His mother, Deborah Melvin-Muse, doesn’t display photos of him, the second-youngest of six children. His brother’s birthday was the day after the crash — and he hasn’t celebrated it since. An older brother carries a deep sense of guilt because he was looking after John that morning.

And Cheek Road, in a predominantly Black neighborhood, still lacks sidewalks for children to safely make their way to the local elementary school.

This, despite the years community activists and academic researchers have spent pleading with city leaders for safety improvements along the busy thoroughfare with sloping shoulders where John died. Drivers zoom along Cheek Road in the Merrick-Moore neighborhood, which connects downtown Durham to industrial sites and newer suburban developments.

Melvin-Muse moved her family out of the neighborhood after John’s death. “Now when I go down there, I look and see, you know, nothing really changed,” she said. “It still looks the same.”

Cheek Road has been “identified as needing improvements” by a local metropolitan planning board, said Erin Convery, Durham’s transportation planning manager, in an email.

“The infrastructure that exists is not well implemented,” concluded a May preliminary report produced by University of North Carolina-Chapel Hill students who collected data on speeding, noise, and air quality along Cheek Road. “Poorly marked crosswalks and inadequately positioned bus stops show a need for safety and accessibility improvements,” the report said.

Data was difficult to collect because “there were areas we didn’t want to get out of our cars because of the dangerous conditions,” said Ari Schwartz, one of the researchers.

In the 1940s, Black military veterans returning from World War II helped establish the Merrick-Moore neighborhood. Since then, residents say they have endured everything from noisy industrial trucks and speeding cars to illegal tire dumping and air pollution that threaten their health and safety.

Pedestrian deaths are highest in formerly redlined areas, neighborhoods where Black people lived because of discriminatory federal mortgage lending practices, research shows. The lack of sidewalks, damaged walkways, and roads with high speed limits are concentrated in these neighborhoods, studies show, creating a little-recognized public health crisis.

Governments invest in roads for people driving through such neighborhoods, but not in safety measures — like sidewalks, crosswalks, traffic circles, and speed bumps — that protect people living in them, researchers and advocates say.

“People will talk about vulnerable communities as if there is a problem with these communities, when in fact it is our systems and policies that have created these failings,” said Darya Minovi, a senior analyst at the Union of Concerned Scientists who studies environmental health and justice.

While the share of Black residents in Merrick-Moore has dropped in recent decades, data shows the neighborhood remains more than 80% Black or Hispanic and households there are typically less well-off than in other parts of the city.

“Local government takes money from the neighborhood but does not invest in it,” said Bonita Green, head of the Merrick-Moore Community Development Corporation and a former City Council candidate.

Green said the community group had documented more than 100 auto crashes along Cheek Road during a recent four-year span and at least three pedestrian deaths before 2020. In this fast-growing city of roughly 300,000, students at Merrick-Moore Elementary and others at a nearby high school sometimes walk along the road — where traffic is heavy, drivers are known to disregard the 25-mph speed limit, and the shoulders slope steeply.

When longtime residents like Ponsella Brown see kids walking there or hear about another accident, they remember the death of John Parker, who was in first grade.

“I just cringe,” said Brown, who worked as an administrative assistant at Merrick-Moore Elementary when John died. “Every time it comes up, it’s like really vivid in my mind.”

On the day John died, someone rushed into the office and said a child had been hit by a car on Cheek Road, recalled Brown, who said she ran to the scene.

“I remember the way his head was turned. I remember the spot of blood on his face. Like one speck of blood,” said Brown, who also works for the Merrick-Moore Community Development Corporation and is now a counselor at another school.

Traffic on Cheek Road is expected to increase as the population grows in Durham and surrounding areas, according to a separate April report from UNC graduate students. It noted that during the morning school drop-off time, many cars driving on Cheek Road don’t observe the posted speed limits.

Under an equity program meant to reverse the harm done to communities of color, Convery said, Durham officials are considering traffic-calming measures, including traffic circles, speed cushions, and high-visibility crosswalks.

