Dueling Plagues: Your Time to Act.

As I write this editorial on June 8, 2020, it is hard to know what will be facing the world and the nursing profession by August. Originally, this editorial was going to focus only on COVID-19. Our lives have changed since March when COVID-19 cases began to increase in the US. The nursing classes I teach had to immediately move to online learning. As families we learned how to live in isolation and learned the ins and outs of Zoom calls. For some of you, the last couple of months have been even more devastating. You may have worked with a skeleton crew to recover emergency surgery patients, or you may have worked on another unit due to low census in the surgery department. Some of you may worked as screeners. Some of you were told to stay home because of low census, and some had your postanesthesia care unit (PACU) transformed into COVID-19 units. You may still be doing that work. Most of you who are working on the frontlines come home, sanitize your car, shed your scrubs at the door, throw them into the wash and then take a long shower before seeing family. Some of you may have lost family members or cared for very sick family members. Some nurses and other healthcare workers have lost their lives.

As if that was not challenging enough, we are confronted with the injustice and systemic racism embedded into society that played out as we watched the horrifying death of George Floyd. His death, and others, such as Ahmaud Arbery and Breonna Taylor, tragically remind us of the inequities and racism that persist today. These past few days have been heart-wrenching.

COVID-19 and racial inequity cannot be separated from each other. As I write this, there have been 9,121,967 cases of COVID-19 and 472,050 deaths worldwide. The US has the highest number of cases at 2,370,346 with 122,407 deaths. The latest overall COVID-19 mortality rate for Black Americans is 2.4 times as high as the rate for White Americans and 2.2 times as high as the rate for Asians and Latinos. Another way to look at the statistics are that Black Americans represent 13% of the population, but account for 25% of deaths. Indigenous Americans have suffered higher rates of COVID-19 as well. While national statistics are unavailable, we know that in New Mexico, the indigenous mortality rate is eight times as high as the White mortality rate, and in Arizona, the indigenous mortality rate is more than five times the rate for all other groups.

We are seeing the results of racism and disparity play out before our eyes both in the COVID-19 pandemic and in the streets, as those who have been treated with inequity strive for equality. The American Nurses' Association (ANA) Code of Ethics discusses the nurse's obligation to change unjust structures and processes. How do we do that? We educate, we identify barriers to health, and we participate in legislative actions to promote health. The American Academy of Nursing (AAN) has called for “action to change structure and policies that have enabled and permitted senseless violence to occur.” We cannot separate racism and violence from the impact on determinants of health including access to care and care delivery. Sherifali reminds us that Florence Nightingale was a social reformer. Nightingale recognized that poverty-induced poor housing, sanitation, and nutrition was contributing to poor health. Nightingale not only fought for nursing as a profession, but also advocated for access to health care for all.

The American Society of PeriAnesthesia Nurses' Board issued a statement that calls for nurses to advocate for safety, equality, and justice for all citizens. The statement also “condemns bigotry and discrimination in any form.” The President of ANA in his statement calls for us to speak up against racism, discrimination and injustice—and goes further to remind us that “to remain silent is to be complicit.”

We need change. That is evident. And it starts with us. It is hard to separate our nursing profession where we care for all patients regardless of color or socioeconomic status with life outside our nursing career. Start with your corner of the world and begin with self-reflection. The beginning of change with unconscious or implicit bias is to realize that it is present. We are locked into two plagues at the moment—COVID-19 and systemic racism. Both the issues of COVID-19 and racism have become politically charged. We have an obligation to point out the evidence regardless of politics. Read a book that discusses racism; see Table 1 for examples of books on racism. Read research studies that point to evidence of health disparities. Point out the evidence as friends and family discuss issues surrounding COVID-19—use of masks, distancing, hand sanitizer, eye protection. Use ASPAN's COVID-19 toolkit available online at www.aspan.org. Read research and clinical articles that are available in the COVID-19 Information Corner of the Journal of PeriAnesthesia Nursing website, www.jopan.org. Let us all work together to bring change in our profession, in our own lives, and in the lives of others.

Table 1

A Sample of Books That Discuss Racism

Between the World and Me, by Ta-Nehisi Coates How to be An Antiracist, by Ibraim X. Kendi Me and White Supremacy, by Layla F. Saad Racism Without Racists: Colorblind Racism and the Persistence of Racial Inequality in the United States, by Eduardo Bonilla-Silva So You Want to Talk About Race, by Ijeoma Olou Stamped: Racism, Antiracism, and You: A Remix of the National Book Award-winning “Stamped From the Beginning, ” by Jason Reynolds and Ibraim X. Kendi White Fragility, by Robin DiAngelo Why Are All the Black Kids Sitting Together in the Cafeteria? And Other Conversations About Race, by Beverly Daniel Tatum