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Latinos and COVID-19

Dr. Jaime Gonzalez discusses Latinos and COVID-19.
Latinos and COVID-19
Jaime Gonzalez, MD
Jaime Gonzalez, MD is a Hospitalist, Salinas Valley Memorial Hospital Emergency Department.

Scott Webb: As, you know, more than 5 million people have been infected by the Coronavirus in the US and that number is climbing quickly. And here in Monterey County, we also continue to see a rise in cases on a daily basis. In the US Hispanics have been hit hard by the Coronavirus. According to the CDC, Latinos represent at least 31.6% of all Coronavirus deaths in the country, even though they make up only 19% of the population. And in California, the country's most populous state Latinos are becoming ill and dying from COVID-19 at far greater rates than other groups. Latinos make up 39% of the population in California, but account for 56% of COVID-19 infections and 46% of deaths, this according to the California health and human services secretary. Joining me today to discuss the current situation in Monterey County and Salinas, is Dr. Jaime Gonzalez. He's a Hospitalist in the Emergency Department at SVMH. This is Ask the Experts, a podcasts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So Dr. Gonzalez, can you shed some light into what we're seeing in Monterey County and particularly Salinas, where we're seeing the most number of infections?

Dr. Gonzalez: You know, we've seen close to 5,500 cases in Salinas or Monterey County, over 340 hospitalizations across our four hospitals. Our hospital is averaging right now in the last couple of weeks, maybe about 15 or 20 patients with COVID-19 in the hospital. We've had in Monterey County 35 deaths, and most of those have come in the last couple of weeks or several weeks. What we're seeing, one of the big things that, you know, that stick out or, you know, the majority of these cases is Hispanics and Latinos. And we're seeing, you know, 75% of these cases are amongst Latinos. And one of the big reasons that we're seeing is that this is a virus that is affecting, you know, people that are out in the community, people that are essential workers, and especially those in the agricultural world where we're seeing 23% of the cases. And this is the biggest number amongst the occupations that we're seeing across Monterey County.

And then there's also, you know socioeconomic factors such as dense housing Latinos tend to live in multigenerational households, you know, increased rates of chronic diseases, such as diabetes, hypertension cardiac disease, obesity and also, you know, lack of access to healthcare, which can exacerbate those conditions. And, you know, sometimes with Latinos and, you know, there's higher rates of poverty. And so, you know, with a lot of these families, they have to decide whether they work to bring food to the table, or can they afford to stay home. And a lot of these jobs, they can't work from home. Obviously you can't pick strawberries from home, you know, you can't work in the food service industry with, you know, from home. And so a lot of that is what we're seeing amongst the patients that were being hospitalized in the hospital. And, you know, there's also the aspect of education and whether we're getting that message across to these communities as to the importance of wearing a mask, maintaining social distance, and also avoiding family gatherings, which is a huge part.

I mean, family is a central part in a Latino community. And so asking Latino families to refrain from visiting our relatives for several months is a daunting task. And so, you know, all of those I think are contributing to the numbers that we're seeing in Monterey County, as well as, you know, the rest of the country. And also other things that we're looking at is, are the age groups. And so what's interesting is that we're seeing the largest group of prevalence in COVID-19 is the age between 25 to 34 where we are seeing 24% of the cases. And so it's the most of any other age group. And again, it's always, we ask the why. And so for some of these factors, it is, you know, younger people, they tend to be the working class group, especially in Monterey County where you have the younger people working in the fields and working in the agricultural industry. And, you know, and then there's the other, there's a psychological aspect where younger people, this age group, tend to feel like they're invincible. And so, you know, they're young, they don't think they're going to get it, or if they do get it, they think they're going to survive because the message of being put across is that, you know, it's affecting older people, it's affecting older people. And so that's what they're hearing.

