Life on the Margins Episode 3: Communities of Color and the Covid-19 Pandemic

Matias Valenzuela:

In terms of cases among the Pacific Islander Hawaiian population and the LatinX Hispanic populations, we have more than four times the rate of COVID-19 when compared to whites.

Enrique Cerna:

Communities of color are being hit hard by the COVID-19 pandemic. For public health officials, it's not a surprise. The challenge now is what to do about it. Plus…

Jessica Esparza:

People, when I'm taking care of them, they don't care about the color of my skin. They don't care if I have an accent or not. They don't care what documentation I have.

Enrique Cerna:

Jessica Esparza is an ICU nurse risking her life as she cares for COVID-19 patients. She's also undocumented and a DACA recipient waiting anxiously to learn the US Supreme Court's decision on the future of DACA, a ruling that could change her life. This is Life on the Margins.

Speaker 5:

[Singing 00:00:56].

Enrique Cerna:

Welcome to Life on the Margins. I'm Enrique Cerna.

Jini Palmer:

I'm Jini Palmer.

Marcus Harrison Green:

And I'm Marcus Harrison Green. In this difficult time with the COVID-19 pandemic, everyone is finding out the hard way what most people of color already knew, that race matters.

Jini Palmer:

Updated data released recently by Seattle King County public health finds COVID-19 is disproportionately impacting communities of color.

Enrique Cerna:

The racial and ethnic disparities found here in King County reflect what's happening elsewhere in the country. And as we learned from Public Health Equity Officer Matias Valenzuela, the data is not surprising, but it is sobering. Matias Valenzuela, thank you so much for joining us. We appreciate it.

Matias Valenzuela:

Thank you for having me.

Enrique Cerna:

Well, let's start with this. When did Seattle King County Public Health decide to look into race and ethnicity and the COVID-19 pandemic? And why did you decide to do this?

Matias Valenzuela:

So we knew from when COVID-19 started that we were going to likely be seeing similar inequities around this disease that we see a lot among many other diseases, current diseases, diabetes, asthma, heart disease, and all of that, but we didn't necessarily have a good mechanism of doing that. So what we've actually done here is gone back and had to do a lot of interviews and get the data we didn't have around race and ethnicity, but then be able to provide a more comprehensive picture. At the same time we're also advocating at the state level and the state board of health to actually make data and ethnicity reporting the standard for all communicable diseases. So there are over 60 communicable diseases in our state that get tracked, and we want to make sure that we, just for COVID-19 and any other disease, that we're actually tracking race and ethnicity.

Jini Palmer:

And what does this data tell us about race equality in King County?

Matias Valenzuela:

If we're talking specifically around COVID-19 in terms of cases among the Pacific Islander Hawaiian population and the LatinX Hispanic populations, we have more than four times the rate of COVID-19 when compared to whites. Similarly, around the African American population, it's twice the rate of whites, or more than twice the rate of whites for the Native American indigenous population, American Indian population. There are differences as well. It's higher than the white population. It's just considered not statistically significant just given the low numbers, but we know we'll be seeing those differences as the numbers increase and we have more cases, and that's for cases. And when we look at the hospitalizations, we actually see the same thing, a disproportionate impact for the same communities that I was talking about. And then in terms of death, we are seeing also not as great of disparities, but we're seeing them as well.

Jini Palmer:

So we know that the data shows that there's a disparity in infections between people of color and non-people of color. What are the factors that are contributing to that?

Matias Valenzuela:

So there are a lot of things that are specific. Some of them are specific to COVID and other things are more, what could be considered root causes. There are things specific to healthcare and access to healthcare. We know that there are some communities that have less access to healthcare. For example, very high rates of uninsured among the LatinX population, the Latin X/Hispanic population, mainly due to having significant numbers of undocumented individuals. So we have that. Then you have other issues, of course, that are based on history and just trust of the healthcare system. So we know native communities, Pacific Islander communities, immigrant communities, the black community, for example, have some real reasons to actually distrust health services. So there's a history of actually often delaying services. We know that happens a lot. So there's those issues. We know also around COVID-19 that underlying health conditions make you more vulnerable and make you more likely to act slow, have complications of COVID-19.

Matias Valenzuela:

So we know among communities of color, African American communities, LatinX communities, higher rates of many diseases, higher rates of obesity as well, for example, the Pacific Islander community. The root causes for some of those things too, are there due to the social determinants of health, right? So we have things such as lower paying jobs among those populations. We have lower levels of education. We have people living in less healthy environments where there's less access to healthy foods, to walkable neighborhoods, to safety, those kinds of things. So those contribute to those underlying health conditions and make it more likely then that you'll have a complication.

