May 8 (UPI) -- New York City has been the epicenter of the COVID-19 outbreak in the United States, with immigrant populations in areas such as the Bronx "disproportionately" affected, say authors of a commentary published Friday by JAMA Internal Medicine.
They say that what they've seen as front-line healthcare workers affiliated with the borough's largest hospital, Montefiore Medical Center, should serve as a cautionary tale for other large cities across the country with significant immigrant populations who live in poverty.
"Our experiences as clinicians in the epicenter of the global COVID-19 pandemic have made it clear to us that immigrants in the Bronx and throughout the U.S. have disproportionately been affected by COVID-19," co-author Dr. Jonathan Ross, an internist at Montefiore, told UPI.
"This is a direct result of long-standing social inequities that have put them at higher risk for exposure and that have made it harder for them to obtain care," said Ross, who also is assistant professor of medicine at the Albert Einstein College of Medicine.
The Bronx is the second-smallest of New York City's five boroughs, with just over 1.4 million people, but it has reported nearly 40,000 of the city's 174,000-plus confirmed cases of COVID-19 -- a total second only to Brooklyn -- according to the New York City Department of Health.
As a result, the Bronx has by far the highest number of cases per capita, with nearly 3 percent of its population infected. This is likely due to a number of factors unique to its population, Ross and his colleagues wrote.
First, the borough is by far the city's poorest, with per capita income below $21,000 and more than 27 percent of the population in poverty, according to figures from the 2010 U.S. census.
Perhaps not surprisingly, as many as 20 percent of Bronx residents lack health insurance, which makes accessing care for COVID-19 -- or any other health condition -- out of reach financially.
The census also considers the area to be the "most diverse" in the United States. In 2013, 55 percent of Bronx residents were Hispanic or Latino, while 43 percent were black or African-American and 4 percent were Asian. More than one-third of those living in the borough were immigrants to the United States.
Historically, immigrant communities in the United States have faced challenges in accessing healthcare, including language barriers, lack of health insurance and fear of accessing medical services because of immigration enforcement fears, Ross and his colleagues noted.
These problems have been exacerbated by the COVID-19 pandemic, they said.
"Limited English proficiency makes accessing accurate information about COVID-19 more challenging," Ross said. "And, infection control policies have necessitated a no-visitor policy at nearly all hospitals, which may particularly affect immigrants whose families often serve as cultural mediators."
And these challenges are "not unique" to the Bronx, said Steffie Woolhandler, a professor of public health at New York City's Hunter College, who was not among the authors of the JAMA Internal Medicine commentary.
"Immigrants in other communities also suffer high rates of the illness [with COVID-19]," she told UPI.
"For instance, Chelsea, Mass. -- a town near downtown Boston with a large immigrant community -- is among the most intense hot spots outside of New York," Woolhandler said. "My Boston-area colleagues tell me their ICUs are seeing a disproportionate number of younger Latinx patients with COVID-19."
This may be because members of immigrant communities also are at higher risk for exposure to the virus because they are "disproportionately represented" in New York City's essential workforce as healthcare workers, subway and bus drivers, and grocery clerks, among others, according to Ross and his colleagues.
This places them at higher risk for COVID-19, due to increased likelihood of exposure to those who are infected, either on the job or when using mass transit to commute.
And like most poorer regions across the country, the Bronx has higher rates of many chronic diseases, according to the New York City Department of Health. Some 15 percent of adults living in the borough have asthma, and a similar percentage have diabetes. In addition, more than 30 percent of its residents have high blood pressure.
These health conditions place them at increased risk for severe disease from COVID-19, especially those who lack legal citizenship or residency status, have limited access to services, have fear of accessing care or social services because of public charge, Ross said.
"Some of the most emotional experiences we have had relate to seeing patients who are already vulnerable in so many ways," Ross noted, "finding themselves in the extremely vulnerable place of facing their illness alone in an unfamiliar hospital."