Dr. James Hildreth remembers the event that changed the direction of his medical career some 30 years ago and put him on the front lines against a deadly virus sweeping across the globe with devastating consequences for Black and Brown communities in the United States.
“I took care of a patient who just profoundly affected me,” recalled Hildreth, president and CEO of Meharry Medical College, in Nashville, Tenn. “That happens with a lot of medical students. It’s some clinical medical experience they’ll have that shapes what specialty they chose.”
That experience was in the late-1980s.
Hildreth earned his doctorate in immunology from England’s Oxford University with aspirations to be a transplant surgeon. But the HIV/AIDS epidemic was raging when a young Hildreth began his medical rotation at Johns Hopkins Hospital. Hildreth’s first patient was a young Black woman who had given birth. Both were HIV positive. At that time, there was little medically Hildreth could do except treat their symptoms. They died. Since then, Hildreth has studied the virus that causes AIDS and is bringing that vast knowledge to fight COVID-19. He sees similarities between HIV and the coronavirus. Both, Hildreth said, are positive-strand RNA viruses and have similar ways of replicating and entering cells. So, he and his colleagues are working to restructure existing drug compounds to treat the disease.
With that, Meharry one of the nation’s four historically Black medical colleges and universities, entered the global race to find a vaccine or a treatment for the novel coronavirus or COVID-19. The virus has already claimed more than 300,000 lives worldwide, according to Johns Hopkins University’s coronavirus resource center. “I think it is important for us to be part of that process,” Hildreth said. “I don’t think it needs to be us who finds the answers. What’s important is that an answer be found.”
Though big-name institutions such as Johns Hopkins, Duke and Vanderbilt Universities garner attention for their medical research in a race to find a treatment or vaccine, the nation’s Black medical colleges and universities are also doing their part. Like Meharry, researchers and medical scientists at Atlanta’s Morehouse School of Medicine, Washington’s Howard University College of Medicine, and Charles R. Drew University of Medicine and Science in Los Angeles are all working on varying fronts — from establishing testing sites, providing medical care to doing research — to fight this disease.
And with a vaccine potentially years away, developing a treatment holds urgency for everyone, but particularly for these historically Black institutions. As the nation struggles to flatten the curve and increase testing in vulnerable populations, the number of cases and deaths continue to rise among people of color.
The virus has claimed more than 100,000 U.S. lives. But in cities such as Chicago, where Blacks make up 30 percent of the population, they account for 65 percent of the deaths and 49 percent of positive tests for coronavirus. That scenario is echoed throughout states with large urban centers. In Michigan, Blacks make up 15 percent of the population but 40 percent of all deaths statewide.“The fact that the virus is having such a devastating effect on African-American communities, creates a certain urgency for us — the Black medical schools — that perhaps might not be exactly the same for majority schools,” Hildreth said.
“We have been studying and warning about health disparities for decades so it (COVID-19) provides us an incentive to do the work but it also gives us standing to … say we would like to be involved in solving this problem,” he added. Dr. Celia J. Maxell at Howard University College of Medicine, agreed. “We are the safety net hospital in Washington, D.C., and I think that if we were not there to serve this community, there would be a greater impact on all health care disparities. So, we serve a significant role,” said Maxwell, the medical school’s associate dean for research.
The school is drawing on its long tradition of medical research on diabetes, cancer, sickle cell, hypertension and other diseases within the Black community to see how these comorbidities interplay with COVID-19. These medical conditions make minorities more susceptible to the virus.
“It’s not because you are Black that people are dying,” Maxwell said. “It’s because of underlying health disparities. Many African Americans suffer from hypertension, diabetes, heart disease or asthma. These conditions put you at greater risk. We’ve seen these conditions in our community for a long time.”
Howard’s researchers have added several initiatives to battle COVID-19. The college’s genome center is working with the National Institutes of Health to learn about genetic susceptibility and COVID-19. They are providing mental health services to residents, first responders and front-line workers during the pandemic. And Howard’s hospital has repurposed a newly opened clinic into an appointment-only testing site in Southeast D.C., the District’s poorest area. The hospital also is developing an in-house testing lab to fast-track results. Currently the hospital outsources its testing to a commercial lab.
Meanwhile at Meharry, researchers are looking at two possible treatment options based on existing drugs for HIV and Zika, a mosquito-transmitted virus that causes birth defects. Hildreth is using his HIV research to develop an antiviral drug that can block the COVID-19 virus from entering cells. His colleague, Dr. Donald Alcendor, is looking at modifying an existing Zika drug compound that blocks the replication of the virus once it enters the cell.
