Summary: Race, class, and the experiences of a Latinx family in Los Angeles County during the epidemic — Editors
By now it is not news that the pandemic has revealed the persistent class and racial inequality the prevails in the U.S. Lack of health care is a persistent problem in the United States for poor and working-class communities, with the least access to be found among Black, Indigenous and other People of Color (BIPOC). These communities register higher levels of major chronic disease, such as diabetes and high blood pressure, which puts them at greater risk of contracting COVID and having severe life-threatening symptoms. In addition, there are significant racialized barriers to quality care, with Black, Indigenous, and other People of Color being turned away or having negative experiences that make BIPOC peoples mistrust the medical system and avoid doctors and hospitals altogether.
While there have been attempts to acknowledge and address these disparities within the medical profession, the structural nature of these inequalities became starkly clear to me in early January as I, a Latinx woman, found myself at the center of making medical decisions and seeking medical services for my mother, who contracted COVID-19.
At the age of 80, my mother is a high-risk patient, with a history of breast cancer (for which she received chemotherapy), colon cancer, diabetes, high blood pressure, heart disease, and other pre-existing conditions. In some ways, the social service system has worked to make up for the oppressive consequences of the capitalist structure that feeds off the poor in our country. After years of living in communities labeled “food deserts,” laboring in the garment industry under poor working conditions that negatively exacerbated these health conditions, and spending years going without needed medications due to lack of medical insurance, she was granted disability status and given full Medicaid and Medicare insurance, which has paid for exorbitantly expensive medications (made so by a greedy privatized pharmaceutical industry), numerous hospitalizations, and finally a consistent assortment of primary care and medical specialists that have followed her carefully for over 20 years. While we are thankful for this exceptional care, we recognize that many other working-class People of Color, with similar life-threatening conditions have not fared as well. In numerous cases, it has been the fact that she has English fluent children, one of them a physician, whose medical knowledge and cultural capital has proved invaluable in securing needed services and pressuring insurance companies.
After my father became symptomatic with a high fever during the holidays, I went online and ordered the free home COVID-19 tests offered by Los Angeles county for both my father and my mother. When we learned four days later that they both tested positive, we purchased an oximeter for them and began monitoring her oxygen levels every two hours around the clock. Each of us shared the responsibility of calling her on FaceTime (she has an iPhone that my sister gave her and which is connected to her account) to monitor her breathing. Although she struggled from the onset to reach the minimum acceptable 93% oxygen level, she did so initially until the third day of symptoms at which point she could not get above 91. I recall becoming extremely distraught as I told her that we needed to go to the hospital (the recommendation when the level is 92 or below). She did not want to go. She became very distressed at the thought of going to the hospital. Although her previous hospital experiences had been overall positive (she has indicated she was always treated well) the fact that each hospitalization has been for a serious condition (a lumpectomy, a mild stroke, etc.) has left her dreading the need for hospitalization.
Added to this was the recent experience of going to the emergency department of her local LA county hospital, amidst the pandemic, to have a painfully inflamed hand examined. Overwhelmed with the rise in COVID cases in Los Angeles (which, in California, had by this time risen to 2 million), that hospital experience made a lasting impact. She recounted that there were patients lying on hospital beds in the hallways and that the doctors who were treating her were visibly distraught at the number of patients they needed to see. She explained that various times they began to work on her and then had to excuse themselves to attend to a COVID patient, returning to her after a while only to be called away again for another patient. This experience, along with media reports about hospitals being overwhelmed with patients and lacking beds, personnel, and oxygen added to her stress and fear. A particular source of her fear was the information that patients were being sent to other hospitals and that family members were not being told where they were taken and had no way to contact them. Other stories about loved ones dying alone in a hospital room without being able to say goodbye to their families also added to the fear.
For myself, making the decision to pick her up and take her to the hospital, was itself traumatic. This was because my father accused me of causing her so much stress that she almost fainted and my sister, who joined me in picking up my mother to take her to the hospital, initially questioned whether I was sure this was necessary. I recalled reading that even when people feel well, their levels of oxygen can be low and by the time it becomes evident, it can be too late to remedy the situation. I recalled also the story of an educator who died in her sleep, asphyxiated due to COVID, not realizing the dangerously low levels of oxygen she must have been experiencing. I noted that my mother seemed confused and distraught and thought this may have had something to do with lack of oxygen. My father kept saying that she just needed to relax and she would be able to breath sufficiently to bring that oximeter level up to the required 93%.
Indeed, when we arrived to my parents’ apartment, with my sister arriving minutes after me, we had to help my mother get dressed because she seemed unable to move. She seemed not to hear us at times and I was sure that she had some form of brain fog. Yet there were moments of clear lucidity as she insisted that she needed to look through her wallet and pull out the $100 bill that she had there so that she would not lose it. Just before we left, my sister suggested we try the oximeter again and with her help, modeling taking deep breaths, my mother reached once again the 95% mark. Again, I questioned whether I was doing the right thing, remembering the common saying (at least in my family) that hospitals are places where people go to die. But my sister’s agreement that since we were already there and prepared to go, we should take her anyway so that she may get some oxygen to take home, was re-assuring. We left immediately for the hospital.
