The state’s two largest community health centers, in East Boston and Lawrence, have encountered a disproportionately large surge of coronavirus cases among Spanish-speakers.
Among COVID-19 patients at Massachusetts General Hospital there are four times more Latinos than are typically patients at the hospital. Boston has what appear to be high concentrations of infection in neighborhoods home to large Black, Latino, and immigrant communities in Hyde Park, Mattapan, and East Boston.
As a virus, COVID-19 does not discriminate, but a patchwork of data appears to show the pandemic is having a disproportionate impact on communities of color, several of which are reporting infection rates that outpace their population.
"This is not about black and brown, it’s about economic conditions and people living in highly dense areas,” said Dr. Joseph Betancourt, vice president and chief equity and inclusion officer at Mass. General.
In other cities and states, similar disparities have been clear because public health departments include racial and ethnic information in daily updates charting the impact of the pandemic. But Massachusetts hasn’t publicly released racial and ethnic data for people who have been tested, infected, or killed by the novel coronavirus.
That lack of information has hamstrung efforts to combat the virus, particularly in communities that have had a complicated relationship with health care providers or have significant language barriers.
The state’s largest community health center, The East Boston Neighborhood Health Center, has seen a disproportionately high infection rate among its Spanish-speaking patients. The health center serves 90,000 patients in surrounding communities, roughly 70 percent of whom speak Spanish. Yet 80 percent of its patients infected by the coronavirus speak Spanish, according to Manny Lopes, president and chief executive of the neighborhood health center.
“This is a vulnerable community and information is sometimes difficult to share and get to these individuals,” said Lopes, who is also chair of Boston’s Board of Health. He added, “It’s a large immigrant community that is always afraid in the environment they live in today, even before the virus."
The virus has hit many Black, Latino, and immigrant-rich neighborhoods especially hard because residents there often work in essential jobs in grocery stores, delivering food, and operating public transit, leaving them more exposed to the virus, according to public health experts. They also typically live in closer quarters, making it harder to practice social distancing, because families can’t afford roomier housing.
The Massachusetts Department of Public Health, long a global leader in the field, had declined requests by the Globe and other organizations to release data showing the impact of COVID-19 on specific racial and ethnic groups. The department is the primary agency responsible for collecting and compiling test data from around the state.
Pressure had begun to build on Governor Charlie Baker’s administration to be more transparent about the makeup of the people infected. An hour after this story published online, state health officials issued a statement that said obtaining racial and ethnic data was “crucial for examining where, and on whom, the burden of illness and death is falling.” However, information submitted to the state by labs and hospitals has been incomplete in too many cases, officials said.
“We will be releasing the data soon and taking steps to improve the completeness of the data as we do on virtually every public health condition,” the statement said.
Last week, the advocacy organization Lawyers for Civil Rights filed a public records request with the state after receiving what it described as “alarming calls” from families in low-income communities facing significant barriers to COVID-19 testing and medical treatment. The request is seeking the racial and ethnic breakdown for everyone who has been tested, positive cases, hospitalizations, and deaths.
“We are concerned that the virus is having a particular impact on low-income communities of color and that this is resulting in a spike in infection, illness, and death in the most vulnerable communities,” said Iván Espinoza-Madrigal, executive director of Lawyers for Civil Rights. “We fear that withholding racial and ethnic demographic information will be counterproductive to combating the virus."
Representative Ayanna Pressley has pushed in Congress for a standardized federal mandate requiring the collection and disaggregation of racial and ethnic data so it can be used to target hot spots. A decade ago, the H1N1 virus disproportionately killed Black Americans, Pressley said, and there are preliminary indications that Black Americans are again dying in troubling numbers in places like Michigan and Chicago.
“The data helps us to better understand if there are clusters,” said Pressley, who wrote a letter to Democratic leaders Tuesday urging the data collection mandate be included in the next federal stimulus bill.
Data from other states has shown an outsized impact on people of color. Louisiana’s population is 32 percent Black, but roughly 70 percent of the people who have died from coronavirus have been Black, a striking disparity attributed to entrenched racial divides around economic opportunity and health care access.
Unlike in Massachusetts, the daily health department updates in Illinois have included a racial and ethnic breakdown of infections and deaths. As a state, Illinois’s population is 14 percent Black, but Blacks represent 29 percent of its COVID-19 infections and 42 percent of its deaths.