And so, they're probably there, you know, there might be a sense of invincibility and, you know, and so the other factor is, you know, when Monterey County started opening up, a lot of these people went out into the bars, they're going out to restaurants. And so, you know, because the social, you know, it's a young group. What I've seen, you know, with some of the patients that have admitted the older folks, I mean, and even just people with non COVID is that the older folks, you know, they're taking this a little bit more seriously and they're staying home and be more cautious about things. But, you know, unfortunately, as we touched on earlier, they tend to live, you know, especially with the Latino community, they live in multigenerational households. And so you have the, [inaudible05:43] the grandparents, the parents, the kids living in the same house. And so you have the younger people feeling invincible, or just out of necessity of having to go out and work, bringing it home. And then, you know, these are the ones that, and then what happens is that the older people that get it from somebody in the household are the ones that end up most of the time, you know getting sicker and ended up in the hospital. Most of the people that are in the hospital are older folks. The majority are from people who live with somebody who works in the agricultural field, or they themselves are working in the agricultural field.

Host: You know, and just trying to process all this and thank you for breaking all that down. And it does seem like an impossible situation and impossible decisions for people. You know, as you say, do they go to work and basically risk their health? Risk their lives? And if they do, then they bring it home to their families and to, you know, older family members in their fifties and sixties, let's talk about children. There's this sort of prevailing sort of feeling. And I know that my kids express this to me as well, that children don't get infected with COVID-19 and if they do, they're going to be just fine. And of course, you know, I ask my kids and I say, well, yeah, you might be fine, but what about me? What about your grandparents? So as we talk about Latinos and the multigenerational, you know, family situations, how's that dynamic playing out with children?

Dr. Gonzalez: Well, I mean, and that's one of the myths, right? That children are not getting infected, but in fact they are, and we just don't know what percentage are getting infected. And we don't know how easily, I mean, a lot of these things, as you know, with COVID-19, there's a lot of unknowns just because it's such a new disease, but we are seeing kids getting infected. And like you touched upon you know, a lot of the kids are getting infected, don't have severe symptoms. And so it doesn't mean that they're not, you know, they may be asymptomatic as we call it, no symptoms, but they are definitely able to spread it. And so their carriers are spreading it, which is why it's important right now to keep schools closed, at least for the time being, because you know, these kids could go out, they, you know, maybe they get it from home, somebody who is working on the agricultural community they go to school, they take it to their classmates. And again, I mean, not all kids are healthy and there are kids with asthma, which is one of the big ones where it can lead to significant complications and respiratory failure and people that get COVID-19.

There is the aspect of not only spreading it to their classmates who may have underlying conditions, but also spreading it to their teachers, who are older. And also each of these kids can take it to their respective homes where, you know, they can give it to their parents or grandparents. And so it's a very real disease. I know the Academy of Pediatrics came out and since then, they've retracted their statement about how schools need to open. And for kids, you know, the further development, but this is a unique disease. And I think the more we're learning about it, the more we can learn ways of how to mitigate the risk. I think for now we need to just shut things down until we get a better hold of this, especially, you know, in this country where we're seeing increasingly high numbers of transmission right now,

Host: You know, I wanted to zoom in a little bit here and talk about specifically your work and where you're seeing patients the type of treatment that you're providing intubation and otherwise, and, you know, just the dynamics of it all, you know, that these people are coming in and hopefully they're coming in soon enough. But of course, as we know, many of them are not. And you've discussed some of the reasons why, you know, they're not coming in. Maybe it's just simple lack of health insurance or stigma or whatever it might be. Right. So let's talk about the work that you're doing, the patients that you're seeing and how you’re navigating all of this and trying to help them.

Dr. Gonzalez: My job as a hospitalist. And so what we do is take care of patients that get admitted to the hospital. They're inpatient that we call it in our hospital. We have COVID units and we have COVID tents. Before the emergency room, once we made the decision that, you know, this person requires oxygen or they're high risk of complications, the emergency department physicians call us, we go down, we see them, we'll evaluate them. And then we make a decision as to whether the patient needs to stay in the hospital. Once the patient stays in the hospital, we have a COVID designated unit. And, you know, when this all started, we had one unit and it was most of the time empty. The reality of it is that the measures that we put in, especially in Monterey County, where we early on, we locked things down and we took precautions. The strategy works, we weren't seeing a lot of hospitalizations. Our hospital, our COVID unit was relatively empty. But once, you know, these restrictions started getting lifted. Now we've had to open up a second unit and we have a third unit available if needed, because there have been times where both of our COVID units were full.

