UC San Diego health experts outline COVID-19’s racial divide and offer suggestions for bridging it

Jess Mandel shared this photo of doctors at Tijuana General Hospital.
Jess Mandel, chief of the Division of Pulmonary, Critical Care and Sleep Medicine at UC San Diego Health, shared this photo of doctors at Tijuana General Hospital, where he helped enact a program to ensure better care for COVID-19 patients.

A panel of UC San Diego health sciences experts shared statistics on inequities in how COVID-19 affects different races, along with their experiences and suggestions during “Alleviating Suffering Caused by COVID-19,” the latest webinar in UCSD’s “Deep Look” series.

“What we’ve seen in the last 11 months is a persistence of excess risk for COVID cases as well as mortality among communities of color, where Black and Latino and indigenous individuals have a threefold higher risk of acquiring COVID-19,” Maria “Happy” Araneta, a professor of epidemiology in the Department of Family Medicine and Public Health at the UCSD School of Medicine, said during the Nov. 19 event.

“When it comes to mortality, although these data are a month old, the trends will still persist in that one out of every 1,000 Black [or] indigenous Americans has died of COVID, compared to about one in 1,800 White Americans,” Araneta said.

The risk of hospitalization, she said, is “highest among Blacks, Hispanics and Asians compared to Whites, and the risk of dying is also similarly higher in communities of color.”

Nationally, Pacific Islanders “tend to be overlooked because they are small community or they tend to be reported aggregately with Asian Americans, thereby obscuring their higher risk” for COVID-19, Araneta said.

The trends in COVID prevalence and mortality are observed in communities of color in other countries such as the United Kingdom and Brazil, she said.

In San Diego, Araneta said, native Hawaiians, Pacific Islanders and Latinos have “the highest prevalence per capita of COVID infection.” Among COVID cases in San Diego, Asian Americans and Blacks have the highest rate of hospitalization.

In California, she said, “the case fatality rates are highest among Asian and Black COVID patients.”

Researchers examining the reasons for the disparities determined that the risk of exposure was higher among essential workers in those communities, Araneta said. She cited a UC San Francisco finding that 90 percent of essential workers surveyed could not work from home, “so these are the people at higher risk, those who don’t have the luxury of working behind the shield of a laptop.”

Other factors that increase COVID disparities include “structural determinants of health, including decent housing, nutrition and access to health care,” which Araneta said is lacking in the Navajo nation, which was found to have a “higher per capita rate of COVID infection compared to New York City.”

Forty percent of Navajo households do not have running water, she said, limiting handwashing, a basic method of disease prevention.

COVID-19’s impact on the economy “also disproportionately affects Blacks and Latinos, who have a higher risk of losing their jobs or living in COVID hotspots, in multigenerational homes,” Araneta said.

People in communities of color, she said, often “have to make the decision between quarantining at home or not having a salary to support their family.”

Moderator Suresh Subramani and panelists Happy Araneta, Francesca Torriani, and Jess Mandel (clockwise from top left)
Moderator Suresh Subramani and panelists Maria “Happy” Araneta, Francesca Torriani and Jess Mandel (clockwise from top left) discuss disparities in COVID-19’s effects and possible remedies.
(Elisabeth Frausto)

Jess Mandel, chief of the Division of Pulmonary, Critical Care and Sleep Medicine at UC San Diego Health, said UCSD hospitals “planned early for a major surge of patients” at the outset of the pandemic, finding non-intensive care spaces to accommodate critical care and stockpiling ventilators and personal protective equipment.

The measures taken, Mandel said, resulted in “very few” health care workers becoming ill.

Simultaneously, UCSD collaborated with other hospitals in the region to share protocols and best practices, including in Tijuana, Mexico, where he said “it was clear a humanitarian crisis was unfolding.”

Hospitals there were “overwhelmed by patients” due to understaffing as a result of the staff’s COVID infection rate, Mandel said.

“We decided to send a volunteer team involving doctors, nurses, translators [and] respiratory therapists” working seven days a week for four weeks, he said. The program eventually transitioned to a “telemedicine approach” that is continuing.

“Our focus is on optimizing intensive care,” Mandel said. “The processes of care have improved significantly, and we believe we’re seeing improvements in outcomes as well.”

He said UCSD started a similar support system with a hospital in Mexicali, Mexico, with more telemedicine than in-person support due to distance.

Francesca Torriani, an infectious-disease specialist at the UCSD School of Medicine, said enabling “scalable and practical solutions … will really help the community.”

She said the “key elements are to enhance safe environments,” including screening for symptoms, testing “as much as we can,” decreasing population density, improving ventilation and implementing universal mask policies.

Citing programs she enacted with the Scripps Institution of Oceanography to improve prevention of virus transmission on its research missions, Torriani said measures that promote a safe environment have been “very successful.”

Those include quarantining researchers for 14 days, along with ensuring that all test negative for the coronavirus before boarding the ship and that they stay masked while on board except when sleeping or eating.

On longer trips, Torriani said, virus tests are administered after 13 days on board, after which researchers are allowed to take off their masks. “Up to now, things are going well,” she said.

In the UCSD health community, a policy of “testing liberally,” including routine testing of asymptomatic health care workers, has helped keep case rates low, Torriani said.

“The key essence,” she said, is “we have to continue non-pharmaceutical interventions until the population can be vaccinated.” ◆