How contact tracers connect with Latinos through culture, language

Areas with large Spanish-speaking communities are hiring tracers who speak the language and understand the culture of those hardest hit by COVID-19.

September 8, 2020

In the early weeks of the pandemic, Ivette Lopez watched helplessly as COVID-19 gripped her state of North Carolina.

When she learned about a nationwide mask shortage, Lopez saw her chance to help. She bought a sewing machine even though she had never sewn in her life. But a few YouTube video tutorials later, she was assembling hundreds of masks. She donated them to clerks at Walmart, volunteers at the Salvation Army, cashiers at her local grocery store — wherever she saw workers on the frontlines of the state’s COVID-19 response.

Then in April, she saw a news clip of North Carolina Gov. Roy Cooper telling reporters about the state’s efforts to hire more contact tracers. By this point, it was becoming clear that the virus was disproportionately affecting communities of color, including Latinos. Latinos alone comprise a third of all COVID-19 cases in the United States, according to the Centers for Disease Control and Prevention. In North Carolina, Latinos represent 9% of the population but account for 37% of the COVID-19 cases.

Lopez, who grew up in New York City with her Puerto Rican family, felt a calling to be a contact tracer. A few weeks later, she was hired.

“I know the Latin community,” she said. “We’re not so trusting when people call and ask stuff, especially with a person who doesn’t speak Spanish. So I felt I needed to do it.”

Across the country, counties with large Spanish-speaking communities are mobilizing to hire more contact tracers like Lopez, who speak the same language and understand the culture of those hardest hit by the pandemic. Contact tracing goes beyond identifying residents who have been exposed to the virus and asking them to self-quarantine in their homes. Several contact tracers who are reaching out to Latino residents said they often find themselves dispelling misinformation about the virus and how it spreads. They also are connecting families with resources, from food bank information to utility bill assistance, so they can stay home.

Empathy is a big part of the job, especially with vulnerable households where many residents are essential workers who don’t have the luxury of working from home.

“There needs to be a lot of compassion. We need to offer as much support as we have the capacity to give,” said Erica Lehman, who supervises a contact tracing team in Lancaster, Pennsylvania, which makes lots of calls to Latino residents. “But more importantly, to help give them the ability to isolate so we can slow this down.”

Knowing Spanish is important, but contact tracers must also understand the longstanding fears among undocumented residents who worry that any brush with the government might land them on the radar of immigration authorities. Contact tracers reassure residents that any information they share is confidential.

Contact tracer Ivette Lopez works from her home in North Carolina (Courtesy: Ivette Lopez)

At Community Care of North Carolina, a statewide care management network, more than half of its roughly 740 contact tracers speak Spanish. Lopez works from home, on Saturday and Sunday from 7 a.m. to 7 p.m., and on Mondays and Tuesdays from 7 a.m. to 3 p.m. By the end of the day, Lopez and her team have typically made between 150 and 300 calls, she said. Sometimes, the work spills into her days off. Lopez remembers getting a call from a mother of five who needed assistance with food and her utility bills. The woman was undocumented and ineligible for resources from official government channels.

Lopez emailed some potential leads to the woman, who later emailed back to thank her. “Her email thanking me, it was worth taking half my day off to send that information,” Lopez said.

Five hundred miles north of Lopez, the Philadelphia Department of Public Health has also recently bolstered their ranks of Spanish-speaking contact tracers. Denisse Agurto started in July and supervises a group of tracers. She previously worked as a community health worker, accompanying residents with chronic illnesses to doctor’s appointments. When COVID-19 hit, she said, a few of her patients died from the virus. Like Lopez, she wanted to help her community and pursued contact tracing. In Pennsylvania, Latinos represent 7% of the population but 25% of the virus cases.

“It’s really rewarding,” Agurto said. “Knowing that we are helping our community and giving them the concrete information that we possess.”

The biggest challenge she faces is convincing Latino residents to self-isolate at home. Many of them are essential workers, or they work in landscaping, construction or restaurants. Many are parents who can’t afford to stop working and worry about paying their rent and providing for their families. A big part of her job is writing letters with the official public health department masthead that she can provide to residents who test positive or are exposed to the virus so they can present it to their employers and get permission to stay home.

West of Philadelphia in the city of Lancaster, the Lancaster Health Center is expanding its team of contact tracers, especially those who speak Spanish. The health center was among the first health providers in the county to begin contact tracing, making their first official call on March 26, said Lehman. Since then, they’ve contacted roughly 1,800 people. If a Spanish speaking contact tracer isn’t available, the health center uses an interpreter service to make calls.

Nicole Eby de Rodriguez, a registered nurse, is a Spanish speaking contact tracer at the health center. She lived in the Dominican Republic for nine years. Knowing the language is a big step in building trust with a client, she said. “It just increases the comfort level so much, to be able to hear a familiar tone.”

The job, she said, “goes beyond contact tracing.” She connects residents with behavioral health specialists and social workers, who can refer them to food banks and rental assistance. That additional support is important, especially for people whose line of work doesn’t allow them to work from home, and for larger families living in cramped housing.

“To me, social distancing is a privilege, not a right,” she said. “There are a large number of people that don’t have that ability.”

Roberto Melendrez (Courtesy: Roberto Melendrez)

In Los Angeles, is a program manager working in the county public health department’s HIV and sexually transmitted disease programs. Melendrez remembers that his last day at the office was a Friday in mid-March. On Sunday night, he got a call from the county: everyone would be working from home Monday. He’s worked remotely ever since, supervising one of the county’s contact tracing teams.

When they started making calls, the script they used was one-and-a-half pages. Now it’s 14 pages, laying out different questions for the myriad of situations that tracers might encounter.

The nights before his shifts, Melendrez looks at new cases assigned to his team and distributes them to group members. A Spanish last name doesn’t necessarily guarantee that the contact only speaks Spanish, given the area’s multi-generational Latino community. So he finds himself asking what language they would prefer to speak in at the start of every phone call.

Melendrez is also aware of the ingrained fear that immigrants have regarding immigration authorities. So he modifies his questions for Spanish speakers. When he asks for their address, he swaps out the Spanish word for residence with the Spanish word for domicile. That’s because residence in Spanish translates to “residencia,” which also refers to green card.

Melendrez remembers the case of one woman who worked at a nursing home. Coworkers and clients were becoming ill with the virus. Eventually, her husband and son tested positive and were hospitalized. Even though both eventually recovered, “she had so much guilt about bringing the virus to her family. That was a heavy burden for her.” Melendrez connected her with a Spanish-speaking mental health provider.

Author Laura C. Morel

Melendrez sees a reflection of himself in the families he contacts. His father died in July from the virus. Growing up in east LA, his Mexican mother put him and his eight siblings through Catholic school. He is familiar with the struggle and resilience that shapes the lives of so many of the Los Angeles County residents he is helping.

All of them, he said, “are doing the best that they can with what they have.”

Laura C. Morel is a journalist based in St. Petersburg, Florida. This is part of a series funded by a grant from the Rita Allen Foundation to report and present stories about the disproportionate impact of the virus on people of color, Americans living in poverty and other vulnerable groups.