And so, we're just, you know, we're, we're opening up covert units and we're seeing our, like I said, we're averaging about 15 to 20 patients at any given day in the hospital with COVID-19. And these hospitalizations, their course tends to run anywhere from a day or two to several weeks. And like I said, everybody, it varies, you know, people obviously, one of the things that we're seeing is people with obesity tend to do a little bit poorly. And so, or at least we have a hard time weaning them off or getting them off the oxygen. In terms of the progression of the disease, some folks they're requiring a little bit of oxygen in the beginning, and then over the next couple of days, they start requiring more and more oxygen. So this is a new disease. And what we were seeing in the beginning was that people were getting intubated relatively early and having a low threshold to intubate patients. But what we're starting to see now is that those patients tended have a worse outcome once they were intubated. And so now the train of thought is to avoid intubation as much as we can and trying to see if we can just maximize their oxygen and doing other things like putting them face down. So, we're employing a lot of these techniques and avoiding intubation.

So, you know, we're still having to intubate a few people, but it's not as much as we were before. And I think that's leading to better outcomes. And also we're using some of the experimental therapies that are available, like the use of Remdesivir and convalescent plasma, which is, you know, getting antibodies from other folks who've had it to try to minimize the complications or the illness of patients, and also using steroids, such as dexamethasone, which has also shown to decrease mortality by 30%. So we're employing up to the minute, therapies that we have available at our arsenal, but it's still a pretty nasty bug that leads to a lot of deaths.

Host: I wanted to talk about, you know, in the Latino community some of the risk factors, diabetes, high blood pressure, cardiovascular disease, these risk factors that are very prevalent in the Latino community. Why specifically is diabetes so dangerous for those who get infected with COVID-19?

Dr. Gonzalez: Really, you can lump diabetes, hypertension, and cardiac disease together, as a chronic condition that is dangerous and in many ways. And one of those ways is the fact that these conditions, especially diabetes tends to increase your risk of developing stroke, heart attacks, blood clots. And the thing about COVID-19 that we're seeing is that one of the common complications from COVID-19 that we're seeing are the same ones is throat, heart attacks, blood clots. And so when you have these complications that are seen in both of them, there's sort of a multiplying effect to it. And then, you know, with other conditions such as asthma COPD, tobacco use, we're seeing higher rates of poor oxygenation, which leads to respiratory failure, which is also a complication from COVID-19. But I think as far as diabetes, it's the risk that it leads to in terms of blood clots, heart disease. But also the other thing that it does is that it lowers your immune system. And so most of these kinds of chronic conditions that I've listed, it just lowers the immune system of the body to be able to fight off diseases. And here you have a very deadly bug that is ravaging the body. And so for somebody with diabetes, it is very hard for them to overcome this deadly disease.

Host: Definitely. And we talk about bugs, as crazy as this is to me to think about, you know, flu season is coming and some influenza and COVID-19 symptoms are similar. So what do people need to know? How can we make sense of this? How do we know when it's a common cold, allergies, or possibly the flu versus COVID-19? And if we suspect that it is COVID-19, what should we do?

Dr. Gonzalez: Both of these infections overlap with each other and it's hard. I mean, even for the experts to know, to be able to differentiate one from the other. And so it's one of the reasons why it's important to get the flu shot you know, this Fall, as soon as you can. And you know, I know the hospital is going to be hosting flu clinics, starting October, getting those flu shots in time. So that, because again, you know, with the flu, the flu shot isn't going to prevent you from getting the flu, but, you know, 30%, sometimes it's a 60% of the time. It minimize the complications from the flu. And so at least you can kind of minimize those complications from the flu. And then also with older folks, you know, we have pneumonia and there's a pneumonia vaccine that people should be getting. One of the things that was interesting, you know, that we saw at our hospital. And I think this also happened nationwide is we didn't see that many flu cases this year. It seems like the flu season kind of cut short, which tells you that a lot of this is community acquired. And I think as soon as everything's shut down you know, once people started stopped going out and stopped, you know, mingling, we kind of also minimize the risk of flu. So both of these are viruses, both of these, we're trying to understand how they get transmitted for as long as flu has been around. And we're still learning more about it. And most of the time for both of these, you're going to be okay, but it's always going to be the people that are higher risk. The older folks, people with chronic conditions are going to be more exposed to it. And so our job in the public health field is to just protect the most vulnerable.

