to push against and talk about it as we go along. But there's something as simple as, what's one of the ways to structure racism acts out? It's where you put the prisons, how you cluster them in areas that separates families and make it even more difficult to even support that family member who may, for whatever reason be caught up in that system, but you're separated from them, detached from them, leaving them without resources. And of course, it works. So that work outside of system works negatively on people. But on the other hand, if you put that jail population in my small town, and I can get that head count for those in the prison, I can get more resources out of a census count, how we distribute money federally and all kind of stuff. So there, again, and those spaces are basically white rule towns. So while no one may have nefariously thought that up as a plan, it lands with that kind of impact nonetheless. So that I pull that out just to say, many of the things that we do in this, we call structural racism really are the things that we live with, like, oh, that's just the way it is. Oh, that's how things work, isn't it? It's been working that way for forever. So why change it? And the answer is because it was based on a racially biased insensitive oppressive system that really needs to be questioned at every corner. Going forward to the next slide. I don't see that, that went forward. Okay, education. Oh my goodness, low resource communities are just that. You know, the resources just aren't there to do the kind of things that are necessary that I believe are necessary for a full, robust, well-rounded people making mechanism. You know, if we look at K-12, it's not just a place to get, baseline information you need to be a functional adult, but rather be our primary organ in society to make human beings in the image of the promise of being human. Well, we have a school system that doesn't even come close to that, you know? And that's a problem. And that's a problem that I believe cuts across in negative ways for all people. This is where all people matter when the K-12 system can't produce for us a well-rounded spectrum of students, you know, from high performers to folks who barely perform, who are now fully developed as human beings to take on the world and do the things that are necessary to self-regulate in a free society that we aspire to. You know, freedom comes with responsibility and without development, few of us act well with that responsibility. And, you know, if you want a great education and you're white, chances are you get this, you get to go to all the best schools. And it just kind of fades out that way. And so, you know, if you start the race with a few steps ahead of me and I have to wait back a few steps after the race starts in order to get started. And oh, by the way, I'm kind of a knapsack full of all of the impressions that are heaped upon me for no reason of my own. And I can't catch you. Well, that's not my personal problem per se. It lands on me as an individual, but those are structural problems that are inflicted upon me that reduce my ability to thrive as a human being and to actually generate myself in the best way possible so I could do my best work and have the best kind of life that I want to have. And that's the, you know, the real issue around how bad this impacts our educational system, says Marcus, moving forward. I used to think, you know, part of the problem with race in America was it was not necessarily only a black and white problem but also a green problem, money, right? And in many ways, we, as a society, we have allowed money, your social, economic earning and wealth status to influence the mobility that you might have in a society if you're a black person, indigenous person, person of color. You can do things with money that you can't do without money. So you gain the class privileges but still are impacted by the restricted race privileges. Can you hear that? So race and class, there's a train wreck going on there. And even if I'm making money, living in high-income neighborhoods which are predominantly white neighborhoods, you know, I'm not necessarily welcome there. And historically, there have been covenants and all kinds of reasons why people can't do stuff. And, you know, if you buy the right house in the right neighborhood in Chicago, and I would say in the United States we're at large, and you read the historical comments and covenants that went along with that piece of property, you may be buying a, if you're a person of color, you may be buying a house that once was covenant that it could never be sold to you 1960, 1970. As late as that. And that's definitely true here in Chicago. And so segregation from whites is, you know, it's pretty pervasive, you know, Oak Park and Hyde Park, you know, you can find a lot of social dynamics, social integration going on there, beautiful, but those are outliers or distinct populations set apart from the other 72 neighborhoods in Chicago. Please move it forward. So we already know the impact on bodies, right? You know, because I didn't get enough to eat over a lifetime on the right things, because of the disparity and like nutrition patterns that we talked about earlier. And because, you know, education is such that, you know, and my relationship to the institutions are such that, you know, I don't believe half the stuff that comes out of institutional stuff. And all of these things, you know, have an impact on how people self-regulate under in a pandemic like this. But here's the structural thing where black and Latino workers are overrepresented in service sector jobs, which makes them more likely to be exposed to COVID-19. And fewer of the populations of black and brown people