José Alberto Arévalo, MD, FAAFP; Sergio Aguilar-Gaxiola, MD, PhD, MS; and Bobby Pena
Focus on Health Equity
COVID-19 is Affecting California’s Latinx Community at an Alarming Rate As COVID-19 continues transforming our society as an everyday reality, it is also exposing glaring and pervasive social and structural inequities in our broken health care system and disproportionately affecting underserved Latinx communities in California. The Latinx population, which accounts for 39 percent of California’s total population, is the most affected by COVID-19. With a significant number of Latinx people employed in jobs that are essential and often not amenable to wearing appropriate personal protective equipment and maintaining adequate physical distancing, their numbers of cases and deaths continue to rise. Being essential workers and having to work regardless of high risk of infection, lack of health insurance, exposure to discrimination and exclusion, and fear and mistrust of government, they are risking their own health and lives in order to meet our state’s and nation’s needs. According to the California Department of Public Health , as of August 28, 2020, more than 275,000 Latinx cases of COVID-19 have been identified, more than three-and-a-half times as many cases as Whites. To-date, Latinx represent 59.9 percent of COVID-19 cases and 48.4 percent of all deaths. Among children ages 0-17, only 8.8 percent of COVID-19 cases are White, whereas 72.3 percent of children and youth cases are Latinx. Almost four out of five deaths in the 35-49 age group are Latinx. Latinx older adults between ages 65-79 have been reported to suffer twice the death rate (67.3 percent) compared to their California representation (32.2 percent). With regards to hospitalizations due to the coronavirus, Latinx people are hospitalized at four times the rate of White Americans and Latinx children at eight times the rates of Whites. This disturbing impact and the related fear have led to an alarming reality, a recent Centers for Disease Control and Prevention survey showed that higher percentages of Latino and Black respondents had seriously considered suicide in the past 30 days. Three main factors help explain the steep surge in disproportionate cases of COVID-19 and death rates among the Latinx population in California: 1. The Latinx community including immigrants are overrepresented as essential workers in agricultural, health, infrastructure, manufacturing, service, food, and safety sectors increasing their vulnerability to infection 22
California Family Physician Fall 2020
due to close working quarters and inadequate personal protection equipment; The Latinx community are among the most socially and economically disadvantaged people living in overcrowded, mutigenerational households and are unable to safely isolate to reduce transmission of the virus; and The Latinx community lacks adequate health insurance coverage as well as access to public assistance (e.g., Medi-Cal and Medicare) benefits, which increases their vulnerability to COVID-19 and severe co-morbid disabling conditions such as diabetes, heart disease, hypertension, and obesity increasing their vulnerability to COVID-19.
According to data from the Centers for Disease Control and Prevention, there is a significant disparity in the number of COVID-19 cases in general, and deaths that underscores structural inequities closely associated with the pandemic. Fear, stigma, or simply not getting accurate information about COVID-19 and testing can be major barriers for Latinx communities to receive access to appropriate safety and avoidance precautions, testing and necessary treatment. Communicating COVID-19 information in Spanish, and in some rural regions indigenous languages (e.g., mixteco, zapoteco, triqui), and using appropriate trusted platforms to disseminate essential information like Radio Bilingue, Mexican Consulates and other key community partners throughout California is critical to dispel fears and provide accurate and easy to understand information. Sadly, an enduring history of mistrust of government and healthcare institutions built on decades of neglect and abuse, most recently the federal anti-immigrant, anti-Latino language, and separating families at the U.S. border, has exacerbated a climate of fear and silence around the Coronavirus. Recommendations: • Outreach and engagement. Work with promotoras, Latinx physicians and healthcare professionals and other trusted, engaged community partners who are frontline public health workers and are trusted members of the community or have an unusually close understanding of the community they serve, with shared lived experiences. Enlist people who speak the same language and understand cultural issues to disseminate reliable information about