Host: Yeah. And that's the real trick, right? That that's the difficult part is of course there are so many who are so vulnerable. And as you say, your responsibility is to try to protect them and to help them. And as I mentioned earlier, you know, SVMH, and the entire system has done everything they can with drive up testing and triaged tents. And as you say, you know, opening up more and more space, unfortunately, because that's needed to treat COVID-19 patients. Dr. Gonzales, as we wrap up here today, what else can we tell listeners about COVID-19 about the treatment that they can receive at SVMH and the entire system, what can they do to protect themselves, whether it's masks or social distancing, break it all down for us?

Dr. Gonzalez: One of the things I did want to mention that kind gets overlooked, and we see it a lot in the media, and also the way that the CDC reports, these things is that, you know, at least in Monterey County, they're saying 71% of cases of COVID-19 are with people with no known preexisting conditions. And so it's a little bit misleading. They're not counting obesity as a preexisting condition. And so what I'm seeing personally, and some of my colleagues here, at least at SVMH, is that the people that are getting admitted and the people that are having prolonged hospital stays are folks with obesity. And one of the reasons why is obesity not only leads to undiagnosed diabetes, which were also diagnosing as they're in the hospital hypertension that we're also seeing for the first time in these people. So they may have, you know, just the fact that they had obesity likely means they had underlying diabetes that was never diagnosed. You know, that itself, as we talked about, at least complications for COVID-19, but obesity itself can cause other lesser known conditions such as sleep apnea. And one of the syndromes that we call obesity, hypoventilation syndrome, which results in the lungs not getting sufficient oxygen because they're unable to expand due to the size of the person.

So, you know, when they say, you know, well, I don't have any preexisting conditions or, you know I don't, I shouldn't worry about it. I mean, obesity is very, is running rampant throughout the country, just because you don't have diabetes, but if you have obesity that puts you at a vulnerable population. And so maybe taking that into account, even if you're young, if you have obesity, that can lead to complications. And so just keeping that in mind, as well to kind of say, well, you know, I'm not as invincible as I thought. And then, you know, the other big things, which, you know, it's very, very, very important to wear a mask and make sure you're wearing it appropriately, that it covers your nose. It covers your mouth. Obviously the best ones are the N95, but those are being used by healthcare providers, but you know, the surgical masks, the ones you can come buy, you know online, those are next best thing, cloth masks. There's still some debate as to whether they're effective, but at this point, all of these are more effective than not wearing a mask. And so wearing a mask, washing your hands, using soap and water, at least for 20 seconds, try not to go out in public. If you can, if you do go out in public, making sure you stay six feet away from others, and then wear a mask when you're out there.

Host: Dr. Gonzalez you have been a wealth of information breaking all of this down for us, especially for the Latino community, which is been hit very hard, you know, in Monterey County and Salinas. And I know that the SVMH and the entire Salinas System is doing everything they can, and we all just need to do our part and hope that we can get through this. I have a feeling I'm going to speak with you again, until I do stay well. If you have questions regarding COVID-19, please call our COVID-19 hotline at (831) 755-0793. Bilingual nurses are answering calls from 7:00 AM to 11:00 PM, seven days a week, and we are constantly posting COVID-19 information in both languages on our social media platforms. Please follow us on Facebook, Twitter, Instagram, LinkedIn, for the latest, and be sure to visit for more information on the Coronavirus in both languages. And we hope you found this podcast to be helpful and informative. This is Ask the Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb stay well, and we'll talk again next time.