are able to work it from home, given the nature of their work. So they can't, you know, don't have the privilege of sheltering in place and only going out for needed supplies and on an absolute basis in order to protect themselves. So they, you know, they disproportionately impacted. And interesting thing about Chicago is that, you know, the income, the social income, social economic divide between blacks and whites, you know, is significant. And our middle-class is evaporating. And differently from the rest of the country, you know, you know, you see middle-class, people who are openly mobile get up into the whatever would be upper-class, I guess you call it the one, two percenters or what have you, that the decrease in the middle-class has to do with functional mobility to move up. In Chicago, it's actually different. Four to five folks who were ex-middle-class adults are actually moving down. They're losing economic, social economic status. And these are structural issues, not population behavior, risk factors, that kind of stuff, you know, not for their own effort. All things being equal, that status telling us something about the quality of life around economics and jobs in Chicago. Let's move forward. So I'll rest the case here by simply making the assertion, the accusation and as a perturbation of dialogue and discussion that structural racism acts as a primary driver of all the social disparities that are experienced by blacks and business people, persons of color in Chicago, and I would say the U.S. writ large. Full stop. Thank you, Marcus. That was very powerful and a great segue into our next conversation. Pat is gonna talk a little bit more about a little bit deeper detail about what's happening in the communities in Chicago. Pat. Thank you. I am gonna actually write on what Dr. Robinson, Marcus Robinson talked about too, because if we're talking about COVID-19 in communities it's really affected particular populations more so than others. And I am gonna talk a little bit about the congregate housing, the nursing homes, the assisted living and the disability homes because in those homes, we still don't have the data. If it was the black population, the Latinx population, who is most adversely affected? But I have a suspicion that we will see the numbers soon and they will show that in those communities, in the communities that we'll be talking about to the Englewood community and other communities that the nursing homes and the home health agencies sometimes are not up to the highest performance. They're star one or star two homes. So again, it sort of plays into all of this, everything sort of concentrating at the disparities in certain communities. And on the next slide, you'll see that I'm gonna go through some slides that demonstrate some of the disparities. And this was just one on looking at, this is for Chicago, the number of cases and the number of deaths. So the number of cases was very high for the Latinx population, that's the highest bar on the first graph. And on the second graph, it's the number of deaths. And that is the black non-Latinx population. So again, you're seeing that there's some disparities that exist that these populations, the black and the Latinx populations are most adversely affected by the COVID-19. And as we'll see too on a few slides, there's a reason why. On the next slide, this is just giving you some numbers because I know sometimes people like to see numbers, but you can see the disparities with the Latinx and the black population where they're most adversely affected and also somewhat with the aging population too. And again, concentrated in communities. On the next slide, it just gives you, this is Illinois. And this is the one I'm very interested in getting more information and data on. But you'll see the number of the population that's been tested. And you'll see in the blue, the white population, the Hispanic or Latinx in the red, and in orange is the black population. And then you move to the center graph and that's the number of confirmed cases of COVID-19. And then you move to the last graph and you look at the number of deaths that have occurred. Well, in Illinois, the black population is maybe about 15% of the population, but it's the Chicago numbers that greatly affect this, the Cook County numbers. And again, very much an adverse population that has suffered from the disparities. And when you look at the number of people tested, that was the starting issue in Chicago was the number of people being tested. It was concentrated in white communities and not in black communities. And so they didn't have those resources available and then they didn't have the resources to address the treatments and population needs. So again, there's a disparity that has existed in its evidence again in the COVID-19. On the next slide are just some areas. So you get a picture of Chicago. I wanted you to have a picture of Chicago because it hasn't changed that much. We have segregated areas, whether it's white segregation or black or Latinx. But on the next slide, you'll see that the segregation does affect outcomes of care. And so in the, what you'll see in the light blue, that's the lowest life expectancy. And it has changed over time, but not for some populations. And the populations you see in the light blue, where Englewood is surrounding that one area, in the light blue, that is actually where most of the black population lives. And then when you go to the other blue on the left side of the third map, that's where the Latinx live, as well as a black population as well. So you see in the areas where they're most populated by black and Latinx, that's where the life expectancy is the lowest. And a study that was just completed last year