4 minute read
COVID-19’s Disproportionate Impact on the “Latinx” Community
By Joseph Graterol, MD
Two experiences have exemplified my work as an emergency physician lately. The first is having a 60-year-old male come into the emergency department (ED) gasping for air after being recently diagnosed with COVID-19. He had saturations of 60 percent and despite my best noninvasive ventilation efforts, he seemed at ease after I told him that he would need to be intubated. The second was a 30-year-old male, also COVID-19 positive, who was stable without an oxygen requirement. He related to me how he felt fortunate that he had SARS-CoV-2 and not coronavirus and was surprised when I explained to him that these terms in fact identified the same virus.
What relates these two separate visits, other than their diagnoses, was that both patients are members of our Latinx community in the Bay Area, a community that has been disproportionately ravaged by this pandemic.
Being Latino myself, and speaking native Spanish, it is one of my favorite
parts of the job to speak with my Latinx patients in their language while caring for them in the ED. Unfortunately, as with many things during this pandemic, this joy has been turned on its head because of how much harder our Latinx community has been afflicted. We in San Francisco have been overall very fortunate to not have had the waves of COVID deaths that other localities have experienced across the country. But what we have seen is the severe ethnic/racial disparities exacerbated by the pandemic.
Per data from the Centers for Disease Control and Prevention (CDC), Latinos account for 34 percent of the cases of COVID-19 nationwide, while only representing 18 percent of the U.S. population. In California, the data is even more stark with Latinx individuals accounting for greater than 56 percent of cases and 45.9 percent of deaths while only representing 39 percent of the population. Within my own community of San Francisco, this disparity is corroborated by a recent University of California, San Francisco (UCSF) study which found that 95.1 percent of those testing positive for COVID-19 self-identified as Latinx while only representing 40 percent of those tested — an almost unimaginable proportion.
This data, however, is likely not that surprising if you have been working
in the ED lately. One would almost be excused for making a test-taking word-association equating COVID-19 to Latinx patients akin to how we were trained to associate sarcoidosis and black female patients for tests like the United States Medical Licensing Examination (USMLE). These associations, although most often not rooted in physiologic bases, do highlight the question of why such disparities in illness prevalence exist across races.
The likely causes for this current disparity in pandemic incidence have been well described. Communal living and multigenerational households — staples of the social structure of Latinx communities — lead to increased rates of disease transmission. Furthermore, Latinos are more likely to work in essential jobs and live at or near poverty levels, making losing their employment untenable.
Latinx patients are also more likely to have associated comorbidities such as uncontrolled hypertension and diabetes, exacerbated by their decreased access to the health care system. Some of this disparity in access can be explained because of a fear of the medical establishment and associated authorities. This fear was shown in a recent study performed in our own hospital which found that a significant number of our undocumented Latinx patients feared going to the hospital because of fear of discovery and reporting of their immigration status. Finally, as my second patient illustrates, our education of these patients regarding issues of health literacy can be lacking.
Many of these explanations bring to light the fact that our health care system and society have set communities of color up for failure. Recent events of racial injustice and police brutality have brought the term structural racism to the forefront. As we should continue to push toward a more just police and criminal justice system, we must also remember that structural racism is well embedded within our ranks in medicine.
What can we do?
As emergency room providers, we should ensure that our patients understand our instructions by providing discharge instructions in Spanish and using interpreters. We should also advocate to have an increased number of contact tracers/public health workers who better represent the communities they are surveilling, meaning increasing the proportion of bilingual staff who may be better able to get the educational message across while decreasing any perceived threat from authorities. Additionally, in order to better target our resources we need to continue to advocate for data that is disaggregated by race and ethnicity both at the national and state levels, but also within our own communities and hospitals. Furthermore, we need to continue to push for a workforce at all levels of health care delivery that is more representative of the racial diversity in our communities.
It has been proven that COVID-19 is not the great equalizer as it was initially thought to be, but in fact an exacerbator of racial/ethnic disparities. Let’s not make it worse as emergency physicians by sitting back and not responding to this public health crisis.
REFERENCES
• CDC COVID Data tracker • Fear of discovery among Latino immigrants presenting to the emergency department • SARS-CoV-2 Community Transmission During
Shelter-in-Place in San Francisco
ABOUT THE AUTHOR
Dr. Graterol is a clinical instructor in the department of emergency medicine at Zuckerberg San Francisco General Hospital and Trauma Center with interests in health care equity and Latinx population health.
