After having a light cough for three days last spring, Miguel Mestiza Valderrabano called his partner Ana Maria Lorenzo to say that, when she got home from work, he planned to go to the hospital. He would never make it, and the mental image of his 32-year-old lifeless body on their living room floor still haunts her.
“I couldn’t believe that had happened in minutes,” Lorenzo said. She had just arrived home from her cleaning job — her first assignment in weeks after she’d lost work during the shutdown — and a neighbor warned her that Valderrabano said he was struggling to breathe.
Paramedics arrived immediately, but there was nothing they could do. He died of COVID-19 on April 16, inside the multifamily house he shared with Lorenzo and their three children in Orange, Essex County. “Sometimes, I ask myself if he was waiting for me to come back to be with my kids. If he didn’t want to die alone with my kids,” Lorenzo said.
Valderrabano was one of 361 young Latino men killed by COVID-19 since the state’s first pandemic death a year ago. These men account for nearly half — 43% — of the confirmed coronavirus fatalities among adults under 50 years old, even though Latino men comprise only 12% of this young adult population.
Nationwide, Latinos in total make up 44% of COVID-19 deaths among young adults, according to data from the Centers for Disease Control and Prevention. But keep in mind that this last figure encompasses both men and women. Something about New Jersey’s pandemic is striking young Latino men in outsize droves.
Looking deeper, COVID-19 killed young Hispanic men in New Jersey at 4 1/2 times the rate of Hispanic women, twice the rate of young Black men, and seven times that of young white men, according to an analysis by WNYC/Gothamist of confirmed deaths.
“We are losing whole generations of fathers,” said Stephanie Silvera, an epidemiologist at Montclair State University. “And there is no way of understanding the economic, as well as the emotionally traumatic impact that that’s going to have on their families, their children, and generations to come.”
Men generally tend to suffer the most severe cases of COVID-19, and research suggests a large part of that could be attributed to social determinants like occupation and likelihood of exposure to the virus.
Latinos are overrepresented in essential work and are the least likely to have health insurance, experts say. Dr. Frank Dos Santos, the chief medical officer for Clara Maass Medical Center, said Latino men also tend to be more likely to suffer from diabetes, heart disease, high blood pressure, obesity — so-called comorbidities that are known to increase the likelihood of dying from COVID-19.
“Many of these things either have no symptoms or they have very few symptoms that allow our Latino men to go on and work hard and be uninsured or underinsured and not recognize that they have these health conditions,” he said. The pandemic “demonstrated the disparity in our socioeconomics of our Latinos and how hard they’re working and …that the most vulnerable people were susceptible to this COVID infection.”
Undocumented and uninsured
Lorenzo, 30, said she’s not sure how the virus snuck into their home. Her partner, Valderrabano, was a seasonal painter and hadn’t worked all winter. She, too, had lost her job last March when the state shut down, and her kids — ages 5, 8, and 9 — were home from school.
Looking back, she thinks he waited to seek medical help because he was worried about the cost.
“We don’t go to the doctor’s office. We don’t have routine exams,” Lorenzo said. As undocumented immigrants from Mexico, neither of them had health insurance. Lorenzo said many families like hers are used to seeking home treatments because they can’t afford professional care.
“Undocumented immigrants are excluded from almost every type of health insurance and public health insurance,” except for emergency Medicaid and Charity Care, said Sara Cullinane, executive director of Make the Road New Jersey, an immigrant advocacy group based in Elizabeth.
Like Medicaid, Charity Care reduces or cancels hospital bills for low-income patients who can’t afford them. Patients, however, still must apply and are screened at the hospital.
A report from the liberal think tank New Jersey Policy Perspective said Latino residents were three times more likely than white residents to report not having health insurance when surveyed in the middle of the pandemic. That’s because a large percentage of the Hispanic population is undocumented, the report’s authors said.
While the 2010 Affordable Care Act helped reduce insurance disparities, the latest state data for people under 65 show Hispanic communities still lag behind. Only 82% of Hispanics are insured compared to 95% of white residents and 91% of Black residents.
And experts say lack of insurance represents just part of the problem. The Latino community’s overall health is also about having access to healthy foods, safer working conditions, and creating a culture of self-care.
“The access issue is a big issue because if they don’t have insurance, then they’re not going to take money from food on the table to spend it on themselves,” Dr. Dos Santos, who grew up in Elizabeth, said. “It’s almost an expectation among Latino men that you become a martyr to your family … you don’t take care of yourself. You take care of your family first.”
Christian Estevez, president of the Latino Action Network, a statewide civil rights group, agreed. Barriers to access create a culture of, “I don’t need it anyway.”
“So people will blame the victim and say, well, ‘it’s your fault because you don’t take care of yourself,’” Estevez said. “It’s like, well, you conditioned me to this as a community.”
‘I couldn’t say goodbye to him’
Every morning since Elizabeth Rojano-Morales can remember, her father would come into her bedroom on her birthday with her favorite ice cream: chocolate-vanilla.
“My last birthday, he gave me a cone,” Elizabeth, 19, said. But this May, when she turns 20, her father won’t be there to bring her ice cream or tickle her awake or make fun of her love of K-pop. Reinaldo Rojano died of COVID-19 on December 14. He was 44.
