Published on Nov 16, 2020

Video Transcript

[MUSIC PLAYING] JOHN WHYTE: Welcome, everyone. I'm Dr. John Whyte, chief medical officer at WebMD. And today, I want to talk about the impact of COVID on Hispanic communities. So I've asked my friend Dr. Juan Rivera. He is a cardiologist and the chief medical correspondent at Univision. Dr. Rivera, thanks for joining me.

JUAN RIVERA: It's my pleasure, John.

JOHN WHYTE: You and I were talking the other day that one of the problems when we're trying to reach the Hispanic community is we simply take information that's in English and put it almost through Google Translate, with no cultural appreciation of what the health messaging should be. Why are we still doing that? How have we not learned, especially when it relates to COVID?

JUAN RIVERA: It's a big mistake, John, and people have been doing that for many years. It has been a serious challenge, especially now with COVID, because the information that the Hispanic community is getting from the CDC, or even from the White House during the daily briefings, has been in English. And there's really not even a translation in Spanish, not even a bad translation to Spanish.

So I knew that it was our job at Univision and my job as chief medical correspondent for Univision to take all of this important information on a daily basis to the Hispanic community. And that's exactly what I have been doing, not only through all of our programming on Univision, but using also my social media to educate the Hispanic community on this important topic. And we have to note that the Hispanic community has been disproportionately affected by COVID, three times more likely to get infected with COVID as compared to white Americans. And the mortality risk is twice as compared to white Americans.

JOHN WHYTE: You know, I came across an interesting statistic the other day where it says that Hispanics, only 13% of them have the opportunity to telework in their job, versus 27% of non-Hispanics. That could be contributing, since many of them are frontline workers, in terms of being exposed to COVID. Is that right?

JUAN RIVERA: That is correct, John. I have spoken to many Hispanic families in the past six to eight months during the pandemic, and that is definitely one of the many social determinants that could explain the increased risk. Obviously, if you don't have a job in which you can stay home, then it is very difficult to protect yourself. In the same line, if you have to take public transportation to get to your work, you're going to be exposed.

Some Hispanics are working two jobs, three jobs. I have spoken to families that live in one relatively small apartment, and it's a family of seven. They have two rooms, two bedrooms. So if one person gets sick, it's very difficult to isolate that person from the others.

JOHN WHYTE: What's the right messaging, Dr. Rivera? I mean, we also know, in Hispanic culture, often there's multiple generations of a family in the same home, taking care of elderly parents, elderly grandparents. So when we talk about isolating, quarantining, maintaining six feet distance, is that realistic? What's the message we need to give them?

JUAN RIVERA: It is not very realistic, John. The message that I have been trying to deliver to Hispanic families is the following. We are a unit. And if someone gets sick, it is very likely that we will all get sick in that household.

So I have spent a lot of time talking to young Hispanics, people in their 20s, to make sure that they understand that we're not only talking about their own safety, but we're talking about the safety of their grandparents or their parents. They have to protect themselves in order to protect family members. So a lot of my messaging has been as a unit, Hispanics as a family unit. And I think that is very important.

It's similar to what happened in Italy. Our culture is such that we have constant communication with our grandparents and with our parents, the same as it happened in Italy. Young people were going to Milan to work during the day, and then they were going back to their parents' and grandparents' homes at night. And that was a significant element that played a role in that particular culture, and the same thing happens in the Hispanic culture. So we've got to think about it as a unit.

JOHN WHYTE: Has the health care system failed the Hispanic community?

JUAN RIVERA: The health system has been failing Hispanics for many years. Obviously, it is exacerbated now during COVID. Hispanics have less access to primary care, less access to preventative care. We have a lot of Hispanics without health insurance.

So what are we seeing now? We're seeing Hispanics that have uncontrolled diabetes, uncontrolled hypertension, uncontrolled coronary artery disease. And that renders them more vulnerable to coronavirus and COVID. And we are seeing that during this pandemic.

JOHN WHYTE: You know, we've talked a little bit about on previous shows about the number of deaths that have occurred in young people, but something that we haven't focused on, Dr. Rivera, with that is 45% of patients under the age of 21 who have died are Hispanic or Latino. Why do you think that's the case? Is it a failure of the system? Is it-- because most people under 21 aren't going to have a lot of underlying health conditions. What's going on there, do you think?

JUAN RIVERA: I think we have to look a little bit deeper into that, John, but we don't want to rule out genetic factors. There is a possibility that there is a genetic factor that is in play here. But again, whether we're talking about older Hispanics or younger Hispanics, there is less access to health care. And that has been very well documented in the past decade, at least. So I think we have to look deeper into that issue, but I suspect that, even in younger Hispanics, you're going to find that there is less access to health care during this pandemic.

JOHN WHYTE: What about the role of obesity? We see incidents of obesity increasing across all ethnicities, but particularly in the Hispanic community. Do you think that's playing a role?

