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COVID-19's Ongoing Reach Into Colorado's Latino Community Stretches Far And Deep

Courtesy of Lorena
Lorena, 52, was infected with COVID-19 in July. An undocumented immigrant who lives among other Spanish-speaking immigrants, Lorena said misinformation about COVID is rampant among those she knows. Many, she said, believe the virus is a hoax.

COVID-19 has reached into Hispanic communities in every corner of Colorado, afflicting some at rates more than double their share of the population, a new analysis by the Colorado News Collaborative found.
The Colorado News Collaborative (COLab) obtained race and ethnicity data through late September from the Colorado Department of Public Health and Environment (CDPHE) for each of the county’s 16 epidemiological regions — blocks of neighboring counties with a combined population of at least 100,000. In all 16 regions, Latinos have tested positive for COVID-19 at rates that are disproportionate — in some cases, dramatically so — to their share of the population.
In seven of the regions, the percentage of Latinos testing positive for COVID-19 was more than twice their share of the population. Among the state’s white, non-Hispanic residents, rates of those testing positive were lower than their share of the population across all 16 regions. 
The disparity was most severe in the northwest region, which covers 11 counties including Garfield and Eagle counties. In Garfield County alone, Latinos make up nearly 30% of the population and close to 70% of the COVID cases. In the region as a whole, Latinos have made up more than half of all cases despite comprising just one-fifth of the population. The data underscores previous analyses both nationally and statewide that show COVID-19's disproportionate impact on Latino, Black and Native American communities.
“That is concerning. That is troubling. That is extremely dangerous and unacceptable and should have never happened,” said Alex Sánchez, the executive director of Voces Unidas de las Montañas, an advocacy organization that focuses on social justice issues among Latinos in Garfield, Eagle and Pitkin counties.
The analysis is limited in part because 20% of the cases provided by the state are missing race and ethnicity information altogether. Collecting this information is difficult when medical providers do not ask patients to self-identify, CDPHE said.
The state gathers its race and ethnicity information from local public health agencies and during case investigations. It also collects the data from laboratory reports and through an electronic disease reporting system, the department said. Several local health agencies told COLab that race and ethnicity data can also be missing from case investigations because people do not respond to calls from investigators or because they refuse to provide that information.
As a result of the missing information, COLab calculated its findings based on the total number of cases where a person’s race or ethnicity was known. But even if Latinos made up none of the positive tests in which race and ethnic information was missing, Colorado’s Hispanic population still would have tested positive for COVID-19 at disproportionately high rates in all 16 regions.
And the disparities may be even higher than COLab’s analysis suggests, said Carlos Rodríguez-Díaz, a George Washington University associate professor who researches infectious diseases and health equity.
“Overall, the disparities in the Latino communities and communities of color might be underrepresented because we are not necessarily outreaching those communities,” said Rodríguez-Díaz. “And therefore the data we have might not be reflecting the real experience in communities of color.”
Access to Information
On a Friday in early July, Lorena, a 52-year-old mother of three, realized she had lost her sense of taste and smell. She had a slight headache, but no cough. Lorena, an undocumented immigrant, works in a Mexican restaurant and cleans houses for a living. She is a monolingual Spanish speaker who lives in an apartment building in west Denver with neighbors who are also Spanish-speaking immigrants. The swirl of information about COVID-19 among her neighbors tends to be laced with denial, she said.
“People say it doesn’t exist, that it’s a government lie,” Lorena said. 
But Lorena also works as a health care outreach worker — a promotora de salud — for the Denver-based Latino-serving nonprofit Servicios de la Raza, and so she went to get tested and then quarantined while she waited. Five days later her result came back positive. She stayed quarantined. Her 18-year-old son quarantined. Her two older boys stayed away. She said she suspects the building elevator was spreading the contagion because others in her building have contracted the virus, too. 
And, yet, even now, Lorena said, she hears people say it’s a hoax. Even now, when they can see her work has dried up and she is struggling to pay her bills because her old employers are wary she still might transmit the virus, people tell her it’s pura mentiras  — all lies. As for President Trump testing positive, she has heard some say it’s all just a bid for sympathy and votes.
“It’s the truth,” she tells them. “I had it.” 
Lorena is not surprised by COLab’s analysis of the depth and breadth of COVID’s traction in the Latino community. Neither is Julissa Soto, the director of statewide programs for Servicios de la Raza. 
“Our Latino community, the front-line workers, need a lot of education when it comes to COVID,” Soto said.
Language isolation is a problem, she said. So, too, is cultural isolation.
Throughout the pandemic, information often has taken a long time to reach Spanish-speaking audiences, GWU’s Rodríguez-Díaz said. With messaging changing over time as public health experts learn more about the disease, that could mean that Spanish-only speakers have not been receiving timely information.
“The information to prevent infection might not be delivered when appropriate or using the tools that would be useful in Latino communities that do not speak the language,” Rodríguez-Díaz said.
In his own analysis, Rodríguez-Díaz found that counties with higher proportions of Spanish-only speakers disproportionately tested positive for COVID-19 even after controlling for Latinos’ proportion of the population.
While that suggests access to translation materials plays a role in Latino disparities in the pandemic, previous analyses show other factors also contribute to those results. Among those factors: Latinos working in low-wage jobs that place them at higher risk, predisposition to underlying health conditions often related to poverty, untreated underlying health conditions due to lack of health insurance, and intergenerational family living. 
Still, Rodríguez-Díaz said,  a lack of Spanish-language resources could be creating barriers preventing some Spanish-only Latinos from getting tested.
“By only having services that are in English, we are creating a barrier,” he said. “So we need to change the services and eliminate those barriers if we were interested, really, in providing services to the Latino community.”
