When Ana Gabriela Ochoa of Olathe found out she had COVID-19 in late June, the first thought that came to her mind was that she might die. Her symptoms included fever, trouble breathing, fatigue, muscle pain, dizziness and nausea. Uninsured, she went to urgent care and left with an inhaler.
Meanwhile, her sister, who tested positive for COVID-19 on the same day but had insurance, was prescribed an inhaler, antibiotics and pain medicine.
Ochoa, 30, tried returning to the clinic to get additional medication and was sent back home without being seen by a doctor. She had lost 20 pounds after two weeks and was still having trouble breathing.
“I came back home crying because I felt really sick. Where is the equality? We are all supposed to be treated the same, but we are not,” Ochoa said. “They didn’t know if they gave me the prescription if I was going to be able to pay for it or not.”
The Latinx community in the Kansas City area has been more significantly affected by COVID-19 than non-Hispanic people.
In Kansas, Latinx people contract COVID-19 at a rate 5.7 times that of non-Hispanic residents for cases in which ethnicity was reported — 22.9% of cases are missing ethnicity data. Latinx people accounted for almost half of COVID-19 cases in Wyandotte County, where 29.8% of the population is Latinx, for cases where ethnicity data is known. Latinx people also face greater disparities in accessing testing. In states where combined age and race data is available, younger Latinx and Black people between ages 18 and 49 are most affected by these disparities — dying more than people over age 65. Missouri and Kansas are currently not releasing this data.
The Latinx community is more likely to become ill from COVID-19 due to working front-line jobs or not being able to social distance in overcrowded households. There also is a lack of information about COVID-19 in Spanish. Latinx people in Kansas City are more likely to face barriers in obtaining identification or health insurance that can be vital for accessing medical services.
‘We need to take away the stigma of testing positive’
A primary barrier for much of the Latinx community is the unavailability of information in Spanish.
“Even if we are talking about immigrants that have been here for over 50 years, they still use Spanish as a primary language,” said Mariana Ramírez, director of the Juntos Center for Advancing Latino Health at the University of Kansas Medical Center. “At the beginning of COVID, we were trying to get information out and when we visited some government websites, it was not in Spanish.”
Juntos has worked to provide accurate information about COVID-19 in Spanish through their social media and by translating web pages for Wyandotte County.
Another health issue that the Latinx community in Kansas City faces is overcrowding. Ochoa and her husband struggled to quarantine themselves from their four children while they were sick with COVID-19 and living in a home with one shared bathroom. As a result, their oldest daughter also caught the illness.
“It is not uncommon in the Latino population, due to lack of resources, and it is also cultural,” Ramírez said. “The way you try to isolate in a home is a challenge.”
Ochoa caught COVID-19 from her husband, who works in construction. Several of his co-workers, including Ochoa’s brother-in-law, became sick as well. Jobs like construction, hospitality and food production have a high number of face-to-face interactions and are common industries for Latinx people in Wyandotte County to work in, Ramírez said. Nationally, Hispanic workers are overrepresented in jobs such as painters, construction and maintenance workers, agricultural workers, and maids and cleaners.
One short-term approach to improving the health of the Latinx community is to talk to employers, Ramírez said.
“How do we work with them to give them the resources they need to take action, to establish safety measures, to make sure they have a way to refer their employees to medical care if they need it?” she said. “If their employees don’t have insurance, then they need to have a way to refer them to a local qualified health center. We need to take away the stigma of testing positive and it being the fault of the employee or employer.”
Ramírez says another issue is that many of the jobs in which the Latinx community in Kansas City are employed do not offer health insurance or paid leave. In Wyandotte County, 46.4% of Latinx insurance holders have public insurance, likely due to not having jobs that carry private employer insurance. Ochoa was able to get two weeks of paid leave from her employer, but her husband, who was asymptomatic, was not paid during his time away from work. He was tested for COVID-19 but continued to work while infectious until he received his positive test result six days later.
When Ochoa’s doctor didn’t prescribe her more medication, she turned to one of her sisters, a nurse in Mexico, for help. Her sister was able to get a prescription from a colleague and sent Ochoa three medications: azithromycin, which is an antibiotic, oseltamivir, which is used to treat influenza symptoms, and ivermectin, which is normally used to treat parasitic infections. All are drugs that are currently being repurposed for potential therapeutic use in COVID-19.
“I didn’t think I could feel worse than what I was already feeling, so I took the risk,” Ochoa said.
Many of Ochoa’s husband’s co-workers did not seek testing or care for COVID-19 due to fears related to immigration, she said. Instead, they also took antibiotics that they were able to get from Mexico.
“The Hispanic people, they hear if you go to the doctor, they might check your legal status,” she said. “And if you’re positive, it might count against you.”
