Dr. Roli Dwivedi, chief clinic officer at Community-University Health Care Center, says health disparates are causing higher COVID-19 infection rates in immigrant communities. Credit: Photos courtesy of the University of Minnesota

As COVID-19 surges across Minnesota and state hospitals near capacity, Sahan Journal checked in with a Minneapolis community health clinic to see how immigrant populations are coping. 

Roli Dwiveldi is the chief clinic officer at Community-University Health Care Center in Minneapolis’ Ventura Village Neighborhood. A federally qualified health center, CUHCC specializes in serving patients who don’t have health insurance. 

Roughly 40 percent of CUHCC’s patients are Black and East African, about 23 percent Latino, and the rest are white, Asian and indigenous.

Instead of contracting COVID-19 from going to the bars at night or informal gatherings, Dwiveldi said most of CUHCC’s patients are contracting the virus from their living situation or workplace.

Many also don’t have easy access to COVID-19 testing, which is why CUHCC has been going to their homes and neighborhoods periodically with mobile testing events. 

We spoke with Dwiveldi about how the recent COVID-19 surge is affecting immigrant populations, what people can do to protect themselves, and what to expect in the coming months once a vaccine becomes available.

This conversation has been edited for clarity. 

What has your COVID-19 patient volume looked like recently? Has it gone up as infections across the state have gone up?

Dr. Dwiveldi: Yes, definitely. The disparities are real, especially in our Latinx communities, our Black communities, and our indigenous and Native American populations. 

The reason the disparities exist is because of the social determinants of health, which can be access to care, transportation, language barriers, and how a lot of folks are essential employees. To respond to these needs, we bring teams of folks to the communities to provide testing. 

In the last couple of weeks there’s been more demand for testing. Last week, in just three hours we had 40 patients show up for the testing. 

Are patients who know they’re infected with the virus coming to the clinic to be treated?

We are trying to keep patients in their houses and provide the care that they need there. The main things that matter is if our patients have access to medication, to food, to supportive care. We serve a lot of patients who experience homelessness. So, having connections in the communities to provide housing so that they can quarantine themselves is key. In my mind, that is safer than getting medicine.

How many of your patients are experiencing mild and moderate symptoms versus serious symptoms? 

Most of the patients are in the younger age group, up to age 35 or 40, and they are experiencing mild to moderate illness. We’ve had some folks in their 70s or 80s who needed hospitalization to stabilize, and then they got discharged. The majority of folks are mild to moderate illnesses and can be managed at home. 

What medications are you recommending for patients infected with COVID-19? 

At CUHCC, one of our providers is very interested in integrative medicine. We have been recommending a lot of immune boosters like vitamin D, vitamin C, melatonin, black seed oil. If someone has a fever, then we recommend hydration and Tylenol. We had a patient with signs and symptoms of pneumonia. In that case, we will treat them with antibiotics and inhalers.

How long are symptoms in patients generally lasting? 

It is unpredictable. There are acute symptoms and then there are chronic symptoms. Acute symptoms like a fever might resolve within two weeks; a cough might resolve in three weeks. But chronic symptoms like fatigue, shortness of breath, nausea, fogginess—all those can take several weeks, or up to two or three months.

How are most of your patients getting infected? From the state level, we’re hearing the leading cause in recent weeks is people going out to restaurants and bars. 

For us it is more like experiencing homelessness, living in crowded housing, being an essential employee—those are the factors which are mainly responsible for infection. Things like living in public housing, working in a crowded environment. People have a fear that if they don’t go back to work they might lose their job. 

There are some people who have not been able to follow recommendations like wearing a mask or keeping good hygiene because they don’t have access to those things.

Because of the disparities, a lot of our patients also have uncontrolled diabetes, uncontrolled asthma, obesity, and heart problems. The bottom line is systemic inequities lead to comorbidities and put many of our patients at a higher risk of getting a severe COVID-19 illness.

What percentage of CUHCC’s COVID-19 testing are coming back positive?

In the beginning we were around 25-26 percent. But since we launched mobile testing and started doing larger events, we are at 16 percent. I know this is way, way higher than the state or national average. (Editor’s note: Since the pandemic began in March, the overall number of people’s COVID-19 tests who came back positive across the state is 7 percent as of November 20. But positive rates across the state have increased sharply in recent weeks. Minnesota’s most recent seven-day average was 15 percent.)

Are you advising the community to act any differently than a few months ago, given the recent surge of infections?

Religious gatherings are very common in the communities we serve. I have been asking people to not go to mosques, don’t be engaged in any social or religious gatherings. Just pray at home. Also, I get a lot of questions from our patients like, ‘Well, if I had it once, that means I had it and I cannot get it again.’ No, you can get it again, even if you had it once. 

A lot of our community members are following masking guidance but are not using the masks correctly. So we have done a lot of education around using the masks correctly. 

Come to the clinic only if it is needed. We can provide care by telehealth. Some patients don’t want to come to the clinic at all because there is so much fear of, ‘If I go to the clinic I will get the virus.’ While the other population, they will be coming to the clinic all the time because it is hard for them to do telehealth. We’re trying to find the balance and making sure that we have adequate access for the people who need to come to the clinic to get the care, and also provide adequate care to the people at home. We have done a lot of work on telehealth education, setting up people on My Chart and engaging our interpreters to do education at mobile testing events.

Any other guidelines you want to tell people right now?

Stay home when you are sick; don’t step outside at all. If you have any COVID-19 symptoms, quarantine. Take a lot of immune boosters. Stay healthy by eating healthy and also taking vitamin D and vitamin C, elderberry juice—all the immune boosters that can keep you safe. 

Have you started talking to patients about the coming COVID-19 vaccine?

We have, and it is going to be a very long journey. It will be very hard to immunize the number of people to get the effectiveness where we want to be. There is so much fear and lack of trust around the vaccine. We will have to break so many barriers. I am working on a task force with community-based researchers, physicians from different health care systems, a lot of members from the Somali community, the Latinx community and Native American communities to build messaging around the vaccine. It will require a lot of work. 

Have you come up with ways to earn community trust over the vaccine yet? 

I had a meeting with an imam a few weeks ago, and we started talking about it. The best way will be engaging leaders that the community already trusts. I can say a hundred things and people might not understand or trust or believe me. But if a community leader—especially a religious leader— says something that the community can understand and process, it can go a long way.

We will be transparent with what the data is showing about the vaccine. Ultimately, our job is to be as honest as we can be to put the communities we serve in the driver’s seat so they have the power to make the decision to get vaccinated. 

Joey Peters is a reporter for Sahan Journal. He has been a journalist for 15 years. Before joining Sahan Journal, he worked for close to a decade in New Mexico, where his reporting prompted the resignation...