Culturally Competent awareness, action are critical for control of virus

The coronavirus pandemic has exacerbated the precarious daily struggle among Latinos for basic necessities. Latinos are at high risk of contracting coronavirus, yet, they are noticeably absent from testing, hospitalization, ICU treatment, death rate and recovery. Unless we address the realities presently compounding the virus’ effect upon the Latino community, the pandemic will create a destiny of deaths of despair.

According to the Ohio Department of Health, Latinos comprise 8% of Cuyahoga County residents, yet they account for over 15% of the Covid-19 deaths, based on my analysis of the available data. These data do not include City of Cleveland numbers.

Accurate data collection is elusive. Much of what is reported by Ohio Department of Health and the Cuyahoga County Board of Health does not include the number nor the rate per 1000,000 of Latino/Hispanics in the coronavirus protocols.

The underlying factors contributing to this overrepresentation of Latinos in COVID-19 mortality rates are vast and complicated. The following is a partial list of deeply rooted socio-economic inequities that contribute to the dismal compliance on stay at home and quarantine orders. 

Housing

Affordable housing is in short supply. The gentrification of the Clark/Fulton area where most Latinos live has decreased affordable housing and created a rise in rents of the existing housing stock that is often beyond the financial scope of many Latinos. With limited options, many families find themselves in crowded conditions with three or even four generations of children and adults living together in overcrowded apartments. Lack of adequate air conditioning in most rental units in the Clark/Fulton community will make compliance with stay-at-home and quarantine orders impossible for many. Forced to venture outside for relief from stifling overcrowded quarters, they become likely targets for citations or arrest by overzealous police officers.

Job loss

For most Latinos COVID-19 is not just a public health issue with genocidal implications, it is also an economic catastrophe. Latinos are overrepresented as health care workers. This includes behavioral health providers, home health workers, nursing home facilities and assisted living employees, emergency medical technicians (EMTs), housekeeping and others who work in healthcare and congregate living settings. Latinos are also widely employed as frontline workers in other essential fields, including childcare, public transportation, food industry and landscaping, where they cannot work from home.

Many of these jobs pay low wages [sometimes “under the table], lack sick day benefits and limited if access to preventative primary healthcare and health insurance. Employees must report to work or risk termination. But they are critical both to society and to the breadwinners who must pay rent and utilities, buy groceries, and other basic necessities. Any job loss or income reduction produces immediate and long term financial effects; increasing stress because of pending evictions, utility shutoffs, food insecurity and the erosion of interpersonal relations between parents, spouses/partners and children. Lack of money increases desperation and social isolation, along with negative mental health symptoms and their repercussions. 

Underlying health conditions

Latinos suffer from many existing underlying health conditions identified as high risk factors to contracting COVID-19. Moreover, Latino people are less likely to have access to quality health care, have higher rates of poverty and are concentrated in high risk jobs. We know that those who struggle with high blood pressure, cancer, diabetes, obesity,  and are over 65 years of age are at higher risk of contracting COVID-19. Latinos suffer from higher rates in all of these categories.

According to Covid-Net, CDC’s weekly publication of the characteristics of hospitalization of U.S. Covid-19 patients, for the week ending May 16, 2020, Latinos comprised 42% of U.S. patients ages 0-17, and 37% of ages 18-49. These data illustrate how COVID-19 has the potential to spread among the most vulnerable among marginalized communities. 

Messaging, awareness and education

Very little Spanish language COVID-19 awareness and educational information exists. MetroHealth Systems has a dedicated page on its website.

The Cleveland Department of Public Health [CDPH] has a Spanish flyer on its website and offers a COVID-19 package to those who have tested positive. CDPH reporting of COVID-19 positive cases does not identify any Latino/Hispanic cases, which complicates any efforts to get accurate numbers from the Latino community.

Ward 14 Council representative Jasmin Santana has organized several food and grocery distributions aimed at reducing food insecurity among mostly Spanish language-dominant Latino residents throughout Cleveland. The success of these efforts comes primarily because information is shared through word of mouth. This brings attention to Cleveland’s large digital divide. The lack of reliable internet service, affordability and access to computers will complicate the creation of a local messaging campaign to reach into the heart of Clark/Fulton Latino neighborhoods and surrounding city wards.

Testing

While testing is currently being offered at limited CVS and Rite Aid stores, neither chain provides testing at stores in Clark/Fulton. The chain’s stores closest that offer testing the Clark Fulton community are both in Parma, five to seven miles away.

Getting to Parma would only be a first step. To secure a test, residents must make an advance online appointment; bring the confirmation notice; obtain a physician’s eligibility notice; provide identification; be at least 18 years old; and drive up — no walk ups allowed.

