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For Latinos and Covid-19, Doctors Are Seeing an ‘Alarming’ Disparity For Latinos and Covid-19, Doctors Are Seeing an ‘Alarming’ Disparity
(25 days later)
Dr. Eva Galvez works as a family physician for a network of clinics in northwestern Oregon, where low-income patients have been streaming in for nasal swabs over the past several weeks to test for the coronavirus.Dr. Eva Galvez works as a family physician for a network of clinics in northwestern Oregon, where low-income patients have been streaming in for nasal swabs over the past several weeks to test for the coronavirus.
Dr. Galvez was dumbfounded by the results. Latinos, about half of those screened, were 20 times as likely as other patients to have the virus.Dr. Galvez was dumbfounded by the results. Latinos, about half of those screened, were 20 times as likely as other patients to have the virus.
“The disparity really alarmed me,” said Dr. Galvez, who began trying to understand what could account for the difference.“The disparity really alarmed me,” said Dr. Galvez, who began trying to understand what could account for the difference.
It is a question that epidemiologists around the country are examining as more and more evidence emerges that the coronavirus is impacting Latinos, and some other groups, including African-Americans, with particular force.It is a question that epidemiologists around the country are examining as more and more evidence emerges that the coronavirus is impacting Latinos, and some other groups, including African-Americans, with particular force.
Oregon is one of many states where Latinos are showing a disproportionate level of impact, and the effects are seen among both immigrants and Latinos from multigenerational American families.Oregon is one of many states where Latinos are showing a disproportionate level of impact, and the effects are seen among both immigrants and Latinos from multigenerational American families.
In Iowa, Latinos account for more than 20 percent of coronavirus cases though they are only 6 percent of the population. Latinos in Washington State make up 13 percent of the population but 31 percent of cases. In Florida, they are just over a quarter of the population but account for two of every five virus cases where ethnicity is known.In Iowa, Latinos account for more than 20 percent of coronavirus cases though they are only 6 percent of the population. Latinos in Washington State make up 13 percent of the population but 31 percent of cases. In Florida, they are just over a quarter of the population but account for two of every five virus cases where ethnicity is known.
Because most of the clients at the Virginia Garcia Memorial Health Center clinics in Oregon are relatively poor whatever their ethnic background, Dr. Galvez decided that income could not explain the disparity.Because most of the clients at the Virginia Garcia Memorial Health Center clinics in Oregon are relatively poor whatever their ethnic background, Dr. Galvez decided that income could not explain the disparity.
Public health experts say Latinos may be more vulnerable to the virus as a result of the same factors that have put minorities at risk across the country. Many have low-paying service jobs that require them to work through the pandemic, interacting with the public. A large number also lack access to health care, which contributes to higher rates of diabetes and other conditions that can worsen infections.Public health experts say Latinos may be more vulnerable to the virus as a result of the same factors that have put minorities at risk across the country. Many have low-paying service jobs that require them to work through the pandemic, interacting with the public. A large number also lack access to health care, which contributes to higher rates of diabetes and other conditions that can worsen infections.
Oregon last month expanded testing criteria to prioritize Latinos and other minorities, citing the higher risk posed from the virus because of “longstanding social and health inequities.”Oregon last month expanded testing criteria to prioritize Latinos and other minorities, citing the higher risk posed from the virus because of “longstanding social and health inequities.”
At the Virginia Garcia clinics, Dr. Galvez sees those inequities among her patients every day.At the Virginia Garcia clinics, Dr. Galvez sees those inequities among her patients every day.
“We realized that it must be how Latinos live and work that’s driving these disparities,” said Dr. Galvez, who works at the clinic in Hillsboro, outside Portland.“We realized that it must be how Latinos live and work that’s driving these disparities,” said Dr. Galvez, who works at the clinic in Hillsboro, outside Portland.
The Hispanic patients, many of them immigrants, help produce some of the country’s premier pinot noir, maintain Nike’s sprawling headquarters and plant berries, hazelnuts and Christmas trees in the Willamette Valley. Others are seasonal workers who are expected to begin arriving by the thousands later this month for the harvest.The Hispanic patients, many of them immigrants, help produce some of the country’s premier pinot noir, maintain Nike’s sprawling headquarters and plant berries, hazelnuts and Christmas trees in the Willamette Valley. Others are seasonal workers who are expected to begin arriving by the thousands later this month for the harvest.
