Public health officials try to tailor their response in California’s communities of color, where the pandemic has had a devastating impact.
In the city of Oakland, when census workers call residents, they’re on a dual mission. Not only do they ask if the individual has filled out a census card, they also ask whether that person wants to get tested for the coronavirus. If so, do they know where to go?
“It’s extremely creative,” said Dr. Tony Iton, a senior vice president of the California Endowment. “They’re doing census outreach in populations that are the hardest to reach, which are exactly the same populations that are disproportionately impacted by COVID.”
These are neighborhoods like East Oakland and the Fruitvale District, home to predominantly African Americans and Latinos. And, since census workers tend to be local, people are essentially checking in on their neighbors, Iton said.
As California and the rest of the nation grapple with the pandemic, one lesson has become painfully clear. While the virus can attack anyone at any time, some populations have been harder hit than others — and testing and contact tracing in these communities will likely take more effort, according to Iton and other public health experts.
Contact tracers are workers trained to track down, interview and isolate people who have come in contact with an infected person.
“Contact tracing, that’s never going to work, particularly in the African American community where trust is a big issue, if we don’t have a solution that works directly with the black community,” said Dr. Stephen Lockhart, chief medical officer with Sutter Health in Northern California.
Solutions need to rely on existing institutions and supports such as churches, barbershops and community leaders, Lockhart said.
Last week, Sutter Health published a Northern California study reinforcing what statewide data has shown— that coronavirus is taking a disproportionate toll on African Americans. According to the study, African Americans are almost three times as likely to be hospitalized for COVID-19 compared with non-Hispanic whites. And the majority, almost 70%, were tested in the hospital rather than in an outpatient setting, meaning it wasn’t until they were very sick that they got a diagnostic test.
Statewide, African Americans account for about 10% of coronavirus deaths, even though they make up only 6% of California’s population. Latinos make up more than half of the cases and about 38% of the deaths while they are 38.9% of the population, according to the California Department of Public Health, which tracks coronavirus cases and deaths by race and ethnicity.
By comparison, whites make up about 21% of the cases, about 34% of the deaths and 36.6% of the state’s population.
Iton, a former Alameda County public health officer, is among those trying to develop efficient contact tracing and testing among communities of color.
In order to minimize harm, Iton said, the state has to prioritize blanket testing, or test as many as possible — especially essential employees working in grocery stores and driving buses, as well as seniors. Outreach has to be persistent and aggressive, and contact tracing must be done in a culturally sensitive manner, he said.
“If we do these things we would see disproportionality start to drop,” he said.
Currently, contact tracers statewide are being pulled from a pool of city and county employees who aren’t working, such as librarians and property tax assessors. But as the economy opens up, they’ll return to work. Iton’s organization is working to assemble groups already working with African Americans and Latinos to help find local tracers.
“Doing contact tracing in populations where there are immigration issues or linguistic issues is harder and slower, so you’re going to need more of those kinds of workers,” Iton said.
The state’s goal is to initially hire about 10,000 contact tracers, but more may be needed if infections resurge as the state opens back up.
The state’s public health department said in an email that it has opened 80 testing sites specifically for communities where people are being disproportionately affected by COVID-19.
In setting up these sites with counties, the state considered the population size, number of cases, income (with a preference for lower incomes), population diversity (with a preference for more diverse communities) and percent of population in high-risk groups, the department said in the email.
The state also recently launched a PSA campaign to educate people on the importance of contact tracing.
“I’m certainly not naive,” Gov. Gavin Newsom said in a press briefing last week. “When you get a call from some stranger on the phone saying they work with the government, not everybody is pleased to receive those calls.”
Some people may think the call is fraudulent, while others may be uncomfortable or reluctant to share information, he acknowledged.
We’re “translating not just documents in multiple languages, but getting trusted messengers from within communities to let folks know that it’s in not only their interest but their community and their loved ones’ interest to work with these trained professionals and provide information in a confidential manner,” Newsom said.
Solange Madriz is one of these contact tracers. She’s also an academic coordinator at UC San Francisco’s Institute for Global Health Sciences and helps with the training of other contact tracers and investigators. The university partnered with the state to build a training program for this workforce.
“The training is focused not just on the information, but how you deliver that information,” Madriz said. “This is sensitive for multiple reasons, we’re talking about disease, individuals have lost their jobs, so these conversations have to be done in a compassionate way.”
Cultural elements play an important role, especially in a world where people are constantly getting scam calls, she said. Madriz, a Latina and a Spanish-speaker, primarily calls other Spanish-speakers. With a few exceptions, most of the people she’s called so far have participated in the investigations, she said.
The need for an appropriate response to the racial disparities of COVID-19 has led to the creation of a special task force in Alameda County. Iton is a co-chair, along with Assemblyman Rob Bonta, an Oakland Democrat.
Bonta said that while racial disparities in health have been persistent and well-documented for decades, the coronavirus pandemic has brought them into focus like never before.
Poor health among communities of color in general has long been attributed to larger systemic issues, like poverty and racism. That and the prevalence of chronic conditions, such as heart disease, diabetes and asthma make black and Latino Californians more vulnerable to falling severely ill from COVID-19.
“The pandemic lays bare the health disparities for everyone to see, you can’t ignore it,” Bonta said. This creates an opportunity to take action on things that once were only ideas, he said.
Still, in absence of a vaccine – and until testing and competent contact tracing exists in Latino and black communities – some local leaders are urging others to stay put.
When Rev. Amos Brown, pastor at Third Baptist Church in San Francisco, receives phone calls from other faith leaders asking him whether they should reopen their doors, he tells them to “settle down.”
“Black people are experiencing disproportionate death; we should not be rushing to these four-corner buildings and put ourselves in harm’s way,” said Brown, who is also the president of the San Francisco branch of the NAACP. Instead, he tells them to “be creative, be the church where the people are.”