LOUISVILLE, Ky. – As the worldwide spread of COVID-19 has spiraled into a pandemic, national health organizations are warning that some members of the LGBTQ community may be “particularly vulnerable” to the effects of the virus.

While LGBTQ individuals have not been found to be more susceptible to contracting COVID-19, some health habits within the community,including significantly higher rates of smoking than the general population, have raised concern among health professionals.

Over 100 different national organizations,including Whitman-Walker Health and SAGE, have signed a letter created by the LGBT Cancer Network to bring attention to several factors that could mean the LGBTQ community is at a greater risk of complications from COVID-19, including:

LGBTQ people smoke at rates 50% higher than the general population, which could be detrimental if a respiratory illness like COVID-19 is contracted.

Higher rates of HIV and cancer in the LGBTQ community means that a greater number of people may have compromised immune systems, which leaves them more vulnerable to COVID-19 infections.

Health care discrimination in America, including denial of care, unwelcoming attitudes and lack of understanding from staff and providers means LGBTQ people may be more reluctant to seek medical care.

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In addition, the LGBT Cancer Network warns, there are more than 3 million LGBTQ+ elderly people living in the U.S. who are already less likely than their heterosexual and cisgender peers to reach out to health and aging providers, like senior centers, meal programs and other programs designed to ensure their health and wellness because they fear discrimination and harassment.

'A time to pay attention to vulnerable communities'

LGBTQ communities are all-too familiar with the phenomena of stigma and epidemics, said Chris Hartman, director of Kentucky's Fairness Campaign. Groups like the Fairness Campaign, SAGE of the Bluegrass and Louisville Pride Foundation have been meeting via conference calls this week to talk about how to provide resources for the Commonwealth's LGBTQ community.

"Our queer community was wholly ignored for years at the beginning of the AIDS crisis, and we saw where that led," Hartman told The Louisville Courier Journal, part of the USA TODAY Network. "HIV/AIDS devastated the LGBTQ community ... unhindered because of the government's intentional inaction as disrespect for LGBTQ people in our community.

"This is a time to pay attention to vulnerable communities, not just folks who are in the age range at risk of contracting COVID-19," Hartman said. "We need to be talking about people with suppressed immune systems and those who need to be supported most in a time like this."

Physician Scott Nass was watching closely over the past few months, acutely aware of how COVID-19 may affect his LGBTQ patients.

The Kentucky native who works in Palm Springs, California, knows that HIV and cancer are more common in LGBTQ communities – not only because of lifestyle choices, such as higher smoking rates, but because of prolonged or delayed access to care.

Folks who identify as LGBTQ don't always feel welcome in the health care environment, Nass told The Louisville Courier Journal, pointing to studies that have found they often report episodes of emotional and psychological trauma from their experiences dealing with the health care system.

A fatalist feeling for some: 'If I get it, I get it'

It took Louisville lawyer Bruce Kleinschmidt months to find a new primary care doctor after switching from a practice where he says he experienced homophobic comments from his physician.

"There's a huge problem with finding a primary care doctor to begin with, even when there's not a crisis going on," Kleinschmidt said.

As COVID-19 has spread and federal, state and local governments are mandating social distancing in an effort to stop or slow the spread of contagious diseases by restricting contact with people, especially in large groups, Kleinschmidt says he's noticed a common fatalist feeling among his peers in the LGBTQ community – folks saying, "If I get it, I get it."

But the 67-year-old lawyer, who has liver disease, is concerned about his own susceptibility to the virus, and how he may be treated if he needs to seek medical care.

Many states, including Kentucky, do not have laws prohibiting health insurance companies from discriminating based on gender or sexual orientation, according to the Movement Advancement Project.

Even young or healthy LGBTQ people may be less likely to seek care, Nass said.

"But now that we're dealing with coronavirus, something as simple as asthma could really be the difference between a mild case and being placed on a ventilator in the hospital," he said. "So it's important that we're making sure that folks get into care early."

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Still, 'a sense of resilience in the LGBTQ community'

About 80% of the people who get COVID-19 have mild or no symptoms, according to the World Health Organization. But older adults and people with serious chronic medical conditions – including heart disease, diabetes and lung disease – are at higher risk, according to the Centers for Disease Control and Prevention.

Symptoms include difficulty breathing or shortness of breath, as well as pain or pressure in the chest, which can lead to a type of respiratory pneumonia in the lungs.

Doctors are still working on estimating the mortality rate of COVID-19, but it is thought to be higher than most flu strains, according to Johns Hopkins Medicine. That is partly because this is a new coronavirus, and people have no immunity to it.

The pandemic is showing us that the country needs to be equipped to take care of a lot of patients in a very short period of time, Nass added – whether that's screening hundreds of people a day through drive-thru tents or on a phone line – to halt the contagion.

"We're not saying that LGBTQ folks need special treatment in this pandemic, but there needs to be consideration of the disparities in health equity for our community," said Nass, who is also the president of GLMA: Health Professionals Advancing LGBTQ Equality.

Nass said there is some concern that young queer people may be turned away from testing if they don't fit the "at-risk" age demographic, which is why the LGBT Cancer Network is calling on public health officials to ensure the LGBTQ community is considered and included in the public health response to COVID-19.

"Hopefully we can draw our attention to the fact that physicians need to create welcoming environments for people of all identities while providing care, especially in this type of pandemic when people are panicking and unsure," Nass said. "I think that's when it's more important than ever to make sure that folks have somewhere that they can turn to."

The Louisville Courier Journal contacted the University of Louisville Hospital, University of Kentucky's LGBT-inclusive Transform Health Clinic and Norton Healthcare to learn more about how Kentucky health providers are considering the LGBTQ community in its treatment of COVID-19, but representatives did not respond to multiple requests for comment as of press time.

For Hartman and others, there's a sense of resilience in the LGBTQ community.

"We have survived," Hartman said. "And I know that we will continue to endure and to embrace our community as we have survived so many hardships for so long. It is through the love and mutual support of our very vibrant, diverse and strong community that we get through this before we see the light at the end of this tunnel."

Follow reporter Savannah Eadens on Twitter at @savannaheadens.

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