Matias Valenzuela:

So you actually begin to create a very volatile situation in which you have folks going to work and having to be exposed and then coming back to places where they have people who might also have underlying health conditions, large families, and are infecting other individuals within their households. So it's a very concerning situation. What we have been able to see in terms of the data is, and it got a lot of attention early on, that there were a lot of the cases were more longterm care facilities, that many of those were among whites, but where we are seeing the trend now is more in communities of color and more in these worrisome, either household or work environments. So that's where a lot of our attention is right now.

Jini Palmer:

Right, and some people in general might wonder why it's even important to look at this data from a race and ethnicity perspective. What's your response to that?

Matias Valenzuela:

Well, inequities, we know, hurt everybody. We know that actually hurt the region and regions that don't have these kinds of health and other kinds of racial inequities, those that don't have those are actually better off. Everybody's better off. And you're even able to see some countries here that have more robust systems in which everybody's protected and then everybody also benefits. There's a case to be made, and from a public health perspective, we're very much interested in protecting everybody. And then in this case, coming up with some specific strategies, because we know when we have either, whether it's education campaigns and other things, that communities of color, people don't speak English, get left behind, and they don't really get the attention that they need. So we use this data to really drive our response, to drive funding, to make sure those communities and those community organizations are getting the resources they need. So both address the virus itself and then some of the other social, economic, and mental health impacts that this current emergency's having.

Marcus Harrison Green:

Yeah, is there any worry at all on your end that if infection rates grow in the communities of color and decrease in non-communities of color, that there could be less of a sense of urgency about the pandemic?

Matias Valenzuela:

Maybe, I mean, I can't predict exactly what's going to happen in that regard. I mean, we, in terms of King County government, and we've been doing this work, the racial equity work and equity and social justice work now for 12 years. And I think we have been really highlighting these differences that we see by race and place and across conditions and how they affect everybody. So, I mean, we've been talking about the race difference. There's also differences by neighborhood too. And we have a new dashboard in which we're able to actually see by census, track the differences and their areas, especially South Seattle, South Kern County, some areas of very North of the county as well that have disproportionate impacts.

Matias Valenzuela:

So COVID-19 also offers an opportunity to raise awareness around an issue and some of the systemic issues around it. And what we're also trying to do is how do you actually address a current emergency, but also use some of this and the learnings to transform things so we can do things better the next time. So even now, the efforts to more comprehensively track race and ethnicity in terms of our data and at the state level is an important effort. We've also started to do some things in the county like using new navigators and community health workers and others to work with specific communities. Those kinds of efforts are extremely important to work by race and by immigration group and those kinds of things. And now one of the most important things that we've been able to do now too, is to use this to guide where we are really pushing the testing.

Matias Valenzuela:

Some of the COVID symptoms have changed, or at least when you should get tested, and it includes things also such as chills or having a loss of sense or taste or smell in addition to some of the other typical coughs and fever symptoms that were being talked about before. But the key thing that was that we have more testing available and we want everybody who's symptomatic to be tested, so what this data also allows us to do by race and place to be really using this data to say, "Where do we need to really be setting up testing and sites?" So the thing that we have been launching this week is working with our community health centers, HealthPoint, Neighborcare, [CMAR 00:10:18] to really have them offer testing, not just for themselves or for their current clients, but to anybody who needs it. So these are important efforts to really reduce the transmission in the community that at the end, is going to affect everybody regardless of race.

Jini Palmer:

Indeed, that's critical. And what can we do to curb this pandemic in communities of color?

Matias Valenzuela:

Yeah. So I think it's going to take an all hands on deck approach. I think one of the things that we did, King County issued a local health directive to also use face coverings. The science around face covering is that it's less to protect you, it's actually to protect the other individual. So what we want to make sure that people are doing is when they are going shopping, going to the supermarket, or picking up food from a restaurant, whatever it may be, that in any situation where you can't have the physical distancing, even for a short while, that then you do use a face covering.

Matias Valenzuela:

And a big driver for this is actually to protect essential workers. Sadly, we've lost King County employees too, bus driver and others who are having to continue to do their work. So we want to make sure that people who are using our buses, people going in grocery stores, all of that are doing things, not just for themselves, but actually protecting other individuals who are, in this case, disproportionately people of color.

Enrique Cerna:

Matias Valenzuela, Equity Officer for Seattle King County Public Health. Thank you so much for joining us.

Matias Valenzuela:

I appreciate it. Thank you so much.

