A new mother's COVID-19 death shines light on ethnic disparities

She would have turned 36 in August, but for COVID-19.

Family decided to gather for her birthday anyway, coming together on a sunny evening to decorate the grave of Aurora Chacon-Esparza with balloons and flowers.

Alongside the plot marked with a simple white cross, they placed a bassinet with the most precious gift of all — the baby girl she was carrying when she was struck by the virus.

"We never thought my wife would have gotten this sick," Juan Duran-Gutierrez said softly, his eyes shielded by sunglasses.

Since reaching the U.S. earlier this year, COVID-19 has been especially cruel to racial and ethnic minorities, who suffer higher rates of underlying illness and more often work jobs that can't be done remotely. As infections continue to spread, it has become increasingly clear that among all expectant mothers, Black and Hispanic women also are contracting the virus in numbers that far exceed their share of the population.

Late last month, the U.S. Centers for Disease Control and Prevention (CDC) reported that pregnant Hispanic or Latino women were the single largest group among pregnant women testing positive for the pandemic coronavirus.

In Minnesota, 900 pregnant women have been infected, including 339 cases among Blacks and 239 cases in Hispanics, health officials say. Combined, Blacks and Hispanics account for nearly two-thirds of coronavirus cases among pregnant women in the state, but only about 15% of all women of childbearing age.

Pregnancy alone doesn't seem to put women at greater risk of dying from COVID-19. Minnesota has seen only two COVID-19 deaths in women within six weeks of delivery — one in April with an African American woman from Brooklyn Park, the other in July with Aurora, who had gained weight with recent pregnancies.

"It's an absolute tragedy," said Dr. Laura Riley, chairwoman of the department of obstetrics and gynecology at Weill Cornell Medicine in New York. "Although there is concern from CDC data that pregnant women may be a greater risk for severe disease, they do not appear to be at greater risk for death."

Most of the roughly two dozen family members present at the cemetery in Osseo to celebrate Chacon-Esparza's birthday had been infected by the coronavirus at some point, Duran-Gutierrez said.

When it reached his home in June, he feared most for Aurora's father and mother, who lived with their daughter and her family and seemed to be more at risk due to their age and medical history.

Aurora's mother spent a month in the hospital, including several days on a ventilator after contracting the disease, but eventually recovered and made it home.

Aurora did not.

"We know she's in heaven right now," Duran-Gutierrez said as family members huddled quietly around Aurora's grave and listened to recordings of her favorite music — from buoyant pop to a wistful ensemble from her native Mexico.

"We want to keep celebrating her birthday here … just to keep on remembering her."

•••Juan Duran-Gutierrez met Aurora Chacon-Esparza in 2003, and from the start, there was a connection. They soon became inseparable, with Aurora finding a marketing job at the Latin dance club in Minneapolis where Juan worked as a DJ.

As they grew closer, she persuaded him to take a parenting class in order to better connect with his children from a previous relationship. In time, the couple obtained custody of Juan's two sons, who are now young adults.

"She taught him how to be a dad," said Juan's brother, Ricardo Gutierrez.

They lived in Minneapolis, but eventually moved in with relatives in a large house in Brooklyn Center. In 2013, Aurora gave birth to the couple's first daughter, also named Aurora. Six years later, a son, Andy, arrived.

As the family grew, Juan switched to a job with a ride-sharing company and Aurora found work assembling medical devices.

At a party last winter, a relative noticed that Aurora declined a michelada, her signature drink that mixes beer with tomato and lime juices. Aurora was pregnant again and thrilled about giving her children another sibling.

Being a mother was Aurora's joy. She reveled in making special occasions out of birthdays or the start of a school year. Always taking photographs and sharing family news on social media, she captured her feelings by posting an image that read: Less Sleep — More Love — Baby #3.

"Her main priority was her children," said Marisol Duran, Juan's cousin. "Every milestone, she wanted to make sure it showed to them that they were important to her."

As the pandemic started to spread across Minnesota in March, Juan, 38, suffered what he says was the first fever of his life. Body aches pushed him to the emergency room with what he believes was COVID-19, but with too few tests available at the time, he wasn't tested and couldn't be sure what ailed him.

To play it safe, he isolated himself in the basement of the family's home for two weeks. No one else got sick, but the scare underscored the importance of doing everything possible — wearing masks, washing hands, keeping distant — to prevent the virus from coming into the house.

Juan, Aurora and their kids shared the home not only with her parents but also with her sister, brother-in-law and their three children. With the baby due in August, the couple talked about getting their own home next year, with room for Grandma and Grandpa.

"We were super excited, because she always said she wanted three kids," Juan said. "We were really happy — this was going to be our last one."

•••In June, the virus hit.

Aurora's sister and brother-in-law suffered minor symptoms. Her father would spike a fever, but his temperature would drop just as suddenly.

The children seemed to be spared, but Aurora's mother developed a cough so painful she couldn't eat. When she went to the emergency room during the first week of June, doctors said her oxygen levels were so low she had to be admitted.

Aurora got sick, too, and showed all the common symptoms, including body aches, loss of taste, fever, a cough and shortness of breath. In a span of just a few days, Juan said, they all tested positive for COVID-19 except for Aurora, although a later test confirmed her infection, as well.

Family members were startled when she went to the hospital in mid-June, but they figured it wouldn't be for long.

"I thought she was going to be there for a couple of days — maybe even one day, or two days, and come back home," Juan said.

From her hospital bed, Aurora regularly called her mother, who was a patient in a different hospital. But soon, Aurora's oxygen levels fell to the point where she was put on a ventilator.