and has been shared widely by the New York University is that the Englewood area, and I know Daria is gonna be talking about that soon, the Englewood area has a life expectancy of 60 years. And then you go up to Streeterville and they have a life expectancy of 90 years. Now, if that isn't more of a profound disparity that I have ever seen, and again, it has nothing to do with the population themselves, their being, it has to do with the structural racism and the systemic racism that we see. On the next slide, are just some factors that we have, the risk factors in Chicago for the population, the black population is unaffordable housing, poverty levels are the highest. Everything that you can imagine that are challenging for anyone to deal with, they're concentrated in our black areas, black population areas. Food deserts, pharmacy deserts, professional manpower shortage areas, where we have, if you look at where hospitals are closing, unfortunately it has been on the South side and the South suburb. So again, it's adversely affecting population. Childhood trauma, the concentration of diabetes, cardiac opioid deaths is also linked to the lack of resources available in the community as well as the services provided. And I always cite this because it just has not changed. 62% of the people on dialysis in Chicago are black, yet they only make up 30% of the population. Huge disparity and one that over several years has not been addressed at all. On the next slide, you'll see for the Latinx, they have some of the same challenges, they're in concentrated communities, low income, overcrowded housing only because they have extended family, they have their entire families living with them, a lack of resources. And the reason why they were so high in COVID-19 testing was because they are essential workers. If you go to a nursing home, they're typically doing housekeeping, some of the dietary, they're at the supermarket, they're the ones that are on the front line, not as a healthcare professional in the sense of being a doctor or a physician, but they are on the front line and they have been adversely affected as well by the COVID-19. And their voices oftentimes are not heard at all. And we do have, being in Chicago, we do have the fear of ice in the community as well. On the next slide, you'll see the nursing homes. And the reason I bring this up is because the majority of deaths in Illinois have been in nursing homes, nursing home residents, 52% and it's growing. You look at Minnesota, Rhode Island, New Jersey, the numbers are up, 82 is 87% and in Canada, it's been the same thing. It's a lack of the personal protective equipment that test kits, a lack of understanding of infection control and prevention, sometimes lack of oversight of nursing homes, but 75% of them are investor owned. And again, the numbers are different when you look at different facilities, but everyone in nursing homes has been affected. They're on lockdown. Actually, tomorrow makes the three months that they'll be on lockdown where they haven't had visitors, no family, nobody visiting the homes to see what is going on in the homes where they can really react to it from a caregiver or a family member perspective. But the reason I bring this up too is we don't have, we have the straight data oftentimes. You know, it's just, it's siloed data. We need the integrated data. So I can see, is this occurring in particular nursing homes and is it the black population? And I have to tell you on the next slide, we do know that the persons that are working that are at risk are also the staff. And so I talked about the essential staff, essential frontliners. Yes, it does include physicians and nurses, but there's many other people working within the nursing homes and assisted living veterans homes, home health staff. Home health is saying they don't even have the personal protective equipment. So I want you to think about all the areas in which we have disparities and how they oftentimes still concentrate on the black population, the Latinx population and how we can start working to address them. But we need this data to better understand are we also really creating greater disparities in communities by not addressing issues, not addressing the structural racism that occurs in the systemic racism. And it's no longer, I say in communities in Chicago, it's no longer about, oh, that's a neighborhood. It's a neighborhood because it was created by others. So thank you, thank you. Thank you, Pat. I really appreciate that. And so now Dr. Daria Terrell is gonna talk about what's happening at St. Bernard Hospital. Dr. Terrell. Warning, Pat, that was a great segue. And I'm actually gonna just start with this map, but I'm going to stay on this very shortly because we've seen these similar demographics, but I just wanted to start with this as a frame of reference of highlighting the populations that we're talking about. And again, this is a map of COVID cases in Cook County by Zipco. And where you're seeing the, on this map, where you're seeing the darker blue colors are the increased rates of COVID-19. And these actually happen to correspond to the service areas that St. Bernard, some of the service areas, particularly those on the left side of the map in the center that St. Bernard services, as well as some of the other safety net hospitals. Next slide, please. And so I'm gonna focus my talk on how the healthcare and particularly hospital systems have been affected and further kind of concentrate this discussion, particularly as it relates to safety net hospitals like St. Bernard hospitals that serve a disproportionate number of patients on Medicaid, Medicare, and those who are uninsured. So if we start with that premise, we need to start