Undocumented immigrants were excluded from all federal coronavirus aid.
Crespin-Palmer said groups like hers have stepped in. They do everything from connecting families with food supplies and mental health support to providing direct cash assistance.
“Many in the Latino community are not receiving the support they need due to their immigration status,” she said. “To me, this is a really important part of the untold story.”
Some of the families live in multi-generational homes where multiple family members caught the virus.
“They’re still having to work two or three jobs,” said Jim Garcia, CEO of Clinica Tepeyac, a community health center in Denver’s Globeville neighborhood. “Typically those are in the frontline, higher risk, type of jobs.”
New research found working in the food service sector is a risk factor for Latinos in the US. For Black residents, risk factors include using public transportation at high rates, breathing a lot of air pollution and living in certain facilities, like nursing homes, or being imprisoned at disproportionate rates.
In Colorado, Black residents make up roughly 6.5 percent of deaths and 10 percent of hospitalizations despite being 4 percent of the population. Hispanics are 22 percent of the population, but have a much higher percentage of cases — 38 percent, according to the state’s COVID-19 data. At one point in May, more than half of COVID-19 patients were Hispanic, according to data released by the state health department.
Whites make up almost 68 percent of the state’s population, but just 37 percent of cases, and 41 percent of hospitalizations. (Note: demographic information is unknown for 15 percent of hospitalized patients.)
The state’s picture echoes the national story. In July, data showed Latino and African-American residents had been three times as likely to get infected with the virus and twice as likely to die from it than white Americans.
When Dr. Jandel Allen-Davis, president and CEO of Craig Hospital in Englewood, began hearing about the emerging health disparities, “my somewhat realistic and cynical comment was ‘This surprises you, why?’” she said. “We’ve got to actually focus on the social determinants of health,” the root causes.
Some hope the pandemic, which has now claimed more than 190,000 lives in the US, serves as a tipping point in awareness about the heavy toll of health disparities.
“This time of incredible loss of life can not be for nothing,” Crespin-Palmer said.
A Slow Initial Response
The pandemic caught many local health professionals, public health officials and political leaders by surprise. It took time for decision makers to realize how heavily Black and Latino residents were impacted. But given the historic realities, doctors and health advocates say that could have been anticipated.
“It was a very slow response. We had a lot of challenges,” said Dr. Pamela Valencia, the chief health officer with Clinica Tepeyac. The community health center serves Denver’s Globeville neighborhood. It was swamped with patients, including staff members, who had COVID-19 symptoms. They needed testing and treatment, but “we didn’t have the testing swabs,” Valencia said.
Instead, they told patients to stay home and isolate or go to the emergency room. She said they needed health guidance in Spanish, and more support for treating patients “who might not feel comfortable going to areas outside their clinic based on immigration status.”
“I think overall there was a general lack of coordination in the response, a general lack of leadership,” Valencia said. That left health centers, and business owners, to figure out how to deal with staff, processes and practices to keep businesses open.
Garcia says they didn’t have enough personal protective equipment. He said support from the state and Denver’s public health department “was on the slow side to start,” but has improved in recent months. He said local foundations also stepped up with substantial philanthropic help.
In the early weeks of the pandemic, communities of color and top national physician groups pushed the Trump administration and states to release more detailed racial data. Colorado’s health department began collecting it in May; now the state has it for the vast majority of COVID-19 patients treated in hospitals.
In mid-April, Gov. Jared Polis established the COVID-19 Health Equity Response Team, headed by the office of Health Equity. Its mission: to ensure racial and ethnicity COVID-19 data are “accessible, transparent and used in decision-making,” determine proactive measures to prevent the virus’ spread and “help curb health disparities” related to it.
“The very first piece to addressing this is shining a light on it,” Gov. Jared Polis said at a mid-August press conference as he unveiled a revamped COVID-19 website, with easier-to-access data on disparities. He said those health gaps “are a result of the long tail of systemic racism.”
Pressed by staff, in July health department director Jill Hunsaker Ryan told the Denver Post the state would declare racism a public health crisis, in response to demonstrations over racial inequities and police brutality and disparities underscored by the pandemic.
In August, Polis issued an executive order to make the state government’s workforce of over 30,000 more diverse and inclusive. It outlines measures like hiring procedures and mandatory training on “implicit bias, historical injustices and trauma.”
“This has been a long time in the making, I’m excited to see what comes of it,” said Web Brown, who directs the Office of Health Equity. The executive order asks agencies to adopt new guidelines using existing budgets. That means there’s no new money for now, but agencies can request more in future years.
Community health groups stepped into the void that a lack of federal and state planning left, and have taken the lead on planning for potential future waves of infection. Clinica Tepeyac now partners with the state health department to offer a free, drive-up test site at the Globeville Community Church right next door.
“We’re doing it by appointment, trying to control the flow of traffic in the neighborhood,” Garcia said. “We want to make it available both to our patients and to the broader community.”
“The big testing sites like at the Pepsi Center, I would say that for communities of color, that may not be the optimum,” he said. Garcia lists language barriers, cultural barriers, “immigration challenges” and transportation as obstacles to getting tested.
“It’s a trust issue. I think a person’s going to be much more comfortable going to a small community health center like ours,” he said. “They’re going to be comfortable sharing information and knowing that we’re going to protect that information and protect that relationship that we have with our patients.”
In recent months, the state health department increased testing availability and access, with more than 50 free community testing sites. It created guidelines for a public health response for people with limited English proficiency and provides translations of critical materials on the state’s COVID-19 website in Spanish, as well as Vietnamese, Simplified Chinese, Arabic, Nepali and Somali.
The governor, who speaks Spanish, has a Facebook page in Spanish, social media posts and press releases are translated, and his COVID-19 press conferences are translated into Spanish and posted to the Facebook page.
Members of the state’s health department participated in a 100 percent Spanish town hall with Univision Colorado, Polis, and other state agencies. The agency also hired Spanish-speaking contact tracers and case investigators to provide “culturally competent” disease investigation.
Meantime, Clinica Tepeyac is now seeing about 40 percent of its patients via telehealth, which seems to be working for most.
“We’re trying to look at unique ways to serve the needs of the community right now,” Valencia said.
The clinic has also become a critical source of other health services. Staff have given out free blood pressure monitors and glucometers, for diabetics to check their blood sugar, and wellness bags with lavender oil and information about behavioral services. They’ve started drive-up service for patients who have uncontrolled hypertension and diabetes. It’s the kind of preventative care Lara, Allen-Davis and other health professionals emphasize.
“The clinic is a very safe place to be,” Valencia said. “We have a small waiting room, so we’re trying to think outside of the box about how we can serve as many patients as we can.”
In North Park Hill, a diverse neighborhood with a large Black population, the Center for African American Health, a community group, is taking a similar approach. On a recent Friday, a steady stream of people lined up in their cars to get the nasal swab and find out if they have the virus.
“I think it’s a very good thing,” Aurora retiree Barbara Goree said.