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HOUSTON — Two weeks after Valery Martinez's 41-year-old cousin was rushed to a hospital with severe symptoms of COVID-19, Martinez wrote a post on Facebook, thanking the doctors and nurses at Memorial Hermann Southeast Hospital in Houston who were working to save him.
"You are the real heroes putting your life on the line in this difficult time," Martinez wrote. "May God continue to cover and protect you and your families."
Afterward, she started getting messages from friends — nearly all of them Hispanic, like her — who said their loved ones were also sick with the coronavirus. One friend's aunt was in intensive care at Memorial Hermann Southeast.
The friend's family was planning a prayer vigil outside the hospital that weekend, so Martinez asked to join. Then members of another family they knew came forward, asking if they, too, could come pray for a loved one hospitalized there with COVID-19.
Martinez choked back tears that Sunday afternoon this month as she and 40 others stood in a parking lot outside Memorial Hermann Southeast, faces covered with masks, hands lifted in prayer for the three patients hospitalized in ICU rooms 2, 11 and 22 — all Hispanic, all connected to ventilators.
The moment made Martinez feel like she wasn't alone, she said, and helped her realize just how rapidly the virus was spreading through her community.
"Pretty much everyone who I know has had coronavirus or has a family member who's been sick or is in the hospital," said Martinez, who by early this week could list 45 Hispanic friends, family members and acquaintances who've been sick with the virus in the Houston area — including four who'd died.
As the coronavirus tears disproportionately through Latino communities in Texas, data released this week by state health officials reveals that an outsized share of these residents are also suffering the worst outcomes. Hispanic Texans make up about 40% of the state's population but 48% of the state's 5,952 confirmed COVID-19 deaths, according to Department of State Health Services data.
In the Houston region, where COVID-19 hospitalizations surged in June before beginning to decline in recent days, data released by the Harris County health department showed a disproportionate share of those requiring hospital care — as high as 65% of newly hospitalized patients during some weeks in June — were Hispanic, despite the fact they are 44% of the population.
At Memorial Hermann Health System, one of the Houston region's largest hospital chains, an analysis of emergency room visits shows that far more Hispanics in their 20s, 30s and 40s have showed up at its hospitals with COVID-19 compared with other ethnicities, an indication that the virus is spreading widely among young Hispanic residents and that they may be waiting until they are sicker to seek care, officials said.
Meanwhile, as the Houston Fire Department reports record numbers of patients dying abruptly at home this summer before paramedics can even reach them, Harris County medical examiner data shows that more than two-thirds of those who've died at home from confirmed coronavirus infections have been Hispanic.
There are numerous reasons for these disparities, experts say. Hispanic residents are more likely to work in service jobs or live in multigenerational households that make social distancing difficult. They are less likely to have health insurance. And they are more likely to have health problems, including diabetes and high blood pressure, leaving them more vulnerable to serious illness.
These factors are more pronounced in Texas, one of the first states to reopen after initial coronavirus shutdown orders, with Gov. Greg Abbott urging people to get back to work beginning in May — including at restaurants, bars and hotels — even as the number of COVID-19 cases continued to grow.
Texas is also the largest state in the nation that refused to expand health insurance for low-income residents under the Affordable Care Act, and it is home to a rapidly growing Latino population. Nearly a third of adults under 65 in Texas lack health insurance, the worst uninsured rate in the country, and more than 60% of those without health insurance in the state are Hispanic.
Dr. Esmaeil Porsa, Harris Health System's president and CEO, oversees Houston's two public safety-net hospitals. He said COVID-19 is amplifying the existing inequalities of "a health care infrastructure that is faulty by design." At Porsa's hospitals, where a majority of patients lack health insurance, the medical staff has run out of ICU space and key drugs needed to treat COVID-19, leaving many patients to linger in emergency room beds for days before being transferred to hospitals outside the city.
Nationally and in parts of Texas, the coronavirus has also disproportionately sickened and killed Black residents, another group with unequal access to health care.
"And what is happening today really is that faulty design coming out in terms of certain hospital systems becoming overwhelmed, and one segment of the population being disproportionately harmed by it," Porsa said. "These problems are all coming to a head after decades of not paying attention to the health care infrastructure."
Another problem: People who lack health insurance often wait too long to seek medical care, leading to worse outcomes, said Dr. Amelia Averyt, a primary care physician at Legacy Community Health, a federally funded center whose patients are about 60% Hispanic.
For those without legal status, Averyt said, there's also the worry about being able to stay in the country and how to pay medical bills without health insurance.
