Recently, a physician friend reached out to me about a COVID-19 patient he was having difficulty treating because he literally didn’t speak her language.
“What if I have to put her on a ventilator?” he asked. “Who is going to explain the circumstances, the side effects, and how it can have long-lasting effects, even if it’s removed?”
Like all COVID-19 hospital patients, this patient was isolated, with no family members present to help her. And because she didn’t speak English, she didn’t understand what was happening to her.
People of color, including many who don’t speak English or have limited English proficiency, have been disproportionately affected by COVID-19 — and they are dying in disproportionate numbers, many of them in their own homes.
In Massachusetts, largely Hispanic communities like Chelsea and Lawrence are experiencing the highest rates of coronavirus cases. Massachusetts General Hospital recently reported that 40 percent of its COVID-19 patients were native Spanish speakers. One medical director there told me he’s never seen so many non-English speaking patients.
Research tells us that people with limited English proficiency do not receive adequate health information. This information gap can worsen health disparities.
Amid a pandemic, it can be a matter of life and death. Patients don’t have the information they need to take preventative measures and protect themselves from infection. They don’t know what the symptoms of COVID-19 are, where to go for testing or how to access the health care system when they need it. Without interpreters, they can’t understand what their doctors and nurses are telling them, and they can’t make informed decisions about their own medical care.
And, of course, many people fear that seeking medical care will result in their immigration status or that of a family member being reported to the government. It’s a terrible predicament.
For the most part, medical facilities are unprepared to accommodate different language needs. The federal government’s National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care — CLAS, for short — directs hospitals to offer free language services and resources to people who have limited English proficiency. But the standard is not enforced, there are no penalties for failure to comply and hospitals fall far short of their obligation.
Too often, interpretation services are not available when limited-English speakers seek services. There are no good estimates of how many limited-English speakers who need interpretation services fail to receive them, but one emergency department study cited a figure of nearly 50 percent.
Some states are taking steps. Massachusetts, like several other states, is using a Spanish text alert system to keep everyone informed “as we confront COVID-19 together,” according to Gov. Charlie Baker. El Planeta, New England’s largest Spanish-language newspaper, is redistributing COVID-19 health information in Spanish.
But critical health information needs to be available in more languages than Spanish. In Jackson Heights, Queens, the epicenter of New York City’s COVID-19 outbreak, more than 200 languages are spoken, according to U.S. Rep. Alexandria Ocasio-Cortez. And census data indicate that 42 percent of limited-proficiency English speakers in Massachusetts speak a language other than Spanish. In response, a first-year Harvard Medical School student started the COVID-19 Health Literacy Project to translate coronavirus information into 37 languages. Similarly, Massachusetts General Hospital has recruited doctors who speak diverse languages to serve their non-English speaking patients.
This is not just a problem for big cities. From Shelby County, Tennessee, where parents with limited English proficiency didn’t know about a quarantined school worker, to Greenville, S.C., to Boise, Idaho, people with limited English proficiency are not getting information about COVID-19. In northwest Arkansas, home to more than 12,000 Marshall Islanders, the Arkansas Coalition of Marshallese is sharing COVID-19 information with the community via social media and radio.
Public health preparedness must include language preparedness. Communities must have plans for communicating emergency information and updates to all residents in their primary languages. And hospitals and clinics must be required to offer services to patients in their primary languages. The federal government should strengthen CLAS. Health professionals and clinic administrators should train and deploy multi-lingual community health workers to spread the word.
In a public health crisis like COVID-19, everyone must know what’s going on to protect themselves, their families, and their communities. It’s the only way we all get through it together.
Dr. Alegría is the Chief of the Disparities Research Unit at the Massachusetts General Hospital and the Mongan Institute, and a Professor in the Departments of Medicine and Psychiatry at Harvard Medical School. Dr. Alegría’s research focuses on the improvement of health care services delivery for diverse racial and ethnic populations, conceptual and methodological issues with multicultural populations, and ways to bring the community’s perspective into the design and implementation of health services. She has published over 250 papers, editorials, intervention training manuals, and several book chapters.