“We’re open to future conversations that will help us achieve zero traffic deaths and injuries,” Convery said.

Yet a 2017 plan that prioritized more than 600 sidewalk projects based on safety, equity, and demand did not include Merrick-Moore Elementary School on Cheek Road, she said.

A strike by Durham school bus drivers this year only heightened concerns about the lack of safe walking routes for the 650 students who attend the elementary school, according to the April report.

Melvin-Muse, now 67, was at work when she got a call that John had been struck by a truck in front of their house. Before she left home that late May morning in 1989, she put her older kids in charge of the younger ones. They passed the time before school riding bicycles near their house, a few blocks from Merrick-Moore Elementary School, when the accident occurred.

John died two months shy of his 7th birthday from “massive head injuries,” according to The (Raleigh) News & Observer, which wrote about his death on Cheek Road at the time. John was buried in Markham Memorial Gardens, according to his obituary in The (Durham) Herald-Sun.

Melvin-Muse said his death sent the family into a tailspin of grief, anger, and regret.

“It caused a big rip in the family,” Melvin-Muse said.

Melvin-Muse and John’s father later divorced. She said she paid for therapy for her other kids, but they still got in trouble at school and two of her children ended up living in a home for kids with behavioral health issues. “It was just a bad time,” she said.

Years after the accident, Melvin-Muse said, she worked up the courage to call the driver who had hit her son. When he answered, he didn’t recognize her name, or John’s, fueling her rage, she recalled.

“I wanted revenge. An eye-for-an-eye kind of thing,” she said. “And I plotted to take him out the same way my son was taken out.”

She went so far as to get a job where he worked, the Durham County tax department, only to find he had left a week before she started.

“God knows what was in my heart and what I planned on doing,” Melvin-Muse said. “God moved him out of that place before I got there.”

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Yet his doctor, Noha Aboelata, believed the patient was sicker than the device showed. So she sent him for a lab test, which confirmed her suspicion that he needed supplemental oxygen at home.

Months later, in December 2020, Aboelata thought back to her patient as she read a New England Journal of Medicine article showing that pulse oximeters were three times as likely to miss dangerously low blood oxygen levels in Black patients as in white ones. At a time when Black Americans were dying of covid at high rates and hospitals struggled to find beds and oxygen for those needing them, the finding exposed one of the most blatant examples of institutional racism in American health care.

“I was like, ‘Were there other patients I missed?” said Aboelata, a family physician and the CEO of Oakland-based Roots Community Health. As she shared the article with colleagues, “there was so much anger and frustration because we had every reason to believe we could rely on this device, and it was systematically not working in the population that we served.”

State attorneys general and U.S. senators have pressed the FDA to take steps to eliminate pulse oximetry’s racial bias, which has caused delays in treatment and worse health outcomes, and more recently has raised concern about the reliability of hospital AI tools that draw on reams of data from the devices.

Aboelata’s clinic has sued producers and stores that sell oximeters, demanding they pull the devices or add safety warnings to the labels. Many of her patients rely on home oxygen, which requires accurate readings for Medicare to cover.

But getting rid of the devices, central to care for heart and lung diseases, sleep apnea, and other conditions, isn’t an option.

Since the 1990s, the convenient fingertip clamps have come to stand in for many uses of arterial blood gas readings, which are the gold standard for determining oxygen levels but dangerous if not done carefully. Makers of oximeters will sell around $3 billion of them this year because they are used in nearly every hospital, clinic, and long-term care facility. During the pandemic, hundreds of thousands of Americans bought them for home use.

One of them was Walter Wilson, a 70-year-old businessman in San Jose who has had two kidney transplants since 2000. Wilson contracted covid last December but delayed visiting a doctor because his home pulse oximetry readings were in the normal range.

“I’m a dark-complected Black guy. I was very sick. Had the oximeter picked that up I would have gotten to the hospital sooner,” he said.

