COVID disparities force a public health reckoning

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The coronavirus feels the way it looks in widely circulated images, said Cleo Otero: like a thorn.

“That’s how it felt inside my body, especially my lungs. It was painful. Like it was scratching the inside of your body. I could really literally feel the virus inside my body.” 

Otero’s first clue she was sick came at the laundromat in Albuquerque where she usually buys a bag of spicy chips as she waits on her clothes. On that Friday in July, she couldn’t taste the chips, and she couldn’t smell them either. A headache came on, the kind with intense pressure behind the eyes. At first she thought it was due to her diabetes because she hadn’t been consistent lately with her medication. By Saturday, she was laid out on the couch in the one-bedroom apartment she shares with her partner and 7-year old son. By Sunday, she had a fever, her throat and eyes were hurting, she had chills from the tip of her toes, “all the way up.”

“I’ve never felt chills like this before,” she said. “I just laid there.”

The family went to Balloon Fiesta Park to get tested for COVID-19, a miserable experience on a hot summer day in a line that took hours. “We all got tested, and we cried,” she remembers. 

All three tested positive, but only she got sick. And she got really sick. She spent the next three weeks alone and struggling in their one bedroom while her son and partner, Jasper, moved into the living room. “It really felt like you were by yourself,” she said. “It was really depressing. But at the same time, I didn’t really think about that or the timeframe. I was just so sick.”

She and her partner, Jasper, usually make a living catering meals for groups, but their small business, Cleo’s Blue Corn Kitchen, has been largely shut down by the pandemic. “We’re lucky we have a community supporting us,” she said. They’ve received a few small business grants, live frugally and take advantage of mutual aid food boxes available to them. “I’m just lucky enough that I know how to make a buck stretch.”

Until she got sick, she spent much of her time working with others in Albuquerque to organize and deliver meals to homeless people in the city, and to help her relatives and friends weather the crisis. Originally from the northern New Mexico village of Torreon, at first Otero thought she might have picked up the virus from one of the back-and-forth trips she was making to deliver supplies to her family. But later, she learned there had been an outbreak at a store where she’d shopped earlier that week, getting supplies for the weekly meal. She now thinks she and her family caught the virus at the store, but can’t be certain.

Those weeks in the bedroom are a long blur. She experienced delirium and her equilibrium was off. She’d stagger to the one bathroom, which the family would then clean and sanitize thoroughly. Pedialyte was a lifesaver, she said. Jasper made brothy stews for her. She was taking anything she could think of to help, over the counter medications, aspirins, “sage tea, a lot of sage tea, and then other teas.” 

She’d wake up gasping for air, even though she slept on her chest as recommended. 

“I’d start doing push ups. My lungs would expand a little bit and after I’d catch my breath I’d start doing yoga, just stretching my lungs, what I thought would help my lungs. That would happen two  or three  times a night.” 

It’s an understatement to say Cleo battled for her life. 

The COVID-19 coronavirus is commonly depicted on the web as having thorny protrudings.

As 2020 draws to a close with almost 340,000  Americans dead from COVID-19, including 2,400 New Mexicans, the unprecedented public health crisis has made plain that people of color and those with lower-incomes are more likely to catch the deadly and highly contagious airborne virus, and consequently to become hospitalized, or die. 

Hardest hit in New Mexico have been Native Americans, like Otero, who is Navajo and Hopi. 

By December 26, 6% of New Mexicans had contracted the virus.  The difference between the highest income and the lowest income communities couldn’t be more stark. In the 30 of 499 census tracts in which less than five percent of the population lives below the poverty level, just one exceeded the statewide positive case average of 6% on Dec. 26. These high income census tracts are disproportionately white.

Conversely, in the 31 lowest income census tracts, in which more than 40 percent of families live in poverty, 20 exceeded the statewide average. These census tracts are home to Navajo chapters, or disproportionately Black, Indigenous and Latino.

The following interactive maps created by New Mexico In Depth using data provided by the New Mexico Department of Health through a public information request illustrate how the percentage of positive cases is higher in lower-income communities and neighborhoods.

Aliya Uteuova

New Mexico census tracts by poverty rate.

Aliya Uteuova

New Mexico census tracts by percentage of COVID-19 cases.

The map on the left shows the lowest income census tracts in darker colors. The map on the right shows higher case percentages in darker colors. The color pattern is similar enough to illustrate how the virus has infiltrated lower income communities the most. Click on either map to explore census tracts by population, demographics and case percentage.

Across the nation, an emerging consensus among public health officials is that poor access to good-paying jobs and wealth are key factors in why lower-income people have contracted the illness at higher levels. They’re more likely to have jobs that force them into contact with others, or to live with greater numbers of people under one roof. They’re more likely to rely on public transportation, or to lack reliable internet connections that help facilitate remote shopping and other essential activities.

Meanwhile, their higher-income neighbors have been able to retreat to their homes for work, can readily access curbside pickup for groceries and other goods, and when the virus does encroach within their families, they’re more likely to have multiple bedrooms and bathrooms that help people maintain physical distance so as to not spread the illness to loved ones. 

