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Brian: Brian Lehrer on WNYC. Yesterday, New Jersey, governor Phil Murphy announced that Luis Herrera, a native of Lima, Peru, and a New Jerseyan, lost his fight against COVID-19. He was just 47 years old and tragically, Mr. Herrera was far from alone. Latino men in New Jersey account for nearly half of the deaths of adults under 50 years old, even though they are just 12% of the under 50 adult population. I'm going to say that again, because it is such a breakout stat from this pandemic.

Latino men in New Jersey account for nearly half of the deaths of adults under 50 years old in this state, even though they are just 12% of the under 50 population. Joining me now for a closer look is Karen Yi, WNYC reporter covering New Jersey who has reported on this shocking disparity in the pandemic in our area. Hi, Karen, welcome back to the show.

Karen: Hi, Brian.

Brian: Can you give us more of the scope of the issue to start out? How do deaths of Latino men compare to deaths of white or Black men in the same age group in New Jersey?

Karen: Yes. When you look at deaths and this is confirmed deaths that we looked at, of people ages 18 to 49, young Latino men are dying twice the rate of young Black men, seven times the rate of young white men and interestingly four and a half times that of Hispanic women.

This was a statistic that the Department of Health highlighted back in October for a smaller sub-group of 20 to 34 year olds. They had said that half the deaths were Hispanic men. That really caught my eye and I wanted to see if that expanded more broadly to the young people who were dying of this illness, and it really did. Like you said, there were a small sub-group of the working young, but are overwhelmingly accounting for a lot of these young deaths in this state.

Brian: What's said to account for the gender disparity there?

Karen: That's still unclear. A lot of see public health experts and doctors I spoke to were really interested by that difference. It could be mom and dad both lost jobs, maybe dad found somewhere to work, there was a childcare issue, mom is staying at home, so dad is going out and getting exposed potentially. Then we know generally men and Latino men are more likely to have several underlying medical conditions, diabetes, high blood pressure, obesity, all these things that put you at higher risk of getting COVID.

This is all really layered, the reasons why we're seeing these deaths, and I think there's still a lot to look into because if you look at the statistic nationally, 44% of COVID-19 deaths are among Latinos overall, that's Latino men and women, but that percentage is a percentage in New Jersey specifically. 43% of the deaths, young deaths in New Jersey are Latino men only. There's something out of whack happening here in New Jersey. We know some of the reasons, but I still think as we do this post-mortem and we try to analyze what we've learned from this pandemic, I think that's one of the things that I really want to keep an eye on.

Brian: We have time for a few phone calls. Any Latino men listening in New Jersey? We want to hear about how you've been living with this news the past year, and of course, it's not just news coming out of your radios or whatever devices. This is news among people you know, in so many cases, so help us report this story, help Karen Yi report this story. What's happening in your community? How is it affecting you and your choices? Do you perhaps live in an intergenerational household? What's that been like during this time? Is the toll that COVID is taking in your community making you reassess your own personal health or life choices?

Of course, some of the reasons for the disparity have to do with lack of choices that people have relative to other people. How are you processing your grief? How do you plan on moving forward? 646-435-7280, 646-435-7280 or tweet @BrianLehrer. Kare, a lot of attention is being paid to comorbidities underlying conditions, and you're right that that's not the whole picture and we'll get to that, but can you talk a little bit about preexisting conditions as a contributor to this disparity?

Karen: We know Latinos and Latino men, in particular, are more prone to having a lot of these underlying conditions that I mentioned. Like heart disease, diabetes, high blood pressure, and something that a doctor pointed out to me is a lot of these conditions don't always present as symptoms. Like very mild symptoms or maybe no symptoms at all. You may not know that you have these things, these illnesses, and so you continue going to work and you continue potentially exposing yourself.

It comes to a head because you're more likely to be exposed, you have these underlying conditions and then you get sick with COVID. On top of that, we know Latinos generally are more likely to be underinsured or uninsured compared to other populations. It all compounds and feeds on itself.

Brian: We talked earlier in the show about undocumented workers, many of whom are Latino, not getting COVID relief act benefits that other people get because they're undocumented, and some of these have to do with access to healthcare, and so that contributes to underlying conditions.

