NORTH CAROLINA, Durham- Eight-year-old Aurea Yolotzin Soto Morales was a playful, intelligent second-grader whose family and friends called Yoshi. She died on Monday, June 1, just four days after she tested positive for COVID-19, or the novel coronavirus. She was born and raised in Durham.
The young girl is the first and only child to die of coronavirus related causes in North Carolina, according to N.C. Department of Health and Human Services. Nationwide, there have been 21 reported deaths in COVID-19 patients under the age of 14, according to most recent statistics updated by the Centers for Disease Control and Prevention.
“This is a loss we will never recover from,” says Araceli Morales Martinez of her daughter’s death.
The name Yoshi comes from her full name, Aurea Yolotzin. Morales Martinez chose the indigenous Nahuatl name for its meaning: “corazoncito de oro” or little heart of gold. She requested that Enlace Latino NC use the name Yoshi to refer to her daughter, so the people who knew her will recognize her name. “The whole world knew her as Yoshi,” she says.
Morales Martinez and her husband, Salvador Soto, both tested positive for the coronavirus on Tuesday, May 26. They do not have health insurance, so they got tested at a local Walgreen’s. The only symptom they have ever experienced was loss of smell. Jennifer Morales, Yoshi’s 17-year-old sister, also tested positive but has remained asymptomatic.
As of June 12, Latinos made up 43% of COVID-19 cases in N.C., yet are just 9.3% of the total population. Within the number of coronavirus cases in the Latino community, pediatric cases make up 13% (ages 0 to 17).
Pediatric deaths caused by the coronavirus are rare. In a June 5 statement released by N.C. Department of Health and Human Services, state epidemiologist Dr. Zack Moore said: “We extend our deepest sympathies to this child’s family. While most COVID-19 cases in children are not severe, this is a tragic reminder for all of us that COVID-19 can be a serious illness for anyone.”
The family was not named in NCDHHS’s release, but they say they want to share their story to keep others safe.
“We’re not spreading fear,” says Yoshi’s sister Jennifer. “We’re spreading awareness on how this virus could hit anyone. The community now is not taking it as seriously.”
Since North Carolina began reopening, the numbers of coronavirus cases and hospitalizations have steadily increased. There are currently 812 coronavirus patients hospitalized as of June 12, a record high. By comparison, there were 442 on May 10.
On Thursday, May 28, Yoshi refused to eat her dinner. She complained of a sore throat and she couldn’t enjoy her food. On Friday, Morales Martinez took both of her daughters to the pediatrician. Yoshi was tested for both strep throat (a bacterial infection) and COVID-19; both tests came back positive.
According to Morales Martinez, the doctor prescribed Tylenol for the coronavirus and an antibiotic for the strep infection. The family left the doctor and drove to a pharmacy a few miles away to pick up the prescription.
That’s when Jennifer looked toward the backseat and saw her sister silently having convulsions. She shouted for her mother to stop the car. Morales Martinez pulled the van over into a parking lot to hold her daughter and call for an ambulance. The family was taken to the emergency room at UNC Hospitals. Morales Martinez said her daughter never said a word, and that she looked scared.
Through the evening Yoshi had multiple seizures. Around 10 p.m. she closed her eyes and slipped into a coma. On Monday, when doctors could no longer do anything for Yoshi, she was taken off life support.
Morales Martinez says she had to demand a doctor see her daughter throughout the first night and felt helpless, without any answers. But doctors didn’t have answers, either. They told her mother that Yoshi experienced swelling in her brain and she lost oxygen. They could not resuscitate her after multiple attempts.
The family understands that what happened to their daughter was rare. According to Morales Martinez, a nurse or doctor (she is not sure who) told her that the two infections may have been a deadly combination.
“That bacteria [strep] combined with COVID became suddenly fatal for my daughter,” says Morales Martinez. “For many parents, if their kids are sick with sore throats, they take them to see a nurse. But with this virus, this disease, I can’t bear to see another mother… “
Her voice trails off as she holds back tears. “I lost my daughter even though I’ve been very careful with them both.”
According to global statistics, most pediatric cases of the coronavirus are mild and a very slim number include sore throat as a symptom. Dr. Gabriela Maradiaga Panayotti, a pediatrician with Duke Medicine, says because “everything is so new with COVID-19” she and her peers can’t assess if there are grave effects to strep throat when combined with the virus.
