Claudio Sanchez is facing his first Christmas without his fiancée, Blanca Leon; his mother, Cecilia; and Blanca’s father, Jose. All three died of COVID-19.
Now Claudio, 33, a machine operator at a paper company, cares for his and Blanca’s two sons, his sister and three young cousins who used to live with his mom and aunt. His aunt is hospitalized with COVID-19 and on a ventilator. The Sanchezes are two motherless generations, grieving together.
“I feel like I’ve been robbed, just beaten up,” said Claudio, who lives in Lancaster. “It’s ripped apart everything.”
Conventional wisdom says COVID-19 threatens only the very old. That’s not true in Texas’ Latino and Black communities, where working-age adults are dying at rates many times higher than whites.
“That discussion of ‘Oh, it’s all the really old people’ — that’s a white people’s story,” said Sarah Reber, a professor of public policy at the University of California, Los Angeles and a fellow at the nonprofit Brookings Institution.
In Texas, among those ages 25 to 64, the COVID death rate for Hispanics is more than four times as high as that of non-Hispanic whites, a Dallas Morning News analysis of state health data found. Blacks in that age group are dying at more than twice the rate of whites. Similar trends hold true for Dallas County.
While losing a person of any age to COVID is tragic, the virus has been disproportionately cutting down Blacks and Latinos during their most productive years, when they’re working, raising children and saving money for homes, retirement and their children’s college educations.
“That has been the untold story of all the injustices that COVID has highlighted,” said Erin Carlson, director of graduate public health programs at the University of Texas at Arlington. “The pandemic is taking people of color during the prime of their lives.”
The deaths have sweeping implications for Texas’ economy, for its higher education system and for a rapidly unfolding mental health crisis fueled by trauma and grief.
More than 4,200 Hispanics between ages 25 and 64 have died of COVID in Texas. That works out to 74 deaths per 100,000 people. Meanwhile, more than 1,100 whites in that age group have died, which works out to 17 deaths per 100,000. The death rate for Blacks fell in between, at 40 for every 100,000.
The age disparities have gone underreported, Carlson said, because health experts were not initially focused on them. “We were aggregating all of the ages together,” she said. “We were not delineating the data by age when it came to race and ethnicity. When you separate it out by age, now we see a significant and unjust disparity that demands attention.”
End of the ‘Latino Paradox’?
The impact of these losses will reverberate long after the pandemic recedes, experts say. Latinos have been by far the hardest hit of Texas’ ethnic and racial groups, and losses threaten to reverse the so-called “Latino Paradox.”
The term describes a seeming contradiction: Latinos have a lower socioeconomic status than whites but a longer life expectancy. Support from extended family and friends is thought to be at least partly behind Latinos’ traditionally low mortality rates.
That was before COVID-19 weaponized family togetherness. Rogelio Sáenz, a demographer at the University of Texas at San Antonio, says the paradox has already vanished among Latinos ages 65 to 74 and will soon fade among those ages 55 to 64. “The longer the pandemic continues, we’re going to see other age categories follow suit,” Sáenz said.
At The News’ request, Sáenz calculated the total number of years of life lost to COVID-19 by racial and ethnic group in Texas. The number represents the difference between a person’s age at death from COVID-19 and that person’s life expectancy in Texas based on their age, race or ethnicity. Latinos have lost more than twice as many life years as whites — a total of 241,446. The figure reflects Texas’ large Latino population, its relative youth, Latinos’ long life expectancy and the heavy toll that COVID has taken on the community.
These staggering losses have several implications. First, they are likely to damage the Texas economy, Sáenz said. Young Latinos have fueled Texas’ economic growth, driving higher-education enrollment, expanding demand for housing, launching new businesses and filling essential jobs in health care, transportation and manufacturing.
The pandemic will also create new cycles of poverty and reinforce the old, said Dr. Sharon Davis, chief medical officer at the nonprofit Los Barrios Unidos Community Clinic. Children who had hoped to go to college may feel compelled to stay home and work to support widowed parents and younger siblings, she said. Families face the financial devastation of unemployment combined with medical and funeral bills.
The pandemic is already leaving a legacy of mental illness. Davis’ clinic employs five bilingual counselors, has an opening for a sixth and may need to add more staff to meet growing demand. Many of Davis’ patients escaped violence and persecution to come to the U.S. The isolation and loss associated with COVID “adds an excruciating layer of emotional pain,” she said.
Trauma and grief
In July, COVID-19 took the life of Metchell Dixon-Cameron’s mother. A month later, the disease returned to claim Metchell’s husband’s life.
The husband, Andrew Cameron, spent his final days in the hospital, and Metchell wasn’t allowed to visit him. She wonders whether being there might have helped Andrew through his illness. “We had been together 25 years, and we’d hardly ever been apart,” said Metchell, 54, who is Black.
