Paxlovid, the FDA-approved antiviral proven to reduce hospitalization and death from COVID-19, is currently free for everybody, yet Black and Latine communities aren’t accessing it as much as they could be. Disparities in prescribing and misconceptions around cost are just some of the systemic inequities that stop folks from getting it.
Public Good News (PGN) spoke to Cecilia Calabria, health and wellness director, and Dulce De La Rosa, community outreach, at community-based organization COPAL (Spanish for Communities Organizing Latino Power and Action) MN. Together, they explained the barriers their community faces in accessing COVID-19 treatments and how COPAL MN is encouraging individuals to become their own best advocates.
PGN: PGN recently reported that Paxlovid received full FDA approval as a treatment for mild to moderate COVID-19 in high-risk adults. However, studies show Black and Latine COVID-19 patients get the antiviral pill at 36 percent and 30 percent (respectively) lower rates than white and non-Latine patients. Could you share your reflections on this based on the work you do in your community?
Cecilia Calabria: It’s not surprising. We know the inequities the Latino community experiences. With regard to Paxlovid, the truth is that what we’ve seen during the pandemic—working with people and talking about COVID—is that, in our community, many people do not feel comfortable going to health care centers or to the doctor.
There are several factors why. Mainly, they have no real access to health insurance, and there’s the uncertainty of not knowing if you’re going to be able to pay for it. How much are you going to owe? That’s a big thing, isn’t it? There are many insecurities that grow from that. Our community is not accessing preventative health.
During the first months of COVID, when people got really sick, they had to be seriously ill and have something of an emergency to go to the doctor. So while we’re not at the same phase of the pandemic, that hesitancy is still present in our communities. When a person gets sick, and their symptoms are mild, it’s most likely that they will not go to the doctor. Or that they don’t have a doctor.
Obviously, it’s great that we have a treatment. The treatment works when the person’s symptoms are just starting, right? Here, in Minnesota, we have some “test-to-treat” sites where the person can be tested, and if they test positive, if they are eligible, they can access treatment. But really, those sites are not used by our community. There’s no trust for that.
Dulce De La Rosa: One of the big barriers is fear. When I approach people to talk about the resources we have, and I ask them if they want to share their name and phone number so that we can connect them to services, they say, unfortunately with fear, “I don’t have insurance. What are you going to use my data for? Who will have access to my data?”
It’s painful to hear this from our community, because this fear often worsens the health of our community.
C.C.: I would also like to add that not speaking English or speaking a different language are also barriers. Really, having certain conversations about difficult health issues when you’re doing it over a phone line, when you have an intermediary who is translating—it’s not easy. It’s not easy when you speak the same language as the doctor. Imagine when you speak a different language, and you have all this mediation.
D.D.L.R.: I want to tell you about a conversation I had with an elderly person. This gentleman suffers from a lot of pain and has difficulty walking. I asked him if he’d been to the doctor recently, and he told me, “No, mija, it’s been many years.” So, I asked him, “Why don’t you go? Why don’t you schedule a physical checkup?” And he tells me that now, with [electronic] devices, that’s less likely. He said, “I tried, and they told me that I should make an appointment online.” So now having to schedule an appointment electronically is such a big barrier because many people don’t even know how to read.
PGN: COPAL MN’s health navigators program supports people in your local area who have questions about COVID-19, accessing health care, or general questions about their health. What self-advocacy tips do you provide folks who face these barriers or who are preparing for a doctor’s visit?
D.D.L.R.: We know our body. No one else will know us better than ourselves. Some advice that a doctor gave us some time ago is to write down your questions. Many times, when we’re at the appointment, the doctor asks us if we have a question, and we go blank. Often due to nerves, or because we’re using an interpreter, or for various other reasons, those questions disappear. So, over time, we get to know our body, our challenges, and we must advocate for ourselves.
C.C.: It’s important to know what our rights are as patients as well. I always tell people, “You have the right to ask.” In other words, ask for an interpreter. You definitely have the right to ask for an interpreter, and they must provide it. And they should wait until the interpreter is there to treat you.
You also have the right to financial assistance. That’s something that hospitals, clinics, centers should be offering. They should make it more transparent, more available, and not wait for you to ask for it. But that’s why I always say, “You have the right to ask. And you shouldn’t feel ashamed about it.”
PGN: Can you share more about that process? What does it look like to know yourself enough to be prepared and participate in your health care?
C.C.: We have to listen to the doctor and take steps to do our part. But it’s also about understanding that if I feel the doctor is not understanding me, I need to seek a second opinion, right? It’s like us putting ourselves in a position of more control and authority over our body.
If the doctors are in a hurry, and it seems like they don’t have the time, we still have the right to ask them to explain: “Look, I don’t understand what I’m supposed to do with this medicine,” or, “I don’t understand what you’re really telling me,” or, “What’s going to happen?”
D.D.L.R.: Absolutely, Cecilia, I agree. And also, we’re talking about ourselves—but many times, when we take our children for physical checkups, sometimes they don’t respond to questions.
It’s important to teach them to explain how they feel. Once a child knows how to speak, we must teach them to express themselves and to advocate for themselves. So, not only us as adults, but also, I think that if we educate the next generations to advocate for themselves, in the future, we’ll have people who know how to advocate for their rights, who know how to navigate the systems, and demand to get what they deserve.