The Washington PostDemocracy Dies in Darkness

Health, economic disparities continue to affect coronavirus hot spots

Neighbors describe virus as a hurricane that swept through violently: It sickened thousands, put many people in mourning, stripped away jobs and caused havoc

Nidia Navarro with her husband, Carlos Gomez, at their home in Langley Park, Md. Navarro lost her job cleaning houses early in the pandemic, and Gomez recently was diagnosed with kidney failure and is unable to work. (Michael S. Williamson/The Washington Post)
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A few yards from Isabel Espinoza’s Langley Park apartment, the area shows signs of the labors of this working-class immigrant neighborhood: Carpet-cleaning trucks sit in parking lots, corner street vendors sell fruit cups with chile and lime, and men walk into three-story brick buildings, their jeans stained with paint.

Then Espinoza pointed to the windows.

“People were evicted there,” Espinoza said, her right index finger indicating an apartment complex across from hers.

“She’s now having long covid symptoms,” she continued, moving her finger slightly to the left.

Her finger moved upward. “He spent last Christmas and New Year’s hiding in a basement because he caught the virus, thinking he was going to die. He even called his children to say goodbye,” she said.

When the coronavirus pandemic took hold in March 2020, thousands of front-line workers like Espinoza’s neighbors became essential — caring for the sick, cleaning schools, packing and delivering supplies, picking produce and processing food that made it to the tables of millions of Americans. As they worked, often close to others and without enough personal protective equipment, the virus spread rapidly, turning their communities into deadly hot spots.

Now, nearly 2½ years later, hot spots like Langley Park in Prince George’s County or the areas around the poultry-processing plants on the Eastern Shore are still suffering the economic and health effects.

“The situation here is that we haven’t been able to recover,” said Espinoza, 55, who despite her diabetes — which puts her at higher risk of complications from the coronavirus — has risked her own health to care for sick neighbors.

During the first coronavirus wave, the 20783 Zip code, which includes the Langley Park neighborhood where Espinoza has lived for more than two decades, had the highest infection rate in the state: 2,671 cases by August 2020.

The coronavirus is still an issue in the area — as of Thursday there have been 9,173 cases in Zip code 20783, according to Maryland Department of Health data — but cases are probably undercounted, as many fall ill more than once but don’t seek medical care or testing. Seventy percent of this Zip code’s population has received at least one dose of a coronavirus vaccine, but some neighbors said they are still hesitant or fearful of getting a second dose or a booster.

Families in these areas have long endured health and economic inequities, and that is why advocates like Michelle LaRue, senior manager of health and science at CASA de Maryland, saw an urgent need to reach the community directly at the start of the pandemic to lessen the hit. A network of volunteer health promoters, or promotoras, led community outreach initiatives to provide information about vaccines and food pantries, along with help on applications for rental assistance and health benefits.

Despite these efforts, advocates and families said long-standing issues have worsened since the start of the pandemic — many people are unemployed or have had their work hours reduced, and more are facing housing instability. With high gas prices, it has become harder to afford food, and access to health care continues to be a challenge.

“We are going to have the longest and slowest recovery phase of the pandemic,” LaRue said. “Other sectors of the community fared pretty well. If you had your own transportation, if you had a job that allowed you to do remote work, if you were already economically stable, I think people weathered the storm a lot better. Our communities didn’t have a lot of those luxuries and still don’t.”

Robust coronavirus relief programs such as direct cash payments, eviction protections, unemployment expansion and sick leave kept many people from falling further into poverty, according to the Center on Budget and Policy Priorities, a think tank that analyzes the impact of federal and state government budget policies. As the pandemic has moved into its third year, though, these benefits have expired or are about to do so. And many families were never able to access the benefits because of their immigration status.

That is the case for Nidia Navarro, who lost her job cleaning houses early in the pandemic.

First, work was scarce until there was none, she said. Because Navarro is undocumented, she did not qualify for unemployment benefits, and losing her income has meant less money for food, clothes and school supplies for her three children, and to buy medicine to treat her diabetes.

“We stop buying medicine to pay for electricity,” said Navarro, who is uninsured.

Life for Navarro and her family has been a battle ever since. Navarro’s husband, Carlos Gomez, was diagnosed with kidney failure this year. Navarro is caring for him — he receives dialysis three times a week and has fainted while climbing the stairs — and she has not been able to return to work. Now, both are unemployed.

“We are worried about paying rent this month,” Navarro said on the last day of July. “How are we going to pay?”

Del. Joseline A. Peña-Melnyk (D-Prince George’s), incoming chair of the Health and Government Operations Committee, said in an interview that she is working on finding solutions to expand health care for the uninsured, including the 4 percent of Maryland residents she said are undocumented.

