People are praying for her husband all over the world, Lizbeth Garcia told the doctors. From American churches. Latin American churches. He's a pastor, she wanted them to know, this man who lay in a hospital bed, felled by COVID-19 and with so many tubes sticking out of him that she found it hard to reach for his hand.
A pastor herself, she and Hector Garcia co-lead Iglesia Celebración de Vida in Edgewood, near their Federal Way home. When he became ill in October, and airlifted to a Portland hospital because of a machine offering a last-ditch chance to save his life, word spread.
Hector, 59, who came to the U.S. decades ago fleeing guerrilla violence in El Salvador, is known among Spanish-speaking congregations for his mentorship, beautiful voice and Christian program on Radio Luz Seattle.
"Cuida que no muera la esperanza," Be sure not to let hope die, a 32-year-old Hector once sang in a Washington youth council choir rehearsal, capturing the heart of 20-year-old Lizbeth. Now, on this December conference call, she asked her husband's medical team at Oregon Health & Science University Hospital (OHSU) not to give up on him.
So many families, she said, are going through the same thing.
Amid the deadliest wave of the pandemic yet, the novel coronavirus seemingly racing to claim as many casualties as it can while vaccination gradually rolls out, it is hitting Latinos harder than ever — far more than whites.
The disparate impact is almost nowhere as pronounced as Washington, where the pervasiveness and demographics of high-tech and other professional jobs mean many whites can work at home, while Latinos often work essential jobs in person. Only Washington, D.C., has a larger difference in the COVID death toll among Hispanics and whites, according to a November Institute for Health Metrics and Evaluation report.
The exact numbers aren't known because race and ethnicity for 44% of the state's 294,017 COVID cases, as of last week, weren't reported. But for the majority of cases in which such information is known, the rate among Washington's Hispanics is four times that of white residents and nearly quadrupled since late August, according to state figures adjusted for age for better comparison across populations. The Hispanic population skews young.
The virus is reaching into almost every corner of that population, which makes up 13% of the state's residents but 33% of COVID cases in which ethnicity is known. Farmworker deaths east of the Cascades got early attention, while the pandemic quietly spread across the Puget Sound region and elsewhere.
It put a Seattle laborer in the hospital for months, while his 20-year-old son, told his father might die, looked for a way to pay rent, buy food and finish school. It made a hospital laundry worker, another Seattle resident, feel like a monster, so keenly aware of people keeping their distance that even after she returned to her work she began eating lunch in her car.
It caused an Everett industrial painter to feel guilty about bringing sickness into his home after playing a Hispanic league soccer game where he believes he contracted the virus. And it coursed through the thousands in White Center's Holy Family Parish, sickening perhaps 20%, said the Rev. Jose Alvarez, finally striking the 39-year-old priest in December.
As he emerged from two weeks of high fevers and sweat-soaked bedding, Alvarez resolved to share his experiences from the pulpit — and to urge parishioners to be vaccinated, including at an upcoming mobile clinic in the church parking lot. The priest said conspiracy myths about the vaccines are common, and surveys also show particularly high reluctance among Hispanics and people of color to getting vaccinated because of distrust in the health care industry and the Trump administration.
"The COVID vaccine is crucial for us," said Dr. Ricardo Jimenez, vice president of medical affairs at SeaMar Community Health Centers, which has a largely Latino patient base. As allotments started arriving in Washington last month, he worried about vaccine hesitancy, but also expressed frustration that the state was not yet sending doses to SeaMar despite its vulnerable clientele.
By Christmas, SeaMar was getting shipments and last week was named a partner in the state's plan to accelerate vaccinations. The organization vaccinates on a walk-in basis, continually updating its website to show which of its sites throughout Western Washington have doses available.
At the same time, it is advocating that farmworkers, not listed in the current vaccination phase, be made eligible as soon as possible, said SeaMar chief compliance officer Kristina Hoeschen.
Doctors, epidemiologists and community members explain the virus' spread among Latinos not only by the prevalence of essential workers but by small, multigenerational homes, and by the cultural importance of family gatherings.
