Her head still aches. She lost 50 pounds. She can’t breastfeed. The fatigue and dizziness and shortness of breath make it difficult to get out of bed in the morning. Doctors say it could take months for her to fully recover from the weeks she spent connected to a ventilator and to an aggressive life support machine that pumped blood into her lungs and heart.
Yet the Salvadoran mother’s concerns over her long-term recovery are eclipsed by her family’s immediate needs: Purchasing clothing for the babies. Paying the rent on their one-bedroom apartment. Buying food for a family of six when both adults lost their jobs because of the pandemic and neither qualifies for unemployment assistance because they are undocumented. Ana and her partner, Alfredo, asked to be identified only by their first names because of fears of deportation.
When she faced complications from the virus, Ana was a 35-year-old expectant mother with chronic hypertension and severe preeclampsia. But she was also a Latina, part of a community that has been exposed to the virus at disproportionate rates.
Nationwide, Hispanic or Latina mothers make up nearly half of the coronavirus cases among pregnant women, according to data from the Centers for Disease Control and Prevention collected from Jan. 22 until last week. Among more than 14,100 pregnant women who tested positive for the novel coronavirus and provided information about race and ethnicity, 6,447 were Latina — the largest group by far. In a study in Philadelphia, researchers at the University of Pennsylvania found the rate of virus exposure among Black and Hispanic women to be five times higher than among White and Asian women.
Doctors say that, anecdotally, they are seeing this same pattern in the D.C. area. During a conference call about three months ago for local obstetricians, D.C. health officials and representatives from hospitals, it became clear that some clinics serving predominantly Latina populations were seeing some of the highest numbers of infections among pregnant women. Among the hardest hit was Mary’s Center, a nonprofit organization that operates community health clinics in the Washington area.
Between March and July, Mary’s Center tested 215 pregnant women for the coronavirus, the vast majority of them Latina. More than 150 of them — nearly 70 percent — were positive.
“It’s very, very alarming,” said Maria Gomez, chief executive of Mary’s Center. “We still can’t figure out why we’re seeing these numbers.”
As of late July, the number of pregnant women who tested positive for the coronavirus was decreasing in most areas of the District and was stable in others, said Constance Bohon, a D.C. obstetrician-gynecologist who is part of the local committee of OB/GYN providers who meet regularly to discuss cases. But doctors worry about a potential rise in cases in the fall, Bohon said.
Research about the impact of the coronavirus on pregnant women continues to be limited. A report from the CDC in June found that infected pregnant women may be more likely than infected nonpregnant women to be treated in an intensive care unit or need a ventilator but are not at higher risk of death. Pregnant women who are Black or Hispanic appear to be disproportionately affected by infection during pregnancy, according to the report.
Tollie Elliott, the chief medical officer at Mary’s Center, said the figures may reflect the actual burden of the disease within the Latino community, which has struggled to access testing. On average, pregnant women see their doctors much more frequently than other people, which allows more opportunities for medical professionals to detect signs of infection, Elliot said.
The virus has been devastating for Latinos, who are overrepresented in occupations classified as “essential,” including construction, cleaning and caregiving. And Latinos more often reside in crowded apartments and multigenerational homes where the coronavirus easily spreads.
In Montgomery County, a Washington suburb with 1 million people, Hispanic residents accounted for 73 percent of all new infections in June despite representing only 20 percent of the population. In Virginia’s hard-hit Fairfax County, Latino residents make up 17 percent of the population but 59 percent of all coronavirus cases. And in D.C., Latino residents represent 11 percent of the population, but a quarter of all cases.
Elliott said that none of the pregnant women who have tested positive for the virus at Mary’s Center has died of covid-19, but his staff is monitoring their conditions for side effects, including postpartum depression.
“When you have covid-19, it’s sustained high-intensity trauma, especially if you’re pregnant,” he said. “The stress, the anxiety — it’s significant.”
Anguish and fear
In many Latino families, the virus has sickened relatives across generations, putting pregnant family members at risk and cutting off their support system. Alicia Delgado, a 19-year-old pregnant woman, said her aunt and her grandfather contracted the virus. And nearly three months ago, she, too, started feeling an intense fever and tested positive for the virus at 20 weeks pregnant. Each day, she felt weaker. She struggled to eat. Then her mother, who was caring for her, also started having symptoms.
Delgado feared she might give birth prematurely and lose her baby. Though she has since recovered, she said, “it was terrifying.”
