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Why Latinx People Are Hospitalized From COVID-19 At 4 Times The Rate Of Whites

Jul 1, 2020
Originally published on July 9, 2020 5:58 am

As COVID-19 continues to sweep the nation, Latinx people are among those who are being hit the hardest.

"I would equate what we've seen with the Latino population as kind of the perfect storm," said Dr. Joseph Betancourt, the vice president and chief equity and inclusion officer at Massachusetts General Hospital, in an interview with NPR's Morning Edition.

According to the Centers for Disease Control and Prevention, Latinx people in the U.S. are hospitalized from the virus at four times the rate of white people.

"If you equate it to a fire, to really have a bad fire there are three components to it: You have to have the substrate, so the set of conditions that would be very flammable with the spark, you have to have a spark, and you have to have material around it that makes the spread of the fire move extensively and quickly," Betancourt said. "And I think in the case of the Latino population, we see all three of those kind of coming together to create this perfect storm."

The set of underlying conditions that Betancourt referred to includes everything from Latinx people being more likely to have preexisting conditions such as diabetes to having less access to care to a hesitation to engage with the health care system.

Daniel López-Cevallos, a professor at Oregon State University who studies how health disparities affect Latinx communities, told NPR that another reason Latinx people are more at risk is that they're less likely to trust the government.

A 2019 report from the Pew Research Center shows that Latinx people are half as likely to trust the government as white people. López-Cevallos called it a "systematic erosion of trust in federal government and other social institutions as a consequence of what we have seen — anti-immigrant, anti-Latino rhetoric over the last few years."

It is because of these compounding factors, Betancourt said, that Latinx people are "coming into the pandemic with these disadvantages."

Those disadvantages hit Latinx communities with such force in part because the virus has a prolonged asymptomatic period and spreads very easily, according to Betancourt.

The spread, or "the conditions that make that spark really catch on," as Betancourt puts it, includes the fact that Latinx people are more likely to live in places that are densely populated, which makes social distancing more difficult. They are also more likely to live in multigenerational homes, which, according to the CDC, can make it more difficult to "protect older family members or isolate those who are sick." Latinx people are also less likely to be able to work from home than their white peers.

"So that's these sets of factors: the substrate that put them at a disadvantage, a spark that particularly made these conditions problematic and then a series of factors that I think led to spread," Betancourt said, adding that these factors "all explain why this has been a pandemic that has disproportionately impacted Latino populations and communities of color around our country."

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NOEL KING, HOST:

Right now we're seeing around 40,000 diagnosed cases of COVID-19 every day in this country. That is a lot. But Dr. Anthony Fauci said yesterday that could rise to 100,000 new cases a day.

(SOUNDBITE OF ARCHIVED RECORDING)

ANTHONY FAUCI: I think it's important to tell you and the American public that I'm very concerned because it could get very bad.

KING: For some communities, it is worse than others. We know that people of color are being hit the hardest. The CDC says Latinos are hospitalized from the virus at four times the rate of white Americans. Why is that? Here to help us answer - Dr. Joseph Betancourt. He's the vice president and chief equity and inclusion officer at Massachusetts General Hospital. Good morning, doctor.

JOSEPH BETANCOURT: Good morning. Thanks for having me.

KING: We're happy to have you. A statistic that's being widely reported, which is staggering when you think about it - 26% of people who've died of COVID in this country are Latino. Now, that's clearly disproportionate. What is happening?

BETANCOURT: That's a great question. And I think, you know, I've had a real bird's-eye view to this. I'm originally from Puerto Rico - care for a large amount of Latino patients here in Boston at Mass General Hospital and, also, had a chance to both engage in activities at the community level related to COVID and at the bedside.

And I think, ultimately, I would equate what we've seen with the Latino population as kind of the perfect storm or the perfect set of kind of characteristics for a really bad fire - right? - if you equate it to a fire. And to really have a bad fire, there's three components to it. You have to have the substrate, right? So the set of conditions that, you know, would be very flammable with the spark. You have to have a spark. And you have to have, you know, material around it that makes the spread of the fire kind of, you know, just go - you know, move extensively and quickly. And I think in the case of the Latino population, we see all three of those kind of coming together to create this perfect storm.

