Our sense of shame is in short supply.
As of Tuesday, the coronavirus pandemic had killed more than 226,000 people across the United States, 17,000-plus in California and almost 1,750 here in the Bay Area. Of that local amount, 461 people—or about 26 percent—resided in Alameda County. That figure is nearly a hundred more people than the number the virus had claimed by mid-September.
But finding out exactly who is dying in the East Bay, and where each person took that last breath, is more difficult to pinpoint.
Data compiled by Alameda County health officials show that the coronavirus has hit predominantly low-income communities of color in East Oakland harder than any other place in the Bay Area. Maps that track infections in the 94601, 94621 and 94603 zip codes—starting in the Meadow Brook and Oak Tree neighborhoods and running south down the Interstate 880 corridor to the Coliseum and Brookfield—show a deep shade of blue that inspires none of the optimism one might hope for in a consequential election season.
Each of these East Oakland zip codes is registering more than 4,300 positive cases per 100,000 residents, which is more than double most other parts of the county. By comparison, the next highest rate of positive tests in Alameda County can be found in two zip codes in Hayward, where 2,612 and 2,345 per 100,000 have tested positive. No other zip codes in the county surpass an infection rate of 2 percent. The only place in the Bay Area area that comes close to the rate of cases seen in East Oakland is in San Francisco’s Bayview/HuntersPoint, another historically Black neighborhood.
But how many people have died from coronavirus in East Oakland? That’s a tricky question, as the county’s COVID-19 dashboard doesn’t list locations for deaths, but instead simply tracks them over time.
A public records request filed by the East Bay Express found that as of Tuesday, 65 people had been killed by the virus in the three East Oakland zip codes where infection has run rampant, accounting for 14 percent of the county’s total Covid-19 deaths. But that figure is disproportionate to the population of these zip codes, which represent just 7 percent of all of Alameda County residents.
“My overarching concern is what it’s been from the beginning—that our communities will not only be disproportionately impacted but will also continue to be impacted beyond the time that we’re all looking toward—when it will, basically, be controlled through a vaccine,” says Dr. Noha Aboelata, CEO of Roots Community Health Center on International Boulevard in East Oakland. The group started testing people from the city’s most-impacted zip codes in April and began contact tracing efforts in July.
The county’s overall covid-related deaths among Black people (52 per 100,000) and Latinos (34.7 per 100,000) are also disproportionately high, but the extent of the problem in local coronavirus hot spots could be greater than even known.
Alameda County health officials admit that the number of cases in the three most-impacted East Oakland zip codes are likely higher due to an imbalance of testing rates in these places compared to high infection rates.
“I think that’s a problem and it’s a real problem we’ve been attempting to address with our testing program and where we’ve invested our own resources both financial resources and efforts to bring other testing programs into play,” says Dr. Nicholas Moss, an infectious disease expert and Alameda County’s interim health officer since July. “It hasn’t been enough when you look at these maps to change the testing rate, though it’s not due to a lack of effort.”
At least not on the county’s part.
While missteps might have been made locally regarding a delay in ordering masks to be worn or reopening too quickly after the shelter-in-place orders went into effect, the most ludicrous aspect of the U.S. response to the pandemic has been the fact that since mid-March, county and state health departments have been leading the charge in issuing health orders and coordinating testing and tracing efforts. With no disrespect to the people in charge of local efforts, the U.S. response is essentially being led by the minor leaguers of medicine, from the bottom-up instead of the top-down. The result over the last seven months has been a haphazard mashup of data dashboards in which counties and states are left to their own devices to conduct testing and contact tracing while compiling information that can’t be easily cross-referenced.
California officials have coordinated with counties on testing and signing off on re-openings, but the state’s role has essentially been to act as a monitor and personal protective equipment facilitator. Meanwhile, Trump has continued to claim victory in the face of nearly a quarter-million dead and tens of thousands more expected to die as his campaign hosts super-spreader events and the Republican-led Senate prioritizes the appointment of a ultra-conservative Supreme Court judge over passing covid-relief packages.
“There has been a federal abdication, and one of the most harmful parts of has been not just the lack of testing but the misinformation,” Aboelata says.
The only reason the public has gained even an opaque understanding of the crisis is thanks to medical experts, the media and counties, which, in partnership with public health systems, private hospitals, community health clinics, nonprofits and churches, have been given the Herculean task of coordinating testing and tracing programs on the fly. Parsing through the data has been mostly left to doctors and journalists who have tracked the pandemic’s deadly toll, day by day, in a time-consuming process that was made difficult by design—in the sense that not having a federal plan means never having to admit the nation has failed.
