Language Barriers, Equity, and COVID‐19: The Impact of a Novel Spanish Language Care Group

Case 28-2021: A 37-Year-Old Woman with Covid-19 and Suicidal Ideation

“…In Boston, Spanish-speaking persons with limited English proficiency represented at one point more than 40% of the patients who were admitted to our hospital because of Covid-19; rates were even higher in other parts of the country. 17 , 18 In a nationwide survey from April and May 2020, 40.3% of Hispanic and Latinx responders reported depression and 22.9% had suicidal thoughts, as compared with 25.3% and 5.3% of White responders, respectively. 19 What does this patient’s occurrence of suicidal ideation signify, if nearly one fourth of Hispanic and Latinx persons felt the same?…”

Major disparities in COVID-19 test positivity for patients with non-English preferred language even after accounting for race and social factors in the United States in 2020

“…One potential mechanism is that the population whose preferred language is not English have greater likelihood of having social factors (such as housing, job type, and transportation) associated with COVID-19 infection, which could explain disparities [ 4 , 17 – 19 ]. We used dimensions of the SVI to consider the role of these factors in our analysis.…”

“…Research has shown that language-concordant providers, professional interpreters, and written materials in the patient’s native language can improve patient experience and outcomes [ 15 , 31 , 32 ]. Yet while there are some examples of how these strategies have been used in the treatment of COVID-19 – such as the formation of a Spanish-Language Care Group at a hospital in Massachusetts [ 19 ] – it is unclear from the published literature if and how these strategies are being used to communicate about COVID-19 prevention.…”

“…These worse outcomes often arise from worse patient experience including unmet informational needs leading patients to be uninformed about their health, lack of cultural safety, and discrimination [ 15 ]. Further, the population whose preferred language is not English, many of whom are immigrants, are also at greater likelihood of having social factors associated with COVID-19 infection such as living in multigenerational households, being “essential workers” who are unable to work from home, relying on public transportation, and having lower socioeconomic status [ 4 , 17 – 19 ]. Taken together, these experiences represent a potentially synergistic myriad of factors that could increase risk for COVID-19 infection and worsened outcomes.…”

“…Similarly, another study of COVID-19 patients found that the non-English speaking population had significantly increased risk of hospitalization within the first 45 days of diagnosis compared to English speakers; this finding was independent of an area deprivation index and was consistent across race/ethnicity [ 6 ]. Another study out of Massachusetts General Hospital showed that their Spanish-speaking patient population with limited English-proficiency increased nearly 20 times during the pandemic - ultimately making up more than 40% of their COVID-19 infected patients [ 19 ]. Despite this early evidence, there have been no comprehensive studies focused on understanding the role of language barriers in COVID-19 infection risk nor has anyone explored the complex intersection of language, race, and social factors in this context.…”