And it's not just here in places like Chelsea, Mass. We see it in Queens, New York, and we see it now out West. But those things include, from a substrate standpoint, a population that comes into COVID with a higher burden of disease, less access to care, subject to immigration policies and concerns around public charge that make them hesitant to want to engage with the health care system and language barriers. So now you're coming into the pandemic with these disadvantages.

You then have the spark, a virus that spreads very, very easily, and there's a prolonged asymptomatic period for spreads. So, literally, you could be spreading this without even knowing. And then you have the spread, the conditions that make that spark really kind of catch on and the fire spread. And that includes Latinos in this country tending to live in environments which are more densely populated, tend to have more extended families in the home to help with child care and even more so in COVID, where child care was especially an issue, as kids weren't able to go to school.

You had a large Latino population who are essential workers, who didn't have the luxury to social distance, had to - couldn't - you know, couldn't work from home, couldn't get their groceries delivered, had to take public transportation at a time, I'll add, when we were telling people they didn't need to wear masks.

And so that's the sets of factors - the substrate that put them at a disadvantage, a spark that particularly made these conditions problematic and then a series of factors that, I think, led to spread - all explain why this has been a pandemic that has disproportionately impacted Latino populations and communities of color around our country.

KING: A question I imagine to be on the top of your mind is, if you look at that set of factors, what are the ones we can do something about as a country and for you in the medical profession? And what are the ones that we can't?

BETANCOURT: Yeah, it's a great question. I mean, you know, the spark is unique. You know, coronavirus, COVID is a unique spark. And so, certainly, as we learn more, vaccinations and the like, I mean, I think that's going to help us as a nation and as a globe.

But if we think about the substrate, there's a couple of different things. So the increased burden of disease, certainly our investments in public health that allow us to eliminate some of the real disparities that we see - higher burden of diabetes and heart disease and high blood pressure and asthma - due to a whole variety of societal conditions and issues, quite frankly, related to decreased access to care are certainly amenable to change. So as we think about the types of things we can do to address the kind of substrate, that's one.

I think, certainly, we do need some common-sense - not blue or red - but common-sense immigration policies. You know, this virus really demonstrates that it does not discriminate between Democrat or Republican. It does not discriminate by socioeconomic status, although it does disproportionally impact certain individuals of lower socioeconomic status who live in those conditions. So, you know, nobody's really immune to this. And our ability to kind of be thoughtful about what we call the social determinants of health - living wage, some of these other factors - good, thoughtful social policy and immigration policies are really, really important.

And public charge was something we faced. You have a lot of people very scared of kind of using services because of, you know, legislation around public charge. I'd say another key piece is just - a key challenge that was faced early on is, how do we get messages out to communities in a language they understand and delivered by a trusted messenger? Those are some of the things that I think we can invest in around the substrate. And, certainly, around the spread, we need to make health care more culturally competent, more linguistically competent. And there's a whole series of things we can do there.

But I think if we break this down and we really think scientifically and in an evidence-based way about how this pandemic has disproportionately impacted communities of color and the Latino population and we break it down into its component parts, there are ample opportunities for improvement. And this is a lesson that I believe is the - you know, clearly, a global case study in the business case for investing in public health, increasing access and providing greater attention to disparities in care.

KING: In the last minute we have left, let me ask you about how to improve trust because that is obviously key here, based on everything you've said. Give me one example that you've seen, there in Massachusetts, work.

BETANCOURT: Yeah, it's a great question. And, you know, it's challenging, right? Because even in this pandemic, communities of color were the canary in the coal mine, right? I mentioned we told individuals to not wear masks. Ultimately, I think, to build trust, we need to say, you know, we're sorry about that. We didn't have any evidence then. This is what we are recommending now. We will be better in the future.

But trust requires an acknowledgment and, quite frankly, an apology for what led to the mistrust, the opportunity to ask for a new chance and then the demonstration that you mean what you say and you're committed to building better relationships. And I think we've tried to do that here with our communities.

KING: Dr. Joseph Betancourt of Massachusetts General Hospital. Thank you so much for your time.

BETANCOURT: Thank you so much. And have a great day. Transcript provided by NPR, Copyright NPR.