Karen: If you don't have care or you are underinsured, that means you don't have a primary care doctor, you're not going to the doctor regularly, you're again, not catching these things because you're not getting checked out regularly. You're also less likely to go to a doctor and take money off the table for your family if you don't necessarily have a huge savings account or you don't have health insurance.

That's what I heard in a lot of these families that I spoke to, it was the lack of care and the lack of access to care was really a barrier for these men and these fathers wanting to go to the hospital, fearing what it would cost and delaying going to the hospital until it was too late.

Brian: And you write about in your story, the calculation that some of the individuals and families you reported on make when they are feeling sick, like paying hospital bills versus putting food on the table, or the potential for paying hospital bills versus putting food on the table, which keeps them from getting the care that they need. Here's a clip of Stephanie Silvera, an epidemiologist at Montclair state, who you spoke to on the issue of comorbidities.

Stephanie: Health disparities have long been written off by people as the result of bad behavior. I think what COVID is really highlighting in a way that cannot be ignored, is that a lot of these disparities are systemic inequality.

Brian: There you go. On many levels, another story from your reporting that I'll highlight along these lines, you told the story of Reinaldo Ruano who died of COVID-19 on December 14th at the age of 44. He began experiencing symptoms after his shift at a carwash in Elizabeth. When he told his story, she urged him, told his daughter, I should say, she urged him to go to the hospital, and he didn't, for exactly the reason we were discussing.

Karen: I think that family is what I heard from several other families. This family lives in Elizabeth and he worked at the car wash right next to their home. What's that about it as a family is looks outside, goes next door, and they're reminded of the place where the father, the husband, got sick. He was somebody who didn't have health insurance as a car washer, worked six days, long days out in the cold, out in the heat, extreme heat, extreme cold and had diabetes.

He got diagnosed with diabetes four years ago and couldn't afford the treatment. It was untreated diabetes, got exposed at work, and for a long time, didn't go to the hospital. I think a part of him didn't want to believe that he was sick. He told his wife that he was scared of how people were dying from the illness alone and away from his family. Then there was the issue of cost. You're in a pandemic, some of his family members were undocumented, they weren't eligible for any aid, and so if he didn't work, if he didn't continue to go to work, there was no income on the table.

Eventually, he was rushed to the hospital, he actually went to get a COVID test and the staff there rushed him to the hospital and most of his household was sick. His wife was also intubated, put in a ventilator, in a coma. She survived. His kids were sick. He unfortunately didn't make it. He was actually in the hospital for a month. He was in a hospital for a long time. One of the many stories.

Brian: Ray in Freehold, you're on WNYC with WNYC and Gothamist, New Jersey reporter Karen Yi. Hi, Ray.

Ray: Hi, Brian. Thanks for taking my call. My input is I had COVID a few months ago. I'm a painter for construction and construction is booming in New Jersey. We have contact with all sorts of people so I definitely think that's one of the reasons-- that's what I think anyway. That could be one of the reasons Latino men are getting higher rate, especially men not women, because more men work in construction than women.

Brian: Can I ask, if you work in construction, Ray, over this year of the pandemic, have the employers, have the construction site managers taken steps to provide you better precautions and all the people working?

Ray: Well, yes and no. I mean not always. That would be my answer. Sometimes in some places, they do, they try-- especially at the beginning. They try to avoid too many people in one construction site and stuff like that but as time went by, the rules got a little looser so yes and no. A little, not enough apparently.

Brian: Ray, thank you very much. Karen, what were you trying to say a minute ago?

Karen: I was going to say that that's exactly right. Latino and Latino men are overrepresented in the service sector, service type jobs, essential jobs like construction, like painting, carwash or restaurant industry, and so many men continue to work throughout the pandemic. In some cases, PPE was a problem. Not getting access to masks and gloves because nobody really had access to masks and gloves during the worst of it. You saw a lot of these deaths happen in April but the family we just spoke about, the car washing family, he died in December. You can't just attribute it to this wave we were all inundated with of COVID, its existing issues that continued through the pandemic and continue to this day.

Brian: Thanks Ray, call us again. Diane in Flushing, you're on WNYC. Hi, Diane.

Diane: Hi Brian. I'm Puerto Rican myself and I just wanted to prefix what I'm about to say by pointing out that I think all of the factors spoken about so far are responsible for the majority of this but something I find deeply concerning and I think it's at least responsible for some of them is this perception of wearing masks as being-- sorry, I haven't spoken on radio before, I'm a little nervous, but there was this concept of machismo in my culture and Latin American culture in general.

