How the virus unraveled Hispanic American families

By RONI CARYN RABIN AND LAUREN LEATHERBY
THE NEW YORK TIMES
JUN 14, 2021 AT 7:18 PM

To a wide circle of friends and family, Jesse Ruby was the go-to guy.
The father who would drop everything and drive across town if his sons needed a ride. The cousin who spent weekends helping relatives move. The partner who worked odd jobs on weekends with his girlfriend, Virginia Herrera, to help make ends meet for an extended household in San Jose, California.

“If he was your friend, or he considered you a friend or family, all you had to do is ask,” Herrera said. “You could depend on him. He was that person.” Then, in December, Ruby caught the coronavirus. He died six weeks later, at just 38 years old.

Across the United States, the pandemic has shattered families such as Ruby’s. Hispanic American communities have been pummeled by a higher rate of infections than any other racial or ethnic group and have experienced hospitalizations and deaths at rates exceeded only by those among Native Americans and Alaska Natives.

But new research shows the coronavirus has also attacked Hispanic Americans in an especially insidious way: They were younger when they died.
They are much more likely than white Americans to have died of COVID-19 before age 65, often in the prime of life and at the height of their productive years. Indeed, a recent study of California deaths found that Hispanic Americans between the ages of 20 and 54 were 8.5 times more likely than white Americans in that age range to die of COVID.

“It matters how old you are when you die, because your role in society differs,” said Dr. Mary Bassett, director of the François-Xavier Bagnoud Center for Health and Human Rights at Harvard’s T.H. Chan School of Public Health.

Her research has found that Hispanic Americans and Black people who died of COVID lost three to four times as many years of potential life before the age of 65 as did whites who died.

The virus more often killed white Americans who were older. Their deaths were no less tragic, but they did not lead to the unraveling of income streams and support networks that was experienced in Hispanic American communities. These families experienced a very different pandemic.
“When you die young, you may be a critical breadwinner for your family,” Bassett said. “You may have dependent children. And we know that losing a parent is not good for children and has an impact on their future development and psychological well-being.”

Ruby and Herrera lived together in San Jose, where the extreme wealth of Silicon Valley’s high-tech elite contrasts with poverty and homelessness, and where working families double and triple up under the same roof, paying some of the highest rents in the country.
“It’s a tale of two cities,” said Jennifer Loving, CEO of Destination: Home, a public-private partnership aiming to end homelessness in Santa Clara County, which includes San Jose. “We literally have Teslas sitting outside homeless encampments.”

Health is as polarized as wealth. An analysis of county death records by The New York Times provides a rare, granular look at who died of COVID in a county of 1.9 million people — by age, sex, race and ethnicity, preexisting health conditions and, importantly, where people lived.
The data shows that people such as Ruby and others in largely Hispanic neighborhoods and in those areas where incomes are lower than the county median were more likely to die at a younger age than those in high-income communities or in those where fewer Hispanic Americans were living.
The records were first obtained by Evan Low, a California Assembly member who advocated unsuccessfully for legislation requiring the state’s health department to collect and publicly report COVID deaths by ZIP code.
“The goal is greater transparency about what has occurred during the pandemic,” Low said. “We need to know which neighborhoods have been most impacted. We want to understand precisely where people died of COVID, so we have data and facts to guide policy.”

Through the end of February, white residents were just as likely to die of COVID as Hispanic residents, according to The Times’ analysis. But the white residents were much older, on average.
The median age at death was 86 for white COVID patients, compared with 73 for Hispanic individuals. The analysis shows that while only 25% of the county’s population is Hispanic, 51 of the 68 residents under age 50 who died of COVID through the end of February were Hispanic.
Only seven were white, although white residents make up nearly a third of the county. Most of the others were of Asian or Pacific Islander backgrounds. (Asian American residents had a much lower death rate, half that of white and Hispanic residents.)
Four San Jose ZIP codes with largely Hispanic populations — 95116, 95122, 95127 and 95020 — accounted for 1 in 5 of the COVID deaths in Santa Clara County, even though they represented only 1 in 8 of the county’s residents. Households in the four ZIP codes had incomes that were lower than the median in the county.
The patterns in Santa Clara County hint at a broader disparity throughout the nation. Hispanic Americans, who are more likely than white Americans to have jobs that cannot be done remotely and do not provide paid sick leave, are three times as likely as white Americans to be hospitalized with COVID and more than twice as likely to die of it. Many lack health insurance.

Extreme Hardship

Ruby was a charmer who could chat up anyone, the life of the party. Friends in school had nicknamed him Buddha, a reference to his happy-go-lucky nature and his chunky frame.
“He was all about having a good time,” said a cousin, Anthony Fernandez. “He would have you laughing within the first five minutes of talking to you.”
In 2011, when Herrera met Ruby, she was reluctant to get involved. He had just been released from a short stint in prison for a burglary involving beer. He had a scar on his stomach from a gunshot wound and a large, prominent tattoo of a Buddha on his forehead. She prevailed on him to remove it.
“I told him, ‘I’m not a pen pal,’” Herrera recalled. “‘I’m not going to write you in jail. You need to be out.’”
The relationship was stormy at first, but Ruby eventually became an integral, trusted part of Herrera’s extended family. He helped support two teenage sons from a previous relationship: Jesse Jr., 18, who plans to start attending community college in the fall, and Joseph, 16.
Ruby became a surrogate father to Herrera’s daughter, coaching her baseball team and watching movies with her when she was moping. He made a mean enchilada casserole and took charge of the laundry and repairs around the house.
He even won over Herrera’s mother, Virginia Marquez, who thought he drank too much when she first met him but came to love him.
“He was the person you could call,” she said. “He would drop what he was doing and go help.”

