No papers, no COVID-19 test? Latino immigrants in NC face obstacles in health care
This story originally appeared in Qué Pasa and was translated from Spanish by Seth Ligo.
Not having legal status hindered Carlos Díaz, a construction worker, from receiving a COVID-19 test.
Gioconda Muñoz received a medical bill of more than $3,400 for her first admittance to the hospital where, despite being diagnosed with pneumonia, she was not tested for the coronavirus.
María Guevara, a worker in a chicken processing facility, saw her weekly paycheck fall to just $50 after missing 33 days of work due to COVID-19.
These cases reflect the disparity and inequality of access to healthcare that Latinos face in North Carolina. These systemic problems have been exacerbated by the pandemic, a fact that Gov. Roy Cooper and Secretary of the Department of Health and Human Resources Mandy Cohen have mentioned many times in the past weeks.
The current situation is the result of years of Latinos being one of the most economically vulnerable populations in the state, health officials say.
“COVID-19 has been shining a light on the fact that we have inequities in our society, and we certainly have disparities in our healthcare access and our healthcare outcome, and that is a longstanding issue we need to make sure we are addressing,” Cohen said in a June interview with Qué Pasa.
As of July 17, North Carolina has exceeded 94,000 cases of COVID-19, over 27,000 of whom are part of the Latino community. There have been more than 1,200 deaths, 154 of which have been Latinos. However, patient ethnicity data is missing from over 35,000 cases. (This paragraph was updated on July 20, 2020, to clarify the statistics.)
“The Latino community is just over 9% of the population, but makes up [roughly] 45% of the COVID cases in North Carolina” for which ethnicity was recorded, said Cohen. “That’s worrisome. That’s the disparity.”
There are many reasons for the disparity, Cohen continued, “but it all goes back to the structural inequities in our system. I know those in the Latinx community experience it every day, whether they are working in jobs that are essential, at our grocery stores, in construction, on farms ... they are critical workers.”
Lariza Garzón, executive director of the Episcopal Farmworkers Ministry, agrees that the problem of disparity existed before COVID-19. “What the pandemic has done is magnify it, put a magnifying glass on it,” she said.
According to Garzón, the gap in access to healthcare that the Latino community faces “creates anguish for families that lack health insurance because they believe that it may affect their ability to get their paperwork in order if they are considered a burden on the state.
They have to pay out-of-pocket, and navigate a system that does not provide support for them.”
Similarly, Cohen identified Latinos’ obstructed access to healthcare as a cause of the ongoing disparity.
“We know they are more likely to be uninsured,” said the Secretary of Health.
No papers? No Covid-19 test.
If Carlos Díaz had health insurance, he probably would not have needed to go to the CVS Pharmacy near his home where he was ultimately denied testing because he could not present a valid driver’s license or Social Security number
Díaz is a construction worker, and therefore an essential worker who the state says should have access a COVID-19 test without problems. Last week, the Durham construction site where Díaz works had an outbreak of the disease.
“My boss sent us home around noon. The next day he sent me a text message asking me to take the test in case I might be infected,” he told Qué Pasa.
Getting an appointment at CVS to get tested was the first barrier Díaz faced.
“They ask if you have symptoms, I said no and they rejected the appointment,” he said in Spanish. “I was struggling because there is no option to put that you were at risk from being in contact with a person who had it. So I called and they told me to put that I had symptoms when I didn’t really have them. I said to them: Are you asking me to lie?”
According to Díaz, CVS led him to understand that in order to get an appointment he had to answer ‘yes’ to the question of whether he had symptoms. “The person who attended to me told me to answer the question ‘correctly’ so they could give me the test,” he said.
This Hispanic father did as he was told and got an appointment for the following day at the CVS at 2017 W. Webb Avenue in Alamance County. He arrived at the scheduled time and presented his passport, the only identification document he had with him.
“I showed her my passport and she told me I had to present a driver’s license and tell her my Social Security number,” Díaz said. “So I asked her if she could just test me, and she replied no. I asked her: Are you refusing to give me a test? And she answered yes.” In this way, Díaz faced another barrier to healthcare.”
Qué Pasa contacted the staff at the W. Webb Avenue CVS by phone, who confirmed that individuals must present a valid driver’s license or Social Security number to be tested.
This policy contradicts some of the guidelines issued by state government for establishments such as CVS, which is one of 26 providers qualified by the state of North Carolina to test communities disproportionately impacted by COVID-19, including the Latino/Hispanic community.
“Federal and state government guidelines say they can ask, but if they don’t have documents like a driver’s license or a Social Security number, it doesn’t mean they can’t get tested,” Cohen said when Qué Pasa asked about this particular instance.
The CVS communications office told Qué Pasa that CVS follows the guidelines provided by states and the Centers for Disease Control and Prevention.
Díaz’ case raises the question of trust in testing systems for the Latino community, while increasing the risk of infection in the state.
“It’s demeaning that they do this,” said Díaz. “They say they want to stop the situation. The lady denied me the test …. God knows who else I might have infected without knowing it.”
Three tests and staggering medical debt
In early May, Gioconda Muñoz was admitted to Moses Cone Hospital in Greensboro with pain in her back.
