From her office, Dr. Bibiana Mancera, Director of Community Engagement at the Border Biomedical Research Center at the University of Texas El Paso, recalls the difficult situation that millions of Latinos experienced after the arrival of the COVID-19 pandemic. She remembers with sadness the health centers that were overwhelmed by the sheer number of infected patients, grateful that the urgency of the crisis is now in the past.
“The hospitalization rates were very high. Here in our community, just to give an example of the dire situation, we did not have enough space in the morgues for the bodies. We had to bring in mobile mortuary units that were parked outside our County Hospital,” he recounted.
As of November 13, 2020, the El Paso, Texas, Health Department reported more than 700 deaths and 68,000 positive cases of COVID-19. At that time, they had 6 mobile morgues and requested 4 more trucks due to the lack of space to hold the deceased. According to Ricardo Samaniego, a county judge, they were registering 20 deaths or more per day.
The combined Latino population of El Paso and Doña Ana counties, along the border with Mexico, is around 2.5 million people. This is a fluid border area where Latinos routinely cross the U.S. border to go to Ciudad Juárez to visit family, seek medical care, and work. Unfortunately, like the rest of the United States, these communities were not immune to the pandemic.
Faced with this situation, Dr. Mancera could not sit idly by when the vaccines became available. Once the opportunity arose, she contacted the National Alliance for Hispanic Health, whose “Vaccines for All” program provided information on vaccines and distributed the information to Latino communities most vulnerable to the virus through the “Promotores de Salud."
The pandemic in El Paso
In El Paso, 8 out of 10 inhabitants are Latino and around 13% of the population is over 65 years of age, according to the United States Census Bureau. Inevitably, the pandemic in this city was going to have a special impact on Hispanics and amplify many of the problems they already had.
By November 2020, the situation for Latinos in Texas was very serious. Although Hispanics were 40.2% of the population, they represented 55% of the known deaths from COVID-19 in the state since the start of the pandemic. Specifically, more than 900 Latino residents in El Paso County had died from the virus, putting the county ahead of its peers in the state in terms of the rate of deaths per 1,000 residents.
At that time, a report from the US Centers for Disease Control and Prevention (CDC) noted that “race and ethnic origin are risk markers for other underlying conditions that affect health, including socioeconomic status, access to health care, and exposure to the virus related to occupation; for example, frontline, essential and critical infrastructure workers.”
These traits describe a good part of the Latino population in El Paso, in the opinion of Dr. Mancera, who, along with her peers, was quick to identify during the pandemic that there were health disparities that stood out in Hispanic communities and made them more vulnerable, not only to the virus but also to its social and economic consequences, due to a lack of resources.
“What was really shocking for our Latino population is that we were dying at higher rates for many reasons. Some of them are that we lack insurance, we work in jobs that may not provide a living wage, we may not have transportation to access health care, and we have mixed immigration status, which decreases the possibilities of access,“ she explained.
Pre-existing illnesses suffered by some people in the community also became an a major factor. Dr. Mancera still vividly remembers how some Latinos in the County who had comorbidities such as diabetes, cardiovascular disease, and obesity did not seek medical attention between 2020 and 2021 due to the pandemic's impact on the health system, which only aggravated their condition.
“Doctors, nurses, and health care providers were overwhelmed, and their work was not focused on providing preventive care,” Mancera said, adding that the deterioration of mental health during the pandemic was another factor that added to this context.
Call to action
According to El Paso Matters, by December 2020, 9 out of every 10 El Pasoans who had died from COVID-19 were Latino. CDC data from that same month showed that Hispanics were four times more likely than non-Hispanic whites to be hospitalized and almost three times more likely to die nationwide.
During the first year of the pandemic, and in the face of these chilling data, Dr. Mancera's work focused on informing people on how to stop or mitigate the spread of the virus: “we knew it was going to be very important to inform the community, because we have a population in which not everyone has access to healthcare.” In 2021, when the vaccines arrived, community health workers were the frontline of defense and were essential for reducing those access barriers.
“One of the main reasons for contacting the community health workers is because I know they are trusted messengers. They have the same lived experiences (as Latinos), come from the communities they serve, and speak English and Spanish,” she described.
Dr. Mancera added that the community health worker model had shown its effectiveness throughout Latin America, Asia, and African countries, since it reaches and supports people who lack a regular source of health care or are neglected by the health system. In El Paso, a partnership with these community health workers complemented the work of UTEP's Border Biomedical Research Center's to report and apply diagnostic tests for the virus.
“The community health workers were more than willing to work with us because they themselves said that they couldn't stand by while our relatives got sick and died. They demonstrated their commitment to serve,” she said.
In a matter of a month and a half, Dr. Mancera estimates, community health workers in El Paso worked in more than 100 vaccination events. These were held outside commercial premises, restaurants, grocery stores, and even in schools.
Thanks to the Border Biomedical Research Center's first step in working with community health workers, the center then also developed partnerships with federally qualified health entities and non-profit organizations dedicated to providing vaccines.
The work goes on
Despite the fact that almost 80% of the population of El Paso is fully vaccinated, Dr. Mancera believes that challenges lay ahead.
“We are not out of the pandemic yet,” she said. Addressing the long-term impacts of the virus on people's mental health and combating the setback that exists in the adoption of vaccines in general due to COVID-19 are tasks for the short and medium term.
Using people from the communities themselves to take the vaccines to their friends and neighbors was a successful decision that helped change the reality of many Latinos in El Paso. Dr. Mancera's voice cracks when she nostalgically recalls the community health workers efforts in one of the worst moments in the County: "they got down to work and wanted to do everything possible."