THERMAL, Calif. — Her lungs aching with each breath, Blanca Quintero, a 53-year-old cancer survivor, sought care for the coronavirus from physicians almost two hours away in Mexicali, Mexico, because her calls to doctors here went unanswered.
Was she being overlooked in the flurry of the winter surge or simply ignored, another instance of the mistreatment she and other Latino patients have faced as Spanish-speaking immigrants, she wondered.
Was the risk of venturing across the border worth it? Yes.
Even as the virus tried claiming Quintero as a casualty, it infected her son, husband and grandson — infections Quintero believes she carried into their home. At last count, 15 friends and family members have been taken from Quintero’s life by the coronavirus.
“People get to the point of where my uncle was. He waited until he couldn’t breathe any longer,” she said. “That’s when they want to look for help.”
Throughout the pandemic, the coronavirus has disproportionately carved a path through the nation’s Latino neighborhoods, as it has in African American, Native American and Pacific Islander communities. The death rate in those communities of COVID-19, the illness caused by the virus, is at least double that of whites and Asian Americans, federal data shows.
Even more stunning: the deadly efficiency with which the virus has targeted Latinos in their 30s and 40s.
In California, which has the nation’s largest Hispanic population, state figures show that as of Wednesday, Latinos ages 35 to 49 died of the virus at more than 5½ times the rate of white people the same age. The gap was even wider a few months earlier: In December, when Quintero fell ill, Latinos in the prime of life were nearly seven times more likely to die than their white peers, according to the Covid Tracking Project, an independent group that collects case, death and hospitalization data.
Put another way: 35-to-49-year-old Latinos represent 41.5% of people in that age range in California but account for about 74% of deaths.
The staggering loss of life at younger ages, plus higher overall mortality rates, is projected to have caused Latinos’ life expectancy nationally to plummet by about three years during 2020, according to a peer-reviewed study published by the Proceedings of the National Academy of Sciences in February. The results were calculated using federal data. The authors of that study, who recently updated their findings, report that Latinos’ reduction in life expectancy was more than three times the loss experienced by the white population.
“A younger age at death represents more lost years of life,” said Theresa Andrasfay, the study’s co-author and a postdoctoral scholar studying health disparities at the University of Southern California. “This shows just how this pandemic is operating a little bit differently than other causes of death.”
The findings proved all the more stunning because for years researchers had recognized that Latinos in the United States lived longer than white people, despite social, political, economic and environmental factors that typically erode health and shorten lives. This advantage had grown since 2006, when the federal government began separately documenting Latinos’ life expectancy.
Now because of the pandemic’s overwhelming loss of life and disproportionate amount of death among younger Latinos, about two-thirds of that advantage has been erased in one year, said the study’s co-author, Noreen Goldman, a Princeton University demographer who has studied Latino health and socioeconomic disparities in health for years.
“That’s huge,” Goldman said. “One would have thought [that advantage] would have carried over to covid. And we’re not done. What’s going to happen by the end of 2021? My hunch is that there will no longer be an advantage at all.”
The quest to reverse that tide of death can be found in California’s eastern Coachella Valley, where citrus and date groves rise from a desert floor lined with rows of broccoli and lettuce. Each person who answers the door in a mobile home community reflects part of Quintero’s story as a Mexican immigrant negotiating life during the pandemic.
Thirty-five years ago, she settled in the United States as an 18-year-old bride pregnant with a child who would be born with special needs. Quintero, already mother to a toddler, spoke no English and had no clue how to navigate the nation’s complex health-care system.
But with the support of promotoras de salud — community health workers — she learned which questions to ask the surgeons and what support services her daughter’s developmental delays required as she worked toward a better life for her family. She washed dishes, cleaned houses, worked in fields and cared for the elderly before going to school and becoming a message therapist and cosmetologist.
Now, Quintero stands on the front lines in the battle against the coronavirus — as a promotora de salud. She knows that battle all too well from her own six-week bout with COVID-19, when she relied on a nebulizer to ease her breathing. Sometimes, she is joined in her work by her daughter Lesly Quintero.
“It was like from one week to the next, people were just getting sick everywhere,” Lesly Quintero said as she walked along Peter Rabbit Road with her mother, promoting a free testing event later that week while emphasizing that coronavirus tests were “por la boca” (for the mouth) because people remained wary of nasal swabs. “Everybody was just having symptoms and testing positive.”
