Inequity could stall reopening
Marin income gaps to factor in state rules
Marin’s chances of getting approval from the state for further reopenings in three weeks under coronavirus rules are slim, and the odds may become longer due to an “equity metric” in the works.
The state uses two indicators — average number of new COVID-19 cases per day, and average percentage of positive test results, both over sevenday periods — to determine where to place counties in its four-tiered risk status framework.
Now, state health officials are preparing to add a third indicator, an equity metric that would compare a county’s COVID-19 percent positivity rate across low-income neighborhoods and more affluent neighborhoods.
That means in order for Marin to move forward, the
difference between those two figures might have to decrease.
“That will be another factor for us in Marin when it comes time that we may be ready to move into tier 3,” said Dr. Matt Willis, the county’s public health officer.
On Monday, the state moved Marin from “tier 1,” or “widespread” risk, to “tier 2,” or “substantial” risk. The extent of reopening permitted increases progressively as a county moves to higher tiers.
In tier 2, restaurants can resume indoor service at 25% of capacity. However, many Marin restaurant owners say that is not enough to merit reopening. They’re waiting for Marin to move into tier 3 so they can resume at 50% capacity.
Omar Carrera, director of Canal Alliance, a nonprofit serving Marin’s largest Latino community, said, “It’s always been our goal to limit the burden of COVID-19 in our community — now it’s everyone’s goal. If we don’t narrow the disparities, it hurts all of us.”
Willis succeeded in appealing the state’s decision on Sept. 7 to require Marin to remain in tier 1 for a minimum of three more weeks.
“We are much closer to tier 1 than we are to tier 3,” Willis said. “It is possible we will continue to move forward, but I really think we should be focusing on maintaining the gains we’ve already achieved.”
Willis said by this week he should know if the county will see an increase in new COVID-19 cases linked to the Labor Day holiday. Another unknown is the effect of wildfires on virus transmission.
“We know for sure that people were spending more time indoors for a significant interval of time,” Willis said. “That is either going to be good or bad.”
He said it all depends on whether people spent their time inside with household members or with people from outside their household.
Willis said Marin’s move into tier 2 itself will increase opportunity for transmission of the virus and could jeopardize the county’s tier 2 status.
“I would define success here as maintaining our status in tier 2 for at least two months,” he said.
Once placed in a tier, a county must remain there for at least three weeks; it must meet the requirements of the next tier for two weeks before being promoted.
Since counties that do more testing are likely to find more people who are infected, the state adjusts the case rate number downward for counties that do lots of testing and adjusts it upward for counties that do too little.
Willis said with the addition of an equity metric as a third indicator, “even if you’ve achieved success in those other two, the state would hold you back if you have not demonstrated improvement in addressing disparities.”
Reducing the difference in positivity rates between underserved and affluent communities in Marin won’t be easy.
When the state agreed to move Marin into tier 2 on Sept. 14, the county as a whole had a positivity rate of 7.1%. But the positivity rate in San Rafael’s Canal neighborhood, where low-income Latinos predominate, is 18%, and before the county launched an effort to bring it down, it was 25%.
Latinos, who make up 16% of Marin’s population, have accounted for 70% of county’s coronavirus infections and 13% of the deaths.
By comparison, White people, who make up 71% of Marin’s population, have accounted for 22% of the infections and 75% of the deaths.
“It’s going to be a challenge for every county,” Willis said of the equity metric. “What we’re being asked to do is to address deep historical inequities that drive differences in case rates between communities. The disproportionate impact of COVID-19 is just a symptom of a much larger societal issue.”
Carrera said he is worried that fewer Latinos in Marin might seek testing as economic pressure, particularly due to housing costs, builds.
“If you are in survival mode and need to work,” Carrera said, “You may choose not to get tested because you don’t want know that you are positive and have to isolate for two weeks.”
Willis said the California Department of Public Health is still working on the details of how the equity metric will be calculated. He said he expects an announcement soon.
A spokesperson for the department declined to comment except to write, “The state continues to work on the Equity Metric component of the Blueprint Framework. Health and Human Services Secretary Dr. Ghaly regularly references his interest in the continuing work during his weekly Zoom briefings and media availabilities.”