Enrique Cerna:

I'm Enrique Cerna. You're listening to Life on the Margins. Jessica Esparza is an essential worker. She's a registered nurse at Central Washington Hospital in Wenatchee, where she works in the Intensive Care Unit. It's there that she cares for those stricken with the coronavirus. Jessica is also an undocumented immigrant and a DACA recipient. DACA, Deferred Action for Childhood Arrivals, established during the Obama administration, allows Jessica and thousands of others like her to work and to go to school without fear of deportation. But soon the Supreme Court will decide whether to uphold president Trump's executive order to terminate DACA. As she waits for the court's decision, Jessica continues to work on the front lines of the pandemic, risking her life and wondering about her future.

Enrique Cerna:

Jessica Esparza, welcome.

Jessica Esparza:

Hi.

Enrique Cerna:

How are you doing?

Jessica Esparza:

I'm doing okay. Overall, my emotions are running a little bit high today. I just filed for my work permit for the fifth time in the last eight years.

Enrique Cerna:

Why are you filing for it now?

Jessica Esparza:

I'm worried that the Supreme Court will rule not in our favor, so I figure that it would be in my best interest to file for my work permit so that it can be valid for two more years.

Enrique Cerna:

So that if they do decide to terminate DACA, you would still have the opportunity to work.

Jessica Esparza:

Correct. And then if I do have a valid work authorization, then I am not at risk to be deported to a country that I have not been part of for 15 years.

Enrique Cerna:

You're working in a high stress situation. You're not knowing what your future is going to be.

Jessica Esparza:

I think some days I try to kind of go day by day, worry about my patients, the things that I'm doing at work. But I do have moments where emotions do get to me and I start considering what will happen if I lose my work permit, what will happen if I lose the protection that I have from being deported. So those days I do get emotional and become anxious, frustrated, upset, but then I can't do anything about it til we find what the Supreme Court Justice is going to rule. So then I just kind of go back to, again, just focusing on providing care of my patients and enjoying the most that I have.

Enrique Cerna:

Do you feel like you're an American?

Jessica Esparza:

I really do. You know, I've been living in this country for about 15 years. I pay taxes every year. I feel like I contribute a lot to society by working as a registered nurse. Even if I wasn't working as a registered nurse, I feel that me working as any part of society, I would still be contributing something to the United States of America.

Enrique Cerna:

You came here when you were 11 years old. Your mother brought you here. Your father was already working near Quincy. You came here unknowing that you did not have documentation.

Jessica Esparza:

Right, I didn't really know that. Sometime later it kind of became clear what that truly meant for me. I was pretty much in American in every way, until it came to me applying to college and applying to receive financial aid. And I think that's when things became more clear to me that I wasn't truly part of this country in that way. And that there was going to be more hurdles or struggles that I had to overcome.

Enrique Cerna:

You actually had an opportunity to get a pretty good scholarship. I think you would have gone to the University of Washington.

Jessica Esparza:

Right.

Enrique Cerna:

And you could not do it because you were undocumented.

Jessica Esparza:

Right. For that scholarship, I needed to have a social security number to claim it, and back in 2011, I did not have that. DACA, that provided me a social security number, was not valid until 2012, which meant that I did not get a social security number til 2013. So that was a pretty big bummer for me as I was pursuing education at the University of Washington, but I still went to school. I still have a college degree. And I think that proves that I'm willing to do everything to contribute to society.

Enrique Cerna:

One of the things that worked out well for you was you became a DACA recipient, Deferred Action for Childhood Arrivals, that gave you an opportunity to remain here, also work.

Jessica Esparza:

Right, DACA has been very beneficial for me the last eight years now.

Enrique Cerna:

And now you're at this crossroads where DACA has been helpful. You've been contributing to the society, as you said, you pay taxes. And now you're on the front lines, an essential worker on the front lines of this battle against coronavirus.

Jessica Esparza:

Right, I feel like DACA gave me a sense of normalcy and belonging because I was able to have a job. Again, I'm able to file for taxes every year, and gave me the opportunity to be working as a registered nurse. And you're right. I am in this spot where I am considered essential because of my title as a registered nurse, but to other people, I am also considered a criminal because of my undocumented status. So I feel like sometimes people struggle to see the big picture and see that undocumented immigrants are not all criminals and in some way or another, we do contribute to the society.

Jessica Esparza:

I have said before, I have provided care to hundreds of Americans in the almost five years that I have worked as a nurse. I have brought people back to life providing CPR, not never caring where that person is from, what their politics stance is, any of that. That doesn't matter to me as a nurse. I don't get to judge. Nurses don't get to judge what your sexual orientation is, if you are a Democrat or you're a Republican. And I guess it gets me sometimes that I have everyone's back, but not everyone has my back.

