By Kathreen Harrison
On May 20, the Maine Center for Disease Control (CDC) updated their data on COVID-19 infection rates among people of color at over 21% of total cases, or greater than one in five infected people in Maine. Meanwhile, 2019 U.S. Census Bureau records indicate people of color make up only 7% of Maine’s population.
Even more stark, upwards of 16% of total infections are among Black or African American Mainers, while the census data indicates only 1.6% of the total population is Black or African American. 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. It has more than tripled since then.
Leaders of Maine’s immigrant communities and their allies predicted early on that COVID-19 was going to slam vulnerable immigrant communities in the state particularly hard because of economic and social conditions that are widely acknowledged to impact public health. They mobilized in mid-March to try and prevent outbreaks, and efforts have redoubled to try and mitigate them going forward.
“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.
“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, reached by telephone.
Epidemiologists and public health specialists are not surprised by the significant disparity in infection rates along racial or ethnic lines. According to the national 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 economic and social conditions such as work circumstances, underlying health conditions, varying access to health care, and living conditions for the disparity.
A number of working groups formed in mid-March to focus on the needs of immigrant communities in Maine during the crisis. The groups meet virtually, and include representatives of different non-profit and grassroots groups from around the state. Some of the groups focus directly on the health crisis, and zeroed in early to 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 before outbreaks occurred.
Other groups are focused on how to mitigate the educational opportunity gap between the least advantaged students and those who are not disadvantaged, which has widened during the pandemic. Still others work on connecting people with food resources. Certain groups are region-specific, tackling the challenges in different counties separately. According to members of the working groups, considerable effort has gone into establishing effective communication lines with leadership in different departments in the Mills Administration, and their liaisons, as well as municipal governments.
On March 13, a group of over 80 people representing many organizations, and targeting the health needs of immigrant communities during the crisis, met with Dr. Nirav Shah, Director of the Maine Center for Disease Control (CDC), at their request. Meetings with Kristine Jenkins and Jamie L. Paul, community liaisons for the CDC, have continued since that time, with meetings occurring more frequently recently, 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 increased, easy-to-access testing and expanded 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.
Nélida R. Berke, coordinator of the Minority Health Program, which is housed within the City of Portland’s Health and Human Services Department, explained over a Zoom call that CHOWs have a close understanding of their patients, often sharing similar values, life experience, ethnic background, socio-economic status, and language. “CHOWs are members of the communities we serve,” she explained. “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.”
Lisa Tapert, CEO, Maine Mobile Health Program, is among those who have encouraged setting up testing stations right in immigrant communities, so they can be accessed by people without transportation, who may not be connected to physicians. She has also highlighted the importance of working with CHOWs, and with presidents and other 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.” Anticipating the outbreaks that have been occurring in recent weeks at processing plants and elsewhere, she said on a phone call May 14, “It’s only a matter of time before we have additional outbreaks if testing is not available.”
Fatuma Hussein, reached by telephone May 20, indicated that after weeks of meetings and building partnerships to develop a structure, Lewiston Auburn is achieving a coordinated community response for their communities.
“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,” said Hussein.
Low-wage jobs in hospitals, group homes, nursing homes, grocery stores, and processing plants are often the fallback employment available to immigrants, and high levels of infection have been documented among workers in these jobs.
“People in these jobs are in the direct line of the virus. They can’t stay home,” Shah said at a press briefing on May 22.
Crowded living conditions are also cited by the CDC as contributing to the heavy toll 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), reached by telephone, 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?” said Cron.
Dr. Shah has repeatedly said 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 providers to recommend testing for all those who are symptomatic, or who have been in close contact with someone who has tested positive, whether in traditionally-defined congregate settings, or in apartment complexes. On May 19, an outbreak was announced by the CDC at the 100 State Street apartment complex in Portland. 200 people were tested right in the lobby of the building on May 20, and test results were pending as of May 21.
In addition to increased testing availability, and the CDC’s resulting abandonment of the tiered prioritization system, hotels have now been designated in multiple cities for those unable to isolate at home. Further, the CDC is in the process of hiring additional contact tracers, and the expectation is that some will be multilingual, and from immigrant communities. Plans are also underway to bring CHOWs on board.
An area where Dr. Shah and some members of the press don’t see eye to eye has been his reluctance to report out at a municipal level the race and ethnicity data that has been collected by epidemiologists. Dr. Shah has expressed many times in press briefings his concern that the release of such data carries risks of targeting for members of certain communities.
Chitam agrees with Shah. “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.”
Alison Beyea, executive director of the ACLU of Maine, stated in a written message, “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.
In an email, Rachel Healy of the American Civil Liberties Union of Maine said, “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.”
Claude Rwaganje, Westbrook City Councilor, and 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.”