Wilson ended up back on dialysis after several years of good health. Now he’s looking to join a class action lawsuit against the device manufacturers.

“They’ve known for years that people with darker skin get bad readings,” he said, “but they tested them on healthy white people.”

After years of little action on the issue, the FDA in 2021 sent a safety warning to doctors about oximeters. It has also funded research to improve the devices and promised to issue new guidelines for how to make them.

But as the FDA polishes draft guidelines it had hoped to publish by Oct. 1, clinicians and scientists are unsure what to expect. The agency has indicated it will recommend that manufacturers test new oximeters on more people, including a large percentage with dark-pigmented skin.

Because of industry pushback, however, the guidance isn’t expected to ask device makers to test oximeters under real-world conditions, said Michael Lipnick, a University of California-San Francisco anesthesiologist and researcher.

Hospitalized people are often dehydrated, with restricted blood flow to their extremities. This condition, known as low perfusion — essentially, poor circulation — is particularly common with cardiovascular disease, which is more prevalent in Black patients.

Pigmentation and poor perfusion “work together to degrade pulse oximetry performance,” said Philip Bickler, who directs the Hypoxia Research Lab at UCSF. “During covid, Black patients showed up sicker because of all the barriers those patients face in accessing health care. They’re showing up on death’s door, and their perfusion is lower.”

The FDA guidance isn’t expected to require manufacturers to measure how well their devices perform in patients with poor perfusion. All this means that the FDA’s efforts could lead to devices that work in healthy dark-skinned adults but do “not fix the problem,” said Hugh Cassiere, who chairs a panel for the FDA’s Medical Devices Advisory Committee, at its February meeting.

A History of Inaction

Although some recent industry-sponsored studies have shown that certain devices work across skin tones, research dating to the 1980s has found discrepancies in pulse oximetry. In 2005, Bickler and other scientists at the Hypoxia Lab published evidence that three leading devices consistently failed to detect hypoxemia in darkly pigmented patients — especially those who were severely oxygen-depleted. Noting that these readings could be crucial to directing treatment, the authors called for oximeters to carry warnings.

The FDA’s response was modest. Its regulatory pathway for pulse oximeters clears them for sale as long as they show “substantial equivalence” to devices already on the market. In a 2007 draft guidance document, the FDA suggested that tests of new oximeters could “include a sufficient number of subjects with dark skin pigmentation, e.g., 30%.” However, the final guidance, issued in 2013, recommended “at least 2 darkly pigmented subjects or 15% of your subject pool, whichever is larger.” The studies were required to have only 10 subjects. And the agency did not define “dark-pigmented.”

Testing the devices involves fitting patients with masks that control the gases they breathe, while simultaneously taking pulse oximetry readings and samples of arterial blood that are fed into a highly accurate measuring device, invented by the Hypoxia Lab’s late founder, John Severinghaus.

Bickler, who evinces the bemused skepticism of a seasoned car mechanic when discussing the scores of devices his lab has tested, said “you can’t always trust what the manufacturers say.”

Their data, he said, ranges from “completely inaccurate” to “obtained under absolutely ideal conditions, nothing like a real-world performance.”

During the pandemic, a medical charity approached the lab about donating thousands of oximeters to poor countries. The oximeters it had chosen “weren’t very good,” he said. After that, the lab set up its own ratings page, a kind of Consumer Reports for pulse oximeters.

According to its tests, some expensive devices don’t work; a few of the $35 gadgets are more effective than competitors costing $350. Over a third of the marketed devices the lab has tested don’t meet current FDA standards, according to the site.

To investigate whether real-world tests of oximeters are feasible, the FDA funded a UCSF study that has recruited about 200 intensive care unit patients. The data from the study is being prepared to undergo peer review for publication, Bickler said.

He said the lab did not warm the hands of patients in the study, which is the customary practice of manufacturers when they test their devices. Warming assures better circulation in the finger the device is attached to.

