Is Kaiser Permanente putting black lives at risk by refusing to consider hypertension a COVID-19 risk factor?

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I am a 71 year-old African American man with hypertension (high blood pressure), so naturally it caught my attention when it was said that older men with hypertension were at special risk of dying from coronavirus disease (COVID-19). I am also aware of the recent findings that African Americans are dying from COVID-19 at a rate two, or even three times, that of the population as a whole. Both my medicare coverage, and full-time employee medical coverage are handled by Kaiser Permanente of Southern California. It is therefore of great concern to me to learn that Kaiser Permanente does not think hypertension a risk factor to be considered when their members are in need of coronavirus testing. That is the reason I am asking: Is Kaiser Permanente putting black lives at risk by not considering hypertension a COVID-19 risk factor?

While I have no formal medical training, my opinion that it should be considered a coronavirus risk factor is well founded, and shared by many, if not most, health experts. For example, WebMD says:

Data from China and Italy -- countries hit early by the virus -- show higher risk of COVID-19 infections and complications in people with high blood pressure.

The City of Los Angeles, which is where I live, and where Kaiser Permanente is a major healthcare provider, considers hypertension a risk factor for COVID-19.

It is also well established in the medical literature that African Americans suffer from hypertension at a higher rated that most people. For example, the National Institute of Health has on its website a paper by Daniel T. Lackland, DrPH titled Racial Differences in Hypertension: Implications for High Blood Pressure Management. The abstract begins:

The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African Americans with greater risks than Caucasians. Blood pressure levels have consistently been higher for African Americans with an earlier onset of hypertension.

While this racial disparity with regards to high blood pressure has been known for decades, the racial disparity with regards to negative outcomes from COVID-19 has only come into view in the past few weeks. Just Sunday, Dr. Tony Fauci, from the National Institute of Health, was on MSNBC's Politics Nation. After Al Sharpton pointed out that while blacks are 22% of the population in New York City, they accounted for 28% of the COVID-19 deaths, blacks are 29% of the population in Chicago but account for 70% of the deaths, and in my town, Los Angeles, blacks are 9% of the population, but we account for 17% of the deaths, he asked, "How do you explain the race gap?"

Dr. Fauci began his answer as follows:

The issues is, as I think you hinted at it in your introduction, that is the situation with minority communities, particularly the African American community, in which the underlying conditions that lead to a poor outcome with coronavirus disease, if you look at the need for hospitalization, intensive care, and death, it's very strongly weighted to individuals who are either elderly, but importantly, who have underlying conditions like high blood pressure, asthma, diabetes, obesity, and other underlying conditions.

Dr. Fauci, didn't just mention high blood pressure as a risk factor in relation to COVID-19, he listed it first! He did this for good reasons. While many risk factors, such as obesity, are risk factors because they are likely to complicate recover from any illness, the relationship between coronavirus and hypertension is very specific. As explained by Benjamin Neuman, Professor of Biology, Texas A&M University, in The Conversation:

The cells that SARS-CoV-2 prefers to infect have a protein called ACE2 on the outside that is important for regulating blood pressure.
...
SARS-CoV-2 has a sliding scale of severity. Patients under age 10 seem to clear the virus easily, most people under 40 seem to bounce back quickly, but older people suffer from increasingly severe COVID-19. The ACE2 protein that SARS-CoV-2 uses as a door to enter cells is also important for regulating blood pressure, and it does not do its job when the virus gets there first. This is one reason COVID-19 is more severe in people with high blood pressure.

Lark, which specializes in chronic disease management, also makes it clear they consider hypertension a coronavirus risk factor:

Current data make it clear that people with underlying health conditions are at higher risk for developing more serious cases of COVID-19, including hospitalizations, the need for ventilation, or death. Overall, an estimate based on a study of 1,590 COVID-19 patients in China found that serious cases were 1.79 more likely for patients with one underlying health condition, such as hypertension, and 2.59 times more likely with 2 underlying health conditions. [4].