Currently, qualified noncitizen immigrants in the U.S. must wait five years for insurance coverage by Medicaid. People who are on work or student visas do not qualify for Medicaid. Nor do immigrants living here without legal permission.
“In the Kansas City area, if you do not have a Social Security number, you cannot purchase insurance, even if you have the money,” Ramírez said. “Medicaid expansion would help. It’s not a 100% solution.”
‘People who don’t have access to identification are going without getting tested’
Immigrants living here without legal permission also face barriers to health care when it comes to having government-issued identification. People without IDs may be unable to get tested for COVID-19 at some locations, see a doctor or pick up prescriptions.
Out of the seven permanent COVID-19 testing locations listed on the Wyandotte government website, four require an ID to be tested. The Unified Government Health Department drive-thru site doesn’t require photo identification but does require proof of living or working in Wyandotte County.
Most health clinics require ID for services to prevent fraud or help provide continuity of care. Many COVID-19 test sites require ID as an easy way to contact trace.
“Is there any law that says you have to have an ID to get medical care? Not really,” said Allison Edwards, a physician at Kansas City Direct Primary Care in Kansas City, Kansas. “It’s more that it helps people with logistics and making sure that people are accounted for and that we can find them and follow up appropriately. It’s not a perfect system, and I think every organization and institution has to wrestle with, if an ID isn’t available, what is their backup option?”
A local initiative called Safe and Welcoming Wyandotte, started in 2017 by community organizations, would help improve health outcomes of immigrants living here without permission and people who are unable to get a state ID or driver’s license. It would provide residents of Wyandotte County with a municipal ID.
“People who don’t have access to identification are going without getting tested and are getting people sick,” said Alex Martinez, a community organizer for Safe and Welcoming Wyandotte. “That is a huge community risk. That’s why this is so urgent. We have thousands of people in the county who don’t have access to” identification.
Municipal ID ordinances already enacted in other cities like Phoenix, Milwaukee and Austin ask for local police departments not to cooperate with Immigration and Customs Enforcement so that photos and data provided by residents when applying for their IDs can remain confidential. Under the ordinances, local law enforcement would only cooperate with ICE if they have a judicial warrant.
“There have been a lot of ups and downs and conversations with the Unified Government,” Martinez said. “The current issue we have is that there is no money for it because COVID-19 has made things extremely tight within the budget. We totally understand and are trying to work with them collaboratively, but also, ICE noncompliance is free. It doesn’t cost them anything.”
On May 28, the Unified Government of Wyandotte County and Kansas City, Kansas, held a special session discussing the Safe and Welcoming Wyandotte ordinance that Martinez described as disappointing.
“The community input was five minutes out of two hours. The special session wasn’t really a fair hearing,” they said.
The Safe and Welcoming organizers are currently advocating for another special session with more input from community organizations and members.
Other states and cities explore health care options
Other states and cities have been moving to cover the health care of immigrants living in the country without legal permission. Illinois recently became the first state to expand state-funded health insurance to all seniors 65 and older, including immigrants here without permission. In 2019, California extended their state insurance to cover such immigrants under 26 years of age and also covers Deferred Action for Childhood Arrivals recipients. More recently, California also allocated state funding to provide COVID-19 relief payments in the amount of $500 to 150,000 immigrants living there without legal permission.
In San Francisco, a health care access program called Healthy San Francisco is available for people who are ineligible for health insurance, regardless of immigration status, who have an income at 500% of the poverty level or lower. Currently, Healthy SF provides coverage to around 14,000 uninsured San Francisco residents, 73% of whom identify as Spanish-speaking. While the program covers most services, it isn’t a complete match for the coverage that health insurance can provide.
Funding for the program comes from a variety of sources: participants paying on a sliding scale, participant employers, health care providers that agree to provide services for the participants, and the City of San Francisco.
San Francisco also recently passed an initiative called Right to Recover that will distribute $2 million in funding to workers testing positive for COVID-19 who don’t have paid leave available to them, regardless of immigration status, using funding from the city’s response and recovery fund.
Currently, Ochoa and her family are trying to help other people in their community who have tested positive for COVID-19, especially those who don’t have family nearby, bringing groceries and natural remedies to help alleviate symptoms, such as ginger and tea, to those who are quarantined.
Before catching COVID-19, Ochoa wasn’t sure if she believed that the disease could be dangerous. A month after her initial sickness, Ochoa says she still has shortness of breath and fatigue.
“Now, I believe more than everybody else,” she said.
Brittany Callan is the health and environment reporter at The Beacon and a Report for America corps member. You can reach Brittany at email@example.com. Funding for this reporting was provided in part by the Health Forward Foundation.