knowing that those hospital systems by definition are not going to have the same financial cushion, shall we call it, as some of the larger hospitals. And so there was this interesting concept that was highlighted in the New York Times that most hospitals kind of work by this kind of blind recipe, let's call it, where we concentrate on surgeries, particularly elective surgeries and scans or radiologic studies, CT scans, MRI scans, ultrasounds, things that patients come in and have done as an outpatient and other well reimbursed services. I'm an orthopedic surgeon. So for example, patients who come in and might have a knee injection in the office, those things that are kind of neatly packaged, we can offer a service, we get you in, we get you out. But when we combine all of those things, that's how hospitals conceivably make their profit. Next slide, please. So then COVID happens and what happens? So most hospitals in the US, including our safety net hospitals, followed the CDC guidelines that said in an effort to conserve protective personal equipment in an effort to conserve staff because now we've got to redistribute staff and reassign staff in an effort to protect equipment. And as it relates to surgeries, ventilators in particular, because we were anticipating a greater need of ventilators to accommodate the COVID-19 patients, that along with also wanting to simply reduce the exposure of COVID-19 to patients, all led to the recommendation to cease all elective surgeries. And with that came other outpatient procedures. So you stop your elective surgeries, you stop your scans, you stop your highly reimbursed services. So what does that leave you? You also stop your main source of income, revenue and profit. Next slide. So if you can imagine that a loss in profits for bigger institutions such as a Mayo Clinic or more locally, Northwestern or University of Chicago, those bigger institutions are reporting losses in the millions and when you talk about Mayo Clinic, even billions of dollars for various reasons, you can imagine how those losses then affect our safety net hospitals who do not have the cushion that those bigger institutions have. Again, so a safety net hospital like St. Bernard, I would say more than 80% of our patients that we serve here are covered by Medicaid. Medicaid traditionally has reimbursed at lower rates than private insurances. So our hospital and the hospitals like us struggle every day basically to make ends meet and to serve those populations. So because of the predominance of Medicaid patients here, the loss of elective procedures and elective revenue as I like to call it is even harder to overcome. Next slide. In some instances, the private insurers pay three to four times what Medicaid could pay for outpatient treatments or if you're talking about an echocardiogram, it could be five to even 10 times difference. So if someone's getting $10 for something at a larger institution, we may be reimbursed $1 for that same service. So I put the schematic in here to sort of over dramatize the effect of these revenue shifts on a hospital system such as ours. So while we're incurring expenses from things like personal protective equipment or PPE as we've all come to use that term quite frequently, trying to protect our staff and our patients, all of that comes with an expense. At one point, we were giving examples how you could go through six or seven gowns in a day for one particular patient. And then you multiply that by the number of patients that you're dealing with. There's also increased cost of the extended ICU stays. So again, if you're starting with our COVID-19 patients who actually were a little sicker than our normal patients, and the average COVID-19 patient across the board nationally, it was stated that average ICU stay ranged anywhere from two to three weeks. So if we take our basic conditions that do not have those extended stays, and now almost everybody who's in the ICU now is there for two to three weeks, we're incurring all of the expenses that occur with that higher level of complex intensive care. So sicker patients basically are going to drive up your expenses in addition to the demands on pharmacy. So again, we have different medications. The need for medications, the need for sedatives, which a lot of those intubated patients were on, add to the cost. In our particular institution, the board of trustees for this hospital took into account the personal sacrifices and consequences that caring for COVID-19 patients had on the staff and voted to give a temporary increase in pay to what they considered essential workers or frontline workers in the hospital. So that also added to the expense side. Now that is contrasted to the revenue side. So again, if we start with our generic model that hospitals follow, we saw a decrease in inpatient revenue, a lot of patients rightfully so were scared to come to the hospital. And so if you had sort of your routine problem that you would have otherwise come for, you stayed at home longer or you stayed at home and didn't come to the hospital because you didn't wanna take a chance of contracting the virus if you didn't absolutely have to be here. For us, the difference in outpatient revenue was about 48%, which is not a small figure if that's what you're relying on to help balance the other losses that we are faced with when you look at the disproportionate reimbursements that we get from our main insurers, which is the state being Medicaid. Our CFO quoted this week that we were averaging about a $3 million loss per month. There was an interview that was done, I believe on WTTW, the PBS station with the CEO of Roseland Hospital, which is another safety net in the area. And he estimated that Roseland was