The same pattern is evident in Michigan, which also releases racial data for COVID-19. The state’s population is 14 percent Black, but Blacks account for at least 33 percent of coronavirus infections and 41 percent of deaths.
Highlighting information released by other states, Massachusetts Attorney General Maura Healey is pushing for “statewide data to identify hot spots and develop immediate public health interventions for these communities."
"Low-income families may not have many options,” Healey said in an interview with the Globe. "So we need to act now.”
For some, misinformation and fear can compound persistent health care disparities. Lesly, a 41-year-old mother from Waltham, lost her health care when she lost her job cleaning offices at the end of March.
Now Lesly’s body aches with symptoms of COVID-19, but she said she hasn’t been able to get tested because her doctor told her she needed health insurance. Tests for coronavirus illness are free to uninsured people, under a federal law passed last month, but Lesly, who speaks Spanish, has struggled to get accurate information — just one of many hurdles facing thousands of residents in low-income communities.
“I’m very scared and I don’t know if I’m going to wake up tomorrow and feel worse,” said Lesly, who asked, through help of a translator, to remain anonymous. “A family down the street, the whole family is infected.”
The health care system has a long history of unequal treatment, a legacy that some are concerned could obscure the impact the virus is having on communities of color.
Doctors and nurses have nobly put themselves at risk to fight the pandemic, but research has shown that at times — perhaps unwittingly — care can be dispensed in an uneven manner for people of different cultural backgrounds. The release of detailed demographic data of all of those tested for the new coronavirus can help ensure fairness particularly with resources in short supply, according to Tanisha M. Sullivan, president of the Boston branch of the NAACP.
“This virus is highlighting the inequities and disparities that existed prior to COVID-19 specifically in the Black community, leaving the Black community more susceptible to higher mortality rates,” Sullivan said.
The infection can be particularly dangerous in neighborhoods with lower incomes and large populations of immigrants and people of color, according to public health experts. High rents have forced many families to double and triple up in cramped quarters, making it hard for those who are sick to quarantine and not infect other family members. Those communities have higher incidents of underlying health conditions such as heart disease, diabetes, and asthma, placing them at higher risk for complications if they contract COVID-19.
“It’s nearly impossible for people to isolate themselves,” said Dr. Zandra Kelley, chief medical officer of the Greater Lawrence Family Health Center. “They are still going out and working, and they have such a hard time distancing themselves from even their own family members.”
The Lawrence facility serves 60,000 patients, making it the second largest community health center in the state, with a large population of Spanish speakers and recipients of Medicaid health insurance. Doctors there say they’ve seen disparities in COVID-19 testing and treatment in stark relief.
At the Lawrence health center, 85 percent of patients identify as Latino or Hispanic. But the number of patients who have tested positive for COVID-19 are 90 percent Latino or Hispanic. The family health center has been swamped with calls from employers seeking confirmation that their staffers — the ones keeping grocery stores and other essential services open — are really sick and can’t come to work.
“It’s really been a struggle,” Kelly said.
In Boston, the city’s public health commission map showing the highest concentration of confirmed COVID-19 cases in neighborhoods with large Black, Latino, and immigrant communities did not surprise City Councilor Andrea Campbell, whose district includes much of Mattapan.
“Many of my constituents are the wage workers,” Campbell said, describing bus drivers, health care workers, and drivers. “They’re on the front lines every single day exposing themselves to this in order to meet the needs of the community."
The Boston Public Health Commission’s data showed per capita rates for people who had tested positive for the virus, but it lacked crucial context. At this point in the pandemic, the infection is so widespread that epidemiologists say the number of positive cases is a reflection of the total number of people that have been tested, which was not included in the data.
The highest known concentration of infection was in Hyde Park, a neighborhood with a large number of Haitian residents, Spanish-speakers, and scores of police officers, firefighters, and other city workers.
“I can’t tell if it’s a language issue,” said the local city councilor, Ricardo Arroyo, who is also pushing for the release of more data. “I can’t tell if it’s just disproportionate that we have more first responders and front-line folks and other folks who are essential workers.”
The city has race and ethnicity data for about half of its residents who have been tested for COVID-19, said Marty Martinez, Boston’s health and human services chief. Martinez said at a Tuesday press conference that officials hope to have a “stronger base of that data” in coming days to make sure “whatever inequities that are there, we’re tackling.”
Danny McDonald of the Globe staff contributed to this report.
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