San Francisco Chronicle - (Sunday)
Dramatic breakdown of infections among races
When Noel Gallo got a call that five or six workers at Cardenas Market in Oakland’s Fruitvale district had tested positive for the coronavirus, the city councilman decided to stop by, maybe ask the owners if they needed help protecting employees and customers.
He was there Thursday, face covered while he talked to managers. Actually, they told him, 12 employees had been infected.
“That’s a pretty significant market. It’s packed daily,” Gallo said. He talked to the managers about enforcing face covering rules for staff and shoppers and about making sure the store didn’t get overcrowded.
And he talked about testing. A new site would be opening on Monday in the Fruitvale BART Station parking lot
nearby, he told the managers. Everyone, whether they had symptoms or not, should get tested, he said.
The market is located in a predominantly Latino East Oakland neighborhood that has astonishingly high rates of coronavirus infections — about 500 cases per 100,000 residents, nearly three times the Alameda County average. It’s one of a handful of communities in the county identified as profoundly vulnerable to the pandemic and in need of expanded public health resources.
That work has taken on new urgency in the last couple of weeks, as the number of cases rose and Alameda County surpassed Santa Clara County as hardesthit in the region. Alameda County has more than 3,200 cases, compared with Santa Clara County’s 2,700.
“As our economy opens up, more and more employment settings are also opening up. And that means we may see upticks, even in counties that are doing well,” said Kimi WatkinsTartt, director of the Alameda County Public Health Department.
New cases in Alameda County jumped more than 30% last week over the one before. The county reported 107 cases on Thursday, the most on a single day since the outbreak began.
Public health officials say that expanded testing explains some of the increase in cases. The county has more than doubled its testing over the past month, so certainly more cases, especially among people who may not have symptoms of illness, are being detected. The county has made strides toward getting testing sites into neighborhoods with the highest rates of cases.
But not all of the increases can be explained by testing, authorities said. Hospitalization numbers, for example, also have picked up over the past two weeks, and those aren’t influenced by testing.
The county issued an alert Friday noting that because of rising hospitalization and case counts, “it is imperative that we proceed with caution” in easing shelterinplace restrictions and reopening the economy. The statement came as the state rapidly picked up its pace in loosening stayhome orders and allowing more business to resume.
Alameda County, along with most of its neighbors, has moved slowly toward reopening. And “because of what we’re seeing in just this week, I’m planning to be super conservative about what else we’ll allow,” said Health Officer Erica Pan in an interview.
She and other public health officials said that as they contemplate easing restrictions, they are especially protective of communities of color, which have been disproportionately hit by COVID19 as well as the economic effects of sheltering in place.
Alameda County may have more cases than any other Bay Area county, but it does not have the highest rate of illness — that distinction goes to San Francisco, which has about 280 cases per 100,000 residents, compared with Alameda County’s 185 per 100,000.
But the case rate varies across the county, and in keeping with statistics in the rest of the United States, communities of color have dramatically higher rates than other areas. Eleven ZIP codes have higher rates than the county average, and all of them have large black and Latino populations. The most affected neighborhoods are in East Oakland and parts of Hayward.
Countywide, Latinos have the highest rate of illness: 321 per 100,000 residents. African Americans have the highest fatality rates: 11 deaths per 100,000 residents, which is double the county average.
“It is not necessarily surprising. For sure it’s disappointing, but not surprising,” said WatkinsTartt, who is heading a team that is addressing health disparities and COVID19.
People of color have higher rates of chronic illness like diabetes and heart disease that already are known to cause more severe symptoms of coronavirus infection, she said. They also are more likely to work in frontline jobs — in grocery stores and health care settings, for example — that put them at risk of exposure to the virus.
“With COVID, those workers were employed by what we designated essential businesses, so they were working while the rest of us were able to go home and stay inside,” WatkinsTartt said. “And it’s usually lowwage work where there’s no paid leave or very little paid leave. After transmission has occurred, that makes it difficult for them to heal, to not spread to other people, because their life is not stopping.”
Pan and others said they don’t yet know if the recent increase in cases is more prevalent in black and Latino communities that have already borne the brunt of illness. Anecdotally, they’re aware of new cases among essential workers — such as the staff members at Cardenas Market — and their close household contacts. But it’s not clear whether those incidents are on the rise.
Noha Aboelata is CEO of Roots Community Health Clinic, which started offering widespread testing on May 8, and has since tested about 1,200 residents, mostly in lowincome neighborhoods. She said she’s been concerned to see that the rate of positive tests has stayed high, at about 12% — suggesting that the virus is still circulating widely after more than two months of stayhome orders.
And she noted, too, that the county’s public hospitals — she’s president of the Board of Trustees for Alameda Health System — have seen the bulk of new patients, a sign that infections are increasing among lowincome residents.
“I remember that earlier on, I would see the overall numbers being hospitalized and they were at Kaiser or Sutter, and I was wondering where are our patients?” Aboelata said. “And now we’re seeing the uptick.
“We talk about flattening the curve, but it stands to reason that it’s going to be more
difficult to contain in our more lowincome communities, and that is likely part of what’s happening right now,” she added.
Alameda County was already more than a month into the coronavirus outbreak before it released neighborhood-level data on infection rates, and by then it was apparent that black and Latino communities were carrying a large burden of disease.
This month, the county reached out to community organizations for help supporting residents. That’s resulted in the expanded testing at Roots, at Allen Temple Baptist Church in East Oakland, and at another site that should start next week at the Fruitvale BART Station, according to Gallo.
Beyond testing, public health officials are trying to get protective gear like face masks and gloves to residents in hardhit neighborhoods, even passing out supplies on street corners. They’ve encouraged store owners to install plastic barriers and signs about social distancing guidelines that will help protect employees and customers.
Among the many guesses as to why Alameda County’s case counts have picked up recently is what Pan describes as “intervention fatigue” — people have been sheltering in place for 10 weeks, and they’re emotionally and financially drained by the isolation.
That may be particularly problematic in lowincome neighborhoods where people have less of a financial cushion, Pan and others said.
“It’s possible, and this is a theory, that things were going well in the beginning with shelterinplace, and people were scared, probably because you’d go outside and the streets were empty,” Watkins-Tartt said. “But after a while, I think that survival brought people out of their houses.”
Gallo noted that in his East Oakland district, some small business owners never shut down, despite shelterinplace orders, because they had no way to support themselves otherwise. And some of those who did close are pushing hard to reopen soon because their financial situation is becoming dire.
“The problem for me politically is, do I shut you down?” Gallo said. “They’ll tell me, ‘I’m sorry, but this is the only way I can survive.’ ”
Gallo’s colleague in City Hall, Councilman Loren Taylor, said that though black and Latino residents have had the highest rates of infection, it’s for the benefit of the county as a whole that the virus be contained. That means even cities and neighborhoods that haven’t seen many cases need to support efforts to test and treat people in atrisk communities, he said.
And everyone needs to obey the county’s socialdistancing orders, he added — by wearing masks in public, avoiding large gatherings, keeping away from others especially when sick — now and in the coming months or years, until the pandemic has passed.
“We are so interconnected,” Taylor said. “Montclair is very connected to what’s happening in East Oakland or West Oakland. The virus doesn’t respect the other side of the tracks, figuratively speaking. We’ve all got to support and look out for and make decisions that are in all our best interest.”