Just then, she overheard her mother admiring an altar devoted to the Virgin of Guadalupe as two tiny dogs barked and chased strangers in the roadway. The shrine — a transformed eight-foot-tall shed — brimmed with candles, roses, daisies and gladioli that had yet to bloom. A huge picture of the virgin hung from the back wall. Pinned to a statue were dollar bills, offerings of gratitude for blessings received.
Blanca Quintero listened as a 48-year-old farmworker, Maria Ines Sanchez, told her that faith spared her family the worst ravages of COVID-19. The shrine rotates to a different member of the indigenous Mexican family, who are Purépecha, each Dec. 12, the feast day of the virgin. This year, it landed in the farmworker’s backyard as the coronavirus surged and four people in the house got sick but recovered quickly.
Later, Quintero said it was faith that helps her cope with an incomprehensible amount of death: “Yes, there’s pain and sadness, but to me it means their mission was accomplished.”
Her daughter was the first person in her family to fall ill from the coronavirus. A medical assistant who used to work at a pain management clinic, Lesly Quintero said she contracted the virus from a patient in June and brought it home, where it spread.
“If I had been tested earlier, I could have prevented passing it on to my partner,” she said. She was sick for a month and lost her job after she recovered, so she joined her mother as a promotora de salud with Visión y Compromiso.
“They are the safety net,” said Linda Sprague Martinez, a professor at Boston University’s school of social work who conducts community health research with adolescents and young adults. “They’re able to translate information from institutions to the community in a way that’s meaningful because they know personally mediated racism and how that plays out. They see people. They see neighbors. They see friends.
“Whereas systems don’t see you,” Sprague Martinez said, “they see a number. They see a chart.”
Part of Lesly Quintero’s mission as a medical assistant had been helping Spanish-speaking patients better understand the doctor’s orders, serving as a bridge between marginalized communities and the medical establishment. COVID-19, with its stranglehold on low-income neighborhoods and communities of color, intensified the need for that work.
Then came the winter surge of cases, which overwhelmed California’s hospitals, deepened the virus’s disproportionate impact and spawned a dangerous variant.
“Now, you hear of people dying all the time,” Lesly Quintero said.
There was her colleague’s uncle, a well-known Catholic priest who worked to ensure that his parishioners did not go hungry during the pandemic.
And her mother’s friend, who lost both parents, a son and a grandchild.
“When communities have very solid social umbrellas, COVID is not going to make much headway,” said David Hayes-Bautista, director of the Center for the Study of Latino Health and Culture at the University of California at Los Angeles’ David Geffen School of Medicine. “But when you get communities that have great big, gaping holes — lack of health insurance, lack of providers, have to be out and exposed, low-income — COVID is just going to go right through there.”
A federal analysis of the first half of 2020 found a precipitous drop in life expectancy among Black and Latino Americans, with African Americans suffering the steepest decline. Life expectancy for Latino Americans was 79.9 years through the first six months of 2020, for white people it was 78 years and for Black people 72 years, according to federal figures. A year earlier, it was 81.8 years for Latino people, 78.8 for white people and 74.7 for Black people.
Andrasfay, of USC, said that as subsequent waves of the virus hit different parts of the country in the latter half of the year, disparities in the racial and ethnic composition of death began to change.
The pandemic has exploited the social and economic inequality that has long dictated who gets access to health resources, including well-equipped hospitals and coronavirus testing and vaccination facilities. Many of the people living in spots such as Thermal are essential workers who cannot avoid the virus in their jobs because they do not have the luxury of working from home. They often live in multigenerational homes with several adult wage-earners, sharing housing because their pay is so low.
“Put any group into that situation, you’re going to see these surges,” Hayes-Bautista said. “It just so happens, particularly here in California, a lot of the occupations, such as farm work, are almost entirely filled by Latinos and immigrants. They kept us fed, but they got exposed.”
The literature on how social stratification affects health is vast. One study on racial inequality and health appearing in a special issue of the journal Du Bois Review: Social Science Research on Race said, “Severe limitations in accessing life opportunities . . . in turn influence exposure to deleterious health conditions.”
There has been less research into the health effects of confronting the stigmas American society ascribes to Latinos — stereotypes that conflate ethnic identity with immigration status and make assumptions about language ability.
Limited research into the health of Mexican Americans, the nation’s largest Latino group, shows that they experience increased allostatic load — a measure of the physiological wear-and-tear caused by social stress and racism — the longer they live in the United States.