They live in close quarters, often multiple families to a house or with several farmworkers crowded into a barracks-style room, where social distancing and self-isolation are impossible. They perform jobs that require interaction with the general public, in food service, transportation and delivery; and some also work in meatpacking plants that have emerged as major hot spots.They live in close quarters, often multiple families to a house or with several farmworkers crowded into a barracks-style room, where social distancing and self-isolation are impossible. They perform jobs that require interaction with the general public, in food service, transportation and delivery; and some also work in meatpacking plants that have emerged as major hot spots.
If they are undocumented, they cannot collect unemployment, which may compel them to work even when they feel unwell, facilitating the spread to their co-workers.If they are undocumented, they cannot collect unemployment, which may compel them to work even when they feel unwell, facilitating the spread to their co-workers.
Carlos, an undocumented Guatemalan who was one of the clinic’s patients, never stopped reporting to his job cleaning large supermarkets, even after he began coughing and feeling ill, said his wife, Blanca, who did not want the family’s last name to be published because of their immigration status.Carlos, an undocumented Guatemalan who was one of the clinic’s patients, never stopped reporting to his job cleaning large supermarkets, even after he began coughing and feeling ill, said his wife, Blanca, who did not want the family’s last name to be published because of their immigration status.
Her husband medicated himself on cough syrup, but his condition quickly deteriorated, and he was gasping for air when she finally rushed him to the hospital. He died on April 1 from Covid-19. Now Blanca, her brother and the couple’s 13-year-old son have all tested positive for the virus.Her husband medicated himself on cough syrup, but his condition quickly deteriorated, and he was gasping for air when she finally rushed him to the hospital. He died on April 1 from Covid-19. Now Blanca, her brother and the couple’s 13-year-old son have all tested positive for the virus.
The situation at the clinics in northwestern Oregon tells only part of the story of the nation’s 60 million Latinos, who represent a wide range of backgrounds and lifestyles — new immigrants and multigenerational families, high-earning professionals and poor migrant farmworkers — and the effects of the coronavirus already reflect that broad experience.The situation at the clinics in northwestern Oregon tells only part of the story of the nation’s 60 million Latinos, who represent a wide range of backgrounds and lifestyles — new immigrants and multigenerational families, high-earning professionals and poor migrant farmworkers — and the effects of the coronavirus already reflect that broad experience.
The disparities are bigger in states like Oregon, Washington and Utah that have newer and less-established Latino communities, compared with states like California, Arizona and New Mexico. In some states, including Arizona and Texas, state data shows that Latinos are getting sick at rates close to their share of population. In New Mexico, Latinos, who make up half the population and have a long history in the state, have about the same number of cases relative to their population as whites.The disparities are bigger in states like Oregon, Washington and Utah that have newer and less-established Latino communities, compared with states like California, Arizona and New Mexico. In some states, including Arizona and Texas, state data shows that Latinos are getting sick at rates close to their share of population. In New Mexico, Latinos, who make up half the population and have a long history in the state, have about the same number of cases relative to their population as whites.
“Not all Latinos are created equal,” said Daniel López-Cevallos, professor of Latino and health equity studies at Oregon State University. More Latinos in states with established communities, he said, are likely to have middle-class jobs or the sort of wealth that could help tide them over through the pandemic without having to work outside the home.“Not all Latinos are created equal,” said Daniel López-Cevallos, professor of Latino and health equity studies at Oregon State University. More Latinos in states with established communities, he said, are likely to have middle-class jobs or the sort of wealth that could help tide them over through the pandemic without having to work outside the home.
By contrast, those in places like Oregon and Washington “tend to be lower income, with lower educational levels, lower levels of health insurance and more employment in essential services,” Mr. López-Cevallos said. “They have fewer support systems in place.”By contrast, those in places like Oregon and Washington “tend to be lower income, with lower educational levels, lower levels of health insurance and more employment in essential services,” Mr. López-Cevallos said. “They have fewer support systems in place.”
According to a Pew Research Center survey in April, about half of the Latinos questioned said they or someone in their household had either lost a job or taken a pay cut, or both, because of the outbreak — compared with a third of all adults in the United States.According to a Pew Research Center survey in April, about half of the Latinos questioned said they or someone in their household had either lost a job or taken a pay cut, or both, because of the outbreak — compared with a third of all adults in the United States.
The data from a number of states takes an unexpected turn: It indicates that even though Latinos may have higher rates of infection, they have been dying from the virus at lower reported rates over all than other groups.The data from a number of states takes an unexpected turn: It indicates that even though Latinos may have higher rates of infection, they have been dying from the virus at lower reported rates over all than other groups.