I think sometimes wearing that mask among most people like younger men from like 20s, mid-30s I think it's seen as an insult to them in that way to be asked to wear a mask. Just anecdotally speaking, just me speaking to those men myself, because I definitely wear it or seeing my friends, the reaction tends to be very aggressive at least among young men. I don't think that speaks for all Latin American men at that age group or in general but I just think that's something that should be considered. I do think that wearing a mask is seen as being an insult in that way.

Brian: We certainly saw the white non-Hispanic former president of the United States reinforce that message that there's something unmanly about wearing the mask. Diane, thank you so much for that. Karen, did that come up in your reporting at all?

Karen: Yes, I'm really glad you brought that up Diane because this culture of machismo and also martyrdom was something that public health experts also brought up. Something that they see. I think that feeds into this idea of manhood, like the true definition of manhood and fatherhood and being head of the household and being the breadwinner is you put up with everything and you continue to go to work despite the pandemic. You don't take care of yourself because you take care of your family first right? "No, I'm fine. I feel fine. I don't need to go to the doctor. I'm okay. I don't feel that bad. It's not that bad."

I think that mask-wearing and mask compliance that feeds into this culture of martyrdom, that a lot of the health experts acknowledge that exists and really saw play out in this pandemic. Again, I think that's another layer to why we saw or seeing Hispanic men so disproportionally hit. I want to talk a little bit more about this idea of self-sacrifice that I found really interesting in my reporting. You have this almost cultural identity, like what is a Hispanic male? What is a Latino man? It's somebody who goes to work six, seven days a week. Is working hard and doesn't really put himself first. It's passed generation to generation continuing this act of sacrifice for the family.

When you have a pandemic, it exposes that and it exposes this lack of self-care, taking care of yourself, being seen as taking care of your family as well. Those are conversations that I think we need to have with the Latino community within themselves and also that public health experts are also trying to educate on.

Brian: In your reporting on Reinaldo Ruano's death and Diane thank you so much for your call. You call us again too. We're going to end on a really sad note here because you speak to his 19-year-old daughter, Elizabeth, who is grieving her father and it's almost as if now that things are opening back up, she's realizing even more acutely that he's gone. Can you talk about this concept of double grief that you reported on?

Karen: Yes, I think this applies to a lot of people who have lost loved ones not just the Latino community but I heard overwhelmingly from families. We lost our loved one when we were quarantined and in isolation and separated from our lives. We went through that grieving process and that acceptance process and now with things opening up again and us going back to school or our routines is another grieving process because now we have to go out in the community and you get the questions of, "What happened to so and so?" Or, "I'm so sorry for your loss."

You grieve this person again and this idea of double grief. I heard so much from families like the more they were able to get together or talk to neighbors, going through this process again but I also-- for Elizabeth who is 19 and her family, the impact when you lose your father and he was so young, there's this impact on the younger generation. In his family, his son now is working at the carwash. His son has taken up the mantel of breadwinner for the home and in conditions that are not changed from the conditions his father worked in.

You see this cycle repeat itself and nothing has changed for that family. You think about the impact of that and we know that children who have these adverse events happen to them are also more likely to have poor health outcomes in the long run and that's something that's been studied. Again, you see this generational cycle continue again, unfortunately.

Brian: Listener on Twitter writes, "Appreciate the discussion. Can't understand how agricultural and construction workers are not yet eligible for vaccinations in New York." I realize your reporting is in New Jersey and Karen we just have 20 seconds left but those would seem to be job categories that disproportionately employ Latino men and we know that there have been agricultural outbreaks construction workers are facing as the previous caller Ray was describing and yet they're apparently not included on the basis of jobs. Last thought. 10 seconds.

Karen: In New Jersey on March 29th, more essential workers like in food production and agriculture will be eligible for the vaccine but that's a great point. If we're trying to fix these disparities, there has to be intentionality where we design re-openings and who is eligible for the vaccines. In New Jersey, at least as of March 29th, a lot more of these workers will be able to get the shot.

Brian: WNYC's Karen Yi, thank you for amazing reporting.

Karen: Thank you so much, Brian.

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