The COVID-19 pandemic has had a profoundly negative impact on the undocumented Latino community, and addressing the issue will require systemic changes, and strong political leadership, according to a commentary published this week in The New England Journal of Medicine.
The research authors work in the Johns Hopkins Health System in Baltimore, where they noted that pre-pandemic, Latino admissions were relatively low. The population are mostly foreign born and face disproportional disparities in income, education, and deal with limited English language proficiency. A large percentage (over 80%) are under the age of 45, and most aren’t eligible for insurance under the Affordable Care Act, so they generally avoid hospital care. The trend in admissions shifted when new cases of COVID-19 exploded in April. “Rapid demographic changes have long strained the city’s capacity to provide culturally and linguistically competent care, but these challenges became especially acute during the pandemic,” the researchers wrote.
The first challenge, the researchers noted, was communication due to the language barrier. Despite possessing robust language-access services, the inpatient teams struggled to deliver results to Spanish-speaking patients using iPads and Smartphones and through heavy layers of personal protective gear. They wrote that, “End-of-life conversations left a bitter taste; even with skillful interpreters, many gestures, sentiments, and cultural nuances and expressions were lost.”
Researchers attempted to ameliorate the communication gap by seeking outside advice from colleagues. They established a group called “Juntos” (meaning “together”), a consult team comprised of bilingual volunteer nurses, physicians, and social workers. This team met with patients and families who relayed their thoughts – many patients understandably expressed fear. “It quickly became evident, however, that language barriers weren’t the only obstacle,” the researchers continued. The patients demonstrated a strong apprehension of the system – a system that excludes them from social safety net services. They cited an example of woman who lived in a shared home, and told the physicians her brother could build a separate drywalled room in less than a day so she could go home rather than stay in an isolation hotel. The patient’s reasoning – she thought a hotel sounded “too good to be true.” The researchers observed the response of another patient, who declined discharge to a field hospital because she thought it was a detention center. “After years of anti-immigrant rhetoric and policy, the fear and mistrust in this community was understandable, painful, and palpable,” the authors remarked, an obvious slight at President Donald Trump and his administration, as they proposed banning people from seeking asylum, citing pandemic-related concerns, even though there’s no evidence that backs asylum seekers contributing to community spread.
COVID-19 infection in this vulnerable community appeared exacerbated by poverty, and woeful living conditions. These people were dubbed “essential workers,” and they expressed gratitude that Maryland’s state-at-home orders didn’t apply to their jobs in cleaning, construction, landscaping, cooking, and food serving. Because the undocumented Latino community are ineligible for unemployment benefits and barely have any monetary cushion, they have no other choice but to work – even if working entails traveling in vans with COVID-infected coworkers, or working without masks in crowded settings. These patients also live in overcrowded, underkept living conditions, and defray their bills by living with other families and work acquaintances. “When we contacted patients to tell them about a positive test result and ask who else could have been exposed, we often found that there were up to 10 workers sharing a two-bedroom apartment or several families living in one house. By the time we reached them, most household contacts were already sick,” the researchers continued.
Patients continually worried about money, which lead to many delaying coming to the hospital for fear that they couldn’t foot the medical expense. These patients cried with relief when the health care professionals explained that their care was covered through the Coronavirus Aid, Relief, and Economic Security Act, and the researchers noted that they learned the importance of providing this information up front. Alarmingly, in the Johns Hopkins Health System, 42.6% of Latino patients tested positive for COVID, juxtaposed to 17.6% of African Americans and 8.8% of Whites.
“The Covid-19 case rate and mortality among undocumented immigrants are undoubtedly much higher than they are in the general Latinx population. Although data on undocumented immigrants could be used to fuel xenophobia, the politicization of Covid-19 generally hasn’t relied on science,” the researchers wrote.
How to Rectify This Inequality
To remedy this disparity in health care experienced by the Latino community, fundamental changes are needed, the researchers noted. These changes should come by way of immigration reform, cash benefits extended to all who need them (regardless of immigration status) occupational protections, and increased wages. Moreover, hospitals and academic institutions should encourage undocumented immigrants to seek help when they experience COVID symptoms by clearly communicating that they don’t cooperate with immigration authorities.
“Finally, we need to recognize community members’ contribution to addressing disparities, integrate them into our health systems, and pay them. During this crisis, community and religious organizations became a lifeline, but at a high cost to frontline workers — most of them minorities — who volunteered their time. A small crew of volunteers cannot make up for years of neglect,” the researchers concluded.
“These changes will require money, political capital, and strong leadership at a time when institutions are facing substantial economic challenges and the country is divided. But doing nothing will cost much more.”
This NEJM Perspective did such a great job of capturing the undocumented immigrant experience during COVID-19 pandemic.
Lessons We’ve Learned — Covid-19 and the Undocumented Latinx Community | NEJM https://t.co/LZ1H7lRNjr
— George Molina (@realgmolina) October 8, 2020
— Juan C Ivancevich MD (@Aller_MD) October 8, 2020