The Disproportionate Burden of COVID-19 for Immigrants in the Bronx, New York

Abstract

As general internists who work in the hospitals and outpatient clinics of a large safety-net health system in the Bronx, we care for an ever-increasing number of patients with symptoms of coronavirus disease 2019 (COVID-19) who call our clinics to ask for guidance, seek care in our hospitals, and die in our wards. We are distressed by the disproportionate burden of the COVID-19 pandemic for immigrant patients.The Bronx, a borough of New York City, is one of the most ethnically diverse urban areas in the US and ranked the least healthy of New York State's 62 counties. It has rates of chronic diseases such as asthma, diabetes, hypertension, obesity, and tobacco use disorder-all factors that appear to increase the risk of complications from COVID-19-that are among the highest in the state. 1 Poor health in the Bronx is due at least in part to decades of policies related to housing, education, environmental health, and criminal justice that have perpetuated racial and economic inequality. Unsurprisingly, the Bronx currently has the highest rate of COVID-19 diagnoses and deaths among New York City's boroughs. 2 More than half a million immigrants live in the borough, and most speak a language at home other than English. Immigrants in the Bronx are disproportionately represented in the essential workforce at risk for exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including physicians, nurses, nursing aides, home health aides, subway and bus drivers, grocery clerks, and others. The limited sociodemographic data available for COVID-19 cases in New York City show that Hispanic or Latinx individuals, who constitutemost immigrants in the Bronx, are considerably more likely to die of COVID-19 than white New York City residents. 3 As we care for patients in the community and in the hospital during this crisis, we are deeply troubled by some of the ways in which COVID-19 uniquely affects low-income immigrant patients. In these communities, the combination of high levels of chronic diseases, chronic stress, and less access to preventive health services 4 increases the risk of more severe SARS-CoV-2 infections. Many immigrant patients live in close quarters with multiple generations sharing bedrooms and bathrooms. In these families it is often impossible to isolate older family members, those with asthma or other comorbid conditions, or even those who are ill with COVID-19 from others in the household, including those who must continue to leave home to work.When conducting telemedicine visits because our clinics are shuttered, we routinely ask about COVID-19 symptoms and answer patients' questions. For immigrants with limited English proficiency, the lack of available translated information about the disease has meant relying on social media to obtain advice that may be

Associations Between Chronic Health Conditions and COVID-19 Preventive Behaviors Among a Nationally Representative Sample of U.S. Adults: An Analysis of the COVID Impact Survey

“…21,22 Recent reports have suggested a disproportionate impact of COVID-19 pandemic by social determinants of health, including characteristics such as immigration status and history, household size, and composition; therefore, future studies should consider inclusion of these variables. 23,24…”

Geospatial Analysis of Individual and Community-Level Socioeconomic Factors Impacting SARS-CoV-2 Prevalence and Outcomes

“…Many experts in the field of health disparities have authored viewpoints suggesting factors which may contribute to risk of infection with or adverse outcomes from SARS-CoV-2, including language barriers, lower health literacy, higher population density, household overcrowding, reliance on public transit, overrepresentation among essential workers, lack of paid sick leave, inability to work from home, and limited physical and financial access to healthcare. 18,[21][22][23][24][25][26] However, despite widespread interest in this topic, [3][4][5][6] relatively few studies have reported data examining robust socioeconomic concepts in relationship to SARS-CoV-2 outcomes. Many COVID-19 surveillance studies on this topic do not present individual data, but aggregated outcomes over large and diverse geographic areas (e.g.…”

Public Perceptions of Resuming Elective Surgery During the COVID-19 Pandemic

“…Patients preferring to undergo surgery soon after health systems reopen may be at a higher risk of postoperative morbidity and mortality. Alternatively, unaddressed concerns leading to delayed presentations may further accentuate health care disparities in disadvantaged and vulnerable populations [ [12] , [13] , [14] , [15] ].…”