Latinos shoulder a disproportionate share of COVID-19 cases. Advocates want more representation in contact tracing.

Roughly half the clients at Neighborhood Health, a chain of medical clinics across Northern Virginia, are Latino. Executive Director Dr. Basim Khan said the nonprofit is well aware of the health disparities that patients often face. Still, he added, it’s been “disturbing” to witness the disproportionate burden that COVID-19 has had on the Latino community.

“Ninety percent of our positive cases have been Hispanic, even though they’re 50 percent of our patient population,” Khan said, drawing on statistics from the organization’s community testing sites. But within the broader context of Virginia, the numbers aren’t surprising. Across the state, Latinos — less than 10 percent of the total population — make up about 45 percent of confirmed COVID-19 cases with reported racial and ethnic data. The numbers are even higher in certain health districts, including Fairfax County, where Latinos make up 62 percent of COVID-19 cases and just 16 percent of the population.

As demonstrators take to the streets to protest the disproportionate impact of policing on Black and brown communities, health inequities remain one of the biggest concerns of the ongoing coronavirus pandemic. Statistics from the Virginia Department of Health show that Black and Latino residents consistently shoulder higher caseloads, hospitalizations and deaths relative to their total percentage of the population. Advocates say the Latino community, which makes up more of the state’s cases than any other racial or ethnic group, is often particularly vulnerable to the disease.

“There is no biological or cultural reason for us to have more COVID,” said Dr. Max Luna, an associate professor of medicine at the University of Virginia and director of the UVA Latino Health Initiative. “It is the particular socioeconomic struggle that many are confronting that exposes them to transmission and to continued infection.”

Perhaps nowhere have those struggles become clearer than in the state’s nascent contact tracing program. As VDH works to expand the number of workers tracking the disease, local health departments — largely responsible for carrying out the task — have been working to find solutions to barriers that can discourage full participation. Latino advocates say those concerns can run the gamut, from an inability to self-isolate to understandable reluctance in providing personal information to government agencies.   

“What it really comes down to is trust,” said Dr. Sergio Rimola, an OB-GYN in Vienna who serves as a member of the Virginia Latino Advisory Board. Contact tracing is a straightforward process of identifying positive COVID-19 cases and reaching out to others who might have been exposed. A case investigator is tasked with reaching out to positive patients and learning more about their illness, which includes compiling a list of people they might have exposed while they were sick. Contact tracers are tasked with calling those possible exposures and recommending the steps they should take to prevent further transmission.

But health experts and advocates say the process can be more loaded when it comes to Latino residents, who are more likely to work low-wage “essential” jobs without benefits or live in high-density housing that makes isolation difficult, said Walter Tejada, president of the Virginia Latino Leaders Council and former chairman of the Arlington County Board of Supervisors. When Latino residents are undocumented, or live with undocumented family members, it can compound the reluctance to speak openly with health officials.

“One of the first things I often hear is, ‘How did you get my information?’” said Susana de la Torre, a public health nurse for the Fairfax County Health Department who’s fluent in Spanish and works as part of the agency’s contact tracing team. 

But with contact tracing increasingly posed as a critical tool in reducing the spread of the virus — including by Gov. Ralph Northam, who on Wednesday cited “enhanced testing and contact tracing” as an important step in lifting social distancing restrictions — advocates are pushing for a stronger focus on the state’s Latino residents.

Together with enhanced testing and contact tracing, we can continue safely easing health restrictions—but everyone must keep taking the necessary steps to protect yourself and those around you.

More information on Phase Three can be found here: https://t.co/dnrwCRiJ0w

— Governor Ralph Northam (@GovernorVA) June 24, 2020

“We would like there to be more urgency,” said Luis Aguilar, the Virginia director of CASA, a nonprofit that advocates for Latinos and low-wage workers nationally and in several Virginia localities. “It continues to show that both government, and the structure surrounding government, hasn’t responded well to the community’s direct need.”

Aguilar was specifically referring to the state’s contact tracing program as a whole, which continues to lag behind goals set earlier in the pandemic. VDH has hired a total of 399 tracers — including in Fairfax and Arlington, which run their health departments independently — out of 1,200 advertised positions, according to agency spokeswoman Tammie Smith. Local health departments have largely been left to fill the void, pulling employees from other programs to fill in. 

But Aguilar, along with more than half a dozen health experts and advocates, emphasized there’s also a strong need for contact tracers who can speak Spanish and demonstrate what Rimola referred to as “cultural competency.”

