Dr. Fermin Leguen has been a familiar presence in Southern Nevada’s COVID-19 response, delivering matter-of-fact updates in English and then pivoting to do the same thing in his native Spanish.

But taking on coronavirus in Nevada’s most populous area isn’t the first time Leguen, 65, has confronted major public health challenges. Raised and educated in Cuba, Leguen cut his teeth in a three-year stint with the World Health Organization in Ethiopia in the 1980s, when the country was devastated by a famine estimated to have claimed 1 million lives and reckoning with the emergence of AIDS.

“It’s different than other pandemics,” Leguen said of COVID-19 in a Spanish interview with The Nevada Independent En Espanol. “At least one in four people who are infected with COVID never present symptoms of the illness, but are able to transmit it. That’s a large volume. So this really changes the dynamic of how someone confronts it.”

Leguen’s ability to communicate in two languages is of particular importance as coronavirus has disproportionately affected Southern Nevada’s Hispanic community. Latinos have been diagnosed with COVID-19 at a far higher rate than any other ethnicity, and more than twice as frequently as whites.

But he’s honest about the shortcomings of the agency he’s led as acting chief health officer since October. The staff doesn’t reflect the full diversity of the population, the response to the community could have been faster and more could be done to make critical information more accessible to Spanish speakers.

“We don’t have the same proportion of employees that speak Spanish within the health district, that can communicate with the Hispanic population,” he said. “This is a big limitation we have.”

He also wants to see more collaboration with groups in the community. The health district earlier this year announced testing at churches with predominantly Latino congregations, as well as the consulates of Mexico and El Salvador, but he said a deeper involvement within subgroups of the county could help detect hot spots and problems before they show up in the health district’s surveillance.

“What we try to communicate to the Hispanic population, doesn’t get to everyone because we haven’t used channels that are going to help us reach those groups within the community,” he said. “Because of that, one of the things that we want to do in the near future is to see how we improve this communication.”

On Tuesday, Clark County announced a new educational campaign to reach out to the Hispanic community, including a battery of bilingual public service announcements and mask distribution events.

Finding his calling

Leguen, who was born in Guantanamo — the Cuban province perhaps best known as home to the American prison — originally wanted to go into neurosurgery. But an aunt who worked in public health in Havana introduced him to the field, and he started a residency in epidemiology.

“I’ve never regretted doing it because I’ve felt very satisfied with what I’ve seen and the things I’ve been able to contribute in many communities,” he said.

He’s been able to help with immunization programs and addressing the cholera outbreak in Ethiopia, opening up new health clinics there. He worked in programs for respiratory illnesses and for AIDS, just as that disease was taking hold in the 1980s. 

“This gave me the opportunity to get to know that country, and its most remote areas,” he said. 

In Cuba, he was a researcher in the Pedro Kourí Institute, where he was part of a group that developed a vaccine against meningitis B — a bacterial disease that attracts the brain and spinal cord, potentially causing death or serious neurological damage. From the time the vaccine started being widely administered in Cuba in 1989 to 2006, incidence of the disease dropped 97 percent.

It wasn’t until after a stint lecturing in the public health field in Galicia, Spain that Leguen came to the U.S. in 1991, with help from an uncle who lived in Miami and sponsored him to come to the U.S. Today, he lives with his wife Rosario, a teacher’s assistant, and his 14-year-old daughter.

Communist Cuba has a tradition of a strong health care workforce, including the highest density of doctors in the world, with 82 doctors for every 1,000 people, according to the World Health Organization. That’s more than three times the rate in the U.S., which has about 26 doctors for every 1,000 people.

It’s led the country to export doctors to other parts of the world. A group of 52 Cuban doctors were dispatched to Italy in March as that country was reeling from coronavirus, for example.

Leguen said the initiatives are motivated both by humanitarian interests and political strategy.

“It is direct and effective aid generally to populations that don’t have access to advanced health care services, and it’s also one of the political tools of the Cuban government to interact or penetrate more strongly into other territories,” Leguen said.

One of the biggest differences he sees from the system in his native country is how health care in America is tied so strongly to employment. Decisions about keeping or quitting a job are often dictated by concerns about losing insurance.

It’s a problem that Leguen expects to become more pronounced as Nevada reckons with a devastatingly high rate of unemployment and people whose companies may have furloughed them and maintained their health insurance eventually move them off the rolls for good. While jobless people can seek out insurance called COBRA, it’s often prohibitively expensive.

Nearly 100,000 more people were expected to enroll in Medicaid by the end of May compared with April.

Leguen said people losing their insurance could mean patients delay care until the situation has escalated to emergency levels. But it could also affect the system at large, making it hard for hospitals to recoup costs of care and throwing off their budgets.

A different kind of disease

With illnesses such as cholera, addressing basic hygiene practices can do much to stop the disease. The stealthy way COVID-19 passes, and the fact that much remains unknown about it, complicate the response.

“The fact that a person doesn’t have a sign or symptom doesn’t mean that they can’t pass the illness on to you,” he said.

Leguen described the situation in March among Nevadans and public health officials as tense, uncertain about how to address a pandemic. Months later, there’s a greater understanding of the disease, even though there are still many unknowns and a new resurgence in cases.

“You see fewer manifestations of fear toward the disease,” he said. “We hope that in the coming weeks or months, this pandemic diminishes or disappears. We don’t know, because this is a new phenomenon, but we have hope that it will be like that, with the measures that we have been taking.”

While he lauded the way various organizations have worked together to respond to the pandemic, Leguen acknowledged the whole situation is personally exhausting.

“I have to work to differentiate Monday from Friday, or Sunday from Wednesday,” he said.

But aside from the workload, the biggest challenge has been the way the disease has been the way the pandemic has prevented him from seeing those he cares about.

“What has affected me is not being able to see my family and friends, not being able to spend time with the people I love most,” he said.