“I never imagined that I would lose him. If I would have known, I would have shared more of my life with him,” Elizabeth said.
Rojano washed cars at the Super Car Wash and Quick Lube off Route 1-9 right next to their home in Elizabeth, where his family thinks he caught the virus. Four other employees at the car wash, including Rojano’s son, also tested positive, said Francisco Morales, 43, who works there. One staff member was hospitalized.
While pre-existing health conditions have been oft-cited during the pandemic, less attention has been paid to how workplace and living conditions contribute to the disparities in COVID-19 outcomes. At this corner car wash in the state’s fourth-largest city, one can see these risk factors play out in real life. Workers clean inside the car’s tight quarters as passengers get out and watch a massive conveyor belt pull their automobiles through the soapy chemicals and scrub cycles. Rojano usually helped drive the vehicles onto the automatic belt, vacuumed the floors, and handled the payments.
“We knew from early on in the pandemic that it was young Latinos at working age who were unable to shelter in place or work remotely,” said Estevez. He said the pandemic compounded existing health and labor disparities prevalent in the Latino community.
“It just has a snowball effect,” he said. “When something like a pandemic comes around, it has a devastating impact.”
At Rojano’s house adjacent to the car wash, the virus swept through the first floor of their multi-family home, sending his wife to the hospital and sickening his three sons. His teenage daughter, Elizabeth, was the only one who didn’t test positive.
“I was scared to think that I was going to lose both my parents,” she said. “Sometimes, I would just stay up and not sleep at all.”
Her mother, Zenaida Morales, was on a ventilator and in a medically induced coma for nine days. She is still recovering but says what hurts her the most is not having been able to see her husband one last time. She was too weak to go to his funeral. “I couldn’t say goodbye to him,” Morales said.
Rojano had been a car washer for more than 25 years, starting when he arrived from Mexico, working with his hands in extreme cold and extreme heat. Elizabeth said her father sometimes complained that his body ached.
A small study conducted by labor groups in New York City and CUNY found one-third of the car wash workers surveyed in NYC reported shortness of breath, and a third suffered from a persistent cough. More than half the respondents said their jobs as car washers contributed to their shortness of breath.
“Health disparities have long been written off by people as the result of bad behavior. What COVID is really highlighting, in a way that cannot be ignored, is that a lot of these disparities are systemic inequalities and racial inequalities,” said Silvera, the epidemiologist. “We’re talking about access to healthy foods, access to physical activity, and safe spaces. We are talking about the impact of stress throughout a lifetime, even up to 20 years of age, and how that wears on the cardiovascular system and puts certain communities at higher risk, not just for COVID, but for a plethora of other health outcomes.”
When Rojano started having trouble breathing in late October, Morales urged him to go to the hospital, but he told her he was scared and worried about how much it would cost, especially since he didn’t have health insurance. Rojano had been diagnosed with diabetes four years ago, but he couldn’t afford to take his medication once his prescription expired, she said.
Hackensack Meridian Health’s Chief Physician Executive Dr. Dan Varga said poor access to care among communities of color often leads to poor health outcomes. And COVID-19 is no different.
“More of the population that’s coming to the hospital very sick are Hispanic people, African American folks. White folks are coming too, but they don’t come in the numbers that others do because they probably sought care earlier,” he said.
Dr. Meg Fisher, a special adviser to the New Jersey health commissioner, said even when Latinos arrive at the hospital, there can be implicit bias in their care.
“We also know that these populations are disproportionately affected by the systemic racism that we know is present in health care,” she said. “It’s a difficult thing to separate out the fact that someone has four or five other things wrong with them versus that people are not paying as close attention to some of their symptoms.”
She said it’s important to understand that health disparities start during childhood. Traumatic events — such as witnessing or being a victim of violence — can impact children’s health over time.
“Everything kind of feeds on itself so that you end up unfortunately not having the outcomes that we would like you to have,” Dr. Fisher said.
New Jersey state health officials said Hispanics are more likely to suffer from underlying medical conditions that put them at risk of developing a more severe case of COVID-19. A third of Hispanic people are considered obese in the state and are twice as likely as white people to have asthma. They’re also more likely to develop diabetes (15%) compared to their white counterparts (7%) but on par with Asians (15%) and Black residents (14%).
Dr. Fisher added that the COVID-19 disparities in young Latinos also extend to children diagnosed with multisystem inflammatory syndrome (MIS-C), a rare condition linked to the infectious disease. She said 42% of MIS-C cases are among Hispanic children in New Jersey, and the CDC has recorded this pattern nationally.
One year into the pandemic, the Latino community is still outpacing every other racial and ethnic group in terms of COVID-19 infections, hospitalizations, and mortality rates, per capita even when adjusted for age, state data show.
On a snowy February afternoon, Elizabeth walked around the car wash, remembering the days she and her brothers rode their bikes across the lot, asking her father to sneak them some ice cream from the convenience store.
What was once her playground is now a reminder of what her family has lost. These days, her oldest brother works inside the car wash, doing oil changes for hurried motorists.