The World Health Organization (WHO) says people with hypertension are among the highest-risk groups for more serious cases of, and death from, COVID-19 [5]. The death rate 8.4% among confirmed cases and 6.0% among all cases. In comparison, the death rate among those with no-preexisting conditions was 0.9%. In addition, ICU patients in one study were more than twice as likely to have hypertension (58.3% versus 21.6%). [6].

I found out that Kaiser Permanente doesn't think hypertension a factor to be considered in their allocation of coronavirus tests to their members quite by accident. I found out because they either failed to read, or misread, a message I sent to my doctor, to inquire about coronavirus antibody testing, which a very different test entirely, one designed to determine if you had the disease already, and recovered.  Near the end of March, I wrote to my doctor:

From: Clay J Claiborne
Sent: 3/28/2020 12:39 PM PDT
To: BRYAN RAYMOND NEY MD, M.D.
Subject: Re: coronavirus antibody test

I am writings you today because back in early January I had an upper respiratory infection that I didn't think quite the flu. I've had the seasonal flu vaccine. It came on quite suddenly and put me in bed for 5 days, with fever (~101) aches and a bad cough. At times I thought I might be losing the battle to keep my lungs clear, and might be in serious medical jeopardy, but I weathered the storms without ever calling Kaiser. Mostly, because I felt too sick to come in. Also, the onset of this illness came 5 days after I was visited by a friend that may have just returned from China, although he has been a little coy on that point since then.

Of course, at the time coronavirus wasn't on my radar (otherwise I definitely would have called). I just took it to be another nameless upper respiratory infection that would blow over, and it did. Now I wonder if it wasn't COVID-19, and would like to take the antibody test for my own peace-of-mind if it becomes available for that purpose.

This was the non-responsive reply I received a few days later:

VANESSA LILY RAMIREZ RN, R.N.

Received: 03/30/2020
To Clay J Claiborne
Message body: Dear Mr. Claiborne,

Thank you for your email. Please read below for coronavirus testing criteria:

As of today our TESTING guidelines are restricted and may change:
If you have no symptoms = NO testing
If you have symptoms (fever and cough/shortness of breath) AND international travel or close contact of confirmed COVID-19 in the last 14 days = testing
If you have symptoms but no exposure (above) and no *risk factors = NO testing
If you have symptoms AND *risk factors = testing
*risks = adult >65, immunocompromised, cancer, transplant, hemodialysis , advanced HIV, chronic lung disease, pregnancy, SNF residents and homeless patients

You can read more by logging into KP.org then reviewing the Health & Wellness tab.

Replies are not allowed for this message.

Obviously, neither Vanessa Lily Ramirez RN, R.N. nor anyone else actually bothered to read my letter, and they don't allow me to rely, and point out their error. 

If you take their website survey to see if you qualify for COVID-19 testing, you will find the same story:

Do any of these apply to you?

• 65 years old or older

• Cardiac disease (e.g., coronary artery disease, valvular disease, congestive heart failure)

• Pulmonary disease (e.g., asthma, chronic obstructive pulmonary disease)

• Pregnancy

• Immunosuppression (e.g., chemotherapy, transplant, or diabetes)

For whatever reason, they  seems to be interested in limiting how many of their members will qualify for testing. You pretty much have to have fever and cough or shortness of breath, meaning you are very sick and need medical treatment in any case, AND international travel or close contact of confirmed COVID-19 in the last 14 days. That last condition contains its own kind of Catch 22, because the more they can limit the testing, the harder it will be to determine if you have had contact with the disease.  By limiting testing in this way, they also limit the need to do the kind of contact tracing that could stop the spread of coronavirus in communities before they are devastated by it. 

All of this brings me back to the question I started with: Shouldn't Kaiser Permantente stop putting black lives at risk by pretending that hypertension, a condition particularly prevalent among African Americans, isn't a risk factor for fatal outcomes from coronoavirus disease?  

Clay Claiborne, Linux Systems Administrator