Previously, in preparation for such an event, it was suggested to us that, if possible, it would be best to take her to a different hospital rather than their local LA County hospital located in the city of Lynwood, which was overwhelmed with COVID cases and where she may have had to wait up to 8 hours before being seen. Instead, it was recommended that we take her to the LA county hospital that is located in the more affluent city of La Cañada Flintridge. As my mother had just reached, even though laboriously, the 95% mark, I decided it would be worth it to go to the hospital in La Cañada. As I drove, and drove, and drove I was worried that this was too far and whether it was worth it to risk my mother by going so far. If she had been in a worse state this would not have been the best course of action. As we left the city lights, we drove through almost pitch darkness and an almost empty highway to arrive at the hospital.
After parking in what seemed to be an empty emergency room parking lot, we were very efficiently attended to almost immediately. Only one person, a stroke victim, arrived immediately after us and noting the critical nature of this patient we moved aside so they could go ahead of us. The small emergency lobby was prepared with dividing curtains to separate the space, presumably to accommodate COVID patients and minimize contagion. Two other people sat waiting for rooms in these separate spaces. After checking my mother in and answering some questions regarding insurance, we waited about 30 minutes before the nurse came to us and began working with my mother, taking her blood pressure, recording the medications that she was currently under, and asking about her symptoms. Immediately the nurse brought her a wheelchair with a tank of oxygen and as she sat, waiting for a room, she was administered the oxygen. Immediately, I felt vindicated. We had made the right decision. She was now breathing deeply without being forced to do so – breathing should just come instinctively.
Where were the crowds of patients? The chaos we were fearing? This place was quiet and well managed. The receptionist and the nurse were the only two people we saw in this small room, but they were efficient, calm, and very caring. They said we could not go inside with my mother as no visitors were allowed inside due to COVID restrictions. We were asked for a contact number so that they could call us when the doctor had seen her. She was admitted to the hospital the next morning, after having received treatment in the emergency room and determining her further needs. The hospital called us to tell us that there were no phones in the room my mother was in and that the battery in my mother’s phone had run out but that she had not brought a charger. They asked if we could bring her one and leave it in the lobby. When I arrived with the charger, a worker came down immediately to retrieve it. Within 15 minutes my mother was calling me. When speaking to the receptionist I had asked if I could go up to see my mother and I was again told that no visitors were allowed but the receptionist added that they were allowing visitors for those patients who were critically ill and may be dying. Again, I wondered about the reports that people were not allowed to see their family members before passing.
Like Lynwood, where the local county hospital nearest to my parents is located, La Cañada Flintridge is a city in LA county but there the commonalities seem to end. In 2019, the population of La Cañada Flintridge was 20,009, with a median household income of $175,788. The population density (the latest report is for 2010) was 2,346.5 per square mile. The demographic breakdown as of 2019, by race and Latinx origin, was 54.0% White (non-Latinx), 0.8 % Black, 31.1 % Asian, and 10.0 % Latinx.
By contrast, in 2019, the population of Lynwood was 69,887, with a median household income of $52,213. The population density (the latest report is for 2010) was 14,415.7 per square mile. The demographic breakdown as of 2019, by race and Latinx origin, was 2.4% White (non-Latinx), 8.1 % Black, 0.7% American Indian and Alaska Native, 0.8 % Asian 0.1% Native Hawaiian and other Pacific Islander, and 88.1 % Latinx.
The hospital in Lynwood faces the ominous task of providing care to an almost 7 times more densely populated community, whose health risks are maximized as a result of the combined ravages of poverty and racism. The hospital in Lynwood serves its city and many of the surrounding cities, all of which have similar demographics. This is a significantly immigrant community, with limited economic resources, with many working in jobs with poor working conditions that do not offer health benefits. Doctors at this hospital are facing a surge in patients, whose close quarter living in apartment buildings and need for employment, often in places that don’t allow for social distancing, results in significant risk. Although doctors and nurses are as caring as those in more affluent hospitals, they are facing a deluge of patients that they are not equipped to care for.
The reports regarding the state of emergency that LA county is currently facing with the pandemic fail to articulate these inequities. Importantly, patients across the county should be able to be dispersed more equitably across hospitals so that patients from more densely populated areas can have the same access to quality care. Although additional structural inequities (lack of transportation, English fluency, ambulance services, etc.) would likely prevent many people from seeking services farther away from their local hospitals, this too could be remedied with services. Unfortunately, the segregation of class and race in our society is taken as a given, accepted as a “natural” reality, rather than a social construction that is directly related to a capitalist system that thrives on inequality.