COVID-19 through the Latinx infectious disease doctor's eyes

Abstract

“Hola, yo soy la Doctora Roque y soy parte del equipo de Infecciones. Estoy aquí para ayudarte. [Hi, I am Doctor Roque and I am part of the Infectious Diseases team. I am here to help you.]” Since my first year of infectious diseases training collided with a global pandemic, I have uttered the above words far too often in COVID-19 wards. When the patient is conscious, I almost scream the words so that they can hear me over the loud hum of the air filters in the isolation rooms. When the patient is intubated, I still say them out loud, hoping that they can hear them, understand them, and feel some comfort. As a Cuban immigrant and physician, the pandemic brought about crushing personal sadness as I saw every day the faces of my loved ones reflected in the patients that I cared for with COVID-19. By now, the brutal statistics are well known about the disproportionate impact the virus has had on racial and ethnic minority groups (ie, African American, Latinx, and Asian communities) throughout the USA. This virus has laid bare what has been known for generations: poverty and inequality in the form of overcrowded housing, lack of access to healthy food, and systemic racism lead to poor health outcomes. As of Dec 11, 2020, I have not cared for a single patient with COVID-19 who is not from an ethnic or racial minority group. I have been a witness to the same stories time and time again; each denting the emotional armour that I have built up over years of medical training. I remember the young man that I spoke to through a glass door in the intensive care unit with big black eyes. He looked so relieved when I introduced myself in Spanish. He told me that he worked at a convenience store and needed the job to support his family in central America. He continued to work even after developing symptoms because he had no other income source. Then, there was the intubated, elderly gentleman who lived with his wife and son. His son was an essential worker who had contracted COVID-19 and was intubated at a different hospital. Within hours, the patient's wife was also admitted to our hospital and I scrambled to answer questions about their care to their devastated daughter and sister. In the patients that I have cared for with COVID-19, I have seen the work ethic of my father, a truck driver who's woken up at 0400 h for decades to work long days to support our family. I saw the commitment to family of my mother, a hotel supervisor who is now unemployed but who is eager to return to work since she helps support our extended family in Cuba with her salary. I saw my own immigrant story, coming to the USA and realising a dream of becoming a physician, but often feeling like an imposter in academic circles with colleagues that rarely share my life experiences. Towards the end of the academic year, in the midst of 80 h work weeks at our county hospital, nationwide protests, a growing number of Latinx patients with COVID-19, and a daily fear of infecting my husband due to my hospital exposures, I hit a breaking point. Exhausted and overwhelmed, one day I closed the door to the infectious diseases office and sobbed silently into my scrubs. Yet, as I have done so many times during my medical training, I dried my eyes afterwards, took some deep breaths, and continued writing consult notes. Since that day, my thoughts have turned to what needs to happen next to help the Latinx community survive this crisis. Hospitals in the USA must increase the number of in-person Spanish translators, as well as provide discharge information in Spanish in the form of written materials and access to videos for patients with limited reading capabilities. Conversations about intubation and experimental treatments for COVID-19 should only happen through a phone translator as a last resort. Language accessibility should extend to the community setting in the form of Spanish speaking contact tracers and health workers to educate Latinx communities about COVID-19. Additionally, there must be increased advocacy for ethnic and racial minority groups. We must fight for universal income assistance during illness so that patients without legal documents do not have to choose between feeding their families and going to work while sick, for safe and affordable housing, for halting cruel detention practices by the Immigration and Customs Enforcement, and to dismantle criminal justice systems that have for so long targeted African American and Latinx communities. We must also work to recruit and promote more physicians from varied ethnic and racial backgrounds, particularly to leadership positions, since we know that diversity in the physician workforce leads to improved health outcomes for patients from ethnic and racial minority groups. COVID-19 is here to stay for the foreseeable future. When there is a widely distributed vaccine, though, and the trauma of 2020 is behind us, we cannot forget to continue to uplift the communities most affected by COVID-19. They are part of the fabric of our nation. They can be your nanny, neighbour, or friend. If you get sick, they might also be your doctor, doing everything they can to help you through layers of personal protective equipment. I declare no competing interests.