But experts say those raw numbers understate the risks for those who become sick, because they do not take into account that the Latino population — the country’s second-largest ethnic group — is significantly younger than other groups. And there have been much fewer deaths among the young from a virus whose lethality grows sharply with its victims’ age.But experts say those raw numbers understate the risks for those who become sick, because they do not take into account that the Latino population — the country’s second-largest ethnic group — is significantly younger than other groups. And there have been much fewer deaths among the young from a virus whose lethality grows sharply with its victims’ age.
But among adult Latinos, fatality rates can be much higher. That was what officials in California found when they took a closer look.But among adult Latinos, fatality rates can be much higher. That was what officials in California found when they took a closer look.
There, Latinos, who are 39 percent of the population, account for almost half of all reported virus cases but only 35 percent of deaths — placing their overall death rate slightly below that of whites who are not Hispanic.There, Latinos, who are 39 percent of the population, account for almost half of all reported virus cases but only 35 percent of deaths — placing their overall death rate slightly below that of whites who are not Hispanic.
But when California public health officials drilled down further, they found that in every age group over 17, Latinos were dying at significantly higher rates than whites — as were African-Americans.But when California public health officials drilled down further, they found that in every age group over 17, Latinos were dying at significantly higher rates than whites — as were African-Americans.
Even in Oregon, Latinos have not appeared to be equally vulnerable to the impacts of the virus. Dr. Galvez, who is Mexican-American, lives in a middle-class neighborhood. “My close friends and family have not been hit by Covid the way the community that I care for has,” she said.Even in Oregon, Latinos have not appeared to be equally vulnerable to the impacts of the virus. Dr. Galvez, who is Mexican-American, lives in a middle-class neighborhood. “My close friends and family have not been hit by Covid the way the community that I care for has,” she said.
Before Oregonians were ordered to stay home on March 23, the Virginia Garcia clinic had started a campaign to educate Spanish-speaking clients about who was at risk of contracting the virus and how to prevent it.Before Oregonians were ordered to stay home on March 23, the Virginia Garcia clinic had started a campaign to educate Spanish-speaking clients about who was at risk of contracting the virus and how to prevent it.
Bilingual posters went up at the clinics, fliers were distributed and Dr. Galvez recorded a public service announcement that aired on a local Spanish radio station.Bilingual posters went up at the clinics, fliers were distributed and Dr. Galvez recorded a public service announcement that aired on a local Spanish radio station.
Updated June 1, 2020
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
But she and other clinic staff members, who confer daily on Zoom about the pandemic, would eventually conclude that having knowledge of the virus did not mitigate its spread among people who are unable to self-isolate and cannot afford to miss a day’s work.But she and other clinic staff members, who confer daily on Zoom about the pandemic, would eventually conclude that having knowledge of the virus did not mitigate its spread among people who are unable to self-isolate and cannot afford to miss a day’s work.
On March 11, Virginia Garcia began screening patients with symptoms of the virus at seven sites.On March 11, Virginia Garcia began screening patients with symptoms of the virus at seven sites.
So far, the clinic has tested 397 Hispanics and 281 non-Hispanics in Washington County and neighboring Yamhill County, another agricultural hub. A total of 87 Hispanics, 21.9 percent, have tested positive, compared with three non-Hispanics, or 1.1 percent.So far, the clinic has tested 397 Hispanics and 281 non-Hispanics in Washington County and neighboring Yamhill County, another agricultural hub. A total of 87 Hispanics, 21.9 percent, have tested positive, compared with three non-Hispanics, or 1.1 percent.
Hazel Wheeler, a manager at the clinic who has analyzed the data, deemed the results “confounding.”Hazel Wheeler, a manager at the clinic who has analyzed the data, deemed the results “confounding.”
“We serve poor people, who live in the same geographical area and make about the same amount of money,” he said.“We serve poor people, who live in the same geographical area and make about the same amount of money,” he said.
But there were deeper distinguishing factors.But there were deeper distinguishing factors.
Most non-Hispanics whom the clinic has tested have been working from home, or staying home because they have been furloughed or laid off, typically with unemployment benefits. They were able to keep distance from everyone but immediate family members.Most non-Hispanics whom the clinic has tested have been working from home, or staying home because they have been furloughed or laid off, typically with unemployment benefits. They were able to keep distance from everyone but immediate family members.
The majority of Latino patients, on the other hand, have remained on front-line jobs, and many are residing in crowded or precarious dwellings.The majority of Latino patients, on the other hand, have remained on front-line jobs, and many are residing in crowded or precarious dwellings.
