We talk about health disparities a lot in the abstract. We talk about the numbers, the statistics. We talk about race and politics and structural violence.
But I wasn’t thinking about any of that when my patient had to be admitted due to serious complications from COVID-19. I was thinking about how stubborn he had been, but at the same time I was angered by the circumstances that had made him so.
A month ago it was his daughter who asked me the favor:
“Doctora, por favor, permítele no trabajar.”
It would be a lie to say I was surprised when she asked me to give her aging father a medical release from work. It’s a plea I have heard painfully often the past few months.
He is a diabetic above the age of 65, with hypertension and heart disease, someone we would consider high risk for complications if he were to contract COVID.
I decided early on in the pandemic that I would not be a gatekeeper for work release forms, but would defer to my patients to guide me in supporting their needs.
“Cuánto tiempo quiere usted señor?” I asked him, trying to understand how I could help.
He replied by shaking his head and looking to his daughter, “no, no mija. Pues que voy a hacer si no trabajo?”
His response was unsurprising as well. I knew him too well.
I spoke to him of the mechanisms of contracting COVID, the nature of his health conditions and the type of complications he could succumb to if he wasn’t careful. But my cautions don’t carry the weight they once did, especially for my latinx patients during this pandemic.
COVID-19 has highlighted and aggravated an inequity that always existed – that migrant populations in the US, most of whom come from Mexico and Central America, work in high risk jobs and have sparse access to healthcare and social support networks.
For my undocumented patients, there is no COVID relief-check coming. There is no unemployment check if they are furloughed, no medicaid to fall back on or medicare when they retire. Many live to work, because they aren’t afforded the luxuries of a social safety net.
And to not work, is simply not an option.
This is part of the reason why Latinx communities have been hit so hard by COVID, with recent data showing nearly 40% of confirmed cases in Chicago occurring in Latinx patients.
My patient chose to work, but it’s unclear how much of that was truly a choice. And now he is still hospitalized, fighting to breathe without oxygen support.
This pandemic has brought to the forefront institutional and social inequities that many of us have been discussing for years. As physicians we see these inequities manifest in the daily lives of our patients ; we see the most vulnerable falling ill, not through fault of their own, but rather as a consequence of innumerable invisible forces placing burdens on their lives.
Until we move towards a more equitable safety net, marginalized communities will continue to face the brunt of the attack from this pandemic.