“It is all based on the fact that viruses differ in a lot of ways,” Hildreth said. “But they have common ways of getting into cells, common ways of replicating. We are just leveraging our knowledge of other viruses and applying that to COVID-19.” Morehouse School of Medicine is also parlaying years of virus research, including on HIV/AIDS, to poke holes in COVID-19 defenses. The school’s researchers are looking at a treatment targeting the “viral envelope,” which protects the viral genetic material while the virus travels between cells.
“We are working on mechanisms to try to attack the virus,” said Dr. Gregory Antoine, the medical school’s senior associate dean for clinical affairs. The medical school, originally founded in 1975 as part of Morehouse College, became an independent institution in 1981.
“You want to expose the virus’ weak spots to neutralize it by antibodies so white blood cells can attack it,” Antoine said. “But we are not the only one doing this research…. This research is being done all over the country. We are just another medical school in the hunt to help cure a disease caused by the virus.”
The pandemic shows the integral role Black medical schools play to combat this virus. They have been the first to establish testing sites in Black and Brown communities, where they serve as safety net hospitals for low-income residents. Meharry opened three free drive-thru testing sites in Nashville’s predominantly Black, Hispanic and immigrant communities.
Charles R. Drew University opened a testing site on its campus, located in South Los Angeles, one of the biggest under-resourced areas in the United States in terms of population. The high number of Black people dying in Los Angeles County from the virus prompted CDU to open a site on its campus. “The classic saying, ‘When America catches a cold, the Black community gets pneumonia,’ is really true,” CDU President and CEO Dr. David M. Carlisle said. “When you have a health care challenge that particularly impacts the African-American community we need at least as much access to COVID-19 testing as other communities around Los Angeles.”
A key part of that testing is data analysis. The 54-year-old university, known for its health policy research, is collecting demographic data from the school’s test site. Analyzing that data helps identify virus spread, allocate resources and aids in contact tracing, Carlisle said. The university is going a step further with its testing protocols. It’s referring virus positive individuals without access to healthcare to the school’s family medicine program at a nearby hospital. Delay in care, Carlisle noted, puts individuals at higher risk for fatal COVID-19 outcomes.
As research for a treatment or a vaccine continues, Carlisle stressed the importance of having Black people represented in clinical trials. Black people have long been absent in such trials. Black medical schools’ involvement in clinical trials could increase participation and determine vaccines’ effectiveness in Black people. “We know … that African-Americans may have different responses or different tolerances to medications and treatments,” Carlisle said. “It’s a reality. We need to structure or develop vaccines and treatments with the African-American population in mind.” It’s a matter of trust, added Howard’s Maxwell.
Many have deep-seeded mistrust of medical studies dating to the Tuskegee Experiment, where Black men with syphilis were not treated for the disease.“[Blacks] are afraid they're going to be experimented on,” she said. “It's important for Black clinicians, like myself and others, participate because we will show our patients we care about what's good for them. So, having Howard be at the forefront of these sorts of activities is extremely important — not just Howard but all four HBCU medical schools have to be at the forefront.”
And to keep the nation’s Black medical schools at that forefront requires funding. Often these schools do more with less compared to larger counterparts. Efforts are underway to lobby Congress to set aside funding in future federal stimulus packages to support Black academic science centers. To continue their cutting-edge research, these schools need funding for data collection, patient care and drug and vaccine development.
During the early days of the HIV/AIDS pandemic Black medical schools lacked the infrastructure, like funding and scientists, to do the research that they’re now doing with COVID-19.
Black people represent only 13 percent of the U.S. population, but they represent 43 percent of HIV infections. According to data collected to date, Black Americans represent at least 60 percent of deaths from COVID-19, says Hildreth, who was the young medical student so moved by the death of the mother and her infant from HIV/AIDS.
He noted a lesson is to be learned from how the country tackled the AIDS crisis that can be applied to the coronavirus. Hildreth said once it was understood how the HIV virus was transmitted and those most at risk, then targeted and focused public health measures were implemented to test for the HIV virus on a national scale.
“The same national, focused and coordinated national response is needed for COVID-19, now that we know which population groups are most vulnerable to this virus and disease,” Hildreth said. “If we are going to save lives, we’ve got to keep the virus from affecting the most vulnerable populations. That cannot work without a lot of testing.”
This article is supported by the Economic Hardship Reporting Project.