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Juan Jose Reyes, 38, and his three daughters got tested for COVID-19 at Neighborhood Health in Fairfax County. Clinics like this provide testing and care in the absence of a coordinated county testing effort. Daniella Cheslow/WAMU hide caption

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Daniella Cheslow/WAMU

Rain fell on a gray Friday as Ana Mejia picked up donated groceries and medication to take back home to Culmore, in Fairfax County. Mejia, 63, said she took precautions because she is diabetic, a risk factor for the coronavirus. She wore a green mask. She said she rarely leaves her home.

"They've told us to protect ourselves and not go outside, and that's what we're trying to do," Mejia said.

She is working, caring for children whose mothers are also still working as house cleaners. Many people she knows have been affected by the coronavirus because Mejia lives in a hotspot for its spread.

In Fairfax County, Latinos make up close to 60% of the county's COVID-19 cases, a rate more than three times their share of the population. Mejia's neighborhood, Culmore, was identified as an "island of disadvantage" in a recent health study; a third of the neighborhood's children lived in poverty, and more than half the residents were uninsured. Many residents are undocumented. In areas like these, workers are more likely to be exposed to infection at work and then bring it home to their cramped apartments.

COVID-19 infections are rising as Gov. Ralph Northam prepares to reopen parts of Virginia for business. Fairfax County and other Northern Virginia governments say they are not yet ready. Managing the pandemic among immigrant communities may be key to limiting its spread.

Ana Mejia, 63, stops by Culmore Clinic in Fairfax County to collect groceries and medications. The clinic serves primarily Latino patients, and recently Mejia's neighborhood has seen an uptick in COVID-19 cases. Daniella Cheslow/WAMU hide caption

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Daniella Cheslow/WAMU

Mejia collected her groceries and medical donations from Culmore Clinic, an interfaith nonprofit that serves the uninsured. Most of its patients are Latino, and co-founder Terry O'Hara Lavoie said costs have spiraled in recent weeks as more patients fall on hard times. Several of the regulars are struggling to afford food and medications — even basics, like Tylenol. Last week, Culmore Clinic began COVID-19 testing. More than half the first 33 tests came back positive, a result that unleashes new expenses, like home blood oxygen monitors and ongoing telemedicine care, as well as the possibility of hospitalization.

"We do get a little nervous about what the future holds," said O'Hara Lavoie.

As she speaks, a volunteer drops off an envelope delivered from a wealthy community next door. O'Hara Lavoie reads the letter inside: "Four women from Lake Barcroft whose names are listed below have been making masks for our neighborhood residents for a few weeks now. And we are very glad to be able to donate the enclosed $690 dollars in checks to your clinic."

"Oh wow," O'Hara Lavoie says, tearing up. It's a lifeline for her overextended organization – and a reminder of the prosperity just a few blocks away.

Terry O'Hara Lavoie, co-founder of the Culmore Clinic, says the coronavirus is stretching the budget of one of the few medical care sites catering to low-income Latino patients. Daniella Cheslow/WAMU hide caption

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Daniella Cheslow/WAMU

Clinics like Culmore are critical to the COVID-19 response because Fairfax County is not mounting a public testing program. Instead, the county directs uninsured patients to clinics that work with Medicaid or to nonprofits.

Luis Aguilar, head of the immigrant advocacy group CASA Virginia, says Latinos have acute needs, in part because many undocumented immigrants do not qualify for Medicaid, unemployment benefits or stimulus checks from the federal government.

"The approach of relying on non-profits to step in during a pandemic ... there needs to be a lot more from the local government," he says.

State Sen. Scott Surovell (D), who represents parts of Fairfax County, agrees.

"Fairfax County is one of the top five wealthiest counties in the United States of America, and if Fairfax can't afford testing for its low-income residents, that would really surprise me," he said.

The county is keenly aware of the challenges facing Latino patients. Board of County Supervisors Chairman Jeff McKay said the county allocated $20 million to area non-profits that help support food and housing among the vulnerable, including undocumented immigrants.

Epidemiologist Rene Najera with the Fairfax County Health Department gives talks on Spanish-language TV and radio stations to help inform the public. The county offers information in Spanish about COVID-19 online and operates a Spanish-language text messaging service.

Najera said the county's public lab does not have enough tests available to launch widespread testing; instead, it follows state guidelines to prioritize healthcare workers and people in nursing homes.

"We're managing I think as best as we can," he said. "Can we do more? Absolutely."

Neighborhood Health gives its highest-risk COVID-19 patients tools to measure their oxygen levels at home. The majority of their COVID-19 patients are Spanish speakers. Daniella Cheslow/WAMU hide caption

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Daniella Cheslow/WAMU

The challenges facing Fairfax County are not unique. Latino patients also comprise a majority of cases in Alexandria and Prince William County, and they make up a high percentage of cases in parts of D.C. and areas of Maryland.

Najera said he noticed at least one encouraging sign – Spanish-speaking patients seem to be surviving the disease.

"We're talking about a generally younger population, maybe a little bit more resilient," he said. "It might be getting them to the hospital but it might not be killing them at a higher rate."

As testing falls on non-profits, they are expanding their work. Neighborhood Health runs five testing sites for COVID-19, including the newly launched operation at Culmore Clinic.

"The way we've been approaching it is we've been trying to ramp up," said Executive Director Basim Khan. "We're doing it first and kind of asking questions later."

The federal government just announced it would support Khan's work with half a million dollars; Khan said Fairfax County agreed to allocate a similar sum, although WAMU could not confirm this.

However, Neighborhood Health has only tested 1,200 people across Northern Virginia so far, and the need is much higher.

"We're really happy it came through," Khan said of the funding. "But to really reach our population we need much more testing. We alone have 30,000 patients."

In addition to testing, Khan said he was negotiating with counties to help patients isolate away from their families in hotels. So far, he has been able to house one patient in Fairfax County and another one in Arlington.

A nurse tests patients at Neighborhood Health clinic in Fairfax County on Friday. Clinics like this provide testing and care in the absence of a coordinated county testing effort. Daniella Cheslow/WAMU hide caption

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Daniella Cheslow/WAMU

Limited as it is, Neighborhood Health provides a vital service. At its headquarters off Richmond Highway in Fairfax County, Juan Jose Reyes, 38, pulled up in a black Ford pickup truck. A nurse used a ladder to climb up and swab Reyes and each of his three daughters.

"I feel the cotton in my brain," Reyes said of the nasal swab used in the test. "Horrible, terrible. But it's necessary."

Reyes, an undocumented immigrant from Ecuador, said he missed five days of work as a glazer while he quarantined with what he thought were COVID-19 symptoms: pain throughout his body and a headache. He and his daughters live in a two-bedroom apartment, typical of households where the virus spreads.

By Monday, Reyes and his daughters received their results: negative. He could go back to work without worrying about spreading the virus to his colleagues.