losing about $10 million due to COVID-19. So again, these are hospitals that don't have that kind of cushion to begin with, and now this is adding to the financial stresses of the system. Next slide, please. So again, when we're talking about the populations that we're taking care of, I just included this slide to highlight some of the co-morbidities. And as Pat expertly and very well, she did a great job of illustrating the co-morbidities and the uniqueness of the differences in the co-morbidities when you're looking at different neighborhoods. And the graph here just shows some of the most common co-morbidities or medical conditions that have been linked in discussions about co-morbidities and why we think there was an increase in COVID-19 among African-American populations in particular and why the disease seemed to have such a devastating effect. We've heard a lot of conversations about how we think that people with underlying diseases were more susceptible to COVID-19. And those diseases then complicated their ability to cope with the disease and contributed to the escalation of the severity of the disease. So what you're looking at is the, we're looking at hypertension, asthma, and diabetes. And I was trying to keep the figures as clean and as honest as possible. So the source here was from Healthy Chicago 2.0. But when you look at the rates of hypertension in blue in Inglewood versus Lincoln Park, which is a community on the north side of Chicago, which where the average income level, the average education household level and the average life expectancy are all drastically different than they are here in Inglewood. And then you see similar patterns with asthma and diabetes. And I highlight this because this is our premise. This is our foundation. These are the patients that we're starting with and the disparities that we're starting with pre-COVID. And then it's magnified with the COVID-19 virus. Next slide. So there was a commercial that used to say it's not just for, and I can't even remember what it was, but the analogy to this would be the disparities are not just for patients anymore. And I wanted to highlight how the hospital systems are also experiencing health inequities or health disparities, if you will. So in the CARES Act, which was basically developed or it was supposed to subsidize COVID treatments for hospitals, and it was supposed to help address some of the economic challenges. What you see before you is the payment in millions of dollars. So those numbers on the graph do represent millions of dollars that several larger hospital systems didn't receive under the CARES Act. On the left side, you can see a number of our safety net hospitals, St. Bernard included, did not receive any of those millions of dollars provided through the CARES Act. So when you stop and look at this and you say, well, these hospitals are serving the patients that have these disproportionate numbers of comorbidities. They're serving the patients who are dying in disproportionate numbers from COVID-19, yet they were not eligible for the funding that's supposed to offset them taking care of these albeit sicker patients. There's been some things discussed about how this magic algorithm was created that set the precedent of who got the dollars. And basically, if you had 100 COVID-19 patients by April 10th, arbitrary date that was set, then you qualified for the funding. Now, if we take our microscope and look at what does that really mean? So if you're a smaller hospital with a lower number of ventilators, that in and of itself limits how many COVID-19 patients conceivably you can take care of. Or if we wanna look at that in the reverse, if you're a larger hospital that might have a medical intensive care unit, a coronary intensive care unit, a surgical intensive care unit, and throw in whatever other CU that you wanna add to the mix, you have the ability to convert all of those units to COVID units. And that's a luxury, a lot of our safety net hospitals do not have. And so from the graph, you can see most of the larger institutions were able to qualify where we were not. Next slide. And most of this I just discussed, but another finding, there was an article that was highlighting some of the research done by the Kaiser Institute that basically showed that Health and Human Service provider grants actually favor hospitals with more privately insured patients, which again, leaves us out. Next slide. So this disparity that the hospital face, I'd like to say is not just economic. So when we're talking about resources, there was also some challenges there as well. So the drug Rendesibir was highlighted and discussed a lot because of its link to reducing inpatient stays in patients with COVID-19. I will start by saying, when you look at this graph on the right, and it just shows when Rendesibir was made available in the state of Illinois, this is data of how many boxes of the medication certain hospitals did receive. Again, you can see some of the smaller hospitals, smaller number of boxes, larger institutions, bigger numbers. We did receive some Rendesibir eventually, not at the same time most of these other hospitals did, but there was a very exhaustive process in qualifying and being able to get the drug. And again, when you have a system that is smaller in terms of staff and resources, even trying to complete all the necessary logistics to qualify for this drug becomes an added burden. Where as opposed to a institution like Rush, which was actually part of a larger clinical trial. So they were actually able to get Rendesibir before most of the other hospitals in Illinois. And I point that out because when we're talking about what resources are available to our patients in safety net