In Wake Forest, North Carolina, a town of about 40,000 near Raleigh, a sweeping national survey of COVID-19 symptoms has exposed a staggering ethnic divide.

Nearly two-thirds of Wake Forest’s Hispanic homes surveyed reported suffering the combination of symptoms most closely tied to the coronavirus, compared to less than 1% of everyone else.

The survey by a marketing research company is believed to be the largest measurement of symptoms of the virus. Since March, 1.6 million people have answered the basic question: Is anyone in your home experiencing symptoms ranging from a dry cough to difficulty breathing?

Across the nation, Hispanic households said yes to symptoms of COVID-19 – the lung disease caused by the virus – nearly a third more often than others, a USA TODAY analysis found. 

When the list of symptoms is narrowed to what the Centers for Disease Control recently identified as the most serious pairs of ailments – dry cough and difficulty breathing, or fever and loss of taste or smell – the differences were far starker: Hispanics experienced them almost twice as often.

Overall, 1 in 12 Hispanic households said someone in their home experienced those combinations at least once from late March to late May, compared with 1 in 21 non-Hispanic households.

Those findings made perfect sense to Clarissa Martínez de Castro, deputy vice president of the nation’s largest Latino nonprofit advocacy group, UnidosUS.

“Data is now emerging that matches the reality that we’re seeing,” Martínez de Castro said. “There are lots of factors at play, but among the biggest is the overrepresentation of Latinos in frontline jobs that don’t allow working from home.”

The gap between Hispanics and the rest of the population is even wider in the symptoms data than in confirmed coronavirus case counts across 33 states that break down their tallies by race and ethnicity, USA TODAY’s analysis found. 

That was true in the Wake Forest area, too, where the proportion of Hispanics reporting symptoms far exceeds their showing in coronavirus case counts both locally and statewide. Roughly a tenth of Wake County and North Carolina residents are Hispanic, but they account for a quarter of cases in the county and a third of cases across the state, according to Wake County spokeswoman Leah Holdren.

The grim picture “has only magnified health inequities that we have been aware of for a long time,” said Jose Cabanas, Wake County’s director of emergency medical services. 

“When I meet with patients in our community, it’s clear that their jobs make it difficult for them to social-distance,” Cabanas said. “Add to that a language barrier, the need to provide shelter for large families and it ends up being hard to follow official recommendations.”

As the pandemic progresses, evidence is mounting that the virus has hit people of color the hardest for reasons ranging from chronic health issues to service sector jobs. The symptoms survey, however, offers a unique window into the hidden prevalence of COVID-19, public health experts said. 

USA TODAY obtained the survey responses, with names kept private, through an agreement with Dynata, an international market-research company. Pattie Pan, Dynata’s executive vice president, said the goal is to leverage the company’s strength — 62 million consumers worldwide recruited to respond to its surveys — to help “solve the biggest challenge of our time.”

The symptoms data may offer a more complete picture of the virus’ true toll, said Daniel Lòpez-Cevallos, associate professor of Latino/a/x Studies, Ethnic Studies and Health Equity Studies at Oregon State University.

The gap between symptoms reported and cases, he said, suggests Latinos may be less likely to seek testing for reasons that include mistrust in health care systems. In Latino homes where some family members are undocumented, add to that a fear of being reported to and monitored by government agencies.

"We have already seen that the consequence of all these barriers is delaying care until it is absolutely necessary,” Lòpez-Cevallos said. “That same logic applies here.”

Wake Forest resident Michael Torres, 18; his parents and his 12-year-old sister have managed to stay healthy so far. But he’s worried. Like many of the other Hispanics in the area, his family hasn’t had the luxury of working from home during the pandemic.

Since the remainder of his senior year of high school was canceled in mid-March, Torres has been working full-time with his father in his painting and construction business to help pay the bills. His mother, a hairstylist, has been out of work for two months. 

“I realized, this is serious, and this is how life is going to be,” Torres said. “There’s no more waking up and going to the bus, seeing your friends at school, doing assignments every day. Now the only reason to get up early is to work and try to support my family.”

Torres thinks about catching the virus each time he and his father go to a job or the store to pick up materials. His mother is nervous about returning to work, lest she fall ill and infect others back at home.

That Hispanic families in Wake Forest have reported serious symptoms at a much higher rate than non-Hispanic came as no surprise to Torres.

