Disproportionately high cases of COVID-19 among South Carolina's Spanish-speaking population indicate the pandemic is hitting Hispanic communities harder than any other, exacerbated by a lack of information and wariness of government involvement.
Trident Health, a North Charleston-based hospital system, says 40 percent of patients it is admitting for treatment are Hispanic. And during a recent spike in Greenville County, DHEC said 30 percent of cases were among the Hispanic community.
Because of patient privacy protections and a lack of data in some cases, it is hard to say for certain where or why Hispanic people are falling ill with the virus disproportionately.
Deylin Marquez, a volunteer helping to spread messages of public health in the Spanish-speaking population in North Charleston, said the Hispanic community already has a lack of trust in established media because they believe they’ve been lied to about prior emergencies like hurricanes and tornadoes, Deylin said. She said many are failing to take the pandemic seriously until someone close gets sick.
"We have to wait to see somebody that we know get sick,” she said. “It’s a cultural problem that we’re suffering as Hispanics.”
Across the state, difficulties reaching a group of people who tend to lack trust in the government and health care institutions are translating into hospitalizations and even deaths.
Trident Health's numbers are far beyond what the hospital would expect, given just 6 percent of the tri-county population it primarily treats is Hispanic, according to the U.S. Census Bureau.
By comparison, 30 percent of its COVID-19 patients are Black, a population that accounts for roughly 25 percent of the tri-county population.
"That made us start scratching our heads," said Dr. Lee Biggs, chief medical officer for Trident Health.
Biggs said four Hispanic men in their 30s — roommates who worked for the same employer — showed up to the hospital with symptoms of COVID-19 recently. Three ultimately died. For people living in close quarters with others, Biggs said infected patients' viral loads can be much higher than usual. That can translate to a more severe case of coronavirus disease.
"They’re coming in sicker than the average COVID-positive person," Biggs said.
Across the state, at least 13 percent of reported COVID-19 cases are in Hispanic people — though the S.C. Department of Health and Environmental Control doesn't know the ethnicity in 30 percent of cases.
A higher-than-expected portion — 20 percent — of Beaufort County's COVID-19 cases are Hispanic. They make up only 11 percent of the county's population.
A spokeswoman for DHEC said the agency is working hard to connect Spanish speakers to the information they need. She said outreach materials are almost all available in Spanish. Bilingual medical personnel or translators are available at testing events in communities where they are likely to be needed.
A DHEC public health expert is making the rounds on Spanish-language radio stations.
Lydia Cotton, board chairwoman for the Latino-focused Art Pot Multicultural Group, said the Spanish-speaking community has been left out of the pandemic's messaging, left to piece together information on COVID-19’s impact from national news sources as well as reports from friends and family abroad.
A lack of reliable and consistent information puts the S.C. Latino community at risk, she said.
“They just don’t understand the importance of it,” Cotton said. “We are being left behind, honestly.”
Cotton and other volunteers with Art Pot, a nonprofit organization that works with the Spanish-speaking community in North Charleston, Hanahan and surrounding areas, have been working with officials and Latino churches to spread awareness of the risks posed by the coronavirus.
A lack of Spanish-language media in the area exacerbates the problem. Despite Art Pot members going house by house in some cases, messages aren't reaching enough people, Cotton said.
"They don't believe that this was happening because we were the only ones talking about it,” she said. “Many believe this is a religious issue. They believe that God will fix it if anything happens, and this is not only happening in the Hispanic community."
Many Spanish speakers are also afraid to go to the hospital, Cotton said.
"They believe if they go to the hospital, they won’t get out," she said.
Art Pot has been working with North Charleston city officials and police to distribute masks in the Latino community.
On Tuesday, a group of volunteers and police went into residential areas near Ashley Phosphate and Stall roads to hand out masks and spread public health messaging.
Ryan Johnson, a North Charleston spokesman, said the city bought 15,000 masks and received 10,000 more as donations last week. The personal protective equipment was distributed in grocery stores and other businesses in areas of the city with underserved populations.
Police and Art Pot volunteers went to Ashley Phosphate and Stall early Tuesday to reach residents before they left for work, Johnson said.
“They went door-to-door to make sure they had face coverings,” he said. “By and large, almost no one did."
On Wednesday, another 10,000 masks were received by the city, Johnson said.
Cotton described the outreach efforts as “nonstop,” and said organizations like hers are working as hard as they can but don’t have the manpower to reach everyone. Mixed messaging is confusing to the general public, and even more so for those who speak little-to-no English, she said.
“The big mistake is not thinking about language, heritage and culture,” Cotton said. "It should not be that way. We should be having it translated, everything in Spanish."
Fetter Health Care Network's migrant worker program has been successful reaching agricultural laborers in the past, but staff have run into new-found roadblocks with the pandemic that have made reaching the community harder, said Aretha Jones, the primary care organization's CEO.
In past years, Fetter's team has been able to lay groundwork in the spring to build trust with groups of migrant workers. Jones said they work with nine regional farms. But this year, lockdowns prevented Fetter from reaching out to the workers.
The workers worry about the government's involvement in managing the pandemic, Jones said. When testing, Fetter's staff has to ask for identification, so that when someone calls back they can ensure they are giving the results to the right person. Though they have to collect some health information, Fetter does not share it with any authorities.
Still, reasons for distrust of the health care system among the migrant community abound.
A recent testing event in Walterboro targeted to the migrant community was not well-attended, Jones said.
Across the rest of the community, Fetter has seen a high number of Hispanic individuals test positive, Jones said. Fetter has networked with employers to try to spread more information about the pandemic and has Spanish-speaking staff and health care providers.
Other health care providers have similar capabilities: Prisma Health, for example, has Spanish-speaking team members at all of its testing sites.
Brayan Marquez, Deylin's son, said he has noticed many people not being cautious or wearing masks. Marquez said he believes that's because of fear and reluctance to go to the hospital or to get tested for the coronavirus.
Many Spanish speakers don’t know where they can get tested, much less where they can get tested for free.
“They need more information,” Brayan said. Some have gone to get tested and returned frustrated, saying they were charged for a test. "When we tell people the numbers, the information, they look at us like we’re liars. They say the media is not telling the truth. When they see the cops and they see us wear masks, that kind of motivates them to also do it."
But despite resistance to the message, Deylin Marquez said she has has seen some hopeful signs.
“We’ve gained a lot of trust in parts of the community,” she said. "We see people that are actually listening."