hospitals, even outside of COVID-19, we don't hear a lot of talk about our patients qualifying or being available for clinical trials. And this is just another example of what kind of disparities exist within hospital systems. Next slide, please. So when you put all this together, basically the financial consequences and some of these shortcomings that are created by COVID forced some very tough decisions and most likely will result in some painful consequences. So some of the hospitals had to make tough decisions about resources and actually stopping some less profitable services. For example, at our hospital and at Trinity Hospital, they had to make a very difficult decision of suspending OBGYN or basically the OBGN, I'm sorry, OB services so that we could accommodate and take care of the increased number of COVID patients. And that's a whole nother discussion for a different webinar. Going forward now that we've started to try to resume services, we've had to take a hard look at our budget and say, are there some things that we need to streamline because of those financial losses that I discussed? For us, we looked at something like occupational therapy, which is not very well reimbursed by Medicaid and have made the decision for right now, that's a service that we're not able to resume. Other institutions have had to do furloughs and layoffs. I can proudly say that everyone here at St. Bernard did extraordinary work and put forth extraordinary efforts to try not to do that. So we were fortunate that we were not one of the institutions that did furloughs and layoffs. And part of that is because St. Bernard is a major employer in the community. And so there was a concerted effort not to add to the burdens of the community by now having people who lose their jobs and in effect lose their insurance. So what happens when you wanna be considerate and ethical and morally responsible while all these other companies are saying during COVID-19, we understand if you can't pay your bills. And while we may wanna do that as a hospital and we know that's the right thing to do, can we really financially afford to do that? And that's a difficult decision because morally and ethically you wanna do that. And you know that there are populations of people here who have been laid off, who don't have the finances. And so when you honor those requests, hey, can I be on a financial plan? Hey, can I pay you whenever I get a job that adds to the financial losses of the hospital? Staffing changes are something that a lot of the safety net hospitals face. So during the height of when the curve was really going up and peaking, there were a lot of offers for highly competitive salaries, I will say. Here in Chicago, when they made McCormick Place into a treatment center or COVID-19 alternate site, there were some very competitive salaries being offered. So there are some hospitals who lost staffing due to those kinds of competitive salaries or people who left Chicago to say, go work in New York. Or you have the flip side where you had staff because of those kinds of economic incentives, shall I say, took a second job, which then increased their exposure to COVID-19 and then possibly put you in a position where now you're losing staff who now test positive because of their exposure at their second job. Daria, I wonder if I could get you to wrap up because we're running out of time and we still have to get to Dr. Wyatt's slides. Sure. So I will move on and actually I just put this here just as a resource, disproportionate impact of COVID-19 on black healthcare workers. I just put the information here because this is a very thought-provoking article and I wanted to at least share the information. I wasn't gonna go into detail, but I wanted to leave that article as something that people should really take a look at. And then the next slide, I don't think there are much more next slide. Just again, and I kind of covered some of these things already, the effect of COVID-19 on the patients that we're serving. We talked about the job insecurity a little bit. Health literacy is a problem because we still have patients who are not sure when they need to come into the hospital and they're avoiding coming into the hospital when they really should come and then they come and they're much sicker. So that's just a kind of overview of the health literacy piece. And then as we're trying to move to telemedicine, there are some patients who just don't have the resources to do a telemedicine visit here in Inglewood. And so that becomes another barrier for healthcare for them. And actually my last slide was actually supposed to be a lead in to Ron's talk about how we need to start changing the system and changing funding so that we can address some of these disparities. Well, thank you so much. And Ron, I'm so sorry that we're running out of time, but we definitely want to know what we can do about this. So thank you very much. And I'll just be brief and stick to the first two slides. And I think the participants will get the rest of the slides. So on this slide, and I'll just spend a few minutes on here. But what this slide summarizes is what you've already heard, that there are populations in Chicago that are disposable, that the decisions that have been made through an institution on structural racism that has made populations of brown and black people disposable. And you've heard pieces of this through the presentations. The one that's not here is issues around incarceration, mass incarceration, over criminalization of black and brown communities. And frankly, militarism that's been prevalent on the streets of Chicago that I've known about for my entire life. So this sets the stage and this stage has been set for where we need