Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In the first of a two-part series, AMA Chief Experience Officer Todd Unger speaks with health care experts on the impact of COVID-19 on the Latinx community. National data shows an upward trend of confirmed cases in that community.
Learn more at the AMA COVID-19 resource center.
- Diana Lemos, PhD, MPH, senior program manager, strategy & development, Center for Health Equity, AMA
- Shari G. Chevez, MD, pediatrician and regional lead, equity, inclusion and diversity, Southern California Permanente Group (SCPMG)
- Luis E. Seija, MD, internal medicine and pediatrics resident, Icahn School of Medicine at Mount Sinai
Unger: Hello, this is the American Medical Association's COVID-19 update. This is part one of a two-part series on the impact of COVID-19 on the Latinx community. I'm joined today by Dr. Shari G. Chevez, a pediatrician and regional lead for equity, inclusion and diversity with the Southern California Permanente Group in Signal Hill, California, Dr. Diana Lemos, senior program manager of strategy and development for the AMA Center for Health Equity in Chicago, and Dr. Luis E. Seija, internal medicine and pediatrics resident at Icahn School of Medicine at Mount Sinai in New York. I'm Todd Unger, AMA's chief experience officer, in Chicago.
The Latinx community has been one of the hardest hit by COVID-19, while data on race and ethnicity is still lacking. Dr. Lemos, let's talk about the data. What is it telling us right now?
Dr. Lemos: Yes. So first, I want to acknowledge the term Latinx as a term that we're using to be inclusive of other terms, including Latino, Hispanic, and in many instances, the preference for national origin or ethnicity, so to the most that we can, we'll try to use Latinx, but sometimes we'll use Latino as an inclusive term as well. But what we're seeing and what we've seen looking at national data for the last few months is that we're seeing an upward trend in the number of confirmed cases amongst Latinx community, and in particularly, Latinx now account for 33.5% of all the cases nationwide, and this is in conjunction with the Black number of cases where now the majority of cases nationwide we're seeing this across states. 42 of the states, plus Washington DC, now report disproportionate number of cases.
What else we're also seeing is we're seeing an increasing burden of the mortality across the US, and particularly for four states, Illinois, Wisconsin, New York and Tennessee, and so this disproportionate impact of morbidity is really concerning us. We're trying to see and better understand the data gaps that continue to be present. I would just make one more point about the data. We continue to recognize there's a gap in the data, especially as it relates to how we capture mortality for Latinx and American Indian populations. There are significant reports and concerns that there might be an undercount given to oftentimes being attributed or coded as White or some other racial and ethic designation, so there is significant concern that the gap is greater than what we're seeing.
Unger: Dr. Chevez?
Dr. Chevez: Yes. Dr. Lemos, it's so interesting that we found at the beginning of the pandemic that the Latino number wasn't disparate. As Dr. Hayes-Bautista from UCLA quoted yesterday in the L.A. Times that Latinos are starting to show up in the numbers at this point, and there's no denying that the essential worker role that so many of our Latino people play in the United States in service, in production, in construction, in the maintenance industry, et cetera, the pandemic has placed a huge responsibility squarely on their backs, and they did not have the option to shelter at home. They were essential to keeping our United States going, and therefore we definitely are seeing the impact of that. They are now sick. They are now testing positive because of that role that they've played in our society.
Unger: Dr. Seija, is that matching up with your frontline experience in New York?
Dr. Seija: It definitely checks out. I think something that's very interesting is we didn't have the numbers upfront at the beginning. A lot of the numbers followed, especially the surge period, and so you print your list every morning and you're going through the names and a lot of recurring names are coming up, a lot of Spanish-speaking ones in particular. Where Mount Sinai is situated, we're located in East Harlem, and 10029 is the area code specifically, and it was the hardest hit in Manhattan, so we have a lot of Dominican, Puerto Rican, Mexican immigrants, undocumented, all the above, were the majority of our patient population.
Unger: How has the communication and messaging challenges contributed to the impact of COVID-19 on this community? Dr. Chevez?
