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Edith Abundis, a teacher at the Chicano Federation’s Child Development Center, got a call from her uncle in early May. He wasn’t feeling well.
A few days later, he was hospitalized with the coronavirus.
A few days after Abundis’ uncle went to the hospital, her aunt followed.
Abundis’ uncle passed away. He was 71 years old. Neither she nor her parents could attend the small funeral for fear of the virus.
Her aunt eventually recovered, was taken off a ventilator and is home, though she still needs oxygen. She didn’t know her husband had died until roughly a month later, because she, too, was in the hospital, unable to see her family.
“My best friend’s dad passed away from the virus, also,” Abundis said. “Now I am just so fearful.”
Abundis’ experience is indicative of the pandemic’s disproportionate impact on Latinos, who are more likely than other racial groups to contract, be hospitalized and die from COVID-19.
Although they make up 34 percent of San Diego County’s population, Latinos account for 62 percent of confirmed COVID-19 cases, 61 percent of hospitalizations and 45 percent of COVID deaths. The virus’ disproportionate impact on Latinos has exposed chronic disparities in health, housing and income throughout the county – issues that existed prior to the pandemic and have ultimately left Latinos more vulnerable to the virus.
Advocates and service providers who have long worked with Latinos say the pandemic’s disproportionate impact on the population was inevitable, and in order to address Latino infection rates, the county and state not only needed to invest in outreach and expanded testing, but provide solutions for some of the underlying issues that make Latinos more vulnerable, like job protections, financial and food assistance and housing solutions.
“This all comes down to the inequities that existed, and this virus has exacerbated those,” said Nancy Maldonado, CEO of the Chicano Federation. “It comes down to these structural inequities. What we’re witnessing right now are the devastating consequences of not addressing them and not taking them seriously.”
Kyra Greene, executive director of San Diego’s Center for Policy Initiatives, said the most impacted ZIP codes in the county have both high concentrations of Latinos and poverty. Many of those ZIP codes are in South Bay.
“It’s taken how extreme this disease is to highlight things that have always been challenges for some folks in our region,” Greene said.
The Essential Workers
Many essential and high-contact job sectors are also staffed disproportionately by Latinos, meaning many work in jobs that may expose them more to the virus – positions they can’t work remotely.
“A lot of these families are essential workers,” said Maldonado. “So their risk increases and then the exposure to their entire families.”
Latino employees are over-represented in grocery, convenience and drug stores, child care and social services, food service and retail, according to SANDAG data.
Compared with the White population, Black and Latino populations are four times as likely to live in areas that have been hit hard by both COVID-19 and unemployment, SANDAG found in a June report. Compared with the Asian population, they are twice as likely to reside in areas with high COVID-19 cases and high unemployment.
Latinos also experienced higher poverty rates overall, compared with poverty rates countywide, prior to the pandemic. This makes them more likely to experience things like food insecurity and lower wages, which means if they have been exposed to COVID or experience mild symptoms, they are often faced with a decision between not going to work or being able to put food on their family’s table.
“At the end of the day, they will choose to feed their families over their own health and safety,” Maldonado said.
Maldonado said that for these families, there need to be more wraparound services when someone tests positive.
“If someone is the sole bread winner in their family and tests positive, we need to have a support system in place, so they don’t have to go to work,” she said.
Abigail has been cleaning offices and hotels downtown for roughly 20 years. As the pandemic hit San Diego, she continued to go to work. She is a single mother and provides the sole income for her household. (Voice of San Diego is withholding Abigail’s full name because of her immigration status.)
“My colleagues and I were living in fear that we would get sick,” she said. “We were risking our health because we were essential workers.”
In May, Abigail’s fear turned into reality when she contracted COVID-19.
The struggle is particularly acute for unauthorized immigrant workers, like Abigail, who don’t have access to any unemployment or other benefits.
Abigail said she is lucky. She had savings and union support, which provided her job protections and health insurance when she was sick.
In May, the state began distributing one-time payments of between $500 and $1,000 to some unauthorized immigrants. By June, Jewish Family Service had distributed $5 million to 10,000 people in the region, KPBS reported.
But the one-time payments haven’t proven much for those who get sick or lose their jobs. Abigail did not receive state assistance.
“In reality, we have to continue to work to pay rent,” Abigail said. “We’re trying to make enough for food, to sustain our households. Some people have had their hours cut, are being paid less. But we get no help from the government.”
Latinos are also more likely than the county as a whole to live in crowded households.
During COVID times, that means when one person in a household gets sick, the disease can spread because family members can’t isolate in a room.
Roughly 6.7 percent of people in San Diego County live in households with more than one person per room, according to 2018 census data. For Latinos in the county, that number increases to 17 percent.
One of the most impacted ZIP codes includes the San Ysidro Elementary School District, which has some of the highest rates of student homelessness in the county, a measure that includes families living in overcrowded or substandard conditions.
