Latino patients who don’t speak English are 35 percent more likely to die from covid-19, Brigham and Women’s Hospital research suggests. Located in Boston, Massachusetts, Brigham is teaching affiliate of Harvard Medical School. In March — when the pandemic first struck the United States — Brigham patient safety reports started to flag “concerns about unequal access to care,” local public radio station WBUR reports. Research has long shown that US Latinos die from covid-19 at disproportionately higher rates than that of white patients. But journalist Martha Bebinger reports Brigham staff noticed an additional disparity: death among limited-English proficient (LEP) patients was even higher.
“We had an inkling that language was going to be an issue early on,” Dr Karthik Sivashanker, Brigham’s medical director for quality, safety and equity, told Bebinger, “We were getting safety reports saying language is a problem.” So Sivashanker and his team compared minority patient prognoses to that of white patients with similar chronic illnesses and found no difference in covid-19 death risk. The discrepancy lay in language.
At the beginning of the pandemic, Sivashanker admits the hospital was not linguistically prepared. “We have really amazing interpreter services, but they were starting to get overwhelmed,” he told WBUR — as almost all sectors of American health care then were.
“We didn’t know how to act. We were panicking,” Spanish interpreter Ana Maria Rios-Velez told WBUR. Many of the words we now use to describe and treat covid-19 didn’t exist yet. Interpreters were confused about how close they could get to patients or whether they should even enter patient rooms. They weren’t always given adequate personal protective equipment (PPE). When they were, Rios-Velez said masks got in the way of establishing patient trust. Many Brigham interpreters were told to interpret by phone from home, which WBUR reports proved problematic.
Brigham resolved this issue by shifting its staff interpreters from telephonic interpreting (OPI) to video interpreting over iPad when possible. The hospital also started translating text messages about coronavirus. These messages benefited not just LEP patients, but employees — like limited English janitors. The hospital also added more interpreters.
As to whether increased language access measures have remedied Brigham’s LEP death disparity, Sivashanker told WBUR that’s hard to prove: “It’s never going to be as simple as we just didn’t give them enough iPads or translators and that was the only problem and now that we’ve given that, we’ve shown that the mortality difference has gone away.”