JUAN RIVERA: I definitely agree that-- I mentioned diabetes, I mentioned hypertension, and I mentioned heart disease, but definitely obesity is an important factor, as well. We know, based on data that you and I have read throughout this whole pandemic, that obesity plays a significant role. People that are obese are in a chronic state of inflammation, so we know that that renders them more at risk for severe complications with coronavirus.

So you have the Hispanic population, more obesity, more diabetes, more cardiovascular disease, and you have a vulnerable population. We also know that this virus targets your vascular system. And if you have diabetes, if you have heart disease, hypertension, obesity, all of those are conditions that target your vascular system, as well.

JOHN WHYTE: We know there's going to be limited resources post-COVID. We just have to be realistic about that. So I'm going to make you choose, Dr. Rivera. So we've talked about access to care. That's important. But we've also been talking about the social determinants of health-- access to fresh fruits and vegetables, the built environment, having the ability to be able to go out in a safe community and exercise.

Can't necessarily invest in both. Where should we be directing most of our money in a post-COVID world? Is it truly the traditional health care system, that brick and mortar type of approach, or is it those social determinants?

JUAN RIVERA: John, that is a very interesting question, and not a very simple question to answer. But I'll try.

JOHN WHYTE: That's why I came to you.

JUAN RIVERA: Listen, one of my biggest frustrations as a chief medical correspondent of Univision is that I'm always talking to the Hispanic community about eating healthier, about losing weight. And I give them even ideas on how to diet, on what to buy, on what to eat, and then I think about it and I say, well, if I'm telling them, for example, to eat more strawberries, but they go to the supermarket and strawberries are $4, and it's easier for them to buy a Happy Meal for their kids at a fast food restaurant, then how am I helping?

So obviously, there's something there that relates to public health that is extremely important that has to do with preventative care that starts home. You need to take care of your own health. There's a lot of education out there to the Hispanic community in terms of how to take care of themselves.

There's got to be some government action from a public health standpoint to make sure that what we are telling the communities, they're able to have access to that. So healthy food-- and we're always talking about that-- should be accessible to everyone. So that relates to how government addresses those issues, right? You have to make healthy food more affordable, as opposed to making pancake syrup more affordable. So there is definitely an issue there.

Now, if I had to pick between those two, John, I still would say access to care. I still would have to say access to care, because if someone doesn't have health insurance, they are not going to seek medical advice when they need it. They're not going to get mammograms. They're not going to get colonoscopies. They're not going to get pap smears. And as you know, all of these things are crucial for someone's well-being.

If someone has an infection, if someone has appendicitis, they need to make sure that these individuals are going to be able to go to a hospital, seek medical advice, and don't be bankrupt or don't be in debt for a long time. So I still think that access to health care is the most important thing that we can accomplish. I think it's a right. I don't think it's a privilege.

I think we have been moving in that direction. I think there's more to do. And then obviously, as you point out, that's not the only thing. We also have to work on allowing these families that need help to be able to access all these other healthy living elements that we are always talking about.

JOHN WHYTE: So I want to end with what are the two or three practical tips that you would have for the Hispanic community how to protect themselves during this COVID pandemic?

JUAN RIVERA: So I've been talking about this constantly to the Hispanic community for the past seven or eight months. And I think that there are things that are obvious that we need to do, like wearing a mask. I think that we need to be social distancing.

I think that we have to avoid unnecessary social interaction. And I know that it is difficult, but this is what the times require. We have to avoid that unnecessary social interaction. Those are things that we need to do to protect ourselves from other people that are infected that could potentially infect us. Wash your hands, obviously.

Now, we also have to take care of our body. And to do that, I've told people make sure that you continue to exercise, even if it's at home. That strengthens your immune system. Make sure that you continue sleeping your seven or eight hours a day. As you know, John, when you don't do that, your immune system also gets weakened.

Make sure that you're ingesting at least three to five portions of fruits and vegetables, those antioxidants which are important. You have to try, as much as this is so difficult during this time, you have to try to control stress, because that has an impact, as well, on our health.

In terms of supplements, because people are always talking about these things, I'll tell you what I recommended to my patients and what I have recommended to the Hispanic community. I think that they need to make sure that their vitamin D level is adequate. There are some studies that show that, if you have low vitamin D levels, you might be at an increased risk.

I've recommended vitamin C, I've recommended zinc, and I've recommended, interestingly enough, melatonin, because there is data that shows that it can help in terms of the inflammatory response of the body. People always want to know what supplements can I take, what can I do to strengthen my immune system. That's what I've been telling the Hispanic community.

And also, the last thing I'll say is this is not going to be here with us forever. Yes, we still have a ways to go. We probably have another 6 to 12 months. But this is not going to be here forever. We're entering the worst months that we are going to see. So we have to now double down on our preventative measures to be able to go through this winter.

JOHN WHYTE: Dr. Rivera, I want to thank you for sharing your insights. I want to thank you for what you're doing for all patients, not just Hispanic patients, but all other patients across the country. And thank you for taking the time today.

JUAN RIVERA: John, it's a pleasure to be here with you, and thank you, because I know that you have also been extremely active educating the American public about this pandemic. And I appreciate it.

JOHN WHYTE: And thank you for watching.