By Kathreen Harrison
Leaders of Maine’s immigrant communities and their allies predicted early that COVID-19 would slam vulnerable immigrant communities in the state particularly hard because of economic and social conditions that are widely acknowledged to impact public health, however the rate of disparity along racial and ethnic lines that is highlighted in recent data has shocked even them.
On June 3, the Maine Center for Disease Control and Prevention (CDC) updated their data on COVID-19 infection rates among people of color to over 27.45% of total cases, or greater than one in four infected people in Maine, even though 2019 U.S. Census Bureau records indicate people of color make up only 7% of Maine’s population.
Even more stark, upwards of 22.53% of total infections where race is known are in Black or African American Mainers, while the census data indicates that only 1.6% of Maine’s total population is Black or African American, or one in 60 Mainers. And that disproportionate infection rate is rising rapidly.
On April 29, the first date the CDC released data by race and ethnicity, the rate of total infections of Black or African American Mainers stood at 5.09%. At the time, that disparity in infection rates along racial or ethnic lines seemed wide . In just one month, however, it has more than quadrupled.
Maine is one of the few states that has not reported deaths from COVID-19 along racial lines, although on June 4 Dr. Nirav Shah, Director of the Maine CDC, indicated in a press briefing that data would be forthcoming. He explained that Maine’s relatively low number of deaths and large number of zip codes, coupled with the CDC’s concern for the privacy rights of individuals, has precluded releasing the data thus far, and added, “Sadly there are a sufficient number of individuals who have passed away in Maine so …[revealing the data now] …is unlikely to accidentally reveal somebody.”
The Atlantic COVID Racial Data Tracker reports that nationally, 25% of deaths are among Blacks or African Americans, while only 13% of the national population is Black or African American. Maine’s rate of infections among Black or African American is among the highest in the nation.
Trying to prevent devastation to their communities, immigrant leaders began mobilizing in mid-March.
“We approached our COVID-19 response work with a sense of urgency from the very beginning. Because of the existing disparities in access to health care and language barriers, among other factors, it was just a matter of ‘when’ our communities would be adversely affected, not ‘if’,” said Mufalo Chitam, Executive Director of Maine Immigrants’ Rights Coalition (MIRC), in an email. MIRC is a coalition of 69 partner organizations.
Working groups such as the New Mainer Working Group formed, with some focused directly on the health crisis. These groups immediately identified the need to get COVID-19 testing, information in translation, culturally competent and multilingual community health workers, and contact tracers out into the communities where immigrants live and work in order to prevent outbreaks.
Other groups focused on how to mitigate the educational opportunity gap between the least advantaged students and those who are not disadvantaged, a gap that has widened during the pandemic. Still other groups work to connect people with food resources. Certain groups are region-specific, separately tackling the challenges in different counties. According to members of the working groups, considerable effort has gone into establishing effective lines of communication with leaders and their liaison in different departments of the administration of Gov. Janet Mills, as well as in municipal governments.
“Since March, when the virus was first reported in Maine, many New Mainer providers quickly mobilized to network, provide system advocacy, develop partnerships, address immediate and emergent needs, and provide targeted culturally relevant and linguistically appropriate COVID-19 information,” said Fatuma Hussein, Executive Director of Immigrant Resource Center of Maine (IRC).
Epidemiologists and public health specialists are not surprised by the significant disparity in infection rates along racial or ethnic lines. According to the U.S. CDC website, “History shows that severe illness and death rates tend to be higher for racial and ethnic minority groups during public health emergencies.” The site blames the disparity on economic and social conditions such as work circumstances, underlying health conditions, varying access to health care, and living conditions.
On March 13, a group of over 80 people representing many organizations – health-focused and not – but targeting the health needs of immigrant communities during the crisis, met with Dr. Nirav Shah, Director of the Maine CDC, at their request. Since then, Kristine Jenkins and Jamie L. Paul, community liaisons for the CDC, have continued to meet with community groups with increasing frequency, in response to heightened concern over community transmission in Cumberland and Androscoggin counties, and outbreaks at work sites where many immigrants work, such as Tyson Foods, and Bristol Seafood. Dr. Shah has met several times since March 13 with immigrant community leaders and their nonprofit allies.
Along with expanded, easy-to-access testing and more contact tracing performed by trusted members of different communities, community leaders have advocated strongly for the involvement of community health outreach workers (CHOWs) in reaching immigrant communities in need of assistance.
“CHOWs are members of the communities we serve,” explained Nélida R. Berke, coordinator of the Minority Health Program, which is housed within the City of Portland’s Health and Human Services Department. She said CHOWs have a close understanding of their patients, often sharing similar values, life experience, ethnic background, socio-economic status, and language. “CHOWs are already known and can get the job done more quickly. They save time and money for the system because people will talk to them readily, give CHOWs personal information they just aren’t able to share easily with someone not from their community. For others, you have to plan how to reach communities, form relationships – it takes a long time.”