“It affects the signal-to-noise ratio,” Bickler said. “Remember when car radios had AM stations, and you’d get a lot of static? That’s what poor perfusion does — it causes noise, or static that can obscure a clear signal from the device.”

Hypoxia Lab scientists — and doctors in the real world — don’t warm patients’ hands. But “the industry people can’t agree on how to handle it,” he said.

Masimo, a company that says it has the most accurate pulse oximeters on the market, would happily comply with any FDA guidance, Daniel Cantillon, Masimo’s chief medical officer, said in an interview.

How Much To Fix the Problem?

The very best devices, according to the Hypoxia Lab, cost $6,000 or more. That points to another problem.

With better accuracy, “you are going to reduce patient access to devices for a large proportion of the world that simply can’t afford them,” Lipnick said.

Even if the FDA can’t please everyone, its anticipated call for more people with darker skin in oximetry tests will “assure there’s real diversity in the development and testing of those devices before they come to market,” Lipnick said. “That bar has been too low for decades.”

It is difficult to assess harm to individuals from faulty oximeter readings, because these errors are often one factor in a chain of events. But studies at Johns Hopkins University and elsewhere indicated that patients whose oxygen depletion wasn’t noticed — possibly thousands of them — had delayed treatment and worse outcomes.

Already, Aboelata said, a few manufacturers — Zewa Medical Technology, Veridian Healthcare, and Gurin Products — have responded to the Roots Community Health lawsuit by including warnings about their devices’ limitations.

There’s not much she and other clinicians can do in daily practice, she said, other than establish a baseline reading with each new patient and be on the lookout for notable drops. Hospitals have other tools to check oxygen levels, but correct readings are critical for outpatient care, she said. In 2022, Connecticut enacted a law banning insurers from denying home oxygen or other services based solely on pulse oximetry readings.

But “adapting around the crappy device isn’t the solution,” said Theodore Iwashyna, the Johns Hopkins Bloomberg School of Public Health professor who co-authored the New England Journal of Medicine article. “A less crappy device is the solution.”

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Sin embargo  su médica, Noha Aboelata, creyó que estaba más enfermo que lo que indicaba el aparato. Así que lo envió a hacerse unos análisis de laboratorio que confirmaron su sospecha: el hombre necesitaba oxígeno suplementario en casa.

Meses después, en diciembre de 2020, Aboelata volvió a pensar en su paciente mientras leía el New England Journal of Medicine. El artículo señalaba que los oxímetros de pulso tenían tres veces más probabilidades de no detectar niveles peligrosamente bajos de oxígeno en sangre en pacientes negros que en pacientes blancos.

En un momento en el que los estadounidenses de raza negra morían de covid a un ritmo elevado y los hospitales luchaban por encontrar camas y oxígeno para quienes los necesitaban, el hallazgo puso al descubierto uno de los ejemplos más flagrantes de racismo institucional en la atención médica estadounidense.

“Me pregunté si otros pacientes se me habrían pasado por alto”, reflexionó Aboelata, médica de familia y directora ejecutiva de Roots Community Health, con sede en Oakland.

Los colegas con quienes compartió el artículo tuvieron percepciones similares. “Sentimos mucha rabia y frustración porque teníamos todos los motivos para creer que podíamos confiar en este dispositivo pero nos dimos cuenta de que el oxímetro fallaba sistemáticamente en la población a la que atendíamos”, explicó.

Fiscales estatales y senadores de EE.UU. han presionado a la Administración de Drogas y Alimentos (FDA) para que tome medidas que ayuden a eliminar la desviación racial en los oxímetros de pulso.

Los funcionarios entienden que esto ha causado retrasos en los tratamientos y resultados desfavorables en la atención de salud. Más recientemente, esta falla del funcionamiento de los oxímetros de pulso también ha generado preocupación sobre la fiabilidad de las herramientas de Inteligencia Artificial en los hospitales, que dependen mucho de los datos que se obtienen de estos dispositivos.