“We don’t have data to know if [strep infection] is a common thing, and it’s not clear whether that was a relevant or accidental finding.”
She added that some children regularly carry strep bacteria in the throats without symptoms; but in severe cases, the bacteria can reach the blood and spinal fluid. “It may have been the strep infection that made COVID-19 worse, like [Yoshi’s] mom said, or not,” says Dr. Maradiaga Panayotti. “I am not even sure her UNC doctors know the answer to this.”
A representative at UNC Healthcare said doctors cannot share patient information with anyone outside the family. On Wednesday, Morales Martinez said that no one from the hospital has called the family to give more information.
As the virus spreads, so do healthcare disparities
Yoshi’s death is the first reported case of a young child getting sick and dying from coronavirus in N.C. It left the Latino community on edge, a group that already faces unique challenges and healthcare disadvantages before and during the pandemic.
“We’re starting to take notice and starting to get better information on the demographics of people testing positive and getting hospitalized or dying from getting the virus,” says Dr. Michelle Hernandez, a pediatrician at UNC Healthcare advocating for Latino families. “But the data is not complete among Latinos. We may not fully understand the impact.”
A large majority of Latinos are considered essential workers, and parents, like Yoshi’s father Salvador Soto, must leave their homes to earn income. He is an electrician who works on construction sites. Statistically, there is a much larger possibility of Latinos spreading the virus in their families compared to other families, who have more opportunities to work from home and practice social distancing on the job.
Available statistics give a glimpse into how the coronavirus can spread through families. According to DHHS statistics updated on June 11, 55% of COVID-19 cases among Latinos are in people ages 25 to 49. For non-Hispanics (as named in the data) in that same age group, it is 36%. Latino children under 17 years old make up 13%. For that same age group in non-Hispanics, positive cases are only 4%.
Exacerbating the reality on the ground is the lack of available workplace data to determine who is getting sick, and where. For example, the state won’t reveal the outbreaks or numbers of positive cases in meatpacking and poultry plants or construction companies, which affect hundreds of families in counties currently experiencing the highest rates of spread, like Duplin, Wayne and Chatham. Even in restaurants, a long time industry for immigrant workers, there is no designated protocol or official oversight in reporting cases or protecting employees on the job.
On Wednesday, June 10, The Latinx Advocacy Team & Interdisciplinary Network for COVID-19, known as LATIN-19, (a group co-organized by Dr. Maradiaga Panayotti) and other Latino community stakeholders organized a call with DHHS Secretary Mandy Cohen to address the issues affecting their community. The secretary acknowledged that inequities exist.
LATIN-19 was formed in March to address community concerns and work toward solutions in providing better access to healthcare, transparent information and culturally sensitive messaging. The group sent a letter to NCDHHS last week with a list of actionable steps the state must take, fully acknowledging that “the COVID-19 pandemic reveals and amplifies deep inequities that put Latinx communities at risk on multiple fronts.”
The letter led to Wednesday’s call. In it, the group explains that Latino families are supported by essential workers, who earn low wages but experience a higher risk of contracting the virus on the job. The letter also expresses “a lag in accurate, timely communication of vital information in accessible languages and with culturally-relevant messaging, such as mitigating risk in multigenerational homes.”
“Children in immigrant families often have parents working for poverty wages, toiling in the shadows of their undocumented status, and living without access to health insurance and public benefits,” the letter states. “In addition, many of these workers lack access to protective equipment and work in jobs where they do not have the ability to enforce the social distancing guidelines to prevent the spread of the virus.”
Durham City Council member Javiera Caballero says the state lagged in paying attention to immigrant communities, at the cost of people’s lives.
“This is the first time we’ve gotten overtures from the state,” she told Enlace Latino NC after Wednesday’s meeting. “I appreciate they are now doing this, but really they should have been doing within the first three weeks into the pandemic.”
She pointed out that a significant number of Latinos in N.C who are undocumented and uninsured can’t risk missing work.
“They didn’t get stimulus money, so that needs to be provided through the state,” says Caballero. In April, states like California and New York set up a fund for their undocumented residents to receive stimulus money from the state.
“Folks are going to keep going to work if they don’t have another economic outcome for themselves,” adds Caballero. “We can’t ask people to stay home if they are not being helped with their rent and essential needs are not being met.”
