A/HRC/45/44 standard than most adults navigating the COVID-19 pandemic, without additional support. Such disproportionately harsh treatment of children of African descent was a serious concern for the Working Group during its visit to the United States (see A/HRC/33/61/Add.2). 24. In some cases, failure to assess and mitigate the risks associated with the COVID-19 pandemic and systemic racism has led to fatalities. In Brazil, the tragic death of Miguel Otávio Santana da Silva, a 5-year-old Afro-Brazilian child, was such a case.21 In Brazil, domestic workers are deemed essential. Schools and child-care facilities were closed, so Miguel accompanied his mother, Mirtes Santana, to work. While Miguel’s mother walked the dog, her frustrated employer left Miguel in a lift. Unsupervised, the five-year-old child fell to his death when the lift stopped on the ninth floor. Miguel’s mother decried the racialized conduct that failed to acknowledge her son’s young age, innocence and vulnerability. Many domestic workers in Brazil work six days a week, which would suggest that precarious situations are more the norm than acknowledged, and require risk mitigation in the context of the pandemic. 25. Medical bias also poses ongoing concerns for people of African descent. Researchers have been able to find examples of racial disparity and bias everywhere they look for it. In many cases, the lack of controls sufficient to ensure that the use of discretion does not result in racism facilitates racial bias in decision-making; for example, research shows doctors underdiagnose illness, discount reports of pain, infer lesser pain and suffering for the same conditions and under-prescribe painkillers for people of African descent, including in the case of serious illnesses. Decision-making by doctors, particularly when they are under stress or lacking sleep, demonstrably defaults to anti-Black bias. 26. In many countries, triage protocols impermissibly broaden the discretion of healthcare workers, pharmaceutical companies and insurers to prioritize patients with “value to society”, to enforce limits based on socioeconomic status or to restrict non-pandemic-related health care and access to pharmaceuticals. People with lupus reported denials of prescription medications redirected for the COVID-19 response. One hospital instructed doctors that time, data or consultation were a “luxury” in critical triage decision-making,22 without appreciating how social conditioning perpetuates institutional racism and how a lack of protocols to amplify assumptions based on race – particularly at its intersections with disability, chronic illness, gender, sexual orientation, gender identity and poverty – may impair racial equity in the COVID-19 response.23 27. The treatment of people of African descent as disposable is reminiscent of historical exploitation and suggests that policymakers are minimizing the needs of and risks to people of African descent in the current crisis. Even where policies appear race-neutral, tolerating risks to people of African descent without a race-centred analysis may facilitate discrimination. Decisions to limit testing to the desperately ill, the failure to include undocumented persons in financial rescue packages, and the failure to recognize the added risks to public safety in carceral practices of arrest and imprisonment have a disproportionate impact on people of African descent in many States. When doctors discount the claims of illness made by people of African descent, which research has shown, another layer of risk is added. 2. Influence of systemic racism on prioritization, and consequent harm to people of African descent 28. Deprioritization and disregard in policymaking throughout the pandemic have compounded harm to people of African descent. In the earliest days of the pandemic, African and Caribbean countries faced disruptions to their supply chains, despite the urgent demand for medical supplies and equipment. In some cases, countries paid for supplies that were then 21 22 23 See Dom Phillips, “Five-year-old’s fatal plunge provokes hard questions about Brazil’s racism”, Guardian, 12 June 2020. See Shalini Ramachandran and Joe Palazzolo, “NYU Langone tells ER doctors to ‘think more critically’ about who gets ventilators”, New York Post, 31 March 2020. See Charles Camosy, “COVID-19 patient was black and paralyzed, so doctors decided his life wasn’t worth saving”, New York Post, 10 July 2020. 7