Responding to the COVID-19 Pandemic

Abstract

The Need for a Structurally Competent Health Care SystemThe coronavirus disease 2019 (COVID-19) pandemic has exposed the consequences of inequality in the US.Even though all US residents are likely equally susceptible to infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), the virus that causes COVID-19 disease, the resulting illness and the distribution of deaths reinforces systems of discriminatory housing, education, employment, earnings, health care, and criminal justice. 1,2The patterns of COVID-19 illuminate centuries of support systems that the US did not build and investments it did not make.Each stage of the pandemic, from containment, to mitigation,toreopening,highlightstheextenttowhichcertain populations were rendered vulnerable long before the virus arrived.As a result, marginalized, minoritized, and communities of low wealth have been at highest risk, with disproportionate death rates among African American, Latinx, and Native American populations across the US. 3,4ociodemographic differences in COVID-19 morbidity and mortality highlight an unavoidable reality facing the US health care system as it strives to fulfill its mission to promote health and well-being, and to treat disease.At its core, the practice of medicine is based on individual-level interactions among clinicians,