But some things remain puzzling, like why there appears to be "a big difference in terms of the course of the disease" between Latinos and whites, as observed by Dr. Leo Morales, co-director of the University of Washington's Latino Center for Health. Hispanics who get COVID are hospitalized at almost six times the rate of whites, according to the state, and die nearly four times as often.
In short order, COVID has chopped three years off the life expectancy of Hispanics, found a Princeton University and University of Southern California study published in mid-January.
"That's a good question," said Morales when asked why COVID is more lethal for Latinos, speculating it could be because of more intense exposure to the virus, dietary trends affecting the body's ability to fight off the infection and lack of access to health care leading to undiagnosed health conditions — although UW health metrics professor Ali Mokdad pointed out such conditions usually show up in older people, while Latinos of working age have a higher risk of dying from COVID.
The disparity between Latinos and whites is all the more startling because, before the pandemic, Hispanic Americans had a lower overall mortality rate, likely in part due to more physical activity, Mokdad said.
"We were shocked"
Hector's and Lizbeth's 2-year-old grandson showed symptoms first. He got a fever, his eyes got puffy and red, and he pointed to his tummy to show it hurt.
When the toddler's positive COVID test results came back in mid-October, "we were shocked," said his mom, Katherine Garcia. She, her son and fiancé were staying with her parents for a couple weeks before moving into a new apartment.
Where the toddler got the virus, nobody knows. He attends a day care where his mom works. All the other children subsequently tested negative. Lizbeth said their church was following social distancing protocols before ending in-person services Oct. 18. Katherine did take her son grocery shopping the weekend before with her grandparents. Could that have been it, Katherine wondered.
Despite initial negative tests, other members of the family soon started showing signs of COVID. All recovered quickly, except the usually healthy Hector. He kept coughing and gasping for air, and a home pulse oximeter reading was alarming.
Lizbeth took him to St. Francis Hospital in Federal Way, where he was put on a ventilator. He didn't get better. There was one more thing to try, doctors said: a way of oxygenating blood outside the body, letting the lungs rest and heal, a process known as extracorporeal membrane oxygenation (ECMO).
But the hospital didn't have the sophisticated equipment needed. Though roughly a half-dozen Washington hospitals have ECMO machines, a collaborative of regional hospitals allowed St. Francis to see the closest available machine was in Portland.
One day longer, and Hector wouldn't qualify. Studies show patients do best on ECMO when they have spent no longer than seven days on a ventilator, explained Dr. David Zonies, associate chief medical officer for OHSU health.
Before Lizbeth knew it, he was whisked away to Portland.
Even on ECMO, Hector's fate was far from assured. The illness affected his kidneys and he needed dialysis. He had pneumonia and a blood infection.
"We believe in miracles," Lizbeth maintained, as did a group of family and church members who held a prayer vigil outside the hospital. She and the couple's four children — the oldest, Katherine, is 27, the youngest is 15 — went back and forth to Portland. Under rules revised as the pandemic went on to allow for family support, OHSU allows COVID patients one visitor a day.
Lizbeth asked Hector's medical team to play Christian music in the hospital room and once sang to him herself while their 21-year-old son played piano, a phone propped up on the instrument in their Federal Way home. Despite Hector's heavy sedation, she was certain he could hear.
In late December, doctors tried lowering his sedation and Hector became alert. "I'm thirsty," he scrawled in Spanish on a piece of paper. By early January, doctors had taken him off ECMO and, though he remained on a ventilator, talked about the possibility of transferring him to Washington.
Lizbeth got Hector a white board to write more notes. One said: "I am always conscious of everything."
"What would happen to us?"
It seemed to 20-year-old Amilcar that his dad needed a miracle, too.
A 54-year-old laborer, he got COVID's telltale fever, cough and body aches last April. (The nonprofit El Centro de la Raza, which helped Amilcar and facilitated an interview with The Seattle Times, asked that clients not be identified by their full names.)