“We don’t really have a choice,” he said. “Most of the Latinx community are undocumented and work in construction. We can’t get money from the government. We can’t get help, basically. We’re forced to go out and work and risk getting infected.”

Virus data catching up with reality

The rate of serious symptom pairs reported by Hispanics exceeded the non-Hispanic rate in every U.S. state except Wyoming, the survey data show. Both rates have decreased since the survey began and started to plateau in recent weeks but the Hispanic rate remains more than twice as high.

High symptom rates have tracked with outbreaks in some major cities, including New York City, where 22% of Hispanic and 11% of non-Hispanic households reported experiencing the most serious symptom combinations. More than 20,000 people have died there, and the outbreak has been worse in lower income areas, like Brooklyn, where 1 in 5 people live in poverty and 1 in 47 have been confirmed positive, according to city and census data.

Lòpez-Cevallos notes that Latinos make up a large percentage of the nation’s essential workers — jobs such as grocery clerks, hotel staff and restaurant cooks — and often live in more confined spaces because of their low pay. Hispanic households also tend to be larger, including extended family, he said, which coincides with higher symptom rates in the data.

Households of at least three people experienced the most serious symptoms at almost twice the rate of those with at most two people, the survey shows. More than half of Hispanic homes surveyed had three or more people. 

Eiran Zomara Arriaza, a 48-year-old restaurant worker, lives with four family members in a three-bedroom apartment in Oakland, California. Across the surrounding county of Alameda, 6.2% of Hispanic homes reported the serious symptoms — roughly twice the rate of non-Hispanic homes in the area.

Arriaza shares a room with her daughter and disabled brother. In April, Arriaza was the first to run a high fever. Soon everyone in the apartment was ill. 

All five eventually tested positive for COVID-19. They quarantined themselves, living for a month mostly on the limited amount of rice, beans and tuna they had on hand. A church group occasionally left vegetables, water and other food items on their doorstep.

While all have recovered, Arriaza says she can't erase the memory of when one member of the household, another brother, became so ill with pneumonia that she feared he would die. 

"This all has affected me emotionally, physically, and financially," she said.

'We are only as strong as the most vulnerable among us'

Factors behind the spread of coronavirus in communities of color, and its potential for being far worse than is known, span all of people’s lives, from health care to work.

A recent Centers for Disease Control and Prevention report showed death rates among hospitalized coronavirus patients in the U.S. were substantially higher for black and Hispanic patients. The symptoms data also show higher symptom rates among black, Native American and Pacific Islander households, in addition to Hispanic.

A poll released May 20 by UnidosUS, in conjunction with SOMOS Healthcare and MoveOn, shows that one in four Latino respondents said they “knew someone” who wanted to but was not able to get tested for coronavirus, while half said they “knew someone ill with COVID-19 symptoms” who could not get tested.

Among the poll’s other results: a quarter of respondents said their employers were still not providing personal protective equipment or hand sanitizer; a quarter felt unsafe going to work; and half were “very concerned” they or someone they knew would fall ill to coronavirus.

“I’m sad, angry and frustrated to hear this data, but it’s not news,” said José Quiñonez, founder of San Francisco-based Mission Asset Fund, which has raised $12 million in emergency funds for those left out of various federal virus stimulus packages. Arriaza’s family received assistance from the fund while they were in group quarantine.

Working in frontline jobs and living in households with little space, the likelihood of exposure to coronavirus increases, said Quiñonez, a financial services innovator who was awarded a MacArthur “genius” grant in 2016 for his work in low-income lending. Adding to the stress for many Latinos, he said, is growing unemployment, as the pandemic has decimated many service-oriented businesses.

“The people coming to us for our $500 grants mostly say they have no income, they have kids depending on them, they have no relief and they’re scared,” he said. “So, many of them are going hungry.”

Ultimately, the plight of Latinos in the U.S. needs to be addressed if only because it is inextricably linked to the fate of the nation as a whole, says Priscilla González, campaigns director at Mijente, a national social justice organization.

“What’s happening to Latinos has to do with not having access to the usual public safety nets, which allows the virus to tear through our community,” González said. “We are only as strong as the most vulnerable among us. If the world wants a full recovery, we need relief for communities that are hardest hit.”