Lessons We’ve Learned — Covid-19 and the Undocumented Latinx Community [nejm.org]

Rafael Maravilla(PACEs Connection Staff) 1/7/2110:39 AM

By Kathleen R. Page and Alejandra Flores-Miller, New England Journal of Medicine, January 7, 2021

In March 2020, when there were 30,000 confirmed Covid-19 cases in the United States, one of us wrote about the pandemic’s effects on undocumented immigrants.¹ By August, there were about 50,000 new U.S. cases per day, and we had spent several months caring for patients with Covid-19. Today, revisiting the issues of anti-immigrant policies, limited access to care, language barriers, and the need to work elicits painful memories of the people we’ve met in the hospital and the community.

We work in Baltimore, where only 5.5% of the population is Latinx.² However, Latinx people are the fastest-growing ethnic or racial group in the city, primarily because of migration from Mexico and Central America. As compared with the general U.S. Latinx population, Latinx people in Baltimore are more likely to be foreign-born and to have low incomes, low educational attainment, and limited English proficiency. Rapid demographic changes have long strained the city’s capacity to provide culturally and linguistically competent care, but these challenges became especially acute during the pandemic.

Before Covid-19, immigrant Latinx patients accounted for a small proportion of admissions in the Johns Hopkins Health System. On average, Latinx people in Baltimore are young (81% are under 45),² and many aren’t eligible for insurance through the Affordable Care Act, so they generally avoid hospital care when possible. But by April, our inboxes were flooded with email messages from colleagues alarmed by the number of Spanish-speaking patients with Covid-19 in our system.

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