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.

IMPORTANCE Undocumented immigrants with end-stage renal disease have variable access to hemodialysis in the United States despite evidence-based standards for frequency of dialysis care. OBJECTIVE To determine whether mortality and health care use differs among undocumented immigrants who receive emergency-only hemodialysis vs standard hemodialysis (3 times weekly at a health care center). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted of undocumented immigrants with incident end-stage renal disease who initiated emergency-only hemodialysis

pproximately 11.3 million undocumented immigrants live and work in the United States. 1 Because this lowincome population is excluded from a range of public benefits that include Medicare, federally funded Medicaid, and the insurance provisions of the Affordable Care Act, undocumented immigrants are a significant portion of the post-Affordable Care Act population who remain uninsured. 2 Their access to health care is limited largely to safety-net provisions for the uninsured, chiefly, nonprofit community health centers, public clinics, and emergency treatment in hospital emergency departments (EDs) mandated by the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA). 2,3 Arranging care is especially complex when an undocumented immigrant is diagnosed with end-stage renal disease (ESRD), for which hemodialysis is a life-sustaining treatment. 4,5 Undocumented immigrants' ineligibility for public benefits means they cannot access the diagnostically based Medicare entitlement for hemodialysis. 6 An estimated 6480 undocumented immigrants in the United States have ESRD. 7 Their access to hemodialysis depends on state policy and local safetynet investments. Some states, including California and New York, use state emergency Medicaid programs to finance scheduled hemodialysis for these patients. 8,9 Most states, including some with large undocumented immigrant populations, IMPORTANCE The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients.OBJECTIVE To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. DESIGN, SETTING, AND PARTICIPANTSA qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis. Demographic information was collected from the participants' medical records. The interviews were audiorecorded, translated, and then transcribed verbatim. The interviews were analyzed using inductive qualitative theme analysis by 4 research team members from March 1 to June 30, 2016. MAIN OUTCOMES AND MEASURES Themes and subthemes from semistructured interviews.RESULTS All 20 undocumented patients included in the study (10 men and 10 women; mean [SD] age, 51.4 [13.8] years) had been in the United States for at least 5 years preceding their diagnosis with ESRD. They described the following 4 main themes: (1) a distressing symptom burden and unpredictable access to emergent-only hemodialysis, (2) death anxiety associated with weekly episodes of life-threatening illness, (3) family and social consequences of accommodating emergent-only hemodialysis, and (4) perceptions of the health care system.CONCLUSIONS AND ...