In a meeting last week, Health Secretary Daniel Carey told Latino leaders he aimed for 20 percent of the state’s contact tracing workforce to be bilingual, Aguilar said. But so far, only 12 percent of hires have “fluency in another language,” according to Smith. She couldn’t specify how many of those workers spoke Spanish or one of the indigenous languages that are also spoken by some among Virginia’s Latino population.

“And that’s really important,” said Joanna Cirillo, a communicable disease public health nurse who’s been leading contact tracing efforts at the Richmond City Health Department. “I can only imagine how much better the experience would be for someone if, when they get this call, it’s someone who speaks their language and understands more about their culture and background and where they’re coming from.”

‘There needs to be more outreach’

After initial frustration with the state’s response to the Latino community, many leaders said the Northam administration is doing a better job with outreach. Last week, the governor traveled to Northern Virginia for a COVID-19 news briefing conducted mostly in Spanish. VDH has released educational materials translated into multiple languages, and Northam said the administration had begun directing free community testing events to communities with large Latino populations. The state’s Medicaid program also provides translated information and is giving “non-citizens additional time, if needed, to document immigration status when they apply for health coverage,” Northam said at the briefing.

He also met with Latino leaders beforehand, giving Tejada the chance to submit a list of six specific COVID-19-related requests. The most prominent was the need for what he described as an “all-out Spanish language media campaign” — something advocates say the administration has yet to do.

“The Latino community relies a lot on Spanish-language radio and Spanish-language television,” Tejada said. Rimola also emphasized that translated web materials — on contact tracing, testing resources, and other public health guidance — had limited usefulness if they weren’t being seen by most Latino residents.

“The resources are there, but how will people know if they don’t have the information?” he said. “There needs to be more outreach. There has been some, but to be honest, I don’t think it’s enough.”

Beyond outreach, experts said the most pressing need for many Latino residents are the economic resources that make it possible to fully participate in the contact tracing process. One of the basic steps is self-isolating (in the case of people with confirmed cases of the disease) or self-quarantining (for suspected contacts) for at least 14 days. A voluntary isolation agreement from VDH directs people to stay in their homes and “avoid all public activities,” including basic shopping and work. Patients with confirmed cases of the virus are asked to separate in another room from other members of their household.

Those restrictions can create significant barriers, de la Torre said. With some residents already reluctant to pick up the phone, it’s another hurdle to find solutions to the very real challenges faced by many low-income and Latino residents. “If they share one bedroom with three family members, totally self-isolating isn’t going to be an option for them,” she added.

Cirillo said she hears from Latino residents who simply don’t have the option of taking paid leave from work or fear that staying home could cost them their jobs. In other cases, work itself could be the biggest risk. Dr. Jonathan Richardson, the CEO for the Eastern Shore Health District, said around 700 poultry plant workers have tested positive for COVID-19 since the beginning of the pandemic — a workforce that largely includes African Americans, Latinos and immigrants. The state is poised to adopt first-of-their-kind workforce safety regulations next week, but thousands of workers have already filed complaints over pandemic-related concerns.

Local health departments are taking steps to overcome some of those barriers. The Eastern Shore Health District, like Richmond and Fairfax, refers patients and contacts to free or low-cost resources, including grocery delivery services and community health clinics. Both Richmond and Fairfax have temporary shelter programs, connecting residents who can’t self-isolate at home with free hotel rooms.

At the state level, Northam said Thursday that his administration will unveil a rent and mortgage relief program as Virginia nears the end of a temporary moratorium on eviction cases. The initial investment of $50 million — funded through the federal CARES Act — will go toward the “tens of thousands of applicants” expected by the state, according to Angela Navarro, a deputy secretary of commerce and trade. But it’s still unclear how many of those applicants will receive relief through the program, and Aguilar said he’d like to a coordinated campaign to relieve economic instability, especially for undocumented workers who haven’t received federal assistance.

“We have people living paycheck to paycheck,” he said. “When you have people with that necessity, it makes the situation a lot harder. It makes it impossible for people to stay home from work.”

Tejada said the district-by-district approach also risked excluding Latino residents in areas where health departments have fewer resources and community activism and nonprofits are less active. In the meantime, local health districts are finding new challenges — and solutions — on their own. Cirillo said one of the latest priorities in Richmond is finding childcare for residents who can’t isolate or quarantine at home but also don’t have the option of leaving their children.

“Every step we take, we get a little bit closer, but then find another barrier,” she said.