Enrique Cerna:

I would imagine that the patients at the time that you're saving their life could have cared less that you were undocumented.

Jessica Esparza:

Right, people, when I'm taking care of them, they don't care about the color of my skin. They don't care if I have an accent or not. They don't care what documentation I have. I've had patients ask me where I'm from, and it's always funny, because I'll say, "Oh, Wenatchee," and then they always ask the following question, "No, where are you really from?" It's always something that I always have to clarify because of the color of my skin. But of course, if someone is in a critical condition, that's the least thing that they care about.

Enrique Cerna:

Let's talk about working in the ICU. You started working there full time, actually as the pandemic really started to hit hard across the nation and in this state.

Jessica Esparza:

Right, so I became a full time ICU nurse by the beginning of March. And that's when we started seeing COVID-19 patients. Overall, it was a pretty scary and overwhelming thing that has been happening. I haven't signed the overall becoming a new ICU nurse because the patients are very sick. They're critically ill. There are more things thanks to manage, and to add on a pandemic, that was pretty rough for the first couple weeks.

Enrique Cerna:

What about your personal life? I know you're engaged, your fiance. I would imagine that he's concerned about you. I imagine that your family's concerned about you.

Jessica Esparza:

Right, I make sure that once I am done with my shift, I change out of the scrubs that my hospital provides at the hospital. I come home, I take off my shoes in my car and leave them there, my work shoes. And then I come into the house, straight into the shower, clean my cell phone with an alcohol wipe, clean my car keys with an alcohol wipe, just anything that can help me reduce the chances of me infecting my fiance. Regarding my family, I have not seen my parents in about two months. I just consider myself a high risk person, so I feel that I could potentially be exposed to the virus every day that I'm working, and I don't ever want to put anyone else at risk.

Enrique Cerna:

How does your fiance feel about all this?

Jessica Esparza:

I think overall, he knows that I'm good at taking care of myself and following the policies with all the equipment that we have to wear, but he's always making sure that I'm doing okay. He has been my support as I come home, sometimes venting about just how I feel with everything going on, not just the COVID-19, but my situation regarding my immigration status. So he has been of much support. We did have to cancel or postpone our wedding because of everything that's happening. So that has been overwhelming, but we believe it is the right thing to do so that we do not expose our families and our friends.

Enrique Cerna:

There have been protests by those who want to see things open up, and gradually some of that is happening here in Washington state, but across the country. They're opening up a bit more. When you see that, how do you feel? What do you think?

Jessica Esparza:

I think sometimes it definitely feels like a slap to the face. When we go to work, we do everything possible so that we are not spreading the virus so that we're not making anyone get sick. And of course, for many, I understand that they have business that might not be doing well because of closures, but the people who are trying to get a haircut or… You know what I'm talking about. Those people are the ones that really, truly get to me because we're working so hard to reduce the number of cases and, overall, I understand that we're not going to eradicate the virus in two weeks.

Jessica Esparza:

But people need to understand that the reason why the social distancings was a thing was because we were not prepared to take care of thousands and thousands of sick patients. At least, our ICU only has 22 beds. Again, you need to have the nurses and the respiratory therapist and the doctors to care for all of those sick people. Sometimes there isn't those people. I was just trained to manage a ventilator. There are many nurses that are not trained to do that. So how are we supposed to manage thousands of people on ventilators?

Enrique Cerna:

You feel like there's a lack of some common sense out there?

Jessica Esparza:

I think there definitely is. Again, I understand where they're coming from, but I hope that they understand as well where the medical professionals and everyone who is working hard to reduce the number of people infected and deaths, they also understand that side as well.

Enrique Cerna:

What about when you see President Trump and the vice president, and they're not wearing masks and now the vice president who's been exposed to the virus?

Jessica Esparza:

I think that doesn't set a good image from everything else that we're trying to do. Every time that I do need to go to the store or I need to go anywhere, I make sure that I wear a face covering, even if it's not a surgical mask, just because I feel that that's my responsibility as, I can't even call myself a citizen, which is funny, as a person living in the United States. I don't even know what the right terminology is there.

Enrique Cerna:

You're a nurse.

Jessica Esparza:

But I feel like it's my responsibility to, if I was exposed at my job in any case, I want to make sure that I don't expose anyone else, so it does feel that they are not setting a good example because I'm sure they have access to face coverings. And as we've been told, you can make one from a shirt. So I feel like they should be wearing one.

Enrique Cerna:

If you had had the opportunity to make your case before the Supreme Court when DACA was being argued, what would you have said?