La clínica de Aboelata ha demandado a los fabricantes y a los comercios que venden oxímetros, planteando la exigencia de que retiren estos dispositivos o por lo menos les agreguen advertencias de seguridad en las etiquetas. Muchos de sus pacientes dependen de la provisión de oxígeno domiciliario y para que el Medicare lo cubra es necesario brindar información precisa.

Sin embargo, eliminarlos no es una opción porque son fundamentales para el tratamiento de enfermedades cardíacas y pulmonares, la apnea del sueño y otras afecciones.

Desde la década de 1990, las cómodas pinzas en la yema de los dedos han sustituido en muchos usos a las lecturas de gases en sangre arterial, que son una referencia definitiva para determinar los niveles de oxígeno en sangre pero también son peligrosas si no se efectúan con cuidado.

Este año, los fabricantes de oxímetros de pulso venderán alrededor de $ 3.000 millones de estos pequeños aparatitos que se utilizan en casi todos los hospitales, clínicas y residencias para adultos mayores. Durante la pandemia, cientos de miles de estadounidenses los compraron para usarlos en su propio hogar.

Uno de ellos fue Walter Wilson, un empresario de 70 años que vive en San José, California. Wilson, que ha atravesado dos trasplantes de riñón desde el año 2000, contrajo covid en diciembre de 2023 pero retrasó la visita al médico porque los indicadores que veía en el oxímetro de pulso que utilizaba en su casa estaban en el rango normal.

“Soy un hombre negro, de piel oscura. Estaba muy enfermo. Si el oxímetro lo hubiera detectado, hubiera ido mucho antes al hospital”, explicó.

Wilson acabó de nuevo en diálisis tras varios años de estar con buena salud. Ahora quiere unirse a una demanda colectiva contra los fabricantes del dispositivo.

“Desde hace años saben que las personas con piel más oscura obtienen lecturas incorrectas”, dijo, “pero solo los probaron en personas blancas saludables”.

Después de dejar pasar el tiempo sin hacer mucho sobre este problema, en 2021 la FDA envió a los médicos un alerta de seguridad sobre los oxímetros de pulso. Por otra parte, financió investigaciones para mejorar los dispositivos y ha prometido publicar nuevas directrices sobre cómo fabricarlos.

Pero mientras la FDA trabajaba en un borrador de directrices, los médicos y los científicos no saben a qué atenerse. La agencia ha informado que recomendará a los fabricantes que prueben los nuevos oxímetros en más personas, y que incluyan un gran porcentaje de individuos con piel de pigmentación oscura.

Sin embargo, a causa de la resistencia que presentó la industria, los fabricantes de dispositivos no tendrán que probar los oxímetros en condiciones reales, según Michael Lipnick, anestesiólogo e investigador de la Universidad de California-San Francisco (UCSF).

Las personas hospitalizadas suelen estar deshidratadas y mostrar un flujo sanguíneo restringido en las extremidades. Esta situación, conocida como “baja perfusión” —es decir, mala circulación—, es especialmente habitual en las enfermedades cardiovasculares, que a la vez son más frecuentes entre los pacientes de raza negra.

La pigmentación y la mala perfusión “actúan conjuntamente para degradar el rendimiento de la pulsioximetría”, explicó Philip Bickler, director del Laboratorio de Investigación sobre la Hipoxia de la UCSF. “Durante la pandemia de covid, los pacientes negros llegaban al hospital en peores condiciones debido a todas las barreras a las que se enfrentan para acceder a la atención médica. Los recibíamos en un estado crítico y su perfusión era mucho menor”, añadió.

“No es probable que las directrices de la FDA obliguen a los fabricantes a medir el rendimiento de sus dispositivos en pacientes con mala perfusión. Por lo tanto, estos esfuerzos de la FDA podrían generar las condiciones para que los dispositivos funcionen correctamente en adultos sanos de piel oscura pero no creemos que logren solucionar el problema”, opinó Hugh Cassiere, que preside un panel del Comité Asesor de Dispositivos Médicos de la FDA, en una reunión del organismo en febrero.

