Experiences of Latinx Individuals Hospitalized for COVID-19

Abstract

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.

Latin American Origin Is Not Associated with Worse Outcomes among Hospitalized Patients with COVID-19 in a Public Healthcare System

“…It is a retrospective observational study, conducted with data from a single center, in a public health system, and with a limited sample size. We do not have data on certain epidemiological factors [ 3 , 4 , 12 , 13 ] (such as the number of cohabiting persons, patients’ current jobs or education level), which may impede the interpretation of the results. Data availability was limited to the electronic medical records at our institution.…”

“…Several studies have suggested that COVID-19 infections could be more frequent among people of Latin American origin than among Europeans, and that both the need for hospital admission and instances of mortality would also be more frequent among them [ 1 , 2 , 3 , 4 , 5 ]. Deaths attributed to COVID-19 among Latin/Hispanic people in the USA are estimated to be 110.005 (18.4% of the total rate) [ 6 ].…”

“…Unfortunately, such detailed characteristics remain sparse, and little is known regarding the relevance of racial/ethnic backgrounds in COVID-19 outcomes in Europe [ 11 ]. If the prognosis were actually worse based on patient ethnicity, it would be necessary to design specific protocols for this group of patients [ 3 , 4 , 12 , 13 ].…”

High Mortality Rate Among Latin American Immigrants With Covid-19 Hospitalised in Milan, Italy: Data From the Luigi Sacco Hospital Registry

“…It is possible that the Latin Americans in our study experienced severe/critical disease more frequently than immigrants from other regions because they knew less about or underestimated the early signs of COVID-19 and were therefore less likely to seek medical advice promptly, or they may have been afraid of losing wages or their often precarious and unregistered jobs. These factors were found to be common in a qualitative study of Latin Americans with COVID-19 hospitalised in San Francisco [23], and may explain the excess burden of morbidity and mortality among Latin Americans in the USA, particularly in more recent immigrants [24,25].…”

Structural Racism and JAMA Network Open

“…At JAMA Network Open, we are making concerted efforts to right these wrongs and are cognizant that our efforts must evolve and expand over time. We will continue to publish studies [12][13][14] and commentaries [15][16][17] that examine the innumerable ways in which racism affects health and health care, and the potential means to mitigate these effects. Ten months ago, we issued a call for papers on the effects of systemic racism in health.…”