A8 Monday, February 28, 2022 — DAILY REPUBLIC
Black From Page One community clinic where Moore got his shot. For some Black residents, the disparity grew worse after vaccines became widely available last summer, according to a study from UC Santa Cruz and UC San Francisco researchers. Middle-aged Blacks make up a growing, disproportionate share of the Californians who died, while the proportion shrank for Latinos and others: In March 2021, Black people ages 40 to 64, who make up roughly 5% of all middle-aged Californians, accounted for 6% of Covid-19 deaths in that age group. But a few months later, their numbers skyrocketed, accounting for 21% by last July, according to the study. In contrast, middle-aged Latinos accounted for 66% of all Covid-19 deaths at the beginning of March 2021, but then last July shrank to 30%, mirroring their proportion of all middleaged Californians. Lead researcher Alicia Riley said preliminary data through November shows continuing disparities. So why did the vaccines apparently help Latinos but not Black Californians? It’s possible that those who are most at risk of dying from the disease aren’t getting vaccinated. Younger African Americans also may not have been included in early vaccination campaigns or may have felt they weren’t at risk of severe illness or death. “What’s puzzling to me is that they have a really different story in terms of who’s dying,” said Riley, a UC Santa Cruz assistant professor of global and community health. “Are the people who were at risk of dying in the Latino community actually being reached with vaccination, whereas somehow that’s not happening for Black Californians as effectively?” Experts say myriad other factors could also be driving the trend, including poverty, lack of insurance, distrust of the health care system and higher rates of health complications like diabetes or heart disease.
Normal From Page One 3% of adultsare estimated to be on immunosuppressive medication. Others with chronic illnesses should also continue to be more cautious, experts say.The CDC lists people with diabetes, chronic obstructive pulmonary disease, heart failure, coronary artery disease and kidney disease, among others, as likely to get very sick from Covid-19. In California, 2.5 million people have been diagnosed with dia-
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The increased share of deaths for Black Californians is a powerful sign of “who was left behind when everyone else was kind of moving on out of the pandemic,” Riley said. The study did not find significant differences for other age groups, although state data suggests Black children fare worse than other races, too. Black children in California are the second most likely to die from the virus among Californians younger than 18, with 1.2 deaths per 100,000 Black children. Pacific Islanders are twice as likely to die from Covid as Black children, while all other races have less than one Covid-19 death per 100,000 children. The drivers for African American deaths are likely deeper than vaccination disparities. Rhoads, who studies death disparities in Black cancer patients, said pre-existing health complications also aren’t entirely to blame. Structural factors like poor quality health care also likely contribute to higher death rates, she said. For instance, medical devices like the pulse oximeter, which is used to determine whether a patient needs supplemental oxygen, don’t work well on dark skin. “If we just say comorbidities, then we’re blaming the victim number one and we’re washing our hands of any responsibility,” Rhoads said.
Vaccine campaigns successful for some Substantial gains have been made among Latinos, according to Riley’s study. After bearing the brunt in the early stages, Latinos’ death rate dropped from nearly 25 deaths per 100,000 people in January 2021 to one death per 100,000 in July. Over the past month, the California Department of Public Health estimates 7.2 Latinos died of Covid per 100,000 people, lower than the statewide rate of eight per 100,000. Around June 2021 the percentage of fully vaccinated Latinos outstripped Blacks and Native Americans, leaving Blacks in last place. Only 57% of Latinos are fully vaccinated, but some hard hit agricultural areas like Imperial County were quick to accept the betes, butmillions more are estimatedto be undiagnosed or prediabetic. And7% of adults in California – about 2.1 million people – have been diagnosed with heart disease.
Vaccines offer some protection Many people with health conditions gain strong protection from vaccines, experts say, but others less so. Transplant patients, like Garza-Silva, take immunosuppressive drugs so their immune system won’t attack their new organ, leaving them vulnerable to infections. For some, the first two doses of the vaccine do not provide adequate protection, and in some cases, even a third dose hasn’t been sufficient, prompting federal health officials to allow people with compromised immune systems to receive a fourth dose. Garza-Silva has received three doses and is talking to her doctor about the fourth. “Being fully vaccinated protects you dramatically, even if you have a chronic condition,” saidDr. Mark Henderson, an internal medicine physician at UC Davis Health. Still, they face an elevated risk. At Henderson’s hospital, about 20% of people hospitalized for Covid-19 are vaccinated – most of them have a health condition that makes them susceptible. Diabetes, for example, is known to affect immune
Marissa Leshnov for CalMatters
George Dowell, 40, receives the Covid-19 vaccine at Umoja Health pop-up clinic in Oakland, Thursday, February 17. The clinic works to vaccinate Black community members against Covid-19 by hosting pop-up sites staffed by people from the community. churches, schools and neighborhoods where they know vaccination rates are low. It takes patience and continued effort, Rhoads said. At Castlemont High School in Oakland, where the clinic frequently sets up shop, it was several weeks before many Black students trusted them enough to get the vaccine. “The Latino students came immediately,” she said. “But as we’ve been there over time, we’re starting to see more and more of the African American students come through, and then we started to see people bringing their parents.”