It’s an uncomfortable conversation that most public health officials would rather not have.
“Look, there’s no question we would have loved to get more resources, earlier access to more testing supplies and more consistency around guidance, but that said we’re not going to wait around for everything to be perfect,” Moss says. “We’re going to take the resources that we do have and the resources that we do get and try to do the best for our county residents. You know, I think, it’s not helpful for—it doesn’t help us get any more work done if we, sort of, complain about the shortcomings of the federal government.”
Perhaps, but a second spike is occurring across the nation—cases recently jumped to a new record of about 68,767 each day over a week-long period, according to Johns Hopkins University. As covid fatigue sets in among the public, and as the holiday gatherings and flu season concurrently approach, it’s worth questioning whether the situation in East Oakland and other heavily impacted areas will slide back and deteriorate while the world waits on a vaccine, which by most estimates won’t be widely distributed until a year from now.
“It seems to be continuing to climb in our zip codes actually, and we’re not sure when that will stop and start coming down,” Aboelata says.
The rate of testing per capita in East Oakland—more than eight months after the virus began its spread through Santa Clara County and embered out like wildfire across the region—still severely trails places like Berkeley, Emeryville and Piedmont, and even other parts of Oakland in which the outbreak has not registered to such a great extent. Why residents of the Oakland Hills have been given more tests per capita than East Oakland is a subject for debate.
“That is like a question for the ages, because the testing rates are driven by the consumer,” says Dr. Jocelyn Freeman Garrick, who serves as the deputy medical director of Alameda County Emergency Medical Services and is leading the county’s testing operations.
Without a national plan for testing in place, higher-income communities have had greater access from the beginning. In some ways, local health officials say, the issue of testing becomes a chicken-or-the-egg discussion on why people fall ill in a broken American health care system that insulates and remedies those who can afford better insurance.
But as an emergency physician at Highland Hospital, Freeman Garrick has seen firsthand how systemic racism has largely created the structural barriers that stop people from getting adequate education and housing opportunities, and by extension health care treatment, which then bleeds over to “distrust among community members to come forward and be tested.”
In the first weeks of the pandemic and subsequent shelter-in-place orders, East Oakland zip codes were seeing infection rates as high as 30 percent among those tested, Freeman Garrick says, but that number has since dropped significantly.
“I think the (county) health department did a good job of prioritizing and allowing me in this role to focus on our vulnerable populations, so that we could try to address covid in an equitable way,” Freeman Garrick says.
However, Dr. Aboelata says the Roots clinic is still seeing people in the 94601, 94621 and 94603 zip codes test positive for coronavirus at rate somewhere between 18.4 percent to 21 percent. “That’s just our tested population,” she says.
“We’re under-testing still. Certainly, we’re very accessible so people are coming to get tested, but I think there’s still underutilization of the testing site in general.”
County health officials have partnered with clinics like Roots to do “community-based testing,” as well as with churches, but officials quickly found that they needed to get “community buy-in and partners in the community to encourage testing,” Freeman Garrick says. “Our disenfranchised communities have distrust. We still have access issues.”
That distrust stems from a variety of factors, from the government’s “legacy of experimentation and exploitation” on Black patients and their “negative contacts” with other parts of the system to Latino households’ distrust of government entities in the current political climate, Aboelata says. “Any contact with the system would be feared,” she says.
By the middle of October, about 4,400 people a day were being tested in Alameda County. Freeman Garrick hopes to ramp that up above 6,000 tests a day with an increase in mobile testing, but this will require continued outreach and collaboration with clinics like Roots and walk-up testing at churches like Christian Tabernacle on Walnut Street.
“We have to be creative with this pandemic and use this to prepare for the future, because, unfortunately, with global warming and the pandemic—this is a sign of the future,” Freeman Garrick says. “We can’t just rely on the federal government to respond to this disaster. If we can be creative with public-private ventures, with better allocation of resources, we have to do that.”
Regardless of election outcomes, a second wave of the virus is expected to hit this winter, which could lead to less obvious—but just as dire—impacts on public health.
Freeman Garrick says county data shows the number of psychotic episodes and cases of depression have increased as people who live alone or with just one other person remain isolated, and parents and children continue to feel overwhelmed with remote school instruction.
“I’m concerned we’re not talking about that enough,” she says. “We’re talking a lot about testing and numbers and here’s where we are with deaths, but there are people who are living and (we’re not talking about) the impact of covid on them.”
Alameda County offers mental health services to those in crisis at the phone number 800.491.9099. More information can be found at acbhcs.org/crisis-information.