Alameda County’s Innovative Covid-19 Plan
After nearly a year of trying to contain Covid-19, the virus, and its now-numerous variants, are still wreaking havoc in communities across the U.S. Although vaccines are being distributed at a rapid pace under President Biden and cases are dropping, the U.S. passed the grim milestone of 500,000 deaths this week, a solemn reminder of the virus’ outsized impact. Deaths are still in the thousands daily, and vaccines may not be distributed to all of the general public for months to come.
By now, most people have heard what people with Covid-19 are supposed to do: Stay inside. Don’t interact with anyone, even people in your household. Above all, don’t go to work. Much of the advice given to Covid-19 positive patients in order to curb the spread of the disease has one thread in common: it’s impossible for the working poor. Seven-in-10 low-wage workers are not entitled to paid sick leave, and may be forced to work—even when carrying Covid-19—to feed their families. At the start of the pandemic, government programs including pandemic unemployment assistance, paid leave and stimulus funding helped to close the gap, but most CARES Act support expired in July, and the $900 billion stimulus package passed at the end of 2020 offered only meager help, such as the $600 stimulus check. A year into the pandemic, workers have few options, even with the recent passage of Biden’s stimulus package.
People who work while Covid-positive can spread infection and are dangerous to their whole communities. “A single positive Covid-19 patient can infect up to 3 other persons; in some cases 12 cases have been linked to a single individual,” said infectious disease expert Priya Soni, an M.D. at Cedars-Sinai hospital. “Though super-spreader events are not fully understood, we do know that the transmissibility of this virus is much more than other respiratory viruses we have encountered.”
Alameda County, California, home to more than 1 million residents and the city of Oakland, is hoping to change that. This summer the county announced a pilot program to pay residents who are Covid-positive to self-isolate. $1,250 checks are distributed via community clinics to vulnerable residents, many of whom may otherwise have been forced to work or face hunger or eviction. The program could serve as a model for other similar cities around the country, where Covid-19 is hitting low-income communities of color hardest.
The stipend program is an important solution, although it’s not enough to serve all residents in need. In total, the county has allocated $10 million for the program—enough to cover about 8,000 people. To date, Alameda County has had nearly 80,000 Covid-19 cases. “These programs provide what I call ‘Band-Aid measures,’ and while they are immensely valuable and are often the only bridge for our most vulnerable populations, they cannot be the only solution,” Soni, who worked in Alameda County during her residency, said.
In order to prioritize highest-need residents, eligible patients must live in a vulnerable zip code with high Covid-19 rates, have tested positive for Covid-19 and be ineligible for paid sick leave. Community clinics with neighborhood contacts distribute the funds. “Our public health department looked at the information and zeroed in on the neighborhoods experiencing peaks in positive tests … it’s no coincidence that those zip codes are often low income, and that most of the people who live in those neighborhoods are Black and Brown,” said Alameda County Department of Social Services Director of Public Affairs, Sylvia Soublet. Research shows that low income communities and communities of color have much higher rates of complications and higher death rates from the virus.
“Many of the racial and ethnic minority groups most negatively impacted by Covid-19 are also the ones that are on the front lines as essential workers, working in healthcare facilities, food handlers, grocery store clerks and integral parts of a fully functioning public transportation system,” Soni said. “Because their livelihood is on the line, many are not able to take time off work to afford the—never thought I’d say this—luxury of quarantining.”
Many front-line workers in California are undocumented. The stipend program is open to all residents regardless of immigration status. It’s estimated that about 5% of the residents in the Bay Area are undocumented, which is among the highest percentage in the nation. Generally, undocumented immigrants are barred from social programs, like SNAP, that are so vital for many low-income families. “Alameda County has always identified itself as an immigrant-friendly county, and we felt strongly as a county and a Board of Supervisors that you don’t start penalizing people for their immigration status in the middle of a pandemic,” Soublet said.
