Patients said they would be more likely to respond to public health messaging if it came from people they know.
Despite the devastating impacts of the COVID-19 pandemic, many Latinx patients avoid or delay seeking medical care due to financial constraints, misinformation, and fears about immigration implications, according to a new report.
The investigation, published in JAMA Network Open, suggests tailored public health messaging and policy interventions are necessary to contain community spread and reduce unnecessary morbidity within the Latinx population.
COVID-19 has led to more than 29 million infections and more than 500,000 deaths in the United States, according to some estimates, but the data also show that patients in certain racial and ethnic groups are overrepresented among cases and fatalities. Lilia Cervantes, MD, of Denver Health and the University of Colorado, and colleagues, noted that Latinx people are more likely to be infected, hospitalized, and to die of COVID-19 compared to White individuals.
In an effort to better understand the causes of the disparities, Cervantes and colleagues conducted semistructured interviews of 60 Latinx adults who were hospitalized in public hospitals in Denver and San Francisco between March and July 2020. Both cities had significantly higher rates of COVID-19 among Latinx individuals compared to the overall population. The interviews were conducted by telephone in English or Spanish, and then analyzed to identify themes.
Most of the patients were classified as essential workers (73%) and few had work situations that enabled them to stay home; just 4 participants could work from home and only 12 patients (20%) had sick leave. More than one-third of patients (21; 35%) lost their job due to the pandemic.
The analysis identified 5 themes from the interviews that have public health information. For instance, some patients minimized the threat of COVID-19 due to social norms, misinformation, or a feeling that the dangers of the pandemic were exaggerated.
Another theme was that the pandemic compounded already existing social disadvantages. In addition to job insecurity, many patients lived in high-density housing, making it more difficult to socially distance.
Some patients said they did not seek care due to a lack of insurance, worry about costs, or fear that they might be deported if the hospital asked about their immigration status.
“Colorado and California are considered sanctuary states, yet undocumented immigrants were fearful of coming to the hospital and being turned away because they are undocumented, or of being deported,” Cervantes told Contagion Live.
Once in a healthcare setting patients said they often felt lonely and isolated and wanted more interaction. They also reported appreciation for clinicians and for translation services.
“Although many patients were hesitant to seek medical care, once in the hospital, patients were very grateful for the care that they received and were particularly grateful for the culturally responsive care and access to language interpreters and language-concordant clinical staff,” she said.
However, many said they felt distressed at discharge because they could not afford follow-up care such as oxygen supplies or physical therapy.
Lastly, the interviews found many patients in the Latinx community relied on faith and spirituality during their ordeals, and many patients subsequently became advocates for COVID-19 public health measures in their communities.
Cervantes said one important finding is that when it comes to public health messaging, the messenger matters.
“Some of the patients I connected with over the phone also said that their community might be more open to protecting themselves and receiving the COVID-19 vaccine if the information came from the community and trusted individuals,” she said.
Cervantes referenced one respondent who said patients tend to downplay generic public service announcements, but would likely respond to testimonials from people in their own communities.
“[I]f we see people that we know with COVID, then we believe what is happening,” the patient said.
Cervantes said she is hopeful that increased awareness of such disparities will translate into better public health programs. She noted that the Colorado Department of Public Health and Environment has launched a program called COVID-19 Equity Champions, which leverages clinicians who are racial and ethnic minorities to engage with community groups through town halls and talks. Similar programs are also being launched in California, she said.
“There are also more safeguards in Colorado, California, and throughout the rest of the country for undocumented immigrants because states have realized that to reduce community spread, they need to provide protections for undocumented immigrants,” she said.
Cervantes said she also hopes federal immigration reforms will help rebuild trust between the Latinx community and public agencies.