California leaders unveil tool aimed at reducing inequity in COVID-19 tests and deaths
California’s top public health officer announced Wednesday that counties will have to demonstrate that they have invested in testing and other resources to eliminate disparities in test positivity rates for COVID-19 before they can advance to a less-restrictive tier of the statewide lockdown.
Dr. Erica Pan said the incidence of infections, hospitalizations and deaths from the respiratory disease have been disproportionately higher among African Americans, Latinos and Pacific Islanders, as well as low-income Californians and essential workers. A new health equity metric has been devised to help counties more effectively fight the disease in all communities.
“Our entire state has come together to redouble our efforts to reduce the devastating toll COVID-19 has had on our Latino, Black and Pacific Islander communities,” said Pan, the acting state public health officer. “This isn’t just a matter of higher cases in these communities – it is an issue of life and death that is hurting all Californians. An all-community, cross-sector approach to work together to slow the transmission of COVID in all populations will help ensure we reopen our economy safely, protect our essential workers, and support our local partners.”
Sacramento and Placer county officials said they needed more time to study the new metric befor they could comment. Leaders of the California State Association of Counties had been expecting the new metric and had offered feedback to Gov. Gavin Newsom’s administration on it and the Blueprint for a Safer Economy released a month ago.
“The state health equity metric represents a new ‘goalpost’ for counties...,” officials said in a statement provided to The Sacramento Bee on Thursday. “Counties appreciate the multiple opportunities provided by the Newsom Administration to provide thoughtful feedback to arrive at a workable solution.”
The California Department of Public Health is taking two different approaches with the health equity metric, depending on the population of the counties, because data is not as reliable when populations sizes are small.
In counties where there are 106,000 or more residents, officials will have to show that the test positivity rate for their most disadvantaged communities do not significantly fall behind the overall county rate. Starting Oct. 6, each county has to offer a plan that not only defines its disproportionately impacted populations, but also shows specific percentages of COVID-19 cases for these communities and explains how they will disrupt transmission of the disease.
In counties with populations below 106,000 residents, officials will have to show how they plan to educate, support and test individuals who have been disproportionately affected.
Public health officials said they would provide technical assistance to counties to help them use the new health equity metric properly.
Dr. Sergio Aguilar-Gaxiola, the director of the UC Davis Center for Reducing Health Disparities, said the technical assistance will play a critical rule in solving what seems to be an intractable challenge in places like Mendota, Parlier and other areas of Fresno, Madera, Stanislaus and Yolo counties.
Counties will need culturally competent health workers who speak Spanish and can form connections, so people will trust what they say rather than continuing to accept misinformation, he said, and the state, city and county also will have to provide sites to isolate those who are sick, feed them and provide some financial assistance to deal with loss of income.
Aguilar-Gaxiola said that he and other researchers at UC Davis separately will be leading work funded by $3.7 million in grants from the National Institutes of Health, aimed at ensuring farm workers get tested for COVID-19 and get results quickly. The NIH is spending more than $200 million nationally aimed at ending the disproportionately high number of deaths among essential workers and in communities of color.
Like many people living on subsistence wages, farmworkers live in crowded conditions, commute with multiple people and cannot afford to buy N95 respirators or other personal protective equipment, even if it was widely available, Aguilar-Gaxiola said. They also struggle with chronic illnesses such as diabetes because they have little time or space to exercise.
All these factors make them especially vulnerable to contracting and dying from COVID-19. Nearly 80% aged 35-49 who die of COVID-19 in California are Latino, UC Davis officials said.
The greatest challenge just might be persuading farmworkers that they can afford to seek testing and treatment, said Aguilar-Gaxiola, noting that on Thursday he learned of a farmworker who was sick and sought a COVID-19 test at a hospital, only to receive a $5,000 bill for the test. When something like that happens, he said, news of it spreads to hundreds of other workers and they won’t seek care.
To get its testing off to a good start, said Aguilar-Gaxiola, UC Davis has connected with community partners that have the trust of farmworkers and will be enlisting their help in promoting the availability of testing at UCD’s mobile health van.
This story was originally published October 1, 2020 at 5:00 AM.