Kimberly Guzman, 19, is still traumatized from going into labor moments after she tested positive for the coronavirus, at Howard University Hospital. She showed no symptoms but delivered her first baby while wearing a mask and worrying that doctors might isolate her from her daughter for two weeks.
“I felt like I was suffocating,” she said. “It was an experience I wouldn’t wish for anyone.”
Ana, the Salvadoran mother of twins, was nervous from the moment she found out she was pregnant. She knew it would be a high-risk pregnancy, given her age and her chronic hypertension. To limit her risk of exposure, she stopped going to her job at a laundromat and left the house only to go to ultrasound visits, which required taking a bus across town.
Then, on April 29, she felt an intense pain in her chest. Her fever spiked, and she struggled to breathe. Her blood pressure shot up. Her doctors diagnosed her with severe preeclampsia and, later, covid-19. They induced labor, and within hours, Ana went into respiratory distress. Doctors transferred her premature daughters to the neonatal intensive care unit and placed Ana on a ventilator.
“She was really fighting two major things at the same time,” said Siobhan Burke, her OB/GYN.
Ana’s partner, Alfredo, was told to quarantine for more than two weeks in his home, but he wasn’t showing any symptoms. For 15 days, the father was unable to visit his newborn twins in the NICU. “I was anguished,” he said. He stayed in the family’s apartment, taking care of their 5-year-old son and Ana’s 14-year-old son.
Shortly after the end of Alfredo’s isolation period, the twins were healthy enough to come home from the hospital. But Ana, still on the ventilator, was getting worse. Ana’s doctors called Alfredo and told him she might have only three hours left to live.
“They told me she needed another option to be saved,” Alfredo said, “or else she would die.”
They placed her on an extracorporeal membrane oxygenation machine, also known as an ECMO. A surgeon inserted large tubes into her blood vessels, removing her blood and running it through an artificial lung to push oxygen-rich blood back into her body.
On May 20, a doctor called Alfredo with news he never thought he would hear: Ana was moving her hands and feet. Within a week, she was strong enough to be released from the hospital. But her recovery had barely begun.
A recovery with no end in sight
Before the pandemic, Ana and Alfredo were each bringing in just enough income to cover the rent for their apartment and to send money to Ana’s ailing mother in El Salvador. Ana had applied for a day-care program for the twins and planned to go back to work once they were old enough.
Now all of their plans have been derailed. Alfredo has been out of work since his employer, a downtown cafe, closed amid the pandemic. The day-care center is closed, and Ana is still too weak to take care of her two older sons and newborn babies. Even if Alfredo could find a job, he wouldn’t be able to leave Ana alone with the children.
The mother barely had a chance to buy clothes and essentials for the twins before she got sick. “I thought I would have more time,” she said. “I never imagined that this would happen.”
Unlike millions of other unemployed people across the country, Ana and Alfredo do not qualify for government assistance, other than WIC. They have been relying entirely on help from her sister and from a nearby church. Although Ana receives health insurance through the D.C. Healthcare Alliance, she said she worries it may not cover the hundreds of thousands of dollars in bills for her weeks of care in the hospital.
Even before the pandemic, many immigrant families were living in uncertainty and fear under the Trump administration, said Victoria White, who provides prenatal care at La Clínica del Pueblo, a network of community clinics serving the Latino community in the D.C. area. Earlier this month, a federal appeals court sided with a Trump administration effort to make it harder for immigrants to seek permanent residency in the United States if they have relied on public assistance programs. Immigrant advocates argue that the rule discourages legal immigrants from using any public benefits such as Medicaid, food stamps or housing assistance.
Burke, Ana’s doctor, worries about whether she and her family will be able to recover from this, both emotionally and financially.
“How is her life going to be after this?” Burke said. “Is this the thing that is going to throw them into abject poverty?”
As Ana’s family missed a second month of rent payments at the beginning of August, she asked herself the same question. Unable to afford the $1,500 rent for the one-bedroom apartment, Ana’s sister and husband were both searching for a new place to live but had not yet found one. The family — all six of them — considered temporarily sharing a room at Ana’s aunt’s house in the Fort Totten neighborhood in Northeast Washington.
Then, earlier this month, the twins started having trouble breathing, and Ana rushed the infants to Children’s National Hospital, where they were given oxygen.
The babies tested negative for the coronavirus and are recovering, Ana said. Doctors told her the illness was a simple cold made worse by the premature babies’ fragile lungs. To be safe, they told Ana, the family should keep the twins isolated inside for 20 days.
“They could catch the virus at any minute,” Ana said.