The hospital allowed her to see him only when he was dying. “If you can suit me up for when he’s getting ready to pass, why can’t I do that when he’s still alive so he can see me and talk to me?” she said.
Metchell, a home health aide, couldn’t face returning to the apartment she’d shared with Andrew, so she moved in temporarily with her son, Cortney, his wife and their six children.
Claudio Sanchez also relives painful memories of being separated from his fiancée the moment he dropped her off in the emergency room. He argued with the guard, trying to persuade him to let him inside.
Now, Claudio wishes he’d spent that time talking with Blanca instead. “That was the last time I saw her,” he said.
Claudio hasn’t had time to process his feelings. Instead, he keeps busy. He works at least five days a week from 7 a.m. until 3 p.m. His sister, a high school senior, cares for her cousins during the day. After work, Claudio stops at Walmart for groceries, fixes dinner, cleans the kitchen, cleans the bathrooms, runs the laundry, plans and organizes lunches for the next day, and finally goes to bed.
Then he wakes at 5 a.m. and does it all over again.
When Claudio isn’t preoccupied with the children, his mind churns over finances. There are food bills for a family of seven, winter clothes, Wi-Fi bills for online school, truck payments, the mortgage, insurance, medical and funeral costs.
Blanca had helped support the family as a medical assistant and had been striving for more. On top of her full-time job, she’d been working toward an associate’s degree to become an MRI technologist.
The worst moments for Claudio come when his children cry. Both his sons, Daniel, 6, and Jose, 14, have days when they break down and want their mother.
“It’s hard to comfort them because I’m not the comforting type,” Claudio said. “I’m more of the strict parent. It’s something I’ve had to try to do.”
What makes a household?
Behind the high mortality rates among young Blacks and Latinos are a host of factors, including lower rates of health coverage and employment in front-line jobs like health care and food production that expose workers to many other people. Black and Latino families are also more likely than white families to live in larger, multigenerational households, where the virus can spread more easily.
Blacks and Latinos also have higher rates of diabetes, obesity and other conditions that can make COVID-19 more severe. The conditions also affect many Blacks and Latinos at younger ages than whites, said Dr. Georges Benjamin, executive director of the American Public Health Association.
Claudio’s fiancée and his mother both had diabetes. But so does Claudio, and he wonders why the virus took both their lives but triggered relatively mild symptoms in him.
While Latinos have higher COVID mortality rates in Texas than in the U.S. as a whole, white and Black people in Texas have had lower COVID-19 mortality rates than they do nationally, said Sáenz of UT-San Antonio.
That may be because Blacks have a relatively higher socioeconomic status in the state than Blacks in the U.S. do, he said. In contrast, Texas Latinos fare worse socioeconomically than Latinos across the nation do.
That does not excuse the disparities, however.
“The numbers are too high for both groups,” said Dr. Jewel Mullen, associate dean for health equity and an assistant professor of population health at the University of Texas at Austin’s Dell Medical School.
Misinformation has also contributed to the deaths. Benjamin, of the American Public Health Association, said Blacks, at the start of the pandemic, were exposed to false social media messages telling them they were immune to COVID-19.
Davis, of Los Barrios Unidos, said Texas’ patchwork of COVID restrictions proved confusing. Many people thought that, once the state reopened, it was safe to see people outside their household again.
Many people also interpreted the term “household” differently. Some believed it applied to close relatives they didn’t live with but saw regularly. Only in November did the U.S. Centers for Disease Control and Prevention define a household member as someone who has lived in the home for the past 14 days, Davis said.
“We are spreading the stuff personally within our families,” said Lupe Garcia, who has run Calvario Funeral Homes for nearly four decades. He said he’s never seen such a sobering chain of death — not even during the AIDS crisis of the 1980s. When he hears that someone died of COVID-19, the cause of infection usually comes up.
“It’s not ‘I got it at Target or Sam’s,’ no. It’s ‘We got it at a birthday party.’ "
That is how the chain of infection started in Claudio’s family. His fiancée Blanca’s parents invited close family to their house to celebrate her mother’s birthday in early July. There was hand sanitizer but no masks.
“We felt there was no need to wear a mask, because we were all being safe,” Claudio said.
The kids were out of school, and Blanca was working from home. But soon after the party, Blanca’s father felt ill. When he had trouble breathing, Blanca drove him to the hospital, and then got sick as well. They died within two weeks of each other, in late July and mid-August.
Claudio’s mother, 53-year-old Cecilia Sanchez, worked as a dispatcher for a moving company. She, too, was able to work from home but fell ill in late October after attending a funeral where everyone wore masks.
On Sunday, Nov. 1, Claudio’s family marked the Day of the Dead, the annual Mexican holiday honoring ancestors, by attending a protest and procession in downtown Dallas.
The event memorialized the many Latinos who had died from COVID-19 but also took aim at the federal and state governments’ slow response to fighting the virus. It was organized by the League of United Latin American Citizens and the Cara Mía Theatre.