In March, Lisa Tapert, CEO of Maine Mobile Health Program, began encouraging setting up testing stations right in immigrant communities for easy access by people without transportation, who may not be connected to physicians. Finally, in late May, these stations began to be set up, with two testing sites in Lewiston now in place. Anticipating the outbreaks that have been occurring in recent weeks at processing plants and elsewhere, Tapert said during a May 14 phone call, “It’s only a matter of time before we have additional outbreaks, if testing is not available.” Tapert also highlighted the importance of working with CHOWs and leaders of immigrant communities. “I would like to see the CDC work with organizations such as Mano en Mano, Maine Access Immigrant Network, New Mainers Public Health Initiative, and others to figure out where the tests are needed.”
On May 20, Fatuma Hussein of IRC indicated that after weeks of meetings and building partnerships to develop a structure, Lewiston-Auburn is achieving a coordinated community response. “We have good partnerships in place, with communication happening on the ground. We are all working together on how to prevent unnecessary outbreaks, and I want to thank the systems and our partners,” she said.
The Maine CDC’s Dr. Nirav Shah has blamed the high level of infection found among people of color partly on the low-wage, public-facing jobs that are often the fallback employment available to immigrants – in hospitals, group homes, nursing homes, grocery stores, and processing plants.
“People in these jobs are in the direct line of the virus. They can’t stay home,” Maine CDC’s Shah said at a press briefing on May 22. He has also cited lack of ready access to health care for the underlying health conditions many low-income people suffer from and which make people more vulnerable to becoming gravely ill from the COVID-19 virus.
The national CDC also cites crowded living conditions as contributing to the heavy toll that infectious diseases take on disadvantaged groups during public health outbreaks. Because rent is expensive in Maine, low-wage workers often share housing. Abdulkerim Said, founder and Executive Director of New Mainers Public Health Initiative (NMHI), explained that in his community many people share a single apartment, and community members who test positive for the virus have no way to isolate from other members of their households in their homes.
Crystal Cron, President of Presente!Maine, an advocacy group for the Latinx community in Maine, agreed with Said. “Many community members live four to five families in an apartment, with each family sharing a bedroom, and that makes it almost impossible to social distance. If you get sick and need to isolate from your family, where do you go?” she asked.
On May 26, Shah reported at his daily press briefing that contracts have been signed with hotels for those unable to self-isolate safely at home. “I have had a number of discussions with New Mainer groups for a while now, and that concern [about a need for locations to self-isolate] has been voiced again and again. We have worked with area hotels to strike contracts so people can be offered places to isolate safely, with the correct social supports provided during that period, and that is now in place,” he said.
Shah has said repeatedly at press briefings that household transmission of COVID-19 is a big player in the spread of the virus in Maine. With expanded test kits now available, he is encouraging testing for those who are symptomatic, or who have been in contact with someone who has tested positive. On May 19, the CDC announced an outbreak at the 100 State Street apartment complex in Portland. The next day, 200 people were tested, right in the lobby of the building. As of May 26, 23 of those tests had been confirmed positive, and investigations were underway to trace where they might have contracted the virus, and to whom they might have inadvertently spread it.
An area where Dr. Shah and some members of the press don’t see eye-to-eye has been his reluctance to report municipal level race and ethnicity data that epidemiologists have collected. Many times in press briefings, Dr. Shah has expressed his concern that the release of such data carries risks of targeting members of certain communities.
Chitam agrees with Shah’s position. “MIRC is not in support of the release of racial and ethnic data on a city/town level because it won’t change what we already know about the disproportionate effect of COVID-19 on communities of color, and we fear that it will just lead to the stigmatization of our communities. The high rate of infection we are seeing is based on longstanding systemic inequities.”
In a written message, Alison Beyea, Executive Director of the American Civil Liberties Union of Maine, stated, “In many Maine communities, disclosing identifiable health information is as good as slapping a target on someone’s back. Given the dangers faced by vulnerable communities, especially communities of color, the government has a special obligation to protect individual privacy from such disclosure.” The ACLU suggests releasing the data on a state level, rather than a county or city level.
Rachel Healy, also of the ACLU of Maine, said in an email, “We all have a responsibility to address both the current disparities and the historic and systemic reasons for them – while at the same time vehemently opposing any attempt to use this data to marginalize, discriminate, or do violence to those same communities.”
Westbrook City Councilor Claude Rwaganje, who is also executive director of ProsperityME, said, “Releasing the data by zip codes will not change anything. The data we already have is enough to show there is racial disparity, already sufficient to give us the big picture of how minorities aren’t properly cared for. We don’t want the data to victimize those who are already victimized.”
Shah indicated on May 26 that he anticipated releasing data on a somewhat more detailed level in upcoming reports. He said he believes the overall case count is now large enough in Maine to release the data and still maintain privacy.