Rafael Castillo, a 37-year-old mason, learned he had the coronavirus recently along with two fellow Latinos on his construction crew.Rafael Castillo, a 37-year-old mason, learned he had the coronavirus recently along with two fellow Latinos on his construction crew.
“The truth is, I don’t know how we got infected,” said Mr. Castillo, a Mexican green-card holder who has lived in the United States for two decades. “When this illness started, our boss told us to work apart. We used hand sanitizer and washed our hands,” he said.“The truth is, I don’t know how we got infected,” said Mr. Castillo, a Mexican green-card holder who has lived in the United States for two decades. “When this illness started, our boss told us to work apart. We used hand sanitizer and washed our hands,” he said.
Since he tested positive, his wife, Yanet Gonzalez, has also contracted the virus. Now Mr. Castillo, who earns about $3,500 a month and lives in a mobile home, said his main concern was keeping his two children healthy. The family shares one shower in a mobile home in Cornelius, Ore., which they try to disinfect after each use.Since he tested positive, his wife, Yanet Gonzalez, has also contracted the virus. Now Mr. Castillo, who earns about $3,500 a month and lives in a mobile home, said his main concern was keeping his two children healthy. The family shares one shower in a mobile home in Cornelius, Ore., which they try to disinfect after each use.
As they treat an ever-larger numbers of patients, Virginia Garcia medical workers are now worrying about the prospect of a second wave of infection when the annual harvest gets underway later in May.As they treat an ever-larger numbers of patients, Virginia Garcia medical workers are now worrying about the prospect of a second wave of infection when the annual harvest gets underway later in May.
By some estimates, the picking season for berries, pears and other crops brings 160,000 Latino seasonal farmworkers to Oregon. They toil side by side in fields and orchards during the day and bunk in crowded spaces at night, creating a fertile environment for the virus to spread.By some estimates, the picking season for berries, pears and other crops brings 160,000 Latino seasonal farmworkers to Oregon. They toil side by side in fields and orchards during the day and bunk in crowded spaces at night, creating a fertile environment for the virus to spread.
A preview of what could happen surfaced in April in central Washington State: Half of the workers at a large orchard tested positive for the coronavirus, even though none had shown symptoms.A preview of what could happen surfaced in April in central Washington State: Half of the workers at a large orchard tested positive for the coronavirus, even though none had shown symptoms.
The findings caught the attention of Oregon’s Occupational Safety and Health Administration, or OSHA, which last week introduced a series of measures to protect migrant farmworkers after Dr. Galvez and a nonprofit law center sought changes.The findings caught the attention of Oregon’s Occupational Safety and Health Administration, or OSHA, which last week introduced a series of measures to protect migrant farmworkers after Dr. Galvez and a nonprofit law center sought changes.
The state agency ordered growers to reconfigure worker housing to eliminate bunk beds for workers not part of the same family and to require at least six feet of space or an impermeable barrier between workers while they sleep. Growers are also required to designate an officer to enforce at least six feet of separation during work, breaks and meals.The state agency ordered growers to reconfigure worker housing to eliminate bunk beds for workers not part of the same family and to require at least six feet of space or an impermeable barrier between workers while they sleep. Growers are also required to designate an officer to enforce at least six feet of separation during work, breaks and meals.
The emergency mandates drew protests from growers who said the rules could cut the amount of housing available for farmworkers and help put many growers out of business.The emergency mandates drew protests from growers who said the rules could cut the amount of housing available for farmworkers and help put many growers out of business.
“Many farms will not survive the cumulative weight of these unattainable rules, which are more burdensome than any set for other sectors of Oregon’s economy,” the Oregon Farm Bureau said.“Many farms will not survive the cumulative weight of these unattainable rules, which are more burdensome than any set for other sectors of Oregon’s economy,” the Oregon Farm Bureau said.
State officials acknowledged that the emergency measures, in effect for six months, are unlike any other action taken by the state in recent history. But they said they were necessary to protect Latino migrants and the greater community.State officials acknowledged that the emergency measures, in effect for six months, are unlike any other action taken by the state in recent history. But they said they were necessary to protect Latino migrants and the greater community.
Michael Wood, the top administrator for Oregon’s OSHA, said he hoped the rules would help avert the possibility that the virus tears through the picking season that runs until fall.Michael Wood, the top administrator for Oregon’s OSHA, said he hoped the rules would help avert the possibility that the virus tears through the picking season that runs until fall.
“You cannot telecommute to harvest crops,” he said.“You cannot telecommute to harvest crops,” he said.