Instructions with the test packages for the self-administered tests are provided in English at the drive up windows, a further challenge for Spanish dominant residents.

MetroHealth Systems on West 25^th Street offers testing according to their website, it does not provide instructions on where to go once on its formidable campus.

Cleveland Clinic Lutheran Hospital on 25^th Street offers COVID-19 testing only to existing patients with a Cleveland Clinic doctor’s order. Testing is typically scheduled within 24 hours. All emergency department walk-ins are evaluated, those experiencing symptoms are isolated and triaged by the COVID nurse.

The testing landscape changes rapidly. Testing sites are added and or deleted regularly. Suffice it to say that the current testing infrastructure is confusing and rife with barriers to adequate access.

Seroprevalence

Seroprevalence surveys  are a testing tool to identify people in a population or community that have antibodies against an infectious disease.

Presently, there is a lack of standardized and coordinated COVID-19 testing and protocols. There is an  inability of  government health officials to  obtain accurate data on ethnicity and race of those tested.  These factors, combined with the  failure to create a uniform multi-language messaging campaign, do not allow for the development of a model to obtain accurate and reliable seroprevalence rates among Latinos. As summer approaches and lockdowns are lifted, and self-quarantine and social distancing compliance wanes,  the lack of coordination, will make it increasingly difficult for an accurate count of Latino COVID-19 patients.  Any efforts to measure new occurrences of COVID-19 on individual and community transmissions, and intensity of the virus will be compromised.

Contact tracing

Generations of marginalized communities have had horrific experiences with appointed and elected government officials. Empty promises, discriminatory and racist interactions, and condescending and disrespectful communication have taken a toll.  This will make the creation of a contact tracing model very difficult to achieve. To a large degree, inquiries to obtain private information of everyone an infected person may have had physical contact with can be seen as intrusive. This natural wariness will be magnified in Latino communities where immigration status of individuals is closely guarded. Moreover, residents with outstanding warrants,  heavily in debt, or  family members, friends, or acquaintances with questionable experiences and behavior will most likely not appreciate being called out to authorities.

Contact tracing is in essence an investigation into one’s privacy, viewed by many as government overreach, and interpreted as another means of control and oppression.

Recommendations

This discussion is meant to highlight the developing crisis in the Latino community and to reinforce the understanding that in a pandemic, no group can be left outside.

In light of the challenges and needs of the Latino community, here are some specific recommendations that local governments, health care providers, and civic leaders should implement: 

Testing:

• Engage businesses and employers to provide or facilitate testing at work sites. This will allow for health care providers, community service organizations and businesses to gather more accurate data to contribute to the establishment of seroprevalence rates among Latinos.
• Free testing for those with or without Medicaid, Medicare or other insurance.
• Promote comprehensive testing day at or immediately after summer festivals, outings, events to measure spikes in contagion.

Messaging:

• Messaging campaign must have a long-term tagline that is relevant to Latinos.
• Spanish (Spanglish) language materials should be at fourth grade reading levels, and include succinct copy, and visuals and sketches that reflect the community [e.g., faith-based, schools, homes, shopping].
• Messaging campaign must be done in phases that correspond with external social norms, events and holidays.
• Study and replicate the ingredients that have been used in previous successful targeted campaigns. According to the Ohio Department of Health, 69.5% of Latinos in Cuyahoga County, reported receiving the Flu vaccination in 2019 — the only group in Cuyahoga County to achieve the national benchmark of 70%.
• Lobby state health officials to elevate and include racial and ethnic minorities to underlying health conditions to Priority 1.
• Conduct workshops with contact tracing imagery and flow charts to explain the seriousness of communication with friends and family.

Conclusion

It is imperative that public health institutions, hospitals, community health centers, faith-based organizations and all others who service Latinx residents insist on the collection and reporting of accurate data on race, ethnicity, gender and age. Although most public health officials believed that this first wave of COVID-19 would begin to wane in July and August, this is no longer the prevalent thought. The demonstrations across the country in response to the murder of George Floyd by Minneapolis police officers will mostly cause an expansion and extension of the first wave.  The second wave of COVID-19, which was expected to hit in upcoming Fall months, will be felt throughout winter, 2021.

The availability, amount, and process to access government funding and economic resources for our communities will be driven by data. If Latinos are not part of the science, we will find ourselves once again fighting for the leftover crumbs, not an equitable share.

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Juan Molina Crespo is a social worker who served as director of The Hispanic Alliance until his retirement last year.

Originally published June 4, 2020 on The Real Deal Press companion site. Updated May 3, 2021.