On the California-Mexico border, the coronavirus continues to disproportionately impact communities where large numbers of essential workers and high rates of poverty render preventative measures, such as social distancing, nearly impossible.
In San Diego County, the discrepancy between case totals tracks the region’s socio-economic divisions. In the county’s southernmost zip code, case rates are roughly three times higher than San Diego City itself and five times higher than several of the county’s wealthiest neighborhoods, including La Jolla, Rancho Santa Fe, and Del Mar.
“The virus and the impact of the virus follows exactly what we already knew about the impact of zip code and health disparities on life expectancy and outcome,” explains Dr. Jeanette Aldous, the clinical director of infectious disease at San Ysidro Health in San Diego, California.
On this episode of the podcast, we speak with Aldous and others on the front lines of the outbreak on the southern border about how their patients have been impacted and what they are doing to respond.
When Covid-19 was first detected in California, Jeannette Aldous braced for the worst.
“We knew it was coming for our community.”
Aldous is an infectious disease doctor at San Ysidro Health in San Diego, California.
“I direct our infectious disease programs and then I’m also our chair for infectious control so at the moment, as you can imagine, my job is 100% COVID.”
The health center has 26 clinic sites throughout San Diego serving low-income communities near the California-Mexico border.
Aldous says that in the beginning, South County didn’t necessarily have more cases than any other part of San Diego. But once California issued its statewide shelter in place order, that changed.
“Then you start to see this separation where the people that have ongoing exposure and ongoing risk and then more difficulty putting into place these protection measures, have more cases.”
Now, South San Diego County is a Covid-19 hotspot.
The southernmost zip code has a case rate nearly 3 times higher than San Diego City itself and roughly 5 times higher than some of the county’s wealthiest neighborhoods, including La Jolla, Rancho Santa Fe, and Del Mar.
Aldous says the discrepancy is not surprising.
“The virus and the impact of the virus follows exactly what we already knew about the impact of zip code and health disparities on life expectancy and outcome.”
In San Diego, Latinx residents make up two-thirds of the county’s coronavirus cases, though they represent just one-third of the overall population. Across the nation, similar trends hold.
According to the CDC, Latinx people in the U.S. are 4 times more likely to be hospitalized due to Covid-19 than white Americans.
“Even though there was no reason for, you know, a person there’s no other reason for a person in the Southern part of San Diego or person in the Northern part of San Diego to be more likely to contract a respiratory virus. It’s a social determinant of health that makes it more likely.”
In several of the communities San Ysidro serves, the poverty rate far exceeds the county’s average.
In National City, just a 15-minute drive from the border, 1 in 5 people are living below the federal poverty level. And in the San Ysidro District, immediately north of the border, one-third of school children are homeless.
“I have some patients who have trouble paying for Ibuprofen. Just simple things are a lot harder for our patients.”
Dr. Pomai Roberts is a physician at San Ysidro Health. She works at their site in National City. The area has the second highest case rate in the county.
“Most of our patients qualify for Medical, have Medicare, or have no insurance at all.”
9 out of 10 are living at 200% or below the federal poverty level and many are essential workers or work in industries that never fully shut down.
“A lot of my patients have continued to work. Housekeeping, cleaning hospitals, construction workers, if they do have jobs. So, a lot of patients have continued to work throughout the pandemic.”
Staying at home to avoid the virus wasn’t an option.
“They don’t have the choice really to sit at home and not work, so they put themselves at risk to continue to get a paycheck.”
As soon as cases began to rise, the health center took measures to make their services more accessible, despite the need to limit in-person visits.
They added a hot line that patients could call with questions or concerns. They set up drive-through testing sites. And they ramped up their telehealth program.
Dr. Roberts says telehealth has helped patients keep their chronic conditions in check during the pandemic.
Within minutes, she can prescribe insulin to a patient or address a blood sugar spike, without them ever having to leave their house.
“If I can keep my, you know, my diabetic as healthy as possible and keep them out of the ER, out of the hospital, that’s kind of the best thing I can do for them right now.”
And for those who do call in with COVID symptoms, Roberts says providing information is key.
“A lot of our patients have more mild symptoms, a little bit of a sore throat or cough, not even necessarily have a fever. And those kinds of patients when they do test positive, a lot of them just need education, a lot of education on what they need to do.”
While the usual advice is to quarantine, she’s careful to assume her patients can self-isolate.
Because of high housing costs, many live in multi-generational homes. If self-isolating isn’t possible, she offers alternative solutions.
“We do have the option of calling county 2-1-1, and there is, um, the option. They will provide