Jessica Esparza:

I think I would have said that I feel like I belong to this country. And again, I can only speak for myself, but there are thousands of DACA recipients out there who contribute to society, have a job. Again, doesn't have to be a nurse, doesn't have to be a doctor, but they're contributing in their way. They're spending money in the economy. I want the Supreme Court justice to know that I belong to this country. This is the only country that I know as an adult. And I hope that they can rule on our favor and as well, provide a pathway towards citizenship. That is something that I've heard for the last eight years. People are asking me, "Why don't you become a citizen?" Well, there isn't a way for me to become a citizen. I just can't show up to an immigration office and request or demand that I should be a citizen. There isn't an application that I can fill out, and if there was, I feel like thousands of us would have done it.

Enrique Cerna:

Jessica Esparza, ICU nurse, Central Washington Hospital, thank you. Thank you for your work, and thank you to all of those healthcare workers like you that are on the front lines, putting yourself out there to save lives.

Jessica Esparza:

Thank you for your support.

Marcus Harrison Green:

As we wrap things up, some thoughts about what we heard from the folks we featured in this episode. For me, I just keep going back to the facts that this pandemic is not necessarily affecting everybody equally. We do know, and we continue to know, and the data continues to bear out, that people of color and those who are on the front lines are obviously being impacted worse than anybody else. And I just keep hoping that we can continue to constantly address the needs and concerns of the communities of color who are being impacted harshly during this time.

Enrique Cerna:

I think the thing that stands out for me is that we had all of this happening beforehand. Even before this pandemic hit, we've known that there have been racial disparities in healthcare, and housing, employment. So this isn't new information, but it does tell us that we haven't dealt with it. And now, as we are dealing with this pandemic, the question is how are we going to handle it in the now, but also in the future? And I think it's up to us in communities of color to step up and say that a change needs to happen. We need to address these things because it's not just our communities. The fact is it affects everyone in this country.

Jini Palmer:

That's right. That's right. That's the thing about the whole term "essential worker," right, is how essential they are to making this community and our society run. We rely on all of these roles of people delivering our packages, of people giving our groceries, to function. And I just think it really shines a light on how important these undocumented citizens are and these communities of color, these marginalized communities, how important they are and how important these issues are because this virus affects everyone, and we clearly know how it's disproportionately affecting these communities of color now. So listening to Matias give us some of the facts and thinking about how we can help keep ourselves safe, keep them safe, and what we can do to provide support to the community, we have to talk about these issues and hopefully that's what we're doing here.

Enrique Cerna:

I think essential workers are not just those people like Jessica Esparza, who is an ICU nurse, very critical role, no doubt about it, but essential workers are also those farm workers in the fields. I'm reminded of the image during the wildfires in California. The fires are raging up in an area and below there was a field of people picking crops, farm workers picking crops, and yet they were in this situation, really risking their lives with smoke and possibility of the fires approaching them, and yet picking the food that feeds all Americans. They're essential workers. So we have to keep all of that in mind. It's not only the people on the front lines that are nurses and have been working as Matias had also pointed out, those folks that were working at the retirement and the nursing homes, but also the people that are in the fields, and the mechanics, and the bus drivers, and the delivery people, and the people in the kitchens.

Jini Palmer:

Right, they're risking their life. What are we doing for them?

Marcus Harrison Green:

Right. And that's why I have to say that I'm somewhat fearful. And that's why I asked Mathias earlier about was he concerned if there started to be, again, stark disparities between who this pandemic wasn't impacting, as the data is bearing out that it is disproportionately impacting folks of color. We do know that when that tends to happen, concern and attention to a pandemic appears to go away. I mean, you look back at history and the mass incarceration crisis didn't become a crisis til it started to affect middle class white people. The same with the opiate crisis when it was just the quote unquote crack epidemic. That was just something that happened in black communities. And you have these pejorative terms like "crack babies" and so forth, right? We certainly don't call people who are impacted by the opiod crisis, we don't call their children "oxy tots." And I think it just goes to show you who we sort of consider worthy of empathy and humanity in times of crisis. And this is a time right now where, as we've said, this is affecting everybody. And so everybody deserves the same level of humanity and empathy.

Jini Palmer:

Life on the Margins is a co-production of the South Seattle Emerald and Town Hall Seattle. I'm Jini Palmer.

Marcus Harrison Green:

I'm Marcus Harrison Green. Our music is courtesy of Seattle artists [Drays 00:31:00]. Our producers are Jeff Shaw and Hans Anderson.

Enrique Cerna:

And I'm Enrique Cerna. If you have a topic you want us to cover or you want to give us some feedback, call, then leave a message for us 206-606-0222. Stay safe, be well, and we'll talk more later.

Speaker 5:

[Singing 00:31:22]