"I think fear is keeping them at home more than anything," she said.
The pandemic's disproportionate toll can be seen in dozens of desperate postings on GoFundMe by Latino families in the Houston region, each pleading for help paying for COVID-19 medical bills or funeral expenses. Several said their loved ones lacked health insurance; others said the virus had hospitalized multiple members of the same family, leaving nobody healthy enough to earn money for rent.
Leonor Quiroz's friends set up a fundraiser for her after she and her husband of nearly 10 years were hospitalized with COVID-19 in May. Leonor, 47, thinks her husband, Valentin, 52, brought the virus home from a construction site. He couldn't afford to take time off work.
She was hospitalized first; Valentin, who continued going to work even as his symptoms worsened, followed her into HCA Houston Healthcare Tomball days later. She got better and was discharged; he got worse and was connected to a ventilator.
Each day, Leonor would call and sing Valentin one of their favorite songs in Spanish, "A Puro Dolor" — "Sheer Pain" — while a nurse held the phone to his ear.
"Give me back my fantasies … The courage that I need to live … The air that I breathe."
Valentin died May 23, leaving Leonor with more than $25,000 in out-of-pocket medical and funeral expenses.
"A lot of my Hispanic friends and family believed the coronavirus was a conspiracy until I actually lost my husband," Leonor said. "Now they realize it's not ... after it cost me everything."
Harris County Judge Lina Hidalgo, the top elected official in the county that includes Houston, called a news conference this month after county data began showing a surge in COVID-19 cases among Hispanic residents. She called the data "a wake-up call," and not just for those communities already reeling.
"We should care about what's happening to our most vulnerable residents right now and not just because it's the right thing to do," said Hidalgo, the first Latina elected to her position. "We are all interconnected. … If some among us are sicker than the rest of us at the moment, guess what? Sooner or later it's going to catch up with all of us."
"He can't catch his breath"
Cristobal Onofre, 22, has a framed photo of his father in his living room, taken on Benito's 44th birthday in February. It shows Benito Onofre in his northwest Houston apartment, smiling with cake frosting on his lips, standing in front of a "Happy Birthday" banner and colorful balloons.
He was healthy, his son said.
Five months later, on July 3, Benito was found dead in his apartment after suffering from an untreated case of COVID-19. He was part of a wave of people who've died at home in Houston this summer as coronavirus infections surged.
Benito had gone to great lengths to protect himself from the virus, his son Cristobal said. He wore a mask at the restaurant where he worked as a dishwasher and gloves when shopping for groceries. If Benito saw too many people inside a store, he would turn back. But there was only so much he could do.
Sometime in late June, he started feeling ill, with an aching throat that kept him awake at night. After a few days, he decided to get tested for COVID-19 at the Mexican Consulate in Houston. But the test results would take days. In the meantime, Benito continued to treat it as a common cold, drinking hot tea and taking cough syrup.
By the end of the week, his symptoms worsened. "My uncle called and said: 'Your dad is not doing very well. He can't catch his breath,'" Cristobal said in Spanish.
His family called an ambulance but said Benito refused to get in when it arrived. Cristobal was told that his father, who still doubted he had COVID-19, was afraid of catching the virus in the hospital. There was also the question of how he would pay for hospital care. Like nearly half of Hispanics in Harris County, Benito lacked health insurance.
Later that night, after the ambulance left, Cristobal's uncle, who lived with Benito, found him sprawled on the bathroom floor. Paramedics declared him dead, and the medical examiner later determined COVID-19 was the cause, listing high blood pressure and obesity as contributing factors.
Data from the Houston Fire Department shows a 45% jump between February and June in the number of cardiac arrest calls that ended with paramedics declaring people dead upon their arrival at the scene. In March, the department recorded about 250 dead-on-arrival calls, the most of any month in the past two years up until that point. In June, the number grew to nearly 300. And during the first 23 days in July, the most recent data available, the department had already surpassed that number, a new record, fire officials said.
Among the small subset of these at-home deaths later tested and confirmed to be the result of COVID-19, an overwhelming majority of people have been Hispanic, according to Harris County Institute of Forensic Sciences data. In the first two weeks of July, the medical examiner attributed the at-home deaths of 22 people in Harris County to the coronavirus — already surpassing the total number for the month of June. Sixteen of the dead, 73%, were Hispanic.
Benito left a wife and four children in his native Mexico. He hadn't seen them in 13 years and was recently talking about heading back for good, becoming more anxious about being here without legal status.
In Houston, it was only father and son. They used to play soccer together and grab a bite at their favorite Mexican restaurant every Friday. A typical dad, Benito would scold Cristobal for not calling his mother or for changing lanes without signaling.
"He was my dad but also my friend," Cristobal said.
"If you are sick, go to the hospital," is his message to others. "We don't know if it can be a common cold or the coronavirus. This illness is nothing to play around with."
“Not giving up on him”
Beginning in June, Dr. Jamie McCarthy, an executive vice president at Memorial Hermann Health System and an emergency room physician, was hearing anecdotes from colleagues suggesting that the coronavirus was hitting Hispanics harder than other groups in the Houston region.
This week, the hospital system ran an analysis of emergency room visits that confirmed those observations. More than 37% of nearly 9,000 patients who've tested positive for the virus at Memorial Hermann hospitals identified themselves as Hispanic, a greater share than the hospital system's typical patient mix, McCarthy said. Another 4,000 patients who tested positive for the virus declined to share their ethnicity with the hospital, but a significant number of them came from majority-Hispanic ZIP codes.
Although the system's Hispanic COVID-19 patients have been younger — more in their 20s, 30s and 40s than other age groups — McCarthy said a similar percentage of them, about 4%, end up requiring admission to an intensive care unit compared with patients of other ethnicities, who tend to be older. Part of the reason, McCarthy said, are the underlying health conditions experts have said can lead to poor outcomes even for young people in otherwise good health.
"Most people who are 40 and have a little bit of diabetes or a little bit of hypertension or maybe who are carrying a little bit of extra weight don't feel like they should be at increased risk for this," McCarthy said. "But that's certainly what we're seeing. People who think they're healthy because their chronic conditions are well managed are still increasingly at risk and requiring hospitalization."
A lack of health coverage, language barriers and bad past experiences may be leading many Hispanic residents to avoid emergency rooms until it's too late, McCarthy said.
"I'm sure there are many people who have the story of, 'My loved one went to the hospital and I never talked to them again, and they died," McCarthy said. "And that's just scary. And so if you're non-English speaking, from a limited socioeconomic background, are you going to call 911 when the other people who did that never came home?"
After noticing the trends, Memorial Hermann launched Spanish-language education initiatives targeting majority Latino communities, including billboards and TV segments, urging residents to social distance and to seek medical care when they begin to feel ill.
Weeks before holding the prayer vigil in the parking lot outside Memorial Hermann Southeast Hospital, Valery Martinez got a distressing call from her aunt. Her cousin, Arturo "Tudy" Valles Jr., 41, had been sick for days before his mother noticed him straining for air in the middle of the night on June 26 and finally called 911. The ambulance rushed him from his home in Pasadena, a majority-Hispanic city southeast of Houston, to the hospital, where he was soon connected to a ventilator.
In the days before being hospitalized, when he first noticed the pain in his throat, Valles made four attempts to get tested for COVID-19 at a free testing site near his home. But each day, his family said, the clinic ran out of tests before he reached the front of the line.
Valles' mother, Nilda De La Peña, tested positive not long after calling paramedics for her son. Then a week later, Martinez caught the virus, too, forcing her to move out of her home to avoid infecting her elderly grandmother.
"Basically everyone I know has been impacted, and people are dying," said Martinez, who by then could tally four people in her life who'd died of COVID-19.
A single father who lived with his mother and his 13-year-old daughter, Valles worked at a chemical plant until his diabetes worsened several years ago, forcing him to have one leg amputated. Despite being only 41, his underlying health troubles put him at higher risk once he became sick with the coronavirus.
Last week, after Valles had spent three weeks on a ventilator, doctors at Memorial Hermann warned that he might not survive another night, prompting Martinez to organize a video chat. Eighteen of Valles' closest loved ones took turns telling him how much they loved him.
"We're not giving up on him," Martinez said last Thursday, two days after the video call. "God has the last word, not doctors or nurses."
Her family hosted a fundraiser Saturday, selling Tex-Mex plates in the parking lot of a Pasadena restaurant to help pay for Valles' mounting medical bills. A week after the doctors' warning, Valles was still alive, giving Martinez and her family hope that he might pull through.
But on Tuesday, the hospital called with a devastating update. The number of people in Martinez's life who'd been killed by the coronavirus had grown to five.
Correction: On July 30, the state said an “automation error” caused approximately 225 deaths to be incorrectly added to the overall death count; a subsequent quality check by Department of State Health Services epidemiologists revealed COVID-19 was not the direct cause of death in these cases. We updated the cumulative numbers for July 27-29 to account for this error.