Morales Martinez says that a GoFundMe campaign set up by a family friend after Yoshi’s death is helping them pay rent and other expenses while the family is quarantined at home. She has yet to receive a medical bill and is unsure of what it will cost. The campaign has raised more than $40,000.
Jennifer Morales, Yoshi’s sister, agrees that the state should be more attentive to her community.
“From the state we need more information about the virus in Spanish, to try to combat the stigma around it,” she says. “There is a problem there. Especially people who can’t speak English are experiencing this situation a lot harder. They don’t have access to enough sources or help.”</span
NCDHHS does not have a plan for undocumented or uninsured residents to access full coronavirus related healthcare during the pandemic.
On the healthcare level, the doctors on the Latin-19 task force push for better care during medical visits and beyond. Hernandez says that telehealth has taken off during the pandemic, and is here to stay. But even that resource isn’t as accessible as it should be.
“There’s a socioeconomic divide for who’s participating in telemedicine and who is not,” says Hernandez, who notes that users are mostly middle to upper-middle-class white families “who are pretty well connected” to online health news and resources.
Language barriers are also still an issue. For example, MyChart is the secure online platform used by UNC and Duke where patients can access their medical records, information about appointments, and prescriptions. The web portal is not available in Spanish or any language other than English. Spanish-language resources are not easy to find or obvious on either hospital or healthcare system’s homepage. County health departments across the state offer a translate function on their websites in multiple languages, provided by Google.
How to stop the spread
Doctors like Gabriela Maradiaga Panayotti and Michelle Hernandez make up a cohort of Latinos in the medical field across the state who are advocating for their own communities.
“The first thing I would do is give a message of hope,” says Dr. Maradiaga Panayotti. “I would encourage our families to know they have a lot of power. You can take control of this situation.”
She suggests visiting the Spanish resources on nc.gov/covid19 for up-to-date information, videos in Spanish, and important phone numbers to keep on hand.
The biggest piece of advice for stopping the spread, say, doctors, is physical distancing.
“Make a conscious choice that you aren’t going to interact with people outside your home,” says Dr. Maradiaga Panayotti. “That’s hard for us because we have strong ties to our community. But it’s a difficult choice we make for each other.
“Instead of saying ‘we are stuck at home,’ say ‘we are safe at home.’”
Morales Martinez does not know how her daughter contracted COVID-19, but worries it may have been on an occasional trip to the store. She warns other Latino parents to reframe how they run their errands, like a walk to the neighborhood tienda, in order to keep their families safe.
“Be conscious about it,” she warns. “It’s easy as a mother to say ‘run to the store and grab some tortillas and some soda.’ Innocent kids walk into the store, they touch and grab things, and they don’t know what kind of germs they are bringing home.”
She urges everyone to stay home, even as the state reopens. She shudders when recalling a trip to Walmart, where people “of all races,” she says, were shopping without wearing masks.
Dr. Hernandez also recommends having a plan with doctors who know your family. It’s much easier to treat patients, especially children, if they have your records on file.
“Try to get in touch with your child’s primary care doctor to maintain management of symptoms in case they occur,” she says.
Less than a week after Yoshi passed away, her mother scrolled through photo albums on her phone to remember her daughter’s laughter. “She was a jokester,” Morales Martinez says. In one video, it’s summertime and Yoshi stands on a large rock at the park, posing and dancing to Drake’s internet hit “In My Feelings.” In another, Yoshi is lying in the snow, sweeping her arms and legs back and forth, giggling. “I’m a snow angel!” she yells.
Morales Martinez sends these images over WhatsApp. In one she’s hugging Wool E. Bull, the Durham Bulls baseball team mascot. Another, eating macarons at Disney World. Despite their age difference, sisters Yoshi and Jennifer, 17, celebrated their birthdays at the Florida theme park each spring ever since Yoshi turned three. It was the family’s annual vacation. Because of the pandemic, the family was saving up to go later into winter.
“It’s been a tough road,” Jennifer Morales says of losing her sister. “I’m trying to keep myself up every day even though I’m not seeing my sister anymore.”
Yoshi was a second-grader at Durham’s Creekside Elementary School. The family hopes to have a celebration of Yoshi’s life at Creekside later this summer. Her mother calls it “her final goodbye.”