to start to think about. Thinking in terms of an internist, this is what I'll say in a provocative way about Chicago. Chicago, and this is hard work for me. That's a work of love. So take it that way. And if I say it's hard work, if I go to the next slide, then Chicago is suffering heart failure. Now the thing about heart failure is it will kill you. The thing about heart failure is that you can't cure it, but you can manage it. You can get some degree of healing. So that's the thing that needs to take place in Chicago. So if we get to what we call equity in Chicago, start with what are the institutional and structural barriers that have been put in place so that the system in Chicago works the way it works? That system is getting the results that it's designed to get. So how do we get there then? Have you heard some of this already? One, we gotta go back and look at our history. Walking back through history is a painful thing to do, but Chicago has a history and W. E. B. DeBose said in 1899, there's a peculiar indifference. And he was talking about Philadelphia. I can say the same thing about Chicago. And when you think about the populations in Chicago to pass point, they're not just essential workers, they are the quintessential essential workers in Chicago. That's how we got to see them. Essential workers as it relates to Brown and Black people started in 1619. That part's not new. The health pandemic for Black and Brown people started in 1619 and manifests itself and everything you've heard this morning. So first, rectify those historical injustices. And unfortunately, we don't have the time to go through the details next. And you've heard this. You gotta value everybody equally. So in 1963, Martin Luther King said, we need a radical revolution of values. And we need to think about how we value every life in Chicago equally. So start with, what does that look like? It looks like addressing economic inequality. It means addressing all those disposable factors that have already been so well described. It means looking at the militaristic attitudes that have taken place in Chicago over the years. And then you've heard, what do we do next? And you heard this from Pat. You heard it from Dr. Terrell. You heard it from Dr. Robinson. We gotta start reallocating resources based on value, not based on zip code, not based on per capita income, but based on where the resources are most needed. Now, we're not talking about taking resources from one place and damage one population, but we're talking about put the resources where the value you've heard it through PPE, through equipment, through ventilators, through access to ICU beds, all the things that Dr. Marcus laid out are there. So you gotta commit to relocating those resources. That means calling on public and private organizations, corporations in Chicago to say, you need to invest in these things like you never invested before because you're in heart failure. And we wanna get out of heart failure. Part of that heart failure is, we gotta eliminate poverty, right? There's no reason that the highest day of a school attendance in Chicago is Monday because kids from the South side are hungry from the weekend, right? A basic human need is to feed people. Why is it that from the loop to where I lived on Western Avenue, life expectancy dropped 18 years, income dropped over $100,000, 18 years. We have blockbuster drugs that may add two weeks to your life, two weeks. So we need a blockbuster drug in Chicago. It's been laid out here. That's the hard work that's gotta be done. Value everyone, reallocate resources, rectify historical injustices, address those in an aggressive way, eliminate racism, structural and institutional racism. The train stop at Western Avenue should look just like a train stop in the loop. And you look at them and they're different. The sidewalks are different. The communities are different. The lighting are different. Those are structural institutional things. Look at racial policies that have been in place in Chicago from the time that the indigenous populations were there. So these are the things and we don't have time to go through all of them. But this is the hard work that's gotta be done in Chicago. And now's the time to commit. And my stepfather was an AME Zion minister. At the end of the service, he said, the doors of the church are open. Step up and commit, right? And as we symbolically get on our knees in Chicago now, then I would say to the private and public corporations and institutions and foundation Chicago, get up off your knees and stand up and move into action. And if you don't know how, find the people like Dr. Robinson and Dr. Terrell and Patricia Maywell that can tell you, we're here to help and serve you. We gotta get you Chicago. Out of heart failure, that requires exercise and hard work. And I know we're out of time, so I'll stop there. I wish I could go on. I wish you could too. My goodness. I think we could solve all the problems of the world if we just have another hour, right, Dr. Wyatt? Well, thank you so much, all of you, for joining us today. We didn't have any questions. Oh, we have one question that looks like it may be coming but best wishes we heard from Sweden. So, but thank you to all of you for joining us today. If we get any questions from our audience after this presentation, I'll certainly pass them on to our panelists so that we can get some expert answers to you. But Dr. Robinson, Dr. Terrell, Pat, Dr. Wyatt, I really appreciate you being here. This is a very important topic and we're gonna need to schedule another webinar, I think, to discuss it in further detail. Thank you very much for joining. Thank you all very much. Everybody have a wonderful day. Thank you. Bye-bye.