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Bay Area Counties Fall Short of Coronavirus Equity Metrics

California’s new health equity metric is one of three indicators it is using to determine when counties may advance reopening and roll back shelter-in-place restrictions, based on a color-coded, tiered assessment system.

by Tatiana Sanchez, San Francisco Chronicle / October 8, 2020
TNS
(TNS) - In the state’s first pass at evaluating health equity during the coronavirus pandemic, four Bay Area counties did not meet the state’s new guidelines required to advance economic reopening, signaling ongoing disparities in infection rates within some of the region’s disadvantaged communities.
 
But these results, released Tuesday, won’t prevent some counties from moving forward with easing restrictions — and don’t necessarily signify a lack of progress in these communities.
 
The state’s new health equity metric is one of three indicators California is using to determine when counties may advance reopening and roll back shelter-in-place restrictions, according to the state’s color-coded, tiered system for assessment.
 
Tuesday’s report showed that four Bay Area counties — San Francisco, Contra Costa, San Mateo and Sonoma — are not meeting the metric goals required for moving forward with additional economic reopening.
 
But almost all of the Bay Area’s nine counties show significant differences in the positive test rates for disadvantaged communities compared to each county overall. In several counties, the positive test rate for lower-income communities is more than double the rate for the rest of the county.
 
Alameda, Santa Clara, Napa, Solano and Marin met the required equity metric Tuesday, though some did not necessarily meet the other two metrics, which measure overall positivity test rates and cases per 100,000 residents. Meanwhile, some counties met the equity metric but still show significant gaps in positive test rates.
 
The equity metric, which counties must meet in order to move forward with reopening, went into effect Tuesday. It relies largely on the positive test rate — the percentage of coronavirus tests that come back positive, which is widely used as an indicator for when it’s safe to ease restrictions and reopen a local economy. Higher positive test rates indicate the virus is spreading more quickly.
 
Under the metric, each county must ensure that positive test rates in its most disadvantaged neighborhoods do not significantly lag behind the county’s overall positive rate. For a county to advance to a less-restrictive tier, the disadvantaged neighborhoods — measured by a variety of social, health and economic factors — must come within 5% of the overall positive test rate required for that tier.
 
State health officials claimed Tuesday that California is the first in the nation believed to implement a health equity metric to track the virus in underserved communities.
 
“We’re incentivizing counties to reduce their infections across every neighborhood, so the counties with the lowest disparities, or the least differences, are going to be able to move more quickly through the color tiers,” said Dr. Erica Pan, the state’s health officer, during a press conference Tuesday. “The counties that are not addressing yet those disparities, or not quite reaching the lower test positivity in the areas that have the most disadvantaged communities, are going to move slower through the colored tiers.”
 
San Francisco — which is in the state’s orange tier — is close to meeting the equity metric.
 
“We have made and continue to make significant investments in an equitable emergency response, including being one of the first cities in the nation to offer free low barrier testing, free isolation and quarantine accommodations, an aggressive outbreak management program for vulnerable communities, and mobile community testing that brings testing to neighborhoods with the highest rates of COVID-19, among others,” San Francisco’s COVID Command Center said in a statement Tuesday.
 
The metric aims to ensure that communities of color no longer bear the brunt of the coronavirus pandemic — a stark pattern that has persisted in the Bay Area and beyond since March. Coronavirus cases and deaths remain highest among Latino, Black and Indigenous communities.
 
“We want all of our businesses and our communities to come together and realize that it is so important, both to address the disparities and interrupt disease transmission and address this pandemic head on,” Pan said. “We have to prioritize our interventions to the communities where we are seeing the most disease.”
 
Contra Costa County Health Services said Tuesday it welcomes the state’s new metric as it “reinforces work we’ve already begun.” Testing positivity rates in the county’s disadvantaged populations reached an estimated 6.8%, compared with the county’s overall 3.3% testing rate.
 
“We believe it’s critical to do as much as we can to help reduce the burden of COVID on historically marginalized communities,” a county spokesman said, in a statement. “Health disparities in any one part of the community affect us all.”
 
In San Mateo County, the positivity rate for vulnerable communities is 5.3%, compared with an overall county positivity of 2.6%, the county said.
 
The county’s health chief, Louise Rogers, said the equity metric, “reinforces our need to double down on the strategies we have already prioritized in San Mateo County to protect lower-income residents and populations of color who face greater exposure and risk.
 
“We see that exposure and risk not only stemming from overcrowded housing but from being frontline workers whose work involves regular close contact with others, such as food services, custodial/maintenance, caregiving, and who cannot afford to isolate when they have been exposed,” Rogers continued. “There are deep, underlying socioeconomic factors that drive the disparate impacts of the virus and won’t be solved quickly.”
 
Sonoma County Health Officer Dr. Sundari Mase said Tuesday the county is focused on targeted testing, contact tracing and bilingual outreach for its most affected communities, “which has shown success, including a nearly 25% reduction in the disparity in case rate between Latinx and non-Latinx residents. Our community still has work to do to address health disparities. The new health equity measure will help us achieve this goal.”
 
Local leaders have expressed mixed feelings about the equity measurement, with some saying it holds counties to unrealistic standards.
 
One official said it’s inadequate and unfair. Yet others said that even if it’s not a perfect solution, they understood the value in tracking the disparate impact of the pandemic on some communities, and especially people of color.
 
Meanwhile, there was no movement for the Bay Area’s nine counties among the state’s four-color, tiered blueprint for a safer economy Tuesday afternoon, according to Dr. Mark Ghaly, the secretary of California’s Health and Human Services Agency.
 
Merced, Ventura and Yuba counties advanced from the state’s most restricted tier of purple into red, Inyo County advanced to orange, and Humboldt, Plumas, Siskiyou and Trinity counties moved to the yellow tier, which is considered “minimal” risk for spreading the coronavirus.
 
Tehama and Shasta counties were the first two counties to slide backward since Gov. Gavin Newsom unveiled the new plan Aug. 28. Tehama dropped back to the most-restrictive purple tier, and Shasta dropped to the second-worst red tier.
 
Humboldt was the only county that moved quicker through the tier system because of the health equity metric, and no counties failed to move forward based solely on the new metric, Pan said.
 
San Francisco Chronicle staff writers Erin Allday and Rusty Simmons contributed to this report.
 
Tatiana Sanchez is a San Francisco Chronicle staff writer. Email: tatiana.sanchez@sfchronicle.com Twitter: @TatianaYSanchez.
 
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