One of the community clinics selected to distribute the funds is La Clinica de La Raza, a community health center that largely serves immigrant communities in East Oakland—where more than half of residents live below the poverty line and median income is less than $30,000 per year, according to the Federal Reserve. In August, East Oakland had higher Covid-19 rates per capita than both Georgia and Florida, the two hardest-hit states in the country last summer. The stipend program is a much-needed lifeline for La Clinica’s patients.
The stipend program is not without limitations. The amount was designed to make up for lost wages from two weeks of minimum-wage work. In an area where the median rent for a 1-bedroom apartment is nearly $2,000, a single $1,250 check doesn’t close the gap entirely for most low-income families. Katie Corbian, La Clinica de La Raza’s contact tracing supervisor, also notes that it does not address long-term housing patterns that contribute to Covid-19’s spread. “I think one of the main issues we are having is that many of our patients live in high-density housing,” Corbian said. “Housing in the Bay Area is really expensive, so people have to live together. It’s often multi-generational.”
Some Covid-positive patients simply have no idea the program exists. Yuri Kye, a concert violinist and violin teacher who lives in Oakland, lost about 70% of her income when the pandemic hit. What she was able to make up with Zoom teaching became difficult when she caught Covid-19 after having dinner with a small group of friends in San Francisco in November. After she began to feel sick, Kye went into her bedroom in the apartment she shares with two roommates, young professionals like herself. For two weeks, she didn’t leave it for more than a minute. “I realized I had a fever and thought, ‘OK, I need to go into my room, and I am not coming out unless it’s to get a test,” she said. “I got a drive-through test, so I wouldn’t have to leave my car.”
She experienced a fairly minor case, but was still in bed for about a week. To protect her roommates from catching the virus, Kye closed the vents for their central heating system and avoided her roommates as best as she could in a small, shared apartment. “I ordered delivery food, enough for a day and a half or so, so I could minimize the amount I went in and out,” she said. She was able to teach some of her students on Zoom, but she canceled some lessons, and of course lost pay.
Besides a short call from a state contact-tracer, Kye was not offered resources and no one followed up with her. It’s possible this was because her income wasn’t low enough to qualify, or because of the zip code where she lives. It’s also possible, however, that in a county struggling to balance the myriad impacts of a pandemic on a vast population of low-income people, Kye and others like her just fell through the cracks.
Patients like Kye, who share bathrooms, kitchens and even bedrooms, are not unusual. “Many of the challenges lower-income families face include living in close quarters with other members of the family, sharing a single bathroom and not having the means to purchase critical supplies to protect themselves and their families—including simple face masks and cleaning supplies to interrupt the transmission of the virus,” Dr. Soni said.
Despite its issues, the stipend program, in conjunction with other policy measures like widespread testing and affordable treatment, could serve as a model for other cities experiencing continued outbreaks as vaccine supplies remain limited. The county’s swift actions to support residents ill with the virus appear to have worked, alongside masking and shelter-in-place protocols. Although Alameda County is experiencing a surge in cases—like most of the U.S.—it has managed to keep hospitalizations and cases low enough to avoid strain on the healthcare system. Overall, Alameda County’s positive rate is currently 4.8%, as compared to the national positive rate of about 6%. Covid-19 hospitalizations have taken up a little over 7% of the county’s hospital beds.
The model of utilizing community clinics to manage tracing and distribute funds, Corbian said, is key. “This pandemic caught us all off guard; the county was struggling to hire as many contact tracers as they could in a very short period of time,” Corbian said. “And it was really, really difficult. So this model provides additional, and badly needed, capacity for the health department. The other thing to note is that we are often already the primary care provider, and so we can connect patients to everything else we offer at the clinic, like behavioral services, health services, primary care services—all in one package.”
As cities in the U.S. and beyond brace themselves to fight the Covid-19 pandemic through 2021, innovative policy solutions will be needed to limit community transmission and curb deaths. Alameda County’s model is an expensive—but effective—solution that protects the most vulnerable from the devastating impacts of Covid-19.