Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited. Academic Medicine, Vol. XX, No. X / XX XXXX 1 Letters to the Editor Focusing on Vulnerable Populations During COVID-19 To the Editor: We have seen during prior pandemics that vulnerable populations are at a higher risk for presenting with more severe illness. Despite these lessons, we in medicine continue to face incredible challenges protecting the most vulnerable; we are seeing these same inequities during COVID-19. There are many vulnerable groups, including but not limited to racial/ethnic minorities, children, the elderly, immigrants/refugees, those who are socioeconomically disadvantaged, disabled, underinsured, from rural communities, incarcerated, facing domestic violence, LGBTQ+, and with certain medical conditions (e.g., severe mental illness). And, although African Americans are disproportionately affected by COVID-19, 1 data on race are still vastly underreported. 2 In addition, the effects of stay-at-home orders put essential workers, who are lower-wage earners and unable to work from home, among the most vulnerable. We need an immediate call to action to protect the most vulnerable from COVID-19, and we must apply the lessons learned from previous crises, such as Hurricane Katrina, using a patient-centered framework. We cannot wait to study these effects until after the damage is done. Social care should be better integrated into health care for vulnerable populations to connect them with needed social and economic services 3 through interventions such as: • Disseminating cultural and linguistically concordant educational materials via email, social media, and phone; • A phone hotline for the community to ask questions and connect with services, including legal aid during this crisis; • Public and private industry partnerships to provide free/subsidized phone, Internet, and broadband, which are essential for distance learning, remote working, and telehealth; • Food delivery programs for low-income COVID-19-positive populations and others in quarantine and at risk of food insecurity during this time of social distancing; and • Leveraging and employing current technologies, such as geospatial mapping and/or predictive modeling at the zip code level, to determine COVID-19 hotspots to target for intervention and better understand at- risk populations. Inequities further exacerbate the impact of COVID-19 on vulnerable populations. We can turn the tide and use this moment to improve the lives of these patients. It is both morally right to advance health equity among vulnerable populations and essential to protect the health of the public. Disclosures: None reported. SreyRam Kuy, MD, MHS Assistant professor, Department of Surgery, Baylor College of Medicine, Houston, Texas; SreyRam.Kuy@ va.gov. Raymond Tsai, MD, MS Assistant clinical professor, Department of Family Medicine, University of California, San Francisco, San Francisco, California. Jay Bhatt, DO, MPH, MPA Internist, geriatrician, and former Chief Medical Officer, American Hospital Association, Chicago, Illinois. Quyen D. Chu, MD, MBA Chief, Division of Surgical Oncology, and Edward & Freda Green Professor in Surgical Oncology, Department of Surgery, LSU-Health Sciences Center- Shreveport, Shreveport, Louisiana. Pritesh Gandhi, MD, MPH Associate chief medical officer, People’s Community Clinic, Austin, Texas. Rohit Gupta Medical student, Baylor College of Medicine, Houston, Texas. Reshma Gupta, MD, MSHPM Medical director of population care and value, Department of Internal Medicine, University of California, Davis, Sacramento, California. Michael K. Hole, MD, MBA Assistant professor of pediatrics, population health, and public policy, Department of Pediatrics, The University of Texas at Austin, Austin, Texas. Benson S. Hsu, MD, MBA Associate professor of pediatrics, Department of Pediatrics, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota. Lauren S. Hughes, MD, MPH, MSc Director, Farley Health Policy Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado. Lenore Jarvis, MD, MEd Clinical assistant professor of pediatrics, The George Washington University School of Medicine and Health Sciences, and Division of Emergency Medicine, Children’s National Hospital, Washington, DC. Sachin “Sunny” Jha, MD, MS Assistant clinical professor, Department of Anesthesiology, University of Southern California, Los Angeles, California. Alagappan Annamalai, MD President, House Medicine, Los Angeles, California. Mansi Kotwal, MD, MPH Clinical assistant professor of pediatrics, The George Washington University School of Medicine and Health Sciences, and Division of Emergency Medicine, Children’s National Hospital, Washington, DC. Joseph V. Sakran, MD, MPH, MPA Director, Emergency General Surgery, Johns Hopkins Hospital, Baltimore, Maryland. Sameer Vohra, MD, JD, MA Chair, Department of Population Science and Policy, and assistant professor of pediatrics, medical humanities, and law, Southern Illinois University School of Medicine, Springfield, Illinois. Tracey L. Henry, MD, MPH, MS Assistant health director, Grady Primary Care Center, and assistant professor, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Ricardo Correa, MD, EsD Program director, Endocrinology, Diabetes, and Metabolism Fellowship, University of Arizona College of Medicine–Phoenix, and Phoenix Veterans Affairs Medical Center, Phoenix, Arizona. References 1 Illinois Department of Public Health. COVID-19 Statistics. http://www.dph.illinois. gov/covid19/covid19-statistics. Accessed April 5, 2020. 2 Johnson A, Buford T. Early data shows African Americans have contracted and died of Coronavirus at an alarming rate. ProPublica. https://www-propublica-org. cdn.ampproject.org/c/s/www.propublica.org/ article/early-data-shows-african-americans- have-contracted-and-died-of-coronavirus- at-an-alarming-rate/amp. Published April 3, 2020. Accessed June 25, 2020. 3 DeSalvo KB, Gracia JN. Health is more than health care. Ann Intern Med. 2020;172(suppl 2):S66–S67. Letters to the Editor