COVID-19 and Racism-a double edged dagger.

COVID-19 has emerged as a multi-system disease with diverse clinical outcomes. But its complexity transcends the sophisticated biological machinery of the virus that causes it. COVID-19 has exposed fragile health systems, inept governments, and rivalry between nations, and led to the worst economic crisis in recent memory. It has hindered access to health care for the most vulnerable, and amplified health inequalities.

Black people and other ethnic minority groups are at higher risk of both contracting the virus and experiencing worse COVID-19 outcomes than white people, as recognised by Public Health England and the CDC. These health disparities are not driven by biology—they are caused by socioeconomic and political determinants, and are fuelled by racism. Minority populations have a disproportionate prevalence of conditions such as type 2 diabetes and obesity, both risk factors for severe COVID-19. As we discussed in a recent Editorial, it is unacceptable that racial inequity still occurs in diabetes care in 2020.

The tragic fate of George Floyd at the hands of a white American police officer and the massive waves of activism it unleashed provide a stark opportunity for self-reflection. The majority of white people might not deliberately discriminate against others based on their skin colour, but how many times have they witnessed white privilege in action and remained silent?

Building on The Lancet's long-standing reputation for advocating for health equity, on July 4, 2020, The Lancet group issued an anti-racism pledge. We will support Black and minority ethnic communities and help amplify their voice, and the time to act is now. On July 10, 2020, The Lancet Diabetes & Endocrinology published a Correspondence by Crystal Johnson-Mann and colleagues on how they have witnessed racial health inequities during the COVID-19 pandemic, as both African-American and female bariatric surgeons.

We will redouble our efforts to increase representation of Black and minority authors in the journal and highlight racial and ethnic inequalities until such time as equitable health care is achieved for all.