“It’s difficult to have our parents quarantine and isolate if they have two families in an apartment,” said Ana Melgoza, the vice president of external affairs at San Ysidro Health. “Just that alone is difficult.”
Latino children are testing positive for the coronavirus at higher rates than other groups of children. Close contact with essential workers and crowded living conditions are to blame, CalMatters reported last month.
In situations where it is impossible to quarantine at home, people can call 211 or have their health care provider or community clinic help connect them to the county’s public health hotel rooms, where they can isolate free of cost, said Barbara Jimenez, director of the central and southern regions for the county’s Health and Human Services Agency.
But Melgoza said there hasn’t been a good connection between the county’s public health hotel room program and service providers on the front lines with these families, which has made moving individuals and families to those rooms difficult.
It’s difficult to gauge how many Latino families are actually using the hotel rooms, though.
Of 1,272 people who have utilized the county public health hotel rooms 282 self-identified as Latino, according to data provided by the county. This data is largely incomplete, though, because the majority of occupants – 736 – did not report their ethnicity. The county also provided what language and translation request data was available, which showed 155 Spanish-speakers using the rooms.
Existing Health Disparities
Before the pandemic, Latinos already had relatively high rates of several health conditions like asthma, hypertension, diabetes and heart disease that put them at greater risk of contracting COVID-19 and experiencing more severe symptoms.
Rates of diabetes and asthma were notably higher among Latinos compared with the county overall, according to a 2016 county report. Rates of some communicable diseases, like the flu and pneumonia, were higher among Latinos than in the county overall, with Latinos in south county experiencing the highest rate among Latinos.
The same report also noted that in 2011, only 37 percent of Latino adults and children between six months and 11 years old said they had been vaccinated for the flu.
A 2014 county Community Health Assessment for the South Bay found that rates of diabetes death, hospitalization and emergency department discharges in the region were higher among Latinos here than in other regions. Rates of heart disease deaths were also higher in communities of color in the southern parts of the county, the assessment found.
The county has been working to address the health disparities for years, said Jimenez.
“Many of these key issues are not new,” Jimenez said. “These are areas that we have been working on, in particularly South County – rates of diabetes, obesity, unemployment factors and housing factors.”
The health realities not only put Latinos in the South Bay at risk of experiencing more dire outcomes with COVID-19, they could also create problems if people don’t seek treatment for those conditions out of fear of the virus.
Ensuring that patients continue to get treatment for chronic conditions, like heart disease and hypertension, has been a priority for San Ysidro Health during the pandemic, said Dr. Maria Carriedo-Ceniceros, the organization’s chief medical officer.
Carriedo-Ceniceros is also concerned about a wave of children who won’t be vaccinated because their parents are fearful of coming to the doctor’s office during the pandemic.
“Why we’re more impacted by COVID-19 really goes back to the whole issue of existing health disparities in our community,” Carriedo-Ceniceros said. “We serve a population that has high rates of diabetes, heart disease, hypertension. All of those have a high correlation with worse outcomes if a person contracts COVID.”
Greene, the Center for Policy Initiatives executive director, divides the reasons as to why Latinos have been so highly impacted into two categories: challenges that existed pre-COVID that are exacerbated by the virus – like poverty and health issues – and challenges related to the way governments addressed COVID.
Advocates and service providers have noted a lack of outreach to the Latino community in the early stages of the pandemic to ensure they had information about the virus, how it could spread and what assistance may be available to them. Greene said while outreach has significantly improved, it was lacking in the pandemic’s early days.
The county could also have ramped up enforcement among employers earlier to help prevent the spread of the virus among essential workers, many of whom are Latino, Greene said. It wasn’t always clear how a worker who felt pressure to show up to work could report that their working conditions were unsafe. Workers who walk off their job are not eligible for unemployment benefits.
The county only recently announced amped up enforcement efforts, like a call center where people can submit complaints.
“I’m glad to see the county step up,” Maldonado said. “We just wish it would’ve happened sooner.”
While Latinos make up 62 percent of COVID-19 cases, only 12.8 percent of county contact tracers – the workers who investigate where sick people have been and reach out to people who might have come into contact with them – and 14.6 percent of public health investigators speak Spanish, according to county data. The county data only reflects county employees and does not include roughly 100 additional contact tracers who have been hired as contractors.
Jimenez said a major focus of hers has been to get information out via radio, television, fliers and word of mouth, through community leaders and promotores. She also said the county has been trying to make clear that in getting tested, accessing public health hotel rooms and speaking with contact tracers that no one will be asked about their immigration status.
“As a Latina and someone who grew up in South Bay, the way me, my mother and my neighbor receive information will all be different,” Jimenez said. “The ongoing effort to share the resources and information is really important.”