The NM Department of Health reported that as of December 21, 8.7% of Native Americans had contracted the virus, more than double the next most impacted group, Hispanics at 3.5%. Native people have been hospitalized and have died at vastly greater rates, as well.

While the COVID-19 pandemic led to an early and ongoing struggle on the Navajo Nation and in certain Pueblos, the harm to Native communities from COVID-19 spread throughout the state over the course of the year.  Mescalero Apache in the south, Jicarilla Apache in the north, the Navajo satellite communities of Alamo and Tohajiilee, and neighborhoods in Albuquerque home to significant Native populations have all been affected by the virus at high rates. 

Shaun Griswold

Pearl Delgarito directs traffic at the Alamo Navajo Medical Clinic.

One of the late surges came to the Alamo Navajo community this fall. About 9% of residents of the rural community an hour northwest of Socorro had contracted the virus as of late December. 

Tera Jaramillo paused before stating how many of her employees had tested positive for COVID-19. “We just had another one, like three minutes ago, that said they have it,” she said during a telephone interview in early December.

It’s all too familiar for Jaramillo, the CEO of Positive Outcomes, a home health and child care provider in Alamo.

By that point, at least 30 clients and 15 employees of Positive Outcomes had tested positive for COVID-19, Jaramillo said. Ten people had died. Hundreds of others who live in the community of almost 2,000 had been affected. It’s not uncommon to see the virus spread among homes that can house up to 20 people, Jaramillo said. 

“Right away we lost two teachers, and a minister and that was from one family. These are people that you know,” she said. “I went to school in Alamo as a kid and I grew up there and these are people I loved.”

Jaramillo said the crisis was like a war, with helicopters coming day and night, taking people to hospitals. “We were backed up at the mortuary, for 15 people that needed to be buried. The guy that digs the graves was sick.”

Jaramillo worked closely with Alamo Chapter President Buddy Mexicano to help rush an aid program from the ground up to address a range of disparities, such as lack of water access, safe housing for those needing to quarantine, testing, food insecurity and other problems the community faced. 

All the while, she said, Mexicano saw several family members die rapidly in succession. Then, he contracted the illness. 

“He became sick a few days prior to the election and President Mexicano was elderly so we were trying to be very cautious with him but he did contract COVID and he was in the hospital for quite some time before he passed.”

Shaun Griswold

Pearl Delgarito is sore from the vaccine shot while directing curbside traffic at Alamo Health Clinic. Otherwise, it’s not an issue. “All of my husband’s side of the family, they lost pretty much the whole family. They just have a few left that’s still here,” she said, which includes six aunts. “It was sad because a lot of people you knew are not here no more.”

Shaun Griswold

A smile from Luis Peralta on a sunny cold day in Alamo, New Mexico. Peralta runs security at the community clinic where many of his friends have come with symptoms. He’s lived in Alamo for nearly 40 years and went to school with Buddy Mexicano, “I knew him ever since we were in school. It’s a tremendous loss because he knew quite a bit and he knew a lot of people.”

In addition to Native communities, the virus has struck particularly hard in low-income, Hispanic communities along the southern border with Mexico; as well as neighborhoods with high Latino, Black and Native American populations in Bernalillo County. 

“These communities are poor, and more isolated,” Dr. Jill McDonald, director of the Southwest Institute for Health Disparities Research and a professor of public health at New Mexico State University in Las Cruces, said of the high rate of COVID in border communities. “The people live in more crowded households. They work in places that put them in close contact with other people like food processing plants, such as one in Sunland Park, or as workers in long term care facilities. They have a lot of those kinds of low paying jobs that increase their exposure.” 

The public health field has long uplifted “social determinants” as key factors in how healthy people and communities are. The World Health Organization attributes most unequal health outcomes to the social, physical, and economic conditions in which people are born, grow, live, work, and age. One prominent public health expert targets poverty as the biggest factor in poor health. “The real causes of many deaths are social determinants such as illiteracy, fatalism, gender bias, racial bias, unemployment, and poverty,” epidemiologist William H. Foege wrote a decade ago in a paper published in the Public Health Reports journal. “Poverty is the single biggest factor contributing to adverse health outcomes, and health outcomes worsen as poverty becomes more severe.” 

The COVID-19 pandemic has starkly illustrated the disproportionate health effects of low-incomes and crowded housing. 

McDonald said that if income were distributed more equitably, the virus might be less concentrated in certain communities because more people would have better-paying jobs, or the ability to work from home, and more would be able to self-isolate if they got the virus. 

Enrique Cardiel, Executive Director of the Bernalillo County Public Health Council, echoed McDonald. 

“People in lower income communities are less likely to work in jobs where they can work remotely,” Cardiel said. “Working class folks are likely to be the ones that have to maybe work on a construction team or work in a grocery store. And even be, you know, medical staff. Not doctors, but working in a clinic.”  

