This is our second story in a new reporting series, “Year One: COVID-19’s Death Toll.” See all the stories and interactive features here.
When Jose Torres was admitted into an ICU in November 2020, his family hoped he wouldn’t be there long. Both he and his wife, Teresa, had gone to Scripps Mercy Hospital for other reasons, then tested positive for COVID-19.
The couple’s health had been declining in recent years but they’d been resilient. Jose was born in Mexico City and Teresa grew up in San Ysidro. Jose worked for an airline, but eventually he and Teresa started their own travel agency, which survived a fire.
Now Jose and Teresa found themselves just feet apart, unable to see or communicate with each other. They were in adjoining hospital rooms, separated only by a wall.
Teresa passed away on Dec. 8. Their daughter, Diana Gimenez, waited days before telling Jose, fearing that an emotional setback might worsen his condition. But Jose kept asking about Teresa and on Dec. 13, Diana finally broke the news.
“He made a gesture like he knew,” she said. “He made a sign with his fingers like he was walking up a ladder and ‘I’m gonna follow her.’”
He died the same day.
The novel coronavirus tore apart families across the county, but a new analysis by Voice of San Diego reveals immigrant families like those of Jose and Teresa Torres were hit harder than almost any other group.
Immigrants accounted for more than half of all COVID-related deaths during the pandemic’s first year. Foreign-born residents make up 23 percent of San Diego County’s population but accounted for 52 percent of all COVID-related deaths.
Voice of San Diego examined and logged 4,046 death certificates — one for each COVID-related death between March 22, 2020, the date of the first recorded death, and March 22, 2021.
Of the immigrants killed in the first year of the pandemic in San Diego County, 68 percent were from Mexico. Filipinos and Iraqis also made up a significant percentage of people from other countries.
In some respects, the findings are surprising. A phenomenon known as the “healthy immigrant effect” indicates that immigrants to the United States are healthier than natural born residents. People who immigrate, the thinking goes, tend to be fitter than those who don’t.
“Our running hypothesis on immigrant health status is that immigrants, at least from Mexico, are actually healthier and have healthier health habits (eg, in the case of diet, smoking, alcohol intake),” wrote Sheila Castañeda, a professor of public health at San Diego State University, in an email.
But Castañeda also acknowledged the problems around COVID pose additional complexities. Immigrants, for instance, have less access to medical care, she said.
“It doesn’t surprise me the majority of deaths were immigrants, because they tend to comprise the essential workers. They didn’t have the luxury of working from home. And there were more likely to be older people who lived in multi-generational homes,” said Maria Rosario Araneta, a professor of public health at UC San Diego.
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Jose and Teresa retired after their travel agency went bust in 2009 — the internet and a recession effectively killed the business — and later moved in with their daughter full time. They bought a 1,700-square-foot townhouse in Bay Terraces in late 2019. There were three generations living together: Jose and Teresa, Diana and her husband, plus Diana’s daughter, Ivette, and her husband.
Diana, Ivette and Ivette’s husband all worked jobs that allowed them to be remote — in insurance, health care and technology — so they turned the home into an office.
Despite having six people under a single roof, Diana described those early months of the pandemic as a joy. They passed the time together playing Monopoly and Dominoes and praying with their extended family of aunties and cousins over Zoom.
They were careful, asking visitors to stay outside and largely restricting their own movements to the grocery store and pharmacy. Diana and Ivette wore masks inside the home but would sometimes remove them to console Teresa. She was suffering from dementia and couldn’t understand why people were covering up their faces.
In the weeks after her parents died, Diana went back through her memory to reconstruct who might have come near them. She interrogated people close to her. Then dropped the issue. It wasn’t going to bring anyone back.
Living in multi-generational housing is more culturally-familiar to many immigrants and also more affordable.
“California has such high housing prices and it has forced many low-income and Latino households to live in these very tiny houses,” said Arturo Bustamante, a UC Los Angeles public health professor. “And we know this kind of setting contributes to the spread of the virus.”
Voice’s analysis identified 32 residential addresses, like Jose’s and Teresa’s, where two people died from COVID-19.
Of those 32, three-quarters were immigrant households. Two of those homes were located on the same block in Otay Mesa West. Door to door, they lived 350 feet from one another.
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It’s unclear exactly what caused immigrants to die at such disproportionate rates in San Diego. Multi-generational housing clearly put them more at-risk. But several other factors may also be at play.
It’s not necessarily immigration status itself that caused the disproportionate death rates, according to Castañeda. Exposure rates, access to care and poverty rates ��may actually play a role,” she wrote.
Poverty does seem closely related to death rates.
A Voice analysis of death rates and median income rates showed a significant correlation. For every $6,600 increase in household income the chances of death decreased by 10 percent.
Education level — which is reflective of income — sticks out too. Among immigrants who died, 51 percent did not have a high school diploma. The same was true for just 10 percent of non-immigrants.
Age didn’t seem to drive the difference in death rates at all. COVID is deadlier for older people. But the median age for both immigrants and non-immigrants who died was 76.
Other variables, like language barriers and a tendency toward essential labor, may have piled on as risk factors. In the early days of COVID especially, there was limited information available in some people’s home languages, said Araneta.
Asian residents, unlike Latinos for instance, speak hundreds of different languages. Officials didn’t have a good sense of which communities they should be targeting information toward, she said.
“There were many conflicting messages and it became difficult to understand why we needed to lock down or why we needed to wear face masks,” Bustamante said. “It was even more challenging for those of us who cannot speak English fluently.”
It’s also unclear whether the healthy immigrant effect has a long shelf life. Some studies have shown that the longer immigrants stay in the United States the more their health is likely to decline.
Like many immigrants who died, Jose had been here for decades. Over the years he developed diabetes — which increases the risk of death in COVID cases.
A full 25 percent of San Diegans who died from COVID had diabetes. Eighty percent had a chronic condition that contributed to their death, such as hypertension, kidney disease or obesity.
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Shortly after Jose and Teresa were hospitalized, Diana and Ivette also tested positive for COVID-19. Their husbands’ tests came back negative. The couples tried to keep their distance. They were living in different rooms when Teresa and Jose died.
“I couldn’t hug my husband. My mom couldn’t hug my dad,” Ivette said. “We had to grieve alone.”
The grief is still very much present these days, but the family takes comfort in the time they got to spend with Jose and Teresa during the pandemic. They’ve made plans to bring the ashes down to the couple’s church in Tijuana. But they’re not quite ready to say goodbye.
The family has watched, in the meantime, as the vaccines roll out, the world opens back up and the death count recedes into the background of everyday life.
“People tend to forget what happened last year,” Ivette said, “except for those who lost loved ones.”
This reporting project is made possible with support from the Fund for Investigative Journalism.