Un historial de inacción

Aunque algunos estudios recientes que patrocinó la industria han demostrado que ciertos dispositivos funcionan correctamente en los distintos tonos de piel, investigaciones que se remontan a la década de 1980 han detectado discrepancias en la oximetría de pulso.

En 2005, Bickler y otros científicos del Laboratorio de Hipoxia publicaron pruebas de que tres de los principales dispositivos no detectaban de forma sistemática la hipoxemia (bajo nivel de oxígeno en sangre) en pacientes con pigmentación oscura, sobre todo en los que presentaban una grave falta de oxígeno. Tras señalar que estas lecturas podían ser cruciales para orientar el tratamiento, los autores pidieron que los oxímetros llevaran un alerta que advirtiera sobre esta dificultad.

La respuesta de la FDA fue poco significativa. La normativa que regula los oxímetros de pulso autoriza su venta siempre que demuestren una “equivalencia sustancial” con los dispositivos ya comercializados.

En un borrador de un documento orientativo de 2007, la FDA sugería que las pruebas de los nuevos oxímetros podían “incluir un número suficiente de sujetos con pigmentación oscura de la piel, por ejemplo, el 30%”. Sin embargo, la guía final, publicada en 2013, recomendó “al menos 2 sujetos con pigmentación oscura o el 15% de su grupo de personas, lo que sea mayor”. Los estudios debían tener solo 10 individuos. Y la agencia no definió “pigmentación oscura”.

Las pruebas de los dispositivos consisten en colocar a los pacientes máscaras que controlan los gases que respiran, al tiempo que se toman lecturas de oximetría de pulso y muestras de sangre arterial que se introducen en un dispositivo de medición de gran precisión, inventado por el difunto fundador del Laboratorio de Hipoxia, John Severinghaus.

Bickler, que cuando habla de las decenas de dispositivos que ha probado su laboratorio exhibe el irónico escepticismo de un avezado mecánico de automóviles, dijo que “no siempre se puede confiar en lo que dicen los fabricantes”.

Sus datos, aseguró, oscilan entre “completamente inexactos” y “obtenidos en condiciones absolutamente ideales, nada que ver con lo que sucede en el mundo real”.

Durante la pandemia, una organización médica benéfica se puso en contacto con el laboratorio para donar miles de oxímetros a países pobres. Los oxímetros que había elegido “no eran muy buenos”, explicaron. Después de eso, el laboratorio creó su propia página de calificaciones, una especie de Consumer Reports para oxímetros de pulso.

Según sus pruebas, algunos dispositivos costosos no funcionan con precisión; unos pocos aparatos de $35 son más eficaces que otros que cuestan $350. Según el sitio, más de un tercio de los dispositivos comercializados que ha probado el laboratorio no cumplen las normas actuales de la FDA.

Para investigar si las pruebas de los oxímetros en condiciones reales son viables, la FDA financió un estudio de la UCSF que ha reclutado a unos 200 pacientes en terapias intensivas. Los datos del estudio se están preparando para ser sometidos a una revisión de pares, con vistas a su publicación, según Bickler.

Bickler explicó que el laboratorio no calentó las manos de los pacientes antes de hacerles el estudio, una práctica habitual entre los fabricantes cuando prueban sus dispositivos. Dar calor a las manos asegura una mejor circulación en el dedo en donde se coloca el oxímetro.

“Afecta la relación señal/ruido”, afirma Bickler. “¿Recuerdas cuando las radios de los coches tenían emisoras AM y se oía mucha estática? Eso es lo que hace una perfusión deficiente: provoca ruido o estática que puede ocultar una señal clara del dispositivo”.

Los científicos del Laboratorio de Hipoxia —y los médicos que atienden en el mundo real— no calientan las manos de los pacientes. Pero “la gente de la industria no se pone de acuerdo sobre cómo manejarlo”, dijo.