Cardiel said that in Albuquerque, just as in other low-income communities, multiple generations often live in one household, increasing the danger that COVID will be transmitted within a home. “…there may be young folks who get it and are asymptomatic and you have older folks living in the home as well,” he said. “So somebody who’s feeling fine may not know they have it, go to work, come home and spread it to their families.”

Concerning high COVID rates in the city’s International District, Cardiel said outbreaks occurred early in some immigrant communities where language barriers got in the way of public health messages about the pandemic.

“In many ways, we would say that racism and not race is the pre existing condition that we’re dealing with here,” said Michelle Melendez, director of the City of Albuquerque Office of Equity and Inclusion. “Black and brown people are in those front facing low wage essential services jobs, you know, stocking grocery shelves, working in child development centers, working in nursing homes, all the cleaning companies, all the food service, all of those continue to operate and have been to keep our city going. And the majority of people in those jobs are people of color.”

In addition to increased risk of exposure, Melendez said, people of color are more vulnerable to getting sicker from the virus because they tend to have higher rates of underlying conditions, such as hypertension, obesity, high blood pressure, or–like Otero–diabetes.

“If you get the virus, you tend to be sicker if you have those underlying conditions,” she said. “And we know that black and brown people have those underlying conditions.”

Her office uses a tool called the Social Vulnerability Index to gauge which parts of town are at the highest risk based on four factors; household composition and disability, minority status and language, socioeconomic status, housing type and transportation. The city used the index to allocate resources like mobile hand washing stations to neighborhoods in the International District. Areas in the South Valley were identified to host mobile testing centers. 

Shaun Griswold

Cleo Otero’s family lived in their living room during the three weeks she self-isolated in their bedroom.

In her second week battling COVID, Cleo Otero started coughing up blood. At first she resisted going to the hospital, because she feared she’d not make it back home. But she was convinced by her family. “My mom would cry on the phone, because all we were hearing on the reservation was that our elders and people with underlying conditions were dying.”

She gets emotional when talking about leaving her partner and son to drive herself to the hospital. “So I’m just watching them, and they’re just really quiet and they’re just looking at me and my son couldn’t even speak to me. He was a little afraid of me. Jasper was just like, you got to go. It took me like a good you know, 30 minutes, to even get the courage to walk out the door.”

The walk to her vehicle, about 200 yards, was hard and slow, and once in the car it took her about 15 minutes to catch her breath. The hospital staff were like “machines,” she said. They did x-rays and a CT scan, and found while her left lung wasn’t so bad, her right lung was riddled with the virus. Her oxygen levels were too low, in the mid-80s. They said they’d give her oxygen for about two hours, and if it didn’t get up to 90 they’d admit her. 

“I started really making myself do breathing exercises… I was fighting this number,” she said about trying to get her oxygen level up to 90. It worked, she was able to go home. Getting there involved another laborious, slow walk to the car. No one escorted her out. She wonders if she would have received a prescription for at-home oxygen therapy, like some in a COVID survivors group she participates in online, had she been on private insurance rather than Medicaid. Instead, she went home empty-handed, to the bedroom where she continued her fight. 

Shaun Griswold

Cleo Otero’s partner, Jasper, shows a bag of herbs they are bundling for others.

As vaccines begin to take hold and the pandemic recedes, millions of Americans will need to find new jobs and do their best to regain their footing. Children and students will need to catch up at school. Many of those who caught COVID and survived may grapple with lingering effects. 

And society as a whole will have an opportunity to tackle the long-standing disparities that have been thrust into the open in an unprecedented way by the pandemic. “Health inequity is when one group deals with a health issue disproportionately than other groups from things that are preventable,” Cardiel said. 

As for Otero, her recovery has been helped by prayer, the teachings of her elders and the support of her friends and family. 

“I definitely feel like I fought,” she said, noting that her elders taught that when one is sick, they need to fight. It’s when she was really tired and gave in to extended sleep that she thinks it got worse. “That was right around the time when I started spitting up [blood],” she said.  

Her friends brought soups, herbal medicines and teas, and stayed in constant touch with her. “I really felt for those who felt for me,” she said, noting the fear they expressed for her.

Breathing gradually became easier and less painful. Meaty stews were palatable. She wasn’t stumbling. Her fingers didn’t tingle anymore. Her brain was less foggy. She no longer coughed up blood. And she could sleep through the night without exercise. When she and her partner decided they could be together again, they stripped and sanitized the bedroom. To this day, they continue to sanitize everything meticulously. “Airborne stuff is really scary, even though we had our masks on, we still got it.” 

She’s better now, and is focused on self-care. But she has lingering symptoms, and sometimes finds herself angry, perhaps, she said, from the trauma. “I can’t even imagine what my brain has gone through.” People remind her to slow down, because she’s still healing five months later. 

As she got better, she focused on returning what she received, gathering sage and other medicinal herbs into bundles to send across Indian country to those coping with what she went through.

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