COUNTY TO PRIORITIZE AREAS FOR ‘HEALTH EQUITY’

Helping disadvantaged zones critical to moving to next tiers

We’re already doing a lot, but we know we could still do more.

That, in a nutshell, was the response of San Diego County leadership Wednesday regarding a new measure that the state started using Tuesday to decide who can climb to the higher levels of the state’s reopening ladder and who will remain stuck on their current rung.

No longer will it be enough for counties to improve their overall case and positivity rates to levels that the California Department of Public Health says signify lower levels of coronavirus transmission. Now, layered on top of the system introduced in late August, is a new measure designed to stop counties from leaving behind their most disadvantaged neighborhoods in the race to open up as quickly as possible.

County Supervisor Nathan Fletcher said during the county health department’s weekly COVID briefing Wednesday that the specific factors incorporated in the state’s latest statistical stop sign are just the kinds of things that are already under way in the very neighborhoods highlighted by the new metric.

The county has recently contracted with numerous nonprofits that work with specific at-risk groups, has already surged significant testing capacity to areas where COVID-related hospitalizations and deaths have been the greatest and is offering income assistance and even hotel accommodations to those who test positive but live in crowded households where there is a big risk they will infect others.

“Even though we’ve done all of those things, and we will continue to do those, we will always search out more opportunities to try and address the equity issues and try and help those communities who are most impacted,” Fletcher said.

Dr. Wilma Wooten, San Diego County’s public health director, said her department awaits a “playbook” from the state that is expected to provide more guidance on the kinds of specific action that counties will be asked to take to bring their health equity scores down. The specific data used by the state, she said, is known to play a significant role in determining overall health and the likelihood of suffering an early death.

Factors that affect overall health, she said, are the same kinds of issues that put a person at a greater risk of coronavirus infection.

“These factors set people up to have greater exposure to COVID-19, so what we are trying to do is to look at those things that we have inf luence on,” Wooten said.

The state’s new approach to health equity uses a special index to identify the parts of each county deemed most disadvantaged. In this case, disadvantage is defined by a composite score that takes more than two dozen factors into account, everything from the number of residents living in poverty, educational attainment and employment, home ownership, household overcrowding, air quality and even the number of nearby supermarkets.

These factors are assessed at a quite granular level, with scores calculated for each Census tract in the state. Tracts, according to the U.S. Census Bureau, represent defined geographic areas with populations that average about 4,000 residents each.

The state’s new metric calculates a separate test positivity rate for the 25 percent of tracts in each county with the lowest health equity scores. In Tuesday’s report, San Diego County’s overall coronavirus positivity rate was 3.5 percent while the rate for health equity areas was 6.2 percent.

While the new equity score will never be used to force a county into a lower tier in the state’s reopening system, counties cannot move to less-restrictive tiers unless both scores meet thresholds set for the state.

Of course, as everyone has learned by now, it’s never quite that simple where state COVID-19 regulations are concerned.

California considers two different factors, the positivity rate and each county’s number of positive cases per 100,000 residents to determine which types of businesses and other organizations can reopen and to what extent.

While the county case rate has consistently been good enough to qualify for the better tier, its case rate has regularly landed on or near the demarcation point where the region could fall to the lowest purple tier.

So, even if San Diego County had a magic wand that could erase the nearly 3 percentage point difference between its overall positivity rate and the one observed in its most disadvantaged neighborhoods, nobody’s going anywhere until the case rate drops below 4 per 100,000, the limit for moving up to the next-least-restrictive tier, color coded orange.

While this might seem a little too much like painting with numbers for anyone to care about, moving up a tier would have immediate effects on the local economy. Restaurants, places of worship, movie theaters and other venues would be able to start using half of their indoor spaces, twice the current limit of 25 percent.

The key, then, is to reduce not just the overall case positivity rates, but to make particularly strong gains in the places currently under the state’s health equity spotlight.

Given that the county has already spent many millions trying to do just that using a range of initiatives, the obvious question is: Why is there still such a gap?

Dr. Eric McDonald, medical director of the county’s epidemiology department, said that the case investigation interviews conducted with each person who tests positive show that a whole range of issues inf luence the numbers in areas with low health equity scores.

“Those may be individuals who rely on public transportation more often, they are living in parts of the county that are more densely populated, they might be individuals who are binational, going back and forth to Mexico frequently for economic reasons, to buy things that are less expensive, to access health care that’s less expensive,” McDonald said. “We are seeing those types of stories being told to us in our contact tracing in terms of what is contributing to each potential set of exposures.”

Moving the needle on the kinds of social factors that inf luence the current infection rates, he added, has traditionally been the work of decades, not months.

“Certainly, with one person in front of you, you can try to connect them to the resources that they need, but when you look at a bigger picture, it’s harder to solve that quickly,” McDonald said. “It doesn’t mean that we aren’t working at it one step at a time, but it is hard to sort of f lip a switch and make it suddenly better because, for many people, things don’t suddenly get better like that. It takes a lot of time, effort and connecting with resources.”

Overall, the pandemic in San Diego County continues to deliver hundreds of new cases daily. Wednesday’s COVID report included 354 new positive test results out of 10,615 returned. The region’s overall 14-day average positivity rate stands at 2.9 percent. The total number of local hospitalizations has crept up a bit, reaching 286 Tuesday, about 6 percent of the 4,601 hospital beds that were in use across the county Tuesday.

Seven additional COVID-related deaths were included in Wednesday’s report. The total included three women and four men ranging in age from their late 60s to late 80s. All had underlying health conditions.