Masimo, una empresa que dice tener los oxímetros de pulso más precisos del mercado cumpliría gustosamente cualquier directriz de la FDA, afirmó en una entrevista Daniel Cantillon, director médico de la compañía.

¿Cuánto cuesta solucionar el problema?

Los mejores dispositivos, según el Laboratorio de Hipoxia, cuestan $6.000 o más. Esto agrega otro problema.

Con oxímetros más precisos, “se va a reducir el acceso de los pacientes a los dispositivos porque una gran proporción de las personas simplemente no puede permitírselos”, dijo Lipnick.

Aunque la FDA no pueda complacer a todos, el requisito de incluir a más personas de piel oscura en las pruebas de oximetría “garantizará que haya una verdadera diversidad en el desarrollo y en las pruebas de esos dispositivos antes de que lleguen al mercado”, afirmó Lipnick. “Ese estándar ha sido demasiado bajo durante décadas”, agregó.

Es difícil evaluar el daño que puede causar en las personas las lecturas erróneas de los oxímetros, porque estos errores suelen ser un factor más en una cadena de incidentes. Pero estudios realizados en la Universidad Johns Hopkins y en otros centros indican que los pacientes a los que no se les detectó falta de oxígeno —posiblemente miles de personas— sufrieron demoras en el tratamiento y obtuvieron resultados más desfavorables.

Según Aboelata, algunos fabricantes, Zewa Medical Technology, Veridian Healthcare y Gurin Products, ya han respondido a la demanda de Roots Community Health incluyendo advertencias sobre las limitaciones de sus dispositivos.

No hay mucho que ella y otros médicos puedan hacer en la práctica diaria, dijo, aparte de establecer una lectura de referencia con cada nuevo paciente y estar atentos a consecuencias significativas.

Los hospitales tienen otras herramientas para medir los niveles de oxígeno, pero las lecturas correctas de los oxímetros son fundamentales para la atención ambulatoria, añadió.

En 2022, Connecticut promulgó una ley que prohíbe a las aseguradoras denegar la provisión de oxígeno a domicilio y otros servicios que se basan en las lecturas de la oximetría de pulso.

Pero “adaptarse a un dispositivo de mala calidad no es la solución”, aseguró Theodore Iwashyna, profesor de la Escuela de Salud Pública Bloomberg de Johns Hopkins y coautor del artículo del New England Journal of Medicine. “La solución es trabajar con un dispositivo menos inexacto”.

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The enthusiasm may be key for Democratic turnout at the polls in critical battleground states.

Black women have always been among the most reliable voters in the Democratic base and were central to former President Barack Obama’s victories in 2008 and 2012. Enthusiasm was also robust for President Joe Biden in 2020. But this year, before he bowed out of the race and Harris became the Democratic nominee, his support among this critical demographic had been fading, which could have dampened turnout in swing states.

Black voters’ support for the top of the Democratic ticket has since increased. In July, before he left the race, 64% of Black voters supported Biden, according to the Pew Research Center. Seventy-seven percent of Black voters supported Harris in August.

Black voter turnout, especially in rural areas of Georgia, North Carolina, and Pennsylvania, could help propel Harris to victory. That support — especially among Black women — has swelled since Biden’s departure, polling shows.

“This is a renaissance,” said Holli Holliday, a lawyer in the Washington, D.C., area who is president of Sisters Lead Sisters Vote, a group that works to advance Black women’s political leadership. “We’re partnering with a collective of Black women organizations to collaborate and collectively move like we never have before.”

Gun safety issues could especially resonate in Georgia, where both Harris and the Republican nominee, former President Donald Trump, are vying for the support of Black voters. A Sept. 4 shooting at Apalachee High School near Winder, Georgia, killed four people and left nine hospitalized with injuries, with scores more facing mental and emotional scars.

Eighty-two percent of Black women voters had a favorable view of Harris in August, according to the Pew Research Center, up from 67% in May.

