Published with permission from Capital and Main.
The overall numbers are nowhere near the horrible peaks of the three years past, and the severity of the cases is significantly lower as well.
Still, three months after the federal government ended its COVID-19 public health emergency, some experts say there is a new normal in the U.S.: regular COVID seasons — and available vaccines — in the same manner as the flu.
And one other “normal” will apply: Whatever punch COVID and its variants have left, it’ll hit working poor families and people of color the hardest.
That truth, which has repeatedly been demonstrated over the course of the pandemic, is one of the key takeaways from the 2023 California Health Interview Survey of more than 5,000 adults, teenagers and children across the state conducted in March and April.
The survey found that Latino adults were twice as likely as white adults to have experienced COVID-19 symptoms for two months or longer. Their long COVID rate, 40%, was well above the statewide average of 28% and nearly three times the rate of Asian adults in California.
Low income families have also struggled for basic protection. Nearly half of adults with the lowest incomes in the state — that is, those whose income was from 0%-99% of the federal poverty level — said they did not have one of the masks that provides the greatest protection against the spread of the virus: N95, KN95 or KF94. Sixty-one percent of all those who did not have such masks said it was because they were too expensive.
And Californians living in crowded conditions, a definition that fits many of the state’s lower income families, have been buffeted by COVID cases. The survey found that 66% of adults who lived in households with five or more people said they had received a positive test for the virus. Every smaller household size had lower rates of positive tests, including 37% for those living alone.
“This does provide evidence for some of our earlier hunches: COVID just crushed households that were poor and households that had so many family members living in one home — the multigenerational piece,” said Ninez Ponce, director of the UCLA Center for Health Policy Research and the principal investigator of the survey.
Ponce noted that many of those living in crowded and multigenerational situations were also those who were deemed to hold “essential” jobs early in the pandemic, including farmworkers, food manufacturing employees, hotel and restaurant workers, transportation employees and sanitation workers. They went to jobs daily that placed them in close proximity to other workers, often with little or no protective equipment provided.
“Poor people were going to work,” Ponce said. “They didn’t have that option of staying home and working remotely.”
The survey’s results square with almost everything that sociologists and epidemiologists warned of in the early days of the pandemic: The poorest Americans, and especially those of color, were going to be vulnerable to the worst of COVID’s ravages. In California, that played out as predicted, with Latino and Black residents accounting for a higher percentage of deaths than their share of the state’s population would suggest.
From the first months of the pandemic’s 2020 explosion in the U.S., those who closely study and work in California’s high-poverty communities — both urban and rural — feared and expected that COVID would take an outsize toll on those areas. Among other things, the communities often lacked access to quality health care.
“In many ways, it’s about the zip code,” Michelle Burton, then director of the Social Change Institute at Community Health Councils in Los Angeles, told Capital & Main in 2021. “Rates of infection, vaccine penetration, access to health care — these go along with where you live in many, many cities, including this one.”
The California Health Interview Survey suggests that hasn’t changed, Ponce said. “A lot of marginalized communities did not have immediate access to vaccines, or did not have immediate access to providers,” she said. Hospital closings in the midst of the pandemic didn’t help, and the collapse of rural health care systems, along with the spread of misinformation about vaccines, were factors.
And there’s financial stress. Among those who responded to the survey, 11% of California adults said they have had difficulty paying rent or mortgage due to the pandemic — but among Latino respondents, that figure shot up to 17%. (For white California adults, it was 6%.) Many Latino adults work in the types of service industries, including hotels and restaurants, that suffered heavy job losses and closures during COVID’s peak. Some have yet to fully recover.
Ponce said the survey’s results can usefully be part of the state’s ongoing conversation about where and how to use its financial resources to improve California’s health picture. One place to look is the dissemination of critical information itself, by those who are trusted within lower income communities.
“Some of this is changeable through better outreach and education that is culturally and linguistically framed, [delivered by] community groups and local institutions,” Ponce said. “I’m an economist, so this asymmetric information — this unevenness of information — was also part of the problem. And that’s solvable through policy, through investments in outreach and education.”
In the larger picture, though, the pandemic did not create the issues described in the UCLA report; it only revealed and exacerbated them. Until the state makes a dramatic commitment to the funding and manpower it’ll take to shore up health care among its poorest and most vulnerable residents, every ensuing public health crisis will hit those same groups, and hard.