Dr. Chevez: Well, and so that's such a good question because this cannot and should not be a one-size fits all, because our communities, particularly I'll speak to the Latinx community, not everyone is standing in the same spot. Not everyone has the ability to shelter at home. So when Safer at Home was announced and that is not an option, that then becomes impossible.
So there's an example that just of a woman who didn't want to go to work, but that wasn't an option. She works at a meat packing plant in LA. She's a mother. She lives in a one-bedroom apartment with her children and her husband. She got sick, and so she was told to quarantine, but quarantine for her may meant wrapping a bunk bed that her family shares in the bedroom in plastic and staying in that plastic, and reaching out to her son who has asthma who she's afraid she's going to get sick and giving him air hugs. So the thing, the concept Of shelter at home and quarantine and all of these things apply differently based on where you stand, particularly in the Latino community.
Unger: Dr. Lemos, Dr. Seija?
Dr. Lemos: Sure. I'd also like to add, when we started to listen in on what the experience of the Latinx community was, one of the things that, we spoke to various agencies and community-based organizations and physicians, was just a general invisibility of the messaging towards the Latino community or the Latinx community. As Dr. Chevez mentioned, there's diversity that's wide ranging, and so oftentimes what happens is we don't hear about the Latinx impact in the national media in some ways, and if we do, it's not culturally nuanced. So one of the challenges that we have is really identifying those trusted community folks and making sure that those messages are reaching the intended audiences.
In that assessment that we did, one of the concerns that came up is the delay in getting accurate information in Spanish and other languages, and so a lag of four to five days in translating materials about prevention, about who's at risk and how to protect yourself has really detrimental effects for those communities that need to reach and hear these messages.
Unger: Well, let's talk about how do you close those communication gaps? What are the strategies that Permanente has used, or Dr. Seija, that you've seen in New York?
Dr. Seija: So going back to the messaging in general, though, the one thing I will say is that the stay home, stay safe, while that sounds all good and dandy, it's very one-dimensional, and that's assuming a lot of things that come with that too, like you're going to be safe at home. But what if your home has 10 to 12 people in it, and one goes out to the grocery store and then brings it back? Are you now safe at home? And then the other thing too about messaging in general is that it's hard to get messaging out there for a process that we don't even fully understand ourselves, and that was the most difficult thing too because you'd have patients asking us what exactly is going on? Why am I not getting better? Sometimes that was the hardest part. We just don't have the answers for you.
So a lot of the things that we were doing, we were just kind of like throwing a dishwasher, I forgot what the phrase is, but you know, the dishwasher at the wall or whatever it is, but it was just like we're trying this, we're trying that, and we're just going to hope that it works. So you get mixed messaging from the medical side and then you get mixed messaging from the public health side. And then speaking to the translation part of it too, that gets lost in translation too, and so you have patients and families just going like this, and you have providers going like this, but we're doing the best that we can.
Dr. Lemos: At KP, at Kaiser Permanente, translation is basic. I mean, that is a must. It's not even a question, can these materials be translated? They must be translated, and we do our best to make that, that's a goal for the material to be released, that it's translated, at least in Spanish, and we try to do at least our top three languages, because there's others that need language assistance. It's very concerning. There's a section, I'm looking to a paper, 1557 of the ACA, that required that we do this, and now that has been repealed. That has been taken away.
Who is not going to receive this message through an online platform, through a telephone text, through a letter? How do we meet people where they are at and in the ways that they can receive the message? Because the message crafting is one thing, but if it doesn't land anywhere, it's like a pass in football, it's not caught. So those kinds of questions are helping us to be mindful of the 4.7 million people we're taking care of and the diversity that exists within that population.
Unger: Well, that concludes part one of our update on COVID-19 and its impact on the Latinx community. Thank you, Dr. Chevez, Dr. Lemos, and Dr. Seija, for being here today and sharing your perspectives. We'll be back on Monday to continue this important discussion with part two of our series. Thanks for joining us today and take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.