And more Black women than before say they will go to the polls. Almost 70% of Black women said in August they were extremely or very motivated to vote, according to Pew, up from 51% in July. Sixteen million Black women in the U.S. are eligible to vote and 67% of them are registered, according to Higher Heights, a political action committee focused on mobilizing and electing Black women.

Trump has also sought support from Black women voters. His campaign released a video in August showcasing Black women pledging to support him over Harris, pointing to his economic policies as a key reason.

Still, only 8% of Black women voters say the Republican Party does a better job of looking out for their interests, according to a poll done in May and June by KFF, a health information nonprofit that includes KFF Health News.

Harris’ attention to health issues particularly important to Black women is helping to draw their support, said Kimberly Peeler-Allen, a co-founder of Higher Heights. In 2021, the vice president called for a more robust government response to the nation’s high maternal mortality rates.

The Centers for Disease Control and Prevention says Black women are three times as likely to die from pregnancy-related complications as white women. The disparity is driven in part by differing access to quality health care, underlying health conditions, bias, and racism.

“The vice president’s focus on Black maternal morbidity has gotten a lot of attention and gratitude,” Peeler-Allen said. “High-quality and affordable care, as well as the economy, are one of the top issues that drive Black women voters to get to the polls.”

As a senator, Harris co-sponsored a package of legislation aimed at improving maternal health, with a focus on Black women. The Biden administration pushed to expand maternal health initiatives in rural communities and improve bias training for health care providers, including by awarding more than $103 million in grants in 2023 to support and expand access to maternal health care.

Trump in 2018 signed legislation intended to reduce the maternal mortality rate that provided $58 million a year for five years to help states investigate and prevent pregnancy-related deaths.

As vice president, Harris also pushed states to extend postpartum care in Medicaid, the state-federal health program for low-income and disabled people. Biden signed legislation that temporarily gave states the option to expand the coverage to a full year from the required 60 days, with federal matching funds, and later signed a law allowing states to make the extended benefits permanent.

Illinois, New Jersey, and Virginia were the only states providing 12 months of postpartum Medicaid coverage when Harris became vice president. Today, the yearlong benefit has been adopted by at least 46 states and Washington, D.C., according to KFF.

“I am so thrilled out of my mind. I didn’t think we’d get there that quick,” said Rep. Robin Kelly (D-Ill.), who has helped lead congressional efforts to reduce mortality and morbidity among mothers and pregnant women, especially Black women. “It helps having everybody at the Senate, House, and White House working together. I am optimistic we are going to have someone at the top who gets it. We still have a ways to go.”

Harris’ support for measures to stem gun violence also helps her appeal to Black women. Harris said during her debate with Trump last month that she’s a gun owner. But she has pressed for banning what are often known as assault weapons and to implement universal background checks ahead of gun purchases — issues that may resonate in Georgia, especially, after the Apalachee shooting.

Eighty-four percent of Black women favor Harris on gun reform over Trump, according to a 2024 poll conducted for The Highland Project, a women-led coalition focused on creating multigenerational wealth in Black communities.

Trump’s campaign advisers have said he would protect access to guns by appointing federal judges who oppose restrictions. He has supported gun rights despite two apparent assassination attempts during the campaign, and as president in 2017 he reversed a controversial Obama administration regulation making it harder for people with mental health issues to purchase guns.

Win With Black Women, a network of Black women leaders, hosted a planning call with Black women the day Biden withdrew from the race. About 44,000 participants joined the meeting.

Waning enthusiasm for the Democratic ticket among Black women before Harris entered the race could have undermined turnout. And turnout matters: In the 2020 presidential race, seven states were won by less than three percentage points each.

“To have 44,000 black women on a phone call that Sunday night? That enthusiasm, that’s good for Democrats,” said Kelly Dittmar, research director at Rutgers’ Center for American Women and Politics. “If Democrats selected someone with less enthusiastic backing, a lot of women who supported Biden may have stayed home.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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