During this year’s legislative session, Peña-Melnyk introduced legislation to expand Medicaid for immigrants regardless of their legal status, but the bill did not leave the committee. Another bill she wrote, allowing undocumented pregnant women access to Medicaid, was successful.

“I had to decide which one was going to be the priority,” Peña-Melnyk said. “We are going to try again next year.”

In Prince George’s, the Emergency Rental Assistance Program designed to help families who are behind in rent has not been taking new applications since December. County officials said the application portal was closed to address the backlog of applications they received.

“If additional funding is provided to us by our State and Federal Partners, we will assess whether the portal can be reopened to new applicants,” Jose C. Sousa, assistant deputy chief administrative officer for economic development, said in an email.

As of May, an estimated 14 percent of Maryland renters were behind on rent; of those, half are unemployed and 82 percent are low income, according to a Maryland Food Bank report released last month.

Rethinking health equity

On a recent Saturday morning in Princess Anne in Somerset County, a coalition of community organizations, volunteers and local health officials came together to support a particularly vulnerable population living in the most remote areas of the Eastern and lower shores: food-processing workers.

“Is it difficult to schedule or find an appointment to get a vaccine?” Ricardo Ortiz, an activist at the migrant rights organization Centro de los Derechos del Migrante (CDM), asked a poultry worker.

Among the options offered, Rosalva Rojas, from Guerrero, Mexico, who works in a Mountaire Farms chicken hatchery, responded: “Totally agree.”

Meat-processing workers became critical to preventing disruptions in the food supply chain during the worst days of the pandemic. But the plants themselves became hot spots for the virus, as workers stood elbow to elbow chopping, deboning and packing meat and seafood.

In May 2020, Gov. Larry Hogan (R) announced that poultry workers on Maryland’s Eastern Shore had registered 279 cases, positioning Salisbury on the Eastern Shore on the national list of coronavirus hot spots. Congregate work, lack of protective equipment and inadequate ventilation at work became key factors in the spread of the virus that put these workers at elevated risk, advocates said.

Community organizations, volunteers and local health departments came together to form the Lower Shore Vulnerable Populations Task Force to address health disparities and connect residents to critical services in the area. The coalition has held events three weekends a month in Wicomico, Worcester and Somerset counties to collect health data, provide vaccines, coronavirus tests, rental assistance, food and translation services to low-income residents, including poultry and farmworkers who are primarily foreign-born and speak languages other than English.

“While covid may be dissipating compared to what it was two years ago, the problems are not,” said Richard Hutson, bilingual program and outreach coordinator at Tri Community Mediation, a nonprofit that is part of the task force.

Advocates said they are concerned about the lack of up-to-date health regulations in the workplace and lack of policies that guarantee paid sick leave for those who continue to fall ill. In June, the Marylanders for Food and Farm Worker Protection Coalition called on the Hogan administration to properly track coronavirus case data for the poultry industry and migrant seasonal food and farmworkers.

“Current data collection masks infections in the meat- and poultry-processing industry, which nationally have been a covid-19 hot spot,” said Leila Borrero-Krouse, community outreach organizer of CATA’s Farmworker Support Committee in Maryland.

A Maryland, Virginia and Delaware survey released in December assessing food-processing workers during the pandemic showed that approximately 1 out of every 6 workers surveyed reported having been diagnosed with the coronavirus or suspected that they had it between March 2020 and the first week of May 2021. Immigrant and migrant workers were eight times more likely than U.S.-born workers to have been diagnosed with — or to suspect that they had been infected with — the virus during that time, according to the “Unpacking the Facts” report sponsored by the Centers for Disease Control and Prevention. More than half of workers reported working less than six feet from other people.

While community efforts have proved to be successful, community health-care initiatives face constant financial uncertainty, advocates said. The CDM, which is part of the task force, has a five-year cooperative agreement with the CDC to assess workplace risks and concerns during the pandemic in this area, but funding is not necessarily guaranteed, said Julia Coburn, CDM’s director of health initiatives.

“There was an influx of covid funding during the pandemic, and a lot of that is starting to run out,” Coburn said. “We are in a great position to continue doing this work long term, but we will not be able to do so unless there’s funding.”

In these three counties, fully vaccinated rates remain below overall rates in the state, and coronavirus transmission as of early August remains high. “Our country has moved on from the virus, but the virus has not moved on from us,” said Amy Liebman, director of environmental and occupational health at Migrant Clinicians Network.

“We have rising rates of domestic violence, of STDs, gaps in immunization for children and adults. We have long covid, which we barely understand,” said Denise Smith, executive director at the National Association of Community Health Workers. “This is a perfect storm, and communities are going to suffer.”