Healthy Choices

Sacramento County’s high-poverty areas hit hardest by fatal flu

As the influenza virus marched across Sacramento County this flu season, a clear pattern emerged showing where the suffering has been most intense.

Many of the deaths and hospitalizations in intensive care units have occurred in low-income, densely packed neighborhoods, where people are more likely to rely on public transit and to have less access to health insurance than the region-wide average.

High unemployment and high concentrations of working-age adults who have given up looking for jobs are more common in the neighborhoods hardest hit. In these areas, generations of families, many of whom are foreign-born, tend to share housing or crowd into small homes, according to a Sacramento Bee analysis of ZIP codes and U.S. census demographics.

The key commonality? Entrenched poverty.

Dr. Olivia Kasirye is the public health officer for Sacramento County. Her work includes monitoring communicable diseases and addressing health disparities in underserved communities where, it’s often said, your ZIP code can be a predictor of how long and how healthy a life you will live.

“One of the most important issues is the poverty,” Kasirye said. “Communities with high rates of poverty get higher rates of chronic disease. Their standard of living is not good. They are in poor health, don’t have access to good nutrition and have higher stress.”

No area has been slammed harder than south Sacramento, with at least 22 intensive care unit cases and 11 flu fatalities, according to a data map that county officials circulate among hospitals.

You do not need to tell this to Tanisha Burns of Florin, who lost her husband and the father of their seven children, to the ravages of the fierce H1N1 virus, which can trigger kidney failure and pneumonia.

Sitting in her modest home in a cul-de-sac on White Rose Court, Burns said her husband, Leon, would have turned 39 last Thursday. In that respect, he was typical of the demographic of otherwise healthy young to middle-aged adults that H1N1 strikes with unusual severity. Typically, the most severe cases of influenza are found in young children and people over age 65.

Burns described her husband as a hearty man. At 5 feet, 4 inches tall and 190 pounds, he was a “hard-working man,” she said, who thrived on providing for his wife and kids. Their family is close, she said. Their children, who range in age from 6 to 22, perform in a hip-hop dance ensemble, Family First, which has appeared on the Ellen DeGeneres show. Leon took pride in their efforts and would join them for impromptu performances at home.

“He was our big supporter, and he took care of everything,” Burns said. “To take down a strong man like that, who’d walk a mile to work just to put food on the table, would have taken a strong virus. Everybody’s worried about what’s going to happen to the family now.”

She did provide two distinct clues as to why her husband may have succumbed to the flu: He didn’t get the flu shot, and he stayed home sick for a few days before he felt ill enough to seek help at Dignity Health’s Methodist Hospital in south Sacramento. Public health experts urge people sick with the flu’s respiratory virus to seek anti-viral medications quickly, upon onset of symptoms.

Head westward from the Burns home in Florin to the next ZIP code area and you’ll find yourself at ground zero: the ZIP code in Sacramento County that has suffered the highest number of deaths and intensive care unit cases. This is 95823, encompassing the Parkway and Valley Hi/North Laguna neighborhoods.

The 11-square-mile area has the highest population density – 6,269 people per square mile – of all the ZIP codes flagged by county health officials tracking influenza activity. Here, 29.2 percent of individuals live below the poverty level, defined by the federal government as one person living on $11,490 a year, or a family of four living on $23,550 annually.

Parkway and Valley Hi/North Laguna also have the distinction of being home to the highest number of foreign-born residents in the region, reflecting widespread diversity, with near equal numbers of white, black, Latino and Asian residents.

Dr. Francisco Aguirre is the chief medical officer for WellSpace Health’s South Sacramento Community Clinic. He said the clinic has seen many patients with high fevers and vomiting, two symptoms common to the H1N1 virus.

“Unfortunately, prior to December and January, there weren’t many people wanting the flu vaccination,” Aguirre said. “They were saying, ‘I never get sick. I’m OK. Just vaccinate my kid.’ It’s like they feel indestructible.”

Then, as stories began circulating about the flu’s severity, there was a run on immunizations. By the end of January, the Florin clinic, in the same 95828 ZIP code where the Burns family lives, ran out of vaccines for adults.

Aguirre said that when people live in close quarters and take public transportation, avoiding contagious disease can be more difficult.

“In the south Sacramento area, there are multiple families living together, and larger families living together,” he said. “You ride a bus, and somebody may try to cover their cough or sneeze, but droplets spread all over the place. Then you grab the railing getting off the bus, touch your eyes and suddenly get infected.”

On Friday, the Centers for Disease Control and Prevention downgraded flu activity in California from widespread to regionally active. Sacramento County’s data show that the flu peaked in the first weeks of January. That’s when the largest number of people sought treatment from doctors or were admitted to intensive care units.

So far, 28 Sacramento County residents under age 65 have died in the 2013-14 influenza season. For the first time since the season became active, there were no new deaths reported last week in the county.

Meanwhile, beyond Sacramento County’s denser urban hub, Placer and Yolo counties have reported no flu deaths and El Dorado County recorded just two dead of the flu.

Throughout California, the number of people who died from flu-related causes rose to 302 last week, state officials said. Nineteen more influenza deaths were reported to the Department of Public Health and may be added to the list.

The county’s data also show that the majority of people hospitalized or dead from the flu had not been immunized. The Burns family, for instance, did not get their flu shots until after Leon fell deathly ill.

“In these ZIP codes, all the populations have lower rates of immunization,” said Kasirye, who is still recommending vaccinations.

If there’s an outlier in every set of data, in this case it may be the intense flu activity also seen in suburban Citrus Heights and Carmichael. These communities, while relatively affluent, are also densely packed with housing.

And several of the county’s flu-related deaths have involved people from higher-income areas who were otherwise healthy. One such case was Nancy Pinnela, 47, an ad executive at News 10 who lived in east Sacramento and perished within days of leaving work early, saying she wasn’t feeling well.

At the Burns residence, Tanisha said she and her children are still processing Leon’s death. On Thursday, his birthday, the family gathered around a cake inscribed in his honor and sang “Happy Birthday” in a spirited tribute. One way or another, she said, they will carry on his dreams of a performing career for the children. Since his death, donations for the family have flowed from dance groups, friends, even local businesses.

“It seems like Leon is still bringing people together,” she said. “He touched so many people. I didn’t even know our family was so loved.”