She was not tested for COVID-19, but she was diagnosed with pneumonia, as Qué Pasa was able to verify through documents provided by this Honduran immigrant.
The possibility of being infected hadn’t worried her until several days later when a friend Muñoz had given a ride called to say she had COVID-19.
Despite having no symptoms associated with the coronavirus, Muñoz called 211 to obtain test information. The help desk told her that since she had no symptoms, she was unable to proceed with testing. Even so, Muñoz went to a health center, where they performed a test that was unsuccessful.
“Six days later they called me to tell me something had gone wrong and I should have another test done.”
The day after the second test, Muñoz was admitted to the hospital again, since her health had worsened. While there, she was diagnosed with COVID-19.
Muñoz has received the first medical bill — for more than $3,400 — and fearfully awaits a second. These bills are a financial blow to this immigrant mother, who earns a living as a beauty consultant.
“If they had tested me the first time, I would not have gone to the hospital and I would not have been double-billed,” she said, worriedly.
Muñoz’ case is an example of how the system can fail the most vulnerable, and how consequences are exacerbated when the person in question does not have health insurance.
William Munn, political analyst at the NC Justice Center, acknowledged that minority communities, such as the Latino community, have jobs that often do not offer health insurance, “so many people have fallen into the coverage gap while the state has refused to expand Medicaid.”
The activist María Mayorga emphasized the need to start implementing permanent health policies.
“Give our people more access to health centers,” she said.
“There is money …. You can move money to create a fund in health centers that offer low-cost services,” she said. “Start now for infected people, but then keep those changes permanently.”
33 days in quarantine
After spending 33 days in quarantine, María Guevara returned to her job at the Butterball poultry processing plant in Duplin County, which experienced a COVID-19 outbreak in April.
At the end of her first week back, Guevara received a paycheck for only $50, three-hundred dollars less than usual due to wages withheld for missed insurance payments.
“They took money from my paycheck for the four weeks’ insurance I hadn’t paid while not working,” she said.
Being out of work, she said, was due to the fact that she was not tested together with her husband when he was taken to the doctor after presenting severe COVID-19 symptoms.
She is certain she became infected in the processing plant where she works, and infected her husband.
“One day I arrived and half of my section was missing …. I assumed they were sick. But the factory did not stop. We did the same production line and pace with half the people.”
When she began to feel ill, Guevara chalked it up to her new excessive workload and the low temperatures in the processing plant.
When her husband was discharged, Guevara had just been tested. Her results came back positive, and she spent 14 days in quarantine. “And then I had to take three more days before returning to work,” she said.
Not being able to work for more than a month caused many financial problems for Guevara and her family. She didn’t have enough to pay rent, groceries, and much less for the oxygen pump that allows her to sleep due to her apnea, for which she still owes more than $1,000.
Actions from the government
On April 9, Qué Pasa sent an email to Gov. Cooper’s office asking, among other things, if he was concerned about the possibility the Latino community could be seriously affected by the pandemic.
There was no reply.
On May 28, Cooper acknowledged publicly for the first time that Hispanics and African Americans are being disproportionately affected by COVID-19. In early June, he signed Executive Order 143 in order to “address the social, environmental, economic, and health disparities” faced by the minority communities affected by the pandemic.
The order presents a series of guidelines and calls for the creation of a task force composed of minority representatives from various sectors.
Although concrete steps to carry out this order have not yet been made public, some questions have already arisen.
- Will these measures be sufficient to bridge the inequality gap?
- Will there be a way to repair a historical error that has caused the Latino community to fall through cracks of an imperfect healthcare system?
Cohen explained to Qué Pasa that her team is collaborating with local organizations to improve communication with the Latino community, is expanding the coverage of free testing, and is working with the managers of poultry processing plants to guarantee sick-leave and safe working conditions.
Nevertheless, Cohen acknowledged that these measures address immediate problems, and that what the community needs are long-term solutions.
“Our team is thinking about immediate solutions, but we are also having conversations about how we are going to use this moment to build back stronger,” she said. “It can’t just be about this month, or the next couple of months in COVID. There are going to be longer term issues, so we will need to take a longer term perspective in order to build something to help folks over the long-term.”
Systemic solutions are also expected by Garzón and Munn.
“It is a step in the right direction, but I am afraid it is not enough,” Garzón said.
Neither does Munn consider it adequate, though he does say the government has taken a “great step” in recognizing that “there are disparities and problems in access to health and education for communities of color.”
“The administration is recognizing that the results of problems in access to health, education, etc. are worse for communities of color during this pandemic,” said Munn.
“But my question is: Where is the money to finance all this? We have to talk about that, too. We want to see the General Assembly support the governor and ensure that the Task Force is adequately funded so it can be effective.”
News & Observer reporter Aaron Sánchez-Guerra updated Covid-19 numbers in this story for publication.
EDITOR’S NOTE: An earlier version of this story did not include that ethnicity is not accounted for over 35,000 Covid-19 cases by the North Carolina Department of Health and Human Services. The data cited by Department Secretary Mandy Cohen is accurate in that Latinos account for roughly 45% of the over 66,000 cases for which ethnicity is reported.
This story was originally published July 18, 2020 at 11:16 AM with the headline "No papers, no COVID-19 test? Latino immigrants in NC face obstacles in health care."