Father and son, who came to the U.S. from Guatemala three years ago, had taken an 18-year-old immigrant from their home country into their Seattle home, but otherwise it was just the two of them, taking care of each other. Amilcar gave his dad Guatemalan home remedies: teas with ginger, lemon and orange; a back massage with egg whites; lemon held against the head with cloth.
Still, he sank into delirium.
Amilcar called an ambulance and heard from Harborview Medical Center the next day: His dad had COVID. Updates only got worse, preparing Amilcar for the possibility his dad would die. He was put on a ventilator, then ECMO.
"I was really scared," Amilcar said in Spanish, speaking through an interpreter. "What would happen to us?"
Amilcar was still in high school, without an income and not proficient in English. Harborview social workers contacted El Centro, which helped with his rent, gave him a gift card he could use for food and got him internet service at home so he didn't have to do remote schoolwork on his phone. But Amilcar couldn't concentrate, letting teachers' messages go by, burying himself in his room.
Little by little, his dad's lungs began to function again. Three months after going to the hospital, he came home. Amilcar rejoiced.
Yet, his dad remained weak and unable to work, even as fall and then winter came. Amilcar found a job in a restaurant kitchen. He works afternoons and evenings, while attending remote classes in the mornings. He squeezes in taking his dad to medical appointments and giving him medications.
"This life was given to me and I have to do it," Amilcar said.
Twin sisters' cases
Doctors tell Mariateresa Baez Guillen it will take time to recover.
Her months-long struggle with COVID last summer didn't put her in the hospital, but it made her cry with pain and feel she was going to die. After seeming to get better, she relapsed repeatedly, testing positive three times before she could go back to work in a hospital laundry operation.
She's been told she may never completely get back her senses of smell and taste — something doctors are finding in a minority of COVID survivors.
Other lingering effects are less tangible but seem at least as damaging.
"I don't even want to remember how people look at you," said the 51-year-old Seattle resident, recalling nevertheless. The urgent care facility staff who drew back when she arrived, after a particularly painful night, and said she had COVID. The friends and relatives who see her at the grocery store and say a cursory "hi" before moving on. The co-workers who look not so happy to see her back even though she had a note from her doctor saying she's not contagious.
Baez Guillen started eating lunch in her car rather than the company lunchroom so as not to face it. She walks in a park near her home at night and early in the morning, when nobody is around.
Her twin sister, Celina Aguiniga, worries about her. The sisters are so close they spent every weekend and holidays together before the pandemic. When Baez Guillen fell ill, Aguiniga delivered food.
At the same time, Aguiniga was concerned about family in their home village in Michoacán, Mexico. In early December, the pandemic hadn't hit the village despite its ravaging much of the country, but she heard that former villagers now living in the U.S. were starting to come home for the holidays. "I'm afraid of people traveling not knowing they have COVID," Aguiniga said.
Villagers weren't protecting themselves. "They don't believe this is real," Aguiniga said. She sent masks to a sister who runs a grocery there, who wore them. "Most people laugh at her."
Then, in late December, she and her husband heard they would have to go to Mexico to sign papers for property they were buying for retirement. They temporarily closed their mattress store. Since the pandemic, some days went by without any sales at all, anyway, people stopping by, she suspected, just to get out of the house.
Aguiniga was nervous about the trip but packed boxes of masks and planned not to move around much.
As she was flying back to Seattle two weeks later, she got goose bumps. After hot weather in Mexico, it must be the air conditioning, she thought. But she and her husband got tested for COVID the next morning.
He was negative. She was positive, soon made clear by coughing, difficulty breathing, pains in her back and a head that felt like it was about to explode. A son and daughter who live with them, 28 and 30, also tested positive but had almost no symptoms.
Aguiniga talked to a nurse but avoided the hospital, believing those who go there "don't make it out alive."
A week later, it seemed she might escape the prolonged misery her sister and so many others experienced. She felt a lot better. She took a shower.
"I think I'm almost through it," she said, though the family's battle with COVID was not quite over. Her husband later tested positive.
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