In Colorado, access to translated materials was limited in the early stages of the pandemic, said Paulina Erices, a maternal child health specialist who works with Jefferson County in a role focused on community inclusion.
“There was not even information being translated — not from the state, not from the county, nowhere,” Erices said.
Servicios’ Soto said that when she created a testing site in Colorado Springs, the public health department did not have Spanish-language flyers or brochures about the pandemic.
“How is it that we expect our community not to get this terrible virus if they don’t even understand how you can be contagious, or how can you get it?” she said.
In addition, much of the information that has been translated has been written at a higher grade level than many Spanish-only speakers can understand, Soto added.
According to CDPHE, it completed its first Spanish translation requests on March 6, a day after Gov. Polis announced the state’s first case. It then hired a translation company to complete 23 translation projects and hired two full-time Spanish translators. More recently, it has conducted audience research to better inform Spanish-speaking Coloradans and other impacted communities.
“The data collected at the state and national level makes it clear that communities of color — particularly Black, Latino, and Indigenous populations — are more likely to contract and die from COVID-19 than white Americans,” the department said. “The state recognizes these disparities are not the result of individual choices, but rather the institutional and systemic barriers that existed long before the pandemic.”
In Garfield, Eagle and Pitkin counties, Sánchez said the availability of Spanish-language information has improved since the group requested better translations in June.
“They have stepped up and have put in resources to ensure that more of their information is working,” Sánchez said. “They’re still far from where they should be, in our opinion, but certainly it is far from where they were when we started the pandemic. And that’s kudos to their efforts.”
Culturally Relevant Testing Sites
In addition to language barriers, Erices and Soto said that many Latinos have also been reluctant to get tested for the coronavirus. This, too, could potentially suggest the disparities in COVID-19 cases may be an underestimate.
Erices said Latinos disproportionately have jobs that are both unstable and that they can’t do remotely, so a positive test could mean a loss of pay or even the loss of a job.
“We have had to do a lot of conversations with the community members about the importance of testing because testing for them may have higher negative consequences than for other people,” Erices said.
And Soto said many Latinos are afraid that their testing information might go to federal immigration officials.
In an effort to address these concerns and to provide testing services in Spanish, Servicios de la Raza set up a testing site in Colorado Springs specifically geared toward the Latino community there. The testing site had a bilingual staff and was organized by Latino leaders in the region,  signaling to Latino community members that it was a safe place for them to get tested.
In addition, Soto said she set up an event to allow struggling families to collect school supplies while they got tested. Twenty-seven percent of people who received tests at that site tested positive, she said — much higher than the rate in the county as a whole, and another potential sign that many Latinos in the region aren’t getting tested.
But in Colorado as in 43 other states, race and ethnicity data of those being tested is not publicly available, according to data from Johns Hopkins. CDPHE said in an email that testing sites are not required to ask for race or ethnicity information.
“While data is critical, requiring too much information at a testing site could become a barrier to getting tested,” the department said.
Still, having testing data broken down by race and ethnicity could help direct resources to where they are needed, said Cato Laurencin, a university professor at the University of Connecticut. Laurencin’s early research showed that Black people in Connecticut were testing positive and were dying of COVID at rates that exceeded their share of the population. 
But Laurencin also said that Black people who were being tested for COVID tested positive at over three times the rate of their white counterparts. That, he said, suggested that Black people were not being adequately tested for COVID.
“By understanding where the higher rates are, resources can be directed properly to be able to both test for COVID-19 and also to combat the disease,” Laurencin said.
Erices and Jefferson County have been working to reduce the disparity and to increase the access Spanish-speakers have to information in the county since March. On March 11, Jefferson County Public Health and the Adelante Network in Jefferson County hosted a meeting where attendees shared phone numbers and helped each other get set up on Zoom.
The two organizations have continued to meet regularly, first daily and now three times a week, informing people in Jefferson County’s Latino community about the rapidly changing pandemic.
“It was so important to keep updating and [following] up everything that was happening with COVID-19,” said Karina Urrego-Restrepo, a family navigator for Jefferson County Public Health.
The county also has set up a phone line where Spanish speakers can talk about their concerns about the pandemic. And it recently launched a testing site like the one Soto launched in Colorado Springs. The site offers bilingual resources and will have five or six community navigators from the Adelante Network who will provide resources and answer questions people have before they receive tests.
“One of the biggest barriers for Latino communities is the lack of trust of agencies or even government entities,” said Hilda Gehrke, a contractor with Jefferson County Public Health. “So we are hoping that by providing that personalized and that community connection to people, they will feel more comfortable getting tested.”
Even with those efforts, though, Jefferson County’s Latino community has been hit hard by the pandemic. Despite comprising 15 percent of the county’s population, as of Sept. 23, Hispanic people accounted for over one-quarter of Jefferson County’s cases.
In Denver, Lorena said her anxiety over losing work due to COVID has cost her sleep and she’s gaining weight. To those who say COVID is not real or that it’s not a big deal, she says: Protect yourselves. Take care of your community. Take care of the elderly. Take care of the children. Se cuiden. Take care. 

Tina Griego contributed to this story 

Max Lee is a recent graduate of Stanford University’s graduate program in journalism. He’s interning for the Colorado News Collaborative through the Stanford Rebele Internship Program.

This story is brought to you by COLab, the Colorado News Collaborative, a nonprofit coalition of more than 60 newsrooms across Colorado working together to better serve the public. Learn more at https://colabnews.co