Background: Distrust of the healthcare system is longstanding in Black communities. This may especially threaten the health of the population when a highly contagious infection strikes. Perceptions, knowledge, and personal safety practices related to COVID-19 are unknown among hospitalized Black patients who distrust the healthcare system.

Methods: Black patients hospitalized patients were surveyed between November 2020 and March 2021 – the instrument assessed. Analyses compared those who trusted versus mistrusted the healthcare system.

Results: 37 Black patients hospitalized patients who distrusted were compared to 103 Blacks that trusted doctors and the healthcare system. Groups had similar socio-demographics (all p-values >0.05). Distrustful patients were less likely to believe they were at high risk of contracting COVID-19 (54.0% vs 75.7%; p=0.05), less likely to believe that people with underlying medical conditions were higher risk of dying from the virus (86.4% vs 98.0%; p=0.01), and less likely to accept COVID-19 vaccination compared to those who trusted (51.3% vs 77.6%; p<0.01).

Conclusions: Healthcare distrustful hospitalized AAs patients were more doubtful of COVID-19 risk and more hesitant about optimistic vaccination. Hospitalizations are concentrated exposures with the healthcare system that can be capitalized on by hospitalists for education and building trusting relationships with patients.