High Rates of COVID-19 Infection Among Indigenous Maya at a US Safety-Net Health System in California

• Published in: Public health reports (1974) Vol. 136; no. 3; pp. 295 - 300
• Main Authors: Foo, Patricia K., Perez, Berenice, Gupta, Neha, Lorenzo, Gerardo Jeronimo, Misa, Nana-Yaa, Gutierrez, Brissa Santacruz, Madison, Olivia, B. Swift, U. Mini, Anderson, Erik S.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.05.2021; SAGE PUBLICATIONS, INC
• Subjects: Adult; California - epidemiology; California - ethnology; Case Study/Practice; Cohort Studies; Comorbidity; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - ethnology; COVID-19 Testing; Critical Care - statistics & numerical data; Electronic health records; Electronic medical records; Female; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Indigenous Peoples; Language; Male; Medical records; Middle Aged; Patients; Prevalence; Public health; Retrospective Studies; Risk Factors; Safety-net Providers; SARS-CoV-2; Viral diseases; California; United States > US; Alameda County California; COVID-19; health disparities; indigenous communities; public health
• ISSN: 0033-3549; 1468-2877
• DOI: 10.1177/0033354921990370

Coronavirus disease 2019 (COVID-19) has disproportionately and negatively affected communities of color in the United States, especially Black, Latinx, and Indigenous populations. We report a cluster of COVID-19 cases among the Maya in Alameda County, California, most of whom were misclassified in public health data as nonindigenous Spanish-speaking people. We conducted a retrospective cohort study of all COVID-19 tests performed from April 1 through May 31, 2020, at Alameda Health System. A total of 1561 tests from 1533 patients were performed, with an overall test positivity rate of 17.0% (N = 265). We used the language field from the electronic health record to identify 29 patients as speaking an indigenous Mayan language; by medical record review, we identified 52 additional Maya patients. Maya patients had a test positivity rate of 72.8% as compared with 27.1% (P < .001) for nonindigenous Latinx patients and 8.2% (P < .001) for all other patients. In our sample, 39.6% of patients who had a positive test result for COVID-19 were hospitalized, 11.3% required admission to the intensive care unit (ICU), and 4.9% died of COVID-19. Maya patients had lower rates of hospitalization, ICU admission, and 30-day in-hospital mortality than non-Maya patients. We shared our data with the county health department to inform responses for education, testing, and isolation for Maya patients in Alameda County. Ongoing COVID-19 public health efforts should assess the community prevalence of COVID-19 in the Maya community and other indigenous communities and implement interventions that are linguistically and culturally appropriate.