Wearing surgical masks, Claudio and his sons placed a large, framed photo of Blanca in the ofrenda, or altar site, that volunteers had set up in City Hall Plaza. There, her image was surrounded by those of other victims of the pandemic and crosses honoring their memories.
On a livestream video, an interviewer asked Claudio’s older son, Jose, what he would miss most about his mother. “Just her,” said Jose, wearing a Dallas Cowboys jersey and looking the interviewer in the eye. “The feeling of her being in the house.”
That same day, Claudio’s mother was feeling worse and worse. Knowing that Blanca and Blanca’s father had died in the hospital, Cecilia was too afraid to go to the emergency room. Though she was coughing uncontrollably, she insisted to Claudio that she would stay home and drink cough syrup.
That evening, she collapsed at home and died in an ambulance on the way to the hospital.
‘Avertable’ deaths
COVID’s devastating effects on Black and Latino communities are not surprising to public health researchers.
In 1985, the federal government published a landmark report on racial and ethnic health disparities. It found that six causes of mortality — including cancer, diabetes and heart disease — were far deadlier for Blacks and other minorities than for whites.
Thirty-five years later, many health disparities persist.
“What you’re seeing now with COVID deaths is a consequence of the continued marginalization of racial and ethnic minorities in this country,” said Erica Spears, an assistant professor at the University of North Texas Health Science Center’s School of Public Health.
Spears is part of a research team studying the impacts of COVID-19 on communities of color, along with ways to make sure members of racial and ethnic minority groups are educated about the disease and included in clinical research trials and vaccination efforts.
“Such a large number of deaths from COVID-19 was avertable,” said Angelina Esparza, a Houston-based public health expert who serves as a senior consultant to the CDC Foundation, a nonprofit that supports the work of the U.S. Centers for Disease Control and Prevention. “It hurts my heart that so many people have died and yet still we’re looking at each other like, ‘What happened?’ We know what happened.”
Closing health gaps
To close health gaps magnified by COVID-19, Davis of Los Barrios Unidos and Sáenz of UT-San Antonio said, Texas needs to expand Medicaid.
The state has the highest rate of uninsured people in the country, of which Latinos make up the majority. Around 38% of Latinos in Texas between the ages of 19 and 64 lack health insurance, compared with 20% of Blacks and 15% of whites, according to U.S. Census Bureau data shared by Sáenz. Benefits like paid time off and sick leave for essential workers are also key.
“We try to make visits as cheap as we can,” said Davis, whose clinic sees uninsured patients for free or on a sliding scale. “But I’m not their employer, so I can’t give them time off to come see us.”
Davis also said medical experts need to do a much better job of engaging low-income, underserved communities and earning their trust. Los Barrios Unidos employs community health care workers known as promotores, who bridge the cultural and linguistic gap between patients and doctors and are expected to play an important role during the distribution of COVID-19 vaccines.
An added benefit of expanding health care: Everyone would have access to a primary care physician, who would become a trusted source of information and help patients monitor chronic health conditions, said Davis.
Esparza, of the CDC Foundation, said the situation won’t improve until society meets the needs of its diverse population, especially in a state like Texas where Blacks and Latinos make up a majority.
“It is no longer a ‘them.’ It is an ‘us,’” she said
In the short term, there’s a simple yet powerful step everyone can take, Spears said.
“One of the best things that we can do — and that people are still choosing not to do — is wear a mask and practice social distancing and stay home when you can,” Spears said. “We’ve politicized this — and some people don’t have that luxury.”
Christmas disrupted
When Claudio’s mother died, his sister, Celeste, was in the hospital with COVID. Her doctors allowed Claudio in briefly to break the news. But he couldn’t tell her the way he wanted to. It pained him to leave her after their conversation.
“I felt like I just wasn’t doing what a brother should be doing for her — comforting her, showing her that you’re not alone.”
This Christmas, Claudio is doing what he can to stabilize what’s left of his family, make his sister, children and cousins feel safe, and lay the groundwork for new traditions.
For the Sanchez family, Christmas was always a multiday affair. Claudio’s mother, Cecilia, would make pork tamales — the largest ones Claudio has ever seen.
On Christmas Eve, the family would gather to eat the tamales with rice, chips and borracho beans, washed down with Cokes. They would joke, laugh and talk about the year that had passed. Before dinner, the men would sit around a plastic table playing dominoes, and after dinner, everyone opened presents.
Christmas Day was split between visits with Blanca’s parents, with whom Claudio was very close, and his mom and aunt.
“This year, nothing will be the same,” he said.
At times, Claudio reflects on how much he has lost so quickly. Just five months ago, his family was intact. Now he’s built an altar to those who have died. A large, framed portrait of Blanca hangs on the wall above, her blond hair in a bob, her cheeks rosy and youthful.
“Instead of being with them, we’ll be praying to them,” he said. “We’ll be celebrating with their pictures instead of actually having them here.”
