IMPORTANCE Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment. OBJECTIVE To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19. DESIGN, SETTING, AND PARTICIPANTS The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020. MAIN OUTCOMES AND MEASURES Themes and subthemes that reflected patient experiences. RESULTS Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates). CONCLUSIONS AND RELEVANCE In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19-related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.
ObjectiveTo describe the drivers of distress and motivations faced by interdisciplinary clinicians who were on the frontline caring for patients with COVID-19.Design50 semistructured interviews. Transcripts were analysed using qualitative thematic analysis.SettingA safety-net hospital in Denver, Colorado.ParticipantsInterdisciplinary frontline clinicians including physicians, advance practice providers, nurses, respiratory therapists and paramedics providing inpatient hospital care to patients hospitalised for COVID-19.ResultsFifty clinicians (32 women and 18 men) participated. Five themes with respective subthemes (in parentheses) were identified: depersonalisation and barriers to care (impeding rapport and compassion, focusing on infection risk at the expense of high-quality care, grief from witnessing patients suffer in isolation), powerless in uncertainty (inescapable awareness of personal risk, therapeutic doubt in a void of evidence, confronting ethical dilemmas, struggling with dynamic and unfamiliar challenges), overwhelmed and exhausted (burden of personal protective equipment (PPE), information overload and confusion, overstretched by additional responsibilities at work, compounded by personal life stressors, feeling vulnerable and dispensable, compassion fatigue, distress from the disproportionate impact on socially oppressed communities), bolstering morale and confidence (motivated by community and family support, equipped with data), and driven by moral duty (responsibility to patient care and community, collegial solidarity and collaboration, contributing to the greater good).ConclusionFrontline clinicians reported distress due to the challenges of PPE, uncertainty and powerlessness, new responsibilities at work and home, losing control of their schedules, grief from witnessing patients suffer in isolation and witnessing healthcare disparities exacerbated by this pandemic. Clinicians feel supported by their colleagues, families, and community and were driven by a sense of moral duty. Healthcare system should adopt strategies to minimise distress faced by interdisciplinary clinicians on the frontline of COVID-19.
of sexually transmitted diseases such as HIV infection. We also acknowledged the problems resulting from non-responders and recognised that a group of young and mobile men may have been differentially missed from our sample. In our discussion we explained that selection or underreporting might mean that the true figure for homosexual intercourse was nearer 3%. There is, however, no evidence to suggest our figures are underestimated by any more than this. Whether or not the use of female, rather than male, interviewers distorted the responses about homosexuality is impossible to assess. Our impression is that the use of trained, professional interviewers who can establish a rapport with their interviewees is a far more important factor than gender per se. When recruiting interviewers for this and other studies we have only ever had one male applicant and he did not meet our selection criteria.There are two more general points that should be emphasised. Firstly, although our respondents were selected as controls for a study of testicular cancer this did not necessarily lead to a biased sample except in so far as men not registered with a general practitioner were not sampled. In the United Kingdom, in the absence of population registers, a selection of a true random sample of the population is, in practical terms, impossible. The electoral register provides one possible means of selecting a sample but suffers from the same sort of disadvantages as using general practitioners' lists-that is, that mobile members of the population and those with no fixed address would be missed. Moreover, because dates of birth are not given the usefulness of this register is limited. The fact that only men aged 20-55 were included in our sample does not lead to bias, although it does mean that our results are generalisable to only this age group. Secondly, our response rate was over 83% and we do not know of any random survey of young and middle aged men in the United Kingdom that has achieved a higher figure. Although our study does have limitations as clearly set out in our paper it does provide baseline information that is otherwise unavailable. It is interesting that Dr Mills does not cite other comparable population based figures which he would consider to be more accurate. As far as we are aware, there are none.
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