On Father's Day weekend, Juan tried to shield the kids from his fears, agreeing to little Aurora's request that she spend her tooth fairy money on a special restaurant meal. He posted a photo from the eatery on social media, with the message that it was a difficult time for the family.

The words alarmed Marisol Duran, who knew it wasn't like Juan to post anything about his family life.

Within days, Duran organized nightly sessions where 10 to 15 family members gathered via Zoom to pray the rosary. Juan felt inspired by the support. But after Aurora's oxygen levels continued to drop, doctors performed an emergency C-section to save the baby.

"That's when I started to get really worried — like, extra worried," Juan said. "That's when it really hit me that she was in really … she was really sick."

The couple had picked out the baby's name — Andrea — and Juan was relieved that the delivery went well.

When Aurora's mother, Refugio Esparza, was discharged in early July, she still had hope for her daughter. With strong faith, she joined the nightly rosary prayers as soon as she could. She pledged along with her daughter Cinthia to cut off all her hair if only God would save Aurora.

But she also recognized the depths of the illness. "I felt that I would never see my daughter again," she said.

About a week and a half before Aurora died, hospital staff arranged for the baby's incubator to be moved alongside her mother's bed. Juan took a photo and posted it with a message asking for prayers.

Around 4 a.m. on July 19, a doctor called Juan to say Aurora was near the end. He was at his wife's bedside, holding her hand, when she died.

"I was telling her: Don't worry, the kids will be fine," Juan said. "I told her that I will take care of them, and that I will tell them every day that she loves them very much. And that one day we will all meet again."

•••Since the start of the pandemic, pregnant Latina women have regularly been infected, with some suffering only mild symptoms while others have required hospitalization, said Sonja Batalden, the director of perinatal care at Minnesota Community Care. The nonprofit operates La Clinica, a medical office on St. Paul's West Side that cares for many Hispanic patients.

"They are essential workers. They are doing jobs that make our community run," Batalden said. "They often live in either multigeneration or multifamily housing situations. So, then you're also being exposed to not just what your family is doing, but to those other family units as well, and all of their exposures."

As of late August, more than 19,000 pregnant women across the country had tested positive for COVID-19, yet there had been only 41 deaths, said Dr. Todd Stanhope, an obstetrician at North Memorial Health Hospital who performed the emergency C-section.

Still, while pregnant women don't seem to be at greater risk of death from the virus compared with nonpregnant women, the CDC this summer added pregnancy to the list of conditions that might put a person at greater risk of being hospitalized, placed in intensive care or put on a ventilator due to COVID-19.

Doctors still aren't sure exactly how much more risk women face with COVID-19 if they are pregnant, since the evidence is evolving, said Dr. Sarah Cross, an assistant professor in the department of obstetrics, gynecology and women's health at the University of Minnesota. What's clear is that they should follow the same broad guidance for controlling the spread by wearing masks, washing hands and maintaining distance from others, Cross said.

"You can reassure patients that it's uncommon for a pregnant woman to die of COVID," she said. "But because the risk is not zero, they still have to be careful."

At the time she fell ill, Aurora was seven months pregnant and considered obese, said Dr. Kathleen Kobbermann, the family physician who cared for Aurora during three pregnancies.

Kobbermann hesitated to raise the issue of weight, knowing it's sensitive, but suggested people need to be aware of obesity and the COVID-19 risk it brings. And in Aurora's case, she said, it's part of her story.

CDC figures show obesity brings a threefold increase in the risk of hospitalization for people with COVID-19 — a risk that's even higher for members of racial and ethnic minority groups.

"I think that's probably been a bigger factor than pregnancy," she says. "That word 'obesity' is a hard word."

Aurora's death was tragic, said Kobbermann, who provides medical care for her children. It's bittersweet, she adds, to see how well baby Andrea is growing and developing.

"The first time I saw the family [after Aurora's death] — and remember, they were coming in because here's new life. Here's a baby," Kobbermann said. "And I look at the baby, and I look at her other children, and I see her. She lives on in her children."

•••The two-story brown house sits on a suburban corner with three tents in the backyard. On the ninth night since Aurora Chacon-Esparza was laid to rest, her family gathers out back for the final night of praying the rosary.

Somber sounds oscillate as a priest leads the prayer and about two dozen adults voice responses in low rumbles of grief. Juan Duran-Gutierrez sits in the front row with eyes closed.

His son, Andy, approaches in tears, and Juan picks up the boy to comfort him. Soon, Andy sees his cousin Angel and scoots off to play.

After Andrea came home from the hospital, Juan tried to keep the baby and Andy with him during the night. But as soon as one child fell asleep the other would wake crying. Now, Andy sleeps with his grandparents.

With a newborn to tend to, Juan's nights are long. Starting around midnight, he wakes every two to three hours to feed the baby, who has nearly doubled her weight since birth.

The couple's oldest daughter, Aurora, 7, has struggled with her mother's death, Juan says, but recently, there's been a shift with her grief.

"Before it was more of a: 'Why? Why? That's not fair,' " he said. "Now it's like: 'I wonder what mom is doing in heaven right now? … Maybe she's watching us feed Andrea.' "

Juan, too, wrestles with his emotions as he adjusts to the role of single parent, but he finds purpose in warning others about COVID-19.

Having seen the devastating consequences, he questions why some people resist wearing a mask. He doesn't shy away from talking about the COVID-19 risks with obesity, saying Aurora gained weight with two pregnancies in as many years but had plans for losing it. And Juan worries for other Latina women who are pregnant in the midst of the pandemic.

"When this first happened, I was just devastated," he said. "I think I cried all my tears out. Now, I've just got to be strong for the kids."

MaryJo Webster contributed to this report.