Speaking as a physician with a duty to care for the health of everyone, the health care system has failed marginalized African American communities – again.

COVID-19 has disproportionately affected African Americans. While blacks are only around 13% of the U.S. population, 34% of COVID-19 deaths are Black. A thoughtful investigation is needed to examine this disparity. So, as a qualitative researcher, I interviewed five Black individuals active in their own communities and well-positioned to give insights. I asked them, “Why are African American communities harder hit by this pandemic?”

Overloads of conflicting information were challenging, even for the well-informed. Some of the recommendations were inaccurate or misleading. “People were listening to TV networks saying, ‘It’s not that serious, and it’s similar to the flu,’” Dr. Harris, a family doctor from Indiana, explained.

Hearing what seemed like “another story blown out of proportion,” Tamira said, people didn’t take it seriously. Tamira is the owner of a hair salon in Seattle that serves Black women. She has rheumatoid arthritis and only started practicing social distancing when her doctor explained the seriousness of the situation. Having a doctor as a reliable source of information is “a blessing” not available to many in her community.

But skepticism wasn’t the main reason for leaving the house. Many marginalized African Americans simply cannot just stay home. Essential workers who, as Dr. Harris, said, “live paycheck to paycheck” have to go to work. Some depend on hourly jobs, where “if you don’t work, you don’t eat.”

Countless Black workers don’t have sick leave and must go to work to avoid losing their jobs, said Ben, a retired football player from Atlanta. They can’t isolate themselves when they get sick, either; if you live in public housing or a crowded apartment, you continue to expose others.

People have often not recognized they were sick with COVID-19. Some went to work blaming their symptoms on the flu, like Dr. Johnson’s niece’s husband did. But there’s also the self-image of invincibility. Even Dr. Johnson, a retired obstetrician in Indiana, described how some in the Black community have to be strong to take care of family. “It’s your duty.”

But others don’t let you have that, either. You look healthy and strong, so you’re not allowed to be sick. Dr. Harris shared how a patient struggled to accept she was ill. “I saw this woman. On the telemedicine visit, she looked very sick. She wants to go back to work because ‘people tell me I’m making this up.’ ” You cannot be your own advocate if you’re Black, Dr. Harris said. “You’ll become the angry Black man or woman.”

The health care system has done poorly at managing chronic conditions among African Americans, including diabetes, hypertension and obesity, which happen to be risk factors for the worst COVID-19 outcomes. The health care system also failed to gain the trust of African Americans, who are left to doubt whether providers, the majority of whom do not look like them, have their best interests at heart. Previous encounters with doctors made others feel their concerns weren’t taken seriously and likely never would be.

The COVID-19 pandemic and response to it is not an exception. When testing became available to essential workers, some couldn’t access it. Jasmin is an adjunct professor who’s an advocate for Black women with disabilities in Indiana. Jasmin was coughing during our interview. Her mother-in-law was just in ICU with COVID-19, and her husband had all the symptoms of COVID-19. But he couldn’t get tested despite going to three different doctors while three of his coworkers had been diagnosed with COVID-19. Jasmin wonders, “Why did other individuals in that company get tested? It’s dependent on who their contacts and networks are.”

Dr. Harris started an initiative to raise awareness by giving public talks. Three of her Black otherwise healthy patients had ended up in the ICU. More community-driven work is probably needed, but we need to have a systematic approach to “bringing information to these communities by people with established rapport,” as Dr. Johnson urged. It’s also time to call out racism – this article only scratches the surface.

This pandemic ultimately affects everyone, and, without a collective effort, the whole ship could go down if we do not address racial health disparities.