Dr. Eva Galvez works as a family physician for a network of clinics in northwestern Oregon, where low-income patients have been streaming in for nasal swabs over the past several weeks to test for the coronavirus.
Galvez was dumbfounded by the results. Latinos, about half of those screened, were 20 times as likely as other patients to be diagnosed with the virus.
“The disparity really alarmed me,” said Galvez, who began trying to understand what could account for the difference.
It is a question that epidemiologists around the country are examining as more and more evidence emerges that the coronavirus is striking Latinos, and some other groups, including African-Americans, with particular force.
Oregon is one of many states where Latinos are showing a disproportionate level of impact, and the effects are seen among both immigrants and Latinos from multigenerational American families.
In Iowa, Latinos account for more than 20% of coronavirus cases though they are only 6% of the population. Latinos in Washington state make up 13% of the population but 31% of cases. In Florida, they are just over a quarter of the population but account for two of every five virus cases where ethnicity is known.
Because most of the clients at the Virginia Garcia Memorial Health Center clinics in Oregon are relatively poor whatever their ethnic background, Galvez decided that income could not explain the disparity.
Public health experts say Latinos may be more vulnerable to the virus as a result of the same factors that have put minorities at risk across the country. Many have low-paying service jobs that require them to work through the pandemic, interacting with the public. A large number also lack access to health care, which contributes to higher rates of diabetes and other conditions that can worsen infections.
Oregon last month expanded testing criteria to prioritize Latinos and other minorities, citing the higher risk posed from the virus because of “long-standing social and health inequities.”
At the Virginia Garcia clinics, Galvez sees those inequities among her patients every day.
“We realized that it must be how Latinos live and work that’s driving these disparities,” said Galvez, who works at the clinic in Hillsboro, outside Portland.
The Hispanic patients, many of them immigrants, help produce some of the country’s premier Pinot Noir, maintain Nike’s sprawling headquarters and plant berries, hazelnuts and Christmas trees in the Willamette Valley. Others are seasonal workers who begin arriving by the thousands later this month for the harvest.
They live in close quarters, often multiple families to a house or with several farmworkers crowded into a barrack-style room, where social distancing and self-isolation are impossible. They perform jobs that require interaction with the general public, in food service, transportation and delivery; and some also toil in meatpacking plants that have emerged as major hot spots.
If they are undocumented, they cannot collect unemployment, which may compel them to work even when they feel unwell, facilitating the spread to their co-workers.
Carlos, a Guatemalan in the U.S. illegally who is one of the clinic’s patients, never stopped reporting to his job cleaning large supermarkets, even after he began coughing and feeling ill, said his wife, Blanca, who did not want the family’s last name to be published because of their immigration status.
Her husband medicated himself on cough syrup, but his condition quickly deteriorated, and he was gasping for air when she finally rushed him to the hospital. He died on April 1 from COVID-19. Now Blanca, her brother and the couple’s 13-year-old son have all tested positive for the virus.
The situation at the clinics in northwestern Oregon tells only part of the story of the nation’s 60 million Latinos, who represent a wide range of backgrounds and lifestyles — new immigrants and multigenerational families, high-earning professionals and poor migrant farmworkers — and the effects of the coronavirus already reflect that broad experience.
The disparities are bigger in states like Oregon, Washington and Utah that have newer and less-established Latino communities, compared with states like California, Arizona and New Mexico. In some states, including Arizona and Texas, state data show Latinos are getting sick at rates close to their share of population. In New Mexico, Latinos, who make up half the population and have a long history in the state, have about the same number of cases relative to their population as whites.
“Not all Latinos are created equal,” said Daniel López-Cevallos, professor of Latino and health equity studies at Oregon State University. More Latinos in states with established communities, he said, are likely to have middle-class jobs or the sort of wealth that could help tide them over through the pandemic without having to work outside the home.
By contrast, those in places like Oregon and Washington “tend to be lower income, with lower educational levels, lower levels of health insurance and more employment in essential services,” López-Cevallos said. “They have fewer support systems in place.”
According to a Pew Research Center survey in April, about half of the Latinos questioned said they or someone in their household had either lost a job or taken a pay cut, or both, because of the virus outbreak — compared with a third of all adults in the United States.)