Repeated allostatic assaults “weather” the body, causing it to age prematurely. Sustained stress has strong links to obesity and can trigger metabolic changes that lead to chronic conditions such as diabetes a decade earlier in life, particularly among African Americans.
Even though Latino people’s life expectancy is greater than that of white people’s, they experience higher rates of at least two chronic conditions that make people more susceptible to severe sickness from the coronavirus: diabetes and obesity.
“That’s a core population at risk in this because they’ve got inflammation. They’ve got metabolic syndrome potentially, or near metabolic syndrome. They’re more likely to have cardiovascular risk,” said William Vega, a distinguished professor of community health at Florida International University who has studied Latino and immigrant health for 40 years. “So those issues compound the risk that they’re already getting from exposure. There’s a lot of very approximate issues that are affecting daily life.”
That includes wealth, salary, education, immigration status, length of time in the country and power.
The median household income for Latino families was about $16,000 less than for white families in 2019, $55,658 compared with $71,664, according to census figures. They were also about three times more likely to be uninsured, and about 15% of all Latino families live in poverty compared with 5.5% of white families.
Still, Latinos live longer.
“Which for many people is kind of puzzling,” Goldman, the Princeton demographer, said. “In the field, we call it the Latino paradox.”
Researchers do not have solid answers for why this paradox exists. Some theories suggest that immigrants arrive in the United States healthier or that those in poorer health or near death return to their country of origin, concepts Hayes-Bautista criticizes as “basically an assumption of what I call ‘minority dysfunction.'”
“We need to look at the strengths within our communities that fly in the face of the U.S. racial narrative, which is: Minority communities have no strengths. They can’t do anything right. And if somehow something is right, they did it for the wrong reasons,” Hayes-Bautista said. “We need to look at the communities — the webs, the interaction, the effect. It’s all these things. It’s not just a bunch of people who just happen to be stuck together.”
When Quintero knocked on Nora Vasquez’s door late in February, the 49-year-old Vasquez thought the promotora de salud came offering salvation from the suffering that no one should know but that too many people in her community have come to understand. But Quintero was giving out information about testing, not vaccination.
Vasquez had endured her oldest daughter’s 15-day stay in intensive care in Los Angeles, listening to her gasp for air after each sentence spoken on video chats that served as their only means of connection and comfort. There were the daily updates from doctors warning that Vasquez’s daughter would not recover if she were put on a breathing machine, because of weight and health issues.
Next, Vasquez’s two sisters and three nieces, who live across the street with her mother, fell ill.
Then, just before Thanksgiving, the coronavirus crept into Vasquez’s home. A co-worker at the McDonald’s Vasquez manages had fallen ill. Vasquez said she caught the virus from her colleague. Soon enough, seven of the eight people in the tan mobile home — everyone but her eldest daughter, who had already recovered and had returned home — were struck down by the coronavirus.
“It’s only four rooms. One restroom. One kitchen,” her 28-year-old daughter, Victoria Samano, said from the front porch as the family’s 5-year-old Chihuahua mix sat sentry in the window. “It’s kind of obvious if one person gets sick, we all get sick.”
Vasquez, who is diabetic, said, “My granddaughter grabbed my head and kissed me” the day her co-worker felt ill.
With that quick act of affection, the virus jumped to yet another house and infected even more relatives. When her son stopped by a few days later to bring her a painkiller, he, too, was coughing. Eventually, all five people in his home, including Vasquez’s 8-year-old granddaughter, got sick.
Vasquez spent days in a fever-fueled dream. Her two teenage sons slept for hours, as did Samano, who only remembers waking to drink sips of the water, tea and Gatorade left at her bedside by her oldest sister, who had become the family’s caretaker as they convalesced. Samano went on an online shopping spree, though she does not remember purchasing the iPad accessories. It was only after she recovered weeks later that she discovered the unopened Amazon packages placed under her bed.
“I got really sick. Not so sick that I couldn’t breathe and had to go to the hospital, but sick enough that I lost 30 pounds,” Samano said. Her younger sister with whom she shares a room, 26-year-old Valerie, spent three days in intensive care.
“Just knowing that we could have lost Vale, knowing we could have lost Grandma — I don’t like thinking about it,” Samano said.
Their family has suffered enough loss, Vasquez said as she began to list the friends and relatives who have succumbed to the coronavirus. Her sister-in-law’s father and 34-year-old sister. Two elderly aunts. Two cousins and one friend, all under 40.
The most recent, her 34-year-old cousin who died in the hospital without family by his side, happened just three weeks ago.
“I know it’s still here,” she said.