Herrera has felt the loss of Ruby in uncountable ways, but money has been a particular concern.
Shortly before he fell ill, Ruby had landed a steady job building walk-in coolers and freezers (Herrera said removing the Buddha tattoo had helped). The job paid well, he got to drive the company truck, and there was plenty of overtime.
For a brief while, “It felt like a weight was taken off our shoulders,” Herrera said. His abrupt death left her grieving — and panicked. “We went halves on everything, so I’ve struggled,” she said.
Researchers have long remarked on the social networks and expansive family ties that help explain why Hispanic Americans tend to be as healthy as, or healthier than, white Americans. Hispanic Americans have high rates of diabetes and obesity but live longer than white Americans, despite lower average incomes and educational levels and reduced access to health care.
But the phenomenon, called the Hispanic paradox, has not held up during the pandemic. A recent study in Health Affairs found that 70% of COVID cases in California where race and ethnicity were known had struck Hispanic individuals, although that group makes up only 39% of the state population. Hispanic Americans also accounted for nearly half of the deaths from COVID in the state.
“COVID-19 is so overwhelming that this previously known paradox, which is also called the healthy immigrant effect, is overwhelmed,” said Erika Garcia, an assistant professor of environmental health at the University of Southern California, whose study identified the discrepancies in death rates among younger adults in California.

The coronavirus spreads very quickly within households, so close ties among extended households have emerged as detrimental factors for Hispanic Americans. A Health Affairs study also found that Hispanic Californians were eight times as likely as white residents to live in a “high exposure-risk household,” which scientists defined as one having one or more essential workers and fewer rooms than inhabitants.
“The stereotype is that Latino families care about family more, but it’s not really about that — it’s about the need to pool together resources,” said Zulema Valdez, a professor of sociology at the University of California, Merced. “There’s a whole web of a social safety net that the family is providing.”
A death creates a hole in the net. “They’re immediately one paycheck away from homelessness,” Valdez said. “Everybody knows someone who has died, or multiple people who have died, and everyone is figuring out how to compensate for the roles and duties that are no longer being done by those people. The hardship is extreme.”
Deaths of wage earners add to the hardships minority communities are already experiencing during the pandemic.
One in 5 Black and Hispanic Americans reported being behind on their rent or mortgage in April, compared with 7.5% of white Americans. One in 5 Black and Hispanic adults in households with children said they did not have enough to eat in the previous week, compared with 6.4% of white Americans, according to analyses of census surveys by Diane Schanzenbach, an economist at Northwestern University.
A Canceled Holiday:

A few days before Thanksgiving, Marquez’s husband, a Lyft driver, got what looked at first like a cold. He started having trouble breathing — and then a coronavirus test came back positive.
He was hospitalized on Thanksgiving Day. Marquez canceled the festive meal she had planned for the family and told everyone to stay away. But Herrera and Ruby stopped by for a brief visit, and then the virus raced through the two households.
Five people in Marquez’s household of nine were infected; aside from her husband, most had mild symptoms. In Herrera’s household of eight, all but two got sick. Ruby’s teenage boys, who did not live with them, also became ill.
On Dec. 4, Ruby’s fever spiked to 104 degrees, and he, too, struggled to breathe. His job’s private insurance had not kicked in yet — he was on California’s Medicaid program, MediCal — and Herrera drove him to a hospital emergency room.
His weight, high blood pressure and diabetes all put Ruby at high risk for severe disease, but the hospital sent him home. Herrera is still tormented about that.
“I keep on replaying over and over,” she said. “What did I say, what did I do? Could I have done something different? Should I have turned the car around and went into the ER myself to say, ‘Why are you sending him home?’”
Ruby spent the next few days at home sleeping. He refused food, and Herrera, who was starting to recover from her own bout with the virus, tried to make sure he stayed hydrated.
When Fernandez, his cousin, texted to ask how he was, Ruby responded with one word: “Tired.”
On Dec. 8, Ruby’s skin began to turn blue, and Herrera called an ambulance. This time, the hospital admitted him. A few days later, Ruby seemed to rally. But he took a turn for the worse and was told he would be placed on a ventilator.

He told Herrera on the phone that he was scared.
“I just kept reminding him, ‘You’re going to come home, you’re going to be OK, and when it’s time, we’ll laugh about this,’” she said. Ruby died Jan. 16.
The family’s grief metastasized into accusations and guilt. Some of Ruby’s family members blamed Herrera, saying she should have gotten him help sooner. Fernandez blames the hospital, saying ER physicians should never have sent Ruby home when he first sought help.
There was bickering over donations raised to help the family get through the crisis, and relationships have frayed. Life will never be the same for anyone in the extended family.
“Jesse always used to say, ‘Nothing can take me out,’” Herrera said. “I was waiting for him to come home and tell stories about how he beat COVID that he’d repeat over and over until he got on my nerves. I never had any doubt in my mind that he was going to come home.”
Courtesy: The New York Times Company