vaccine – and it has made a difference. Eduardo Garcia, senior policy manager for the Latino Community Foundation, said high death rates among Latinos early in the pandemic galvanized local groups and clinics to dole out vaccines and combat misinformation. “Over 34,000 California Latinos have died since the beginning of the pandemic,” Garcia said. “It touched people close to home. I think that also created an impulse for people to get information from reliable sources and get the vaccine.” Rhoads said refocusing Covid-19 vaccination messaging on preventing deaths rather than infections is important for equity, particularly since getting her community to trust the vaccine has been harder. “It’s about a historical relationship between Black people and public health and health care,” Rhoads said. “Instead of saying lack of trust, I’m saying there’s no relationship there, so there should be no expectation of trust.” That trust was further shaken last spring when the Food and Drug Administration warned of rare but severe side effects associated with the Johnson & Johnson vaccine. Rhoads said the number of people seeking vaccinations at her clinic dropped precipitously. To help bridge the gap, Rhoads founded Umoja Health, a collective of community and faith-based organizations in the Bay Area, to make Covid-19 testing and vaccination easy and accessible for African Americans. They bring pop-up clinic supplies to
Gov. Gavin Newsom’s recent announcement that California would be moving into a new phase of the pandemic worries advocates and community health organizers like Rhoads. The new state action plan acknowledges continuing disparities when it comes to Covid-19 deaths and highlights money in Newsom’s budget that includes $819 million to expand Medi-Cal to undocumented individuals next year, $1.7 billion to spend in a more diverse health care workforce over five years and $65 million to fund the creation of an office of community partnerships and strategic communication. But the plan offers little in terms of immediate action to fix disparities, and includes no specific programs to help Black communities. The state health department Thursday announced new $27 million contracts would be awarded to more
function, Henderson explained. “White blood cells, which are the basis of fighting infections, don’t work the same way in diabetics.” Diabetes was listed as an underlying condition in15% of Covid-19 deathsnationwide. As the state and nation look to turn the page on the pandemic, these patients, as well as older residents, have to be more vigilant in keeping up with boosters and wearing masks, Henderson said. “The pandemic has always been about the vulnerable. In terms of the havoc that it’s wreaked, it has been about the elderly, the medically vulnerable and now those who are unvaccinated,” Henderson said. Andy Imparato, director of Disability Rights California, said that unlike conversations around vaccine distribution in which advocates were able to provide input, they were not invited to discuss thestate’s SMARTER plan, a blueprint released this month that will set the stage for the next phase of the pandemic. The plan sets preparedness goals that state officials say will help them quickly respond and adapt to changing conditions, including new variants. But the 30-page document mentions people with underlying medical conditions only to emphasize that they use masks and stay up-to-date on their shots. Under the state’s exist-
ing guidelines, vaccinated people can go maskless in most public places. People who are unvaccinated must still wear a mask in all public settings, although throughout the pandemic, the rules have rarely been enforced, mostly leaving it up to businesses to decide whether to check vaccination status. And even then,vaccinated people can still transmit the virus. High-risk individuals can’t live in a bubble. People with health conditions or disabilities, for example, often depend on others for assistance. Many people with heart disease or diabetes have to venture out into the world to work. “We want the state to recognize those who even after they have been vaccinated are at high risk,” Imparato said. “We recognize that the state is trying to balance competing demands, including keeping business afloat and helping people resume their lives, but we don’t want it to happen prematurely.” The state is alsoexpected to soon set a datefor when masks will be able to come off inside schools. The imminent end of indoor masking at schools concerns Garza-Silva, who teaches middle school film appreciation for the Los Angeles Unified School District. In a sign of loosening protections, the district recently announced that it is lifting its outdoor mask mandate. Her students, she said,
‘Back to normal’ threatens Blacks and Pacific Islanders