The data from a number of states takes an unexpected turn: It indicates that even though they may have higher rates of infection, Latinos have been dying from the virus at lower reported rates overall than other groups.
But experts say those raw numbers understate the risks for those who become sick, because they do not take into account that the Latino population, the country’s second-largest ethnic group — is significantly younger than other groups. And there have been much fewer deaths among the young from a virus whose lethality grows sharply with its victims’ age.
But among adult Latinos, fatality rates can be much higher. That was what officials in California found when they took a closer look.
There, Latinos, who are 39% of the population, account for almost half of all reported virus cases but only 35% of deaths — placing their overall death rate slightly below that of whites who are not Hispanic.
But when California public health officials drilled down further, they found that in every age group over 17, Latinos were dying at significantly higher rates than whites — as were African-Americans.
Even in Oregon, Latinos have not appeared to suffer equally from the effects of the virus. Galvez, who is a Mexican-American, lives in a middle-class neighborhood. “My close friends and family have not been hit by COVID the way the community that I care for has,” she said.
On March 11, Virginia Garcia began screening patients with symptoms of the virus at seven sites.
So far, the clinic has tested 397 Hispanics and 281 non-Hispanics in Washington and neighboring Yamhill County, another agricultural hub. A total of 87 Hispanics, 21.9%, have tested positive, compared to three non-Hispanics, or 1.1%.
Hazel Wheeler, a manager at the clinic who has analyzed the data, deemed the results “confounding.”
“We serve poor people, who live in the same geographical area and make about the same amount of money,” he said.
But there were deeper distinguishing factors.
Most non-Hispanics whom the clinic has tested have been working from home, or staying home because they have been furloughed or laid off, typically with unemployment benefits. They were able to keep distance from everyone but immediate family members.
The majority of Latino patients, on the other hand, have remained on front-line jobs, and many are residing in crowded or precarious dwellings.
Rafael Castillo, a 37-year-old mason, was diagnosed with the coronavirus recently along with two fellow Latinos on his construction crew.
“The truth is, I don’t know how we got infected,” said Castillo, a Mexican green-card holder who has lived in the United States for two decades. “When this illness started, our boss told us to work apart. We used hand sanitizer and washed our hands,” he said.
Since he tested positive, his wife, Yanet Gonzalez, has also contracted the virus. Now Castillo, who earns about $3,500 a month and lives in a mobile home, said his main concern is keeping his two children healthy. The family shares one shower in their mobile home in Cornelius, Oregon, which they try to disinfect after each use.
As they treat an ever-larger numbers of patients, Virginia Garcia medical workers are now worrying about the prospect of a second wave of infection when the annual harvest gets underway later in May.
By some estimates, the picking season for berries, pears and other crops brings 160,000 Latino seasonal farmworkers to Oregon. They toil side by side in fields and orchards during the day and bunk in crowded spaces at night, creating a fertile environment for the virus to spread.
A preview of what could happen surfaced in April in central Washington state: Half of the workers at a large orchard tested positive for the coronavirus, even though none had manifested symptoms.
The findings caught the attention of Oregon’s Occupational Safety and Health Administration, which last week introduced a series of measures to protect migrant farmworkers after Galvez and a nonprofit law center sought changes.
The state agency ordered growers to reconfigure worker housing to eliminate bunk beds for workers not part of the same family and to require at least 6 feet of space or an impermeable barrier between workers while they sleep. Growers are also required to designate an officer to enforce at least 6 feet of separation during work, breaks and meals.
The emergency mandates drew protests from growers who said the rules could slash the amount of housing available for farmworkers and help put many growers out of business.
“Many farms will not survive the cumulative weight of these unattainable rules, which are more burdensome than any set for other sectors of Oregon’s economy,” the Oregon Farm Bureau said.
State officials acknowledged that the emergency measures, in effect for six months, are unlike any other action taken by the state in recent history. But they said they were necessary to protect Latino migrants and the greater community.
Michael Wood, the top administrator for Oregon’s OSHA, said he hopes the rules will help avert the possibility that the virus tears through the picking season that runs until fall.
“You cannot telecommute to harvest crops,” he said.
