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Vulnerable Communities Last to Be Vaccinated, Treated for COVID

It wasn’t a surprise to health-care workers that those in vulnerable communities were more likely to get sick from COVID-19, less likely to get vaccinated and last in getting treated with antibodies.

COVID-19 is crushing black communities. Some states are paying attention
Volunteers line up to begin taking hundreds of free COVID-19 tests at a pop-up site at the House of Hope in Decatur, Ga. Many African Americans watching protests calling for easing restrictions meant to slow the spread of the new coronavirus see them as one more example of how their health, their safety and their rights just don't seem to matter. (Curtis Compton/Atlanta Journal-Constitution/TNS)
Curtis Compton/TNS
In looking back over the pandemic, health experts working with vulnerable communities note that it was no surprise that those communities got sick at a higher rate, and got vaccinated and treated last.

Dr. Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health, said recently that the country’s federal and state systems for distributing anti-viral drugs “failed our most vulnerable patients.”

He said monoclonal antibodies should go first to patients with the highest risk of death but instead went to the richest.

That’s not a surprise to those in health-care working with vulnerable communities. Dr. Anita Zamora, COO for the Venice Family Clinic in Los Angeles, said her clinic’s patients, more than 70 percent of whom are people of color, were delayed in getting vaccinated because the mega sites got the vaccine first.

“Here in California, what happened is initially the affluent communities got the vaccines and that’s because of how they were rolled out,” Zamora said. “They were rolled out to the mega sites and a couple of hospitals.”

To get vaccinated at those sites, a patient would need transportation, need to know where to go to get vaccinated, and, of course, need to know that vaccines are available and accessible. Early on in the pandemic access to the internet was important for online registration and location of vaccine sites.

Zamora said during January through March of last year, when people were beginning to get vaccinated, the clinic was advocating to obtain vaccines. “Even though we have 44,000 patients across the county [after merging with another clinic] already coming to us for care. ... We should have gotten a supply of vaccines earlier.”

To compound matters, many of those 44,000 patients were frontline workers and didn’t have the luxury of telecommuting as many did.

“We realized one of the most important things we need to do going forward is that we need to use the infrastructure and our strengths,” Zamora said. “We’re used to being out in the community, we’re trusted. We learned going forward that we have to have our own supply of vaccine.”

“Given the American society and its health-care system, it’s not a surprise to see this impact with COVID,” Dr. Allison Agwu, Johns Hopkins University School of Medicine fellow, said recently in a briefing with the Infectious Diseases Society of America.

Agwu said not only did vulnerable populations lag in terms of getting vaccinated, but they also were behind in getting tested for the virus and weren’t well represented in medical and clinical trials.

Agwu said Blacks were 22 percent less likely to get treated than whites, Hispanics were 58 percent less likely and Asians were 48 percent less likely. “Others” were 47 percent less likely.

Dr. Emily Spivak, co-director of the Antimicrobial Stewardship Programs at the University of Utah Health and Salt Lake City VA Healthcare System, added that, “We already had the experience to know that things were not equal and that we were seeing far more patients infected and hospitalized and having really bad outcomes, who were essentially of nonwhite race or ethnic groups.”

Zamora said her clinic is still out in the community at various sites vaccinating people and providing benefits to vulnerable populations, such as the homeless.

“Now that the mega centers have closed down, it’s really a community-based, boots-on-the-ground effort, handing out flyers, going to parking lots and doing same-day walk-ins,” Zamora said. “We might start the day with 20 appointments and at the end of the day, 80 or 100 people have come in because they saw us or heard about us.