than 100 communitybased health organizations to shore up vaccination efforts in underserved communities, including African American ones. However, community advocates worry that rhetoric used by Newsom like “turning the page” on the pandemic will ultimately prevent groups that have never caught up from moving forward. “We still have growing death rates and case rates. How can we move forward in the pandemic when we’re still suffering?” said Karla Thomas, policy director for the UCLA Native Hawaiian and Pacific Islander Covid-19 Data Policy Lab. Throughout the pandemic, Pacific Islanders have been hit the hardest by Covid-19. Their mortality rate is nearly twice that of the statewide rate and nearly six times higher than the lowest rate of 2.5 deaths per 100,000 people among those who identify as multiracial. While data suggests that Pacific Islanders are nearly 100% vaccinated, Thomas said there is reason to believe the state’s numbers are inaccurate. At times that number has creeped above 100%. From personal experience, Thomas said she is one of only two people in her 50-person Samoan church in San Bernardino that she knows is vaccinated. It’s not uncommon for there to be more than two funerals a month in her community. “I’m really concerned that we’re not taking an equitable approach to mitigate the pandemic among (Native Hawaiian and Pacific Islander) communities and other communities of color,” Thomas said. She criticized the lifting of the state’s mask mandate on Feb. 15 and the governor’s endemic plan. Rhoads echoed Thomas’ sentiments. The pandemic “is not over. It’s not for people who aren’t vaccinated, who don’t have regular health care,” she said. Rhoads and more than 35 organizations have sent a letter to the state health department in part criticizing the state’s inconsistent and confusing messaging on masking. The health department’s initial criteria for lifting the indoor mask mandate included vaccination are very understanding of her immunocompromised condition and are good about wearing masks in the classroom. She keeps windows and doors open for better airflow. She doesn’t know what will happen when masks are no longer required in schools. “Our principal has been very supportive, and maybe it will be OK for students to wear masks at least for my class, I really don’t know,” she said. Earlier this month,a Placer County high school teacher, who was fully vaccinated but had suppressed immunity from prescriptions treating his autoimmune disorder, died from Covif after returning to the classroom.
Looking to the future One hopeful sign is that therapeutics, like Remdesivir, are now much more widely available than in the earlier days – although during the omicron surge supply still struggled to keep up with demand, said Dr. Shira Abeles, an infectious disease specialist at UC San Diego Health. Also, another recently approved drug,known as Evusheld, can be used as a preventive measure, before infection, for those at highest risk, although that is still only available in more limited supplies. Liber, who lives in San Diego, said one of her friends who also is high risk was treated with monoclonal antibodies when they caught Covid,
and infection rates that were unmet when the mandate expired. Rhoads said instances like this erode public trust in government and scientific organizations, particularly among groups that placed little faith in the institutions to begin with. In response, the department agreed to schedule a meeting between Rhoads and State Public Health Officer Dr. Tomas Aragon. In a separate response to CalMatters, the state health department said vaccine equity was the “north star” of its efforts to reach marginalized communities, and that it would continue to partner with community organizations, ethnic media, translators and faith-based groups. “This work is ongoing, and closing the equity gap across all California communities remains a priority to the state’s vaccination efforts,” the department said in a statement.
‘Nothing to be afraid of’ In Oakland at the Umoja clinic, George Dowell, a 40-year-old African American, said he was getting his second vaccination dose because he didn’t “want to be left behind” as more and more businesses require proof of vaccination for entry. Dowell is among the age group experiencing higher death rates in Riley’s study. He spent the past year watching vaccinated friends and family carefully for side effects before deciding to get the shot himself. Social media and misinformation played a role in Dowell’s hesitation. “I was listening to certain people, social media, instead of listening to myself and doing what’s right,” Dowell said. He decided it was time about three weeks ago. He found the Umoja clinic while driving around the neighborhood and got his first Pfizer-BioNTech shot. Dowell wanted to show his school-age nieces and nephews that “there was nothing to be afraid of” as they became eligible for the vaccine. Dowell’s 27-year-old son is also unvaccinated, and Dowell said he promised he would call to let him know how he feels after this second shot. “but there’s no guarantee it’ll be available if I need it.” Her Type 1 diabetes is well-managed, but she knows that in combination with her age, 68, “back to normal” for her may still be a long way off. But “I’m not 15 anymore, I don’t have my whole life ahead of me,” she said. People older than 65 account for71% of Covid-19 deathsin California. About 84% of older Californians are vaccinated with two doses and 72% are boosted. At the beginning of the pandemic, Liber and her husband were on total lockdown, rarely leaving their house. “We got really good at Amazon and Instacart,” she said. Vaccines and stricter mask guidelines gave her some confidence to resume some of her favorite activities. When cases came down and things started to look a little better, she journeyed to restaurants to eat outdoors on patios. It’s happened so infrequently in the past two years that she knows exactly how many times she’s dined out – five. But every surge sends her back inside, and she fears pandemic-weary people will forget about people like her and stop taking precautions. “I still want to do things,” she said, “I don’t want to give up on life.”
