In Rhode Island, the Latinx community fights COVID-19 by fighting health disparities.
Last spring, as COVID-19 surged across the US, early data indicated a trend that’s only worsened in the year since: the disease disproportionately sickens and kills people of color.
Policymakers and talking heads wrung their hands, asking how this could be. But medical professionals and researchers who have dedicated their careers to fighting health disparities saw it coming.
“The most surprising thing is that people are surprised that a pandemic would exacerbate and would amplify disparities that have always been there,” Cape Verde native Carla Moreira MD’08 RES’10 said last April. The multilingual vascular surgeon and clinical assistant professor of surgery works tirelessly, on the clock and off, to educate fellow immigrants about their health care rights and, now, the virus.
But education is one thing; reality is another. The admonishment to stay home and social distance was fine for white-collar workers who could do their jobs remotely and pay for delivery services; those we now call “essential” workers—including the people who stock and deliver those goods—had no choice but to leave their houses.
“The hashtag about ‘we’re all in this together’—we’re really not,” Moreira said. In Rhode Island much of the burden, and the danger, fell on immigrants who toil in grocery stores and factories and behind the scenes at hospitals, rely on public transportation, and live in multigenerational households. “If there’s eight other people that live in your home and there’s one bathroom, no matter how much you’re trying to follow the rules … you’re putting yourself and your whole family at high risk,” she said.
In the Ocean State, people who identify as Latino or Hispanic (or the gender-neutral Latinx) account for 16 percent of the population, but 30 percent of COVID-19 cases, according to the Rhode Island Department of Health. Providence, Central Falls, and Pawtucket—all cities with large Latinx communities—were especially hard hit.
The state took notice; after some early missteps, it increased testing sites in these areas, along with bilingual signage and information. It opened free “quarantine hotels” so people could isolate away from their families, and gave cash to those whose immigration status excluded them from federal stimulus funds. As the vaccine rolled out, Rhode Island prioritized Central Falls, where nearly a third of residents tested positive for the coronavirus.
Brown faculty, students, and affiliated physicians have been among the key advocates for the state’s Latinx population through the pandemic. They’ve advised state and local leaders and the Rhode Island Department of Health, translated educational materials and combated misinformation, crunched numbers to identify hotspots, and led food drives. One doctor even got vaccinated on national TV.
The impulse to get involved, for many, was personal. “This is a tale of tragedy for [Latinos]. We certainly feel like we’ve left somebody behind,” says Dioscaris “Dio” Garcia PhD’12, an immigrant who lost many relatives in the Dominican Republic and New York City to COVID-19. When the virus landed on American soil last year, the microbiologist stepped up to help his community through the crisis—service for which he was honored by the State Senate, the Pawtucket School Department, and many others.
“Being a child of Rhode Island, a child of Central Falls and Pawtucket, and seeing what we’ve been able to accomplish since February , and seeing the community really start to bring back a little bit of normalcy,” Garcia says, “it’s just an absolute joy and a massive privilege.”
WHEN THE FIRST PERSON in New England got the COVID-19 vaccine, on December 14, it was big news. The Boston Globe carried the story on the front page, and MSNBC broadcast it live.
The cameras were ready before the recipient—a Rhode Island Hospital emergency physician—knew he’d be their subject. “I was only supposed to be in the first batch. And then it seemed like it was that game-time decision,” recalls Christian Arbelaez RES’04, MD, MPH, an associate professor of emergency medicine. “Boy, was I honored.”
Born in Cali, Colombia, Arbelaez and his family moved to Houston when he was 10. After residency at Brown he went to Harvard, returning three years ago to become Brown Emergency Medicine’s vice chair of academic affairs. He thinks he was chosen to get the vaccine first so he could be a “role model” to people of color—not only in the community, but among the hospital’s support staff. “I had a ton of nurses and staff coming up to me saying, ‘I was leaning, and now I’m doing it … thanks to you.’ So that definitely was very satisfying,” he says.
Arbelaez says he’s found people’s biggest concerns to be around vaccine safety: worried it was produced too fast, worried about side effects. On Spanish-language TV and radio, he told reporters and their audiences that he trusts the scientists who made the vaccine. He sent a reassuring WhatsApp to a colleague’s mom in Mexico, and says that helped convince her to get the shot. “And the woman that I take my dry cleaning to, she was like, I saw you on TV, I’m waiting to get my vaccine,” he adds.
Just a few days after Arbelaez got his first dose, one of his uncles in Colombia died of COVID. “It became very personal,” he says, and his message became more urgent than ever.
“We’re seeing essentially 3,000 to 4,000 Americans die a day. I mean, if you imagine planes falling out of the sky, you’d be horrified,” he says. “And it’s predominantly older and predominantly the Latino and Black communities. …
“I was very fortunate to have been the first to be vaccinated in New England, and to raise that message to make sure we don’t forget our communities of color. Many of us are working in medicine for them. They’re the reason we went into medicine.”
YOVANSKA DUARTE-VELEZ, PHD, an assistant professor of psychiatry and human behavior (research), was already the principal investigator on one research grant when she got a phone call last summer asking her to help lead another.
The caller was James Padbury, MD, the program director of Advance Clinical and Translational Research (Advance-CTR), a statewide, Brown-led research partnership that was assembling an application to the NIH to improve COVID-19 testing rates in Rhode Island’s Latinx communities. Part of a national initiative known as Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP), the Rhode Island project—which received more than $880,000 to fund its first seven-month period—seeks to understand and reduce testing disparities with the help of bilingual health aides known as promotoras de salud.
As a clinical psychologist at Bradley Hospital who primarily treats Latinx youth, Duarte-Velez knew from her patients and their families how the virus had upended their lives. Most had gotten sick; all had struggled with remote schooling, isolation, or financial problems. So it didn’t take much for Padbury to convince her to join RADx-UP. In fact, it took just one word.
“Disparities,” Duarte-Velez says. “COVID had hit so hard the Latinx community. That was the hook.”
Born and raised in Puerto Rico, Duarte-Velez moved to Providence eight years ago to work with her research mentor at Brown. She began volunteering with Progreso Latino, a local nonprofit, and joined the board. It was that connection Padbury—the William and Mary Oh-William and Elsa Zopfi Professor of Pediatrics for Perinatal Research—sought; the community trusts the organization, which has continued to provide food, social services, and other resources throughout the pandemic.
“I see myself as a bridge … between the Latinx community and the scientific community,” Duarte-Velez says. Progreso Latino “has been working for so long with the Latinx community. So things that are coming from them, obviously, will be a lot more [well]received than anything that is coming from just the scientific community.”
Progreso Latino helped the RADx-UP team recruit promotoras, who lead focus groups with community members and with providers at clinics that serve Latinx patients in Providence and beyond, to understand attitudes about and barriers to testing, while Duarte-Velez and other researchers observe. They’re putting the findings together to identify challenges and possible solutions, says co-PI Neil Sarkar, PhD, MLIS, a biomedical informatician.
“We’re doing the best we can with the data that we have,” says Sarkar, the president and CEO of the Rhode Island Quality Institute, the state’s designated regional health information organization. RIQI helps the Department of Health receive COVID-19 test results from across the state and identifies hotspots with that data; the RADx-UP project uses focus groups to dig deeper. “We need to understand the spread,” he says, “to make sure that we have appropriate testing to cover the population at the highest levels of density that we can.”
Testing remains crucial even as vaccination campaigns ramp up. “The only way we will know the vaccines are working is if the tests are coming back increasingly more negative and if what we’re seeing is high positivity rates are starting to go down,” says Sarkar, who is also an associate professor of medical science in the Brown Center for Biomedical Informatics. Promotoras will communicate that message, help people navigate the health care system, and—ideally—keep them engaged after the pandemic recedes.
“The infrastructure that will come out of this will not only be purposeful and helpful for COVID-19 but for any other such cases where vaccines have a huge impact,” Sarkar says. For example, the community- and data-driven approach of RADx-UP could improve the state’s HPV vaccination rates.
“Infrastructure that we’re setting up will allow us to identify populations that we should be targeting,” he says. But “the wrong answer is to go into those populations and say, here’s some needles. … Let’s talk to those communities and try to understand.” Is it a lack of access to vaccines? Or are people hesitant due to social or cultural factors? “Understanding that before we storm in as heroes,” Sarkar says, “is actually the type of infrastructure that we’re trying to set up here.”
HOW DO YOU CONVINCE SOMEONE to go to the doctor if they don’t feel sick? To get tested for a virus when the time and location are inaccessible? To stay home when they need to feed their family? The answer to all those questions, according to Dio Garcia, is trust. The assistant professor of orthopaedics and of molecular pharmacology, physiology, and biotechnology (research) has been building that trust for years. A native of the Dominican Republic who grew up in Central Falls and lives in Pawtucket, he’s cashing in on his local reputation to fight the disease that has targeted his communities so ruthlessly. He may be a scientist and a professor from Brown, but what matters more is that people know his parents.
“In order to gain access into that circle of trust, they have to recognize you as one of our own,” he says. “That doesn’t necessarily mean that you need to be Latino. It simply means to be recognized that you are somebody that has their best at heart.”
Garcia knew quarantining would be impossible in crowded, multifamily households like the one he grew up in. He knew people who live paycheck to paycheck would keep going to work. He knew people with limited time and no car wouldn’t trek to the Dunkin’ Donuts Center in downtown Providence for a COVID test, and that undocumented immigrants wouldn’t go to any test site anywhere. “That’s a very hard sell,” he says.
So he shared those thoughts with the Department of Health and got involved with policy at the state level, but he also joined community leaders and the mayors of Central Falls and Pawtucket at local food drives and holiday events. “If you have food, then it’s a little bit easier to convince you to skip work,” Garcia says. They handed out masks along with meals, and answered people’s COVID questions. That regular presence—no doubt along with Garcia’s dynamic personality and big laugh—made people feel at ease. “And they know that if they need anything, they now reach out to us, which is a massive, a huge, huge accomplishment,” he says. “It’s something that I take great pride in.”
At a vaccination clinic at Central Falls High School in January, some of his old teachers told him they’d seen on Facebook that he’d gotten his shot. “Now I’m going to be extra careful on what I post,” Garcia laughs. “But they just said, ‘we saw your post that you got it. So here we are.’”
DURING THE PANDEMIC people have struggled with more than medical care. Many lost jobs; many more lost pay because they had to quarantine or care for sick family members. First- and second-year medical students, who lacked the training or confidence to fulfill health care needs, stepped up to help in other ways.
Student volunteers with Clínica Esperanza, a free clinic on Providence’s West Side, collaborated with its team of navegantes—bilingual community health workers who connect patients with free care and social services. Working remotely, students called patients prior to their appointments to screen not only for COVID-19 symptoms but also whether they needed help with food, bills, or supplies like diapers; they then referred those clients to the navegantes.
“Back in March when it all started … we felt a sense of powerlessness,” Rocío Oliva MD’23, MS, says. “We couldn’t really help, most of us were not in Providence, but we really wanted to be there.” She and other students were grateful to continue to support the clinic from afar, but as a Spanish-speaking Cuban American, Oliva felt especially connected to the community.
“The high rate of positivity among Latino patients … was a huge source of fear and a lot of misinformation,” she says. Oliva answered questions about the disease and treatments and testing, sometimes countering rumors spreading on social media and WhatsApp. “It was just really hard listening to people’s stories,” she adds, “to ask someone, do you have enough money for food, and not expect a longer response of all the struggles that were going on.”
Another volunteer, Sarah Nuss MD’23, says, “I spoke with a lot of families who would ask me, what am I supposed to do, I live in a house with all of these people and I can’t quarantine while I’m waiting for my [test]results for five days.” Some employers wouldn’t let people take time off while they awaited results, or even to go get tested. “That spurred a lot of the continued efforts to try to find ways to support those families, and there wasn’t always a solution. And there still isn’t,” Nuss says.
“Often these were very much Band-Aid measures to deal with larger socioeconomic gaps that result from policy and systems at statewide and nationwide levels,” adds Sam Mickel MD’23. “Rhode Island as a state has done better than many,” he says, by specifically targeting the Latinx population with outreach and funding, including some cash relief for undocumented immigrants—but those measures are “still severely lacking.” And while Mickel and his fellow volunteers praise Clínica Esperanza as a “wonderful” and trusted resource for the community, they question a system that puts the health care of underserved patients in the hands of students and other unpaid workers. “Free clinics really shouldn’t need to exist,” Mickel says.
Connecting Clínica’s patients with food and other resources felt more ethical to med student volunteers, says Neha Reddy MD’23, MPH. She coordinated drop-offs from the Rhode Island Community Food Bank, grassroots organizations, and other groups, and then deliveries to patients’ homes. “The fact that we have cars, and the fact that we are able to lug boxes around, and communicate with different organizations across the city, make those connections—it felt like something that we were more qualified to do than providing medical care during the pandemic,” Reddy says.
The students say COVID-19 has reinforced their drive to work in underserved communities, address systemic inequalities, and diversify the health care workforce. “Increasing Spanish-speaking providers and representation in medicine is really important,”