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Boston Hospital Examined Why Latinos Are Especially Vulnerable To COVID


In the early chaos of the pandemic, a top Boston hospital started to realize something - COVID-19 was having a much bigger effect on people of color, both patients and employees, including how likely some were to die. The hospital, Brigham and Women's, set out to understand why. WBUR's Martha Bebinger has the story.

MARTHA BEBINGER, BYLINE: It was March, just weeks into the pandemic. This deadly new coronavirus appeared to be killing more Black and brown patients than whites. But some Latinos, those who spoke Spanish, seemed to be at even higher risk.

KARTHIK SIVASHANKER: We had an inkling that language was going to be an issue early on.

BEBINGER: This is Dr. Karthik Sivashanker. His job was to build equity into daily operations at Brigham and Women's Hospital. Sivashanker grew concerned as one patient safety report after another flagged language as a problem.

SIVASHANKER: And that's where we started to really discover some deeper, previously invisible inequities.

BEBINGER: These inequities were not just about race.

SIVASHANKER: There was no mortality difference when we just looked at Hispanic patients with COVID-19. But there was a mortality difference when we looked at Hispanic patients who were not English speaking.

BEBINGER: Researchers combed through the data, adjusting for diabetes and other conditions that make COVID worse for all patients. They found something shocking. Those patients who primarily spoke Spanish had a 35% greater risk of death from COVID. Outside the hospital, the virus was spreading quickly in predominantly immigrant communities among people living in close quarters with jobs they could not do from home. COVID patients surged into Boston hospitals.

SIVASHANKER: We have really amazing interpreter services, but they were starting to get overwhelmed.

BEBINGER: Interpreters like Ana Maria Rios-Velez.

ANA MARIA RIOS-VELEZ: Well, in the beginning, we didn't know how to act. We were panicking.

BEBINGER: Rios-Velez remembers searching for Spanish words to describe this new disease. Interpreters called to a COVID patient's room were confused about how close they should get. Rios-Velez often couldn't look her patients in the eye.

RIOS-VELEZ: I want them to see the compassion in me. And with the mask, with the shields, with the gowns, it was very difficult.

BEBINGER: Soon, many were told to stay home and interpret over the phone.

RIOS-VELEZ: The patients were having breathing issues. They were coughing. Their voices were muffled.

BEBINGER: Eventually, the hospital hired more interpreters and bought more iPads. The goal is that every patient who needs an interpreter will get one. The Brigham is close but not there. The hospital also found other disparities. Sivashanker says lower paid hospital employees like medical assistants and cleaners were getting the coronavirus more often than doctors and nurses.

SIVASHANKER: We shared the data with them around the fact that they were testing positive at higher rates. We encouraged them to get testing and let them know that they would not lose their jobs and that we realize you're risking your life just like any other doctor or nurse is every single day you come to work.

BEBINGER: The hospital started distributing PPE more uniformly to all workers. It sent coronavirus messages via text, which people on the move all day are more likely to read. So are all these efforts helping? It's hard to know. Since the first surge, the Brigham hasn't done a new analysis of COVID deaths by race. But even when they do, Dr. Shivashanker says a cause and effect might not be clear.

SIVASHANKER: It's never going to be as simple as, well, we just didn't give them enough iPads or translators, and that was the only problem. And now that we've given that, we've now shown that that mortality difference has gone away. No.

BEBINGER: Because hospitals can't fix the poor housing, education, income stress and racism that feed health disparities. But Sivashanker says the Brigham is improving the experience patients have inside the hospital, and he counts that as a success.

For NPR News, I'm Martha Bebinger in Boston.


MARTIN: This story comes from NPR's partnership with WBUR and Kaiser Health News.

(SOUNDBITE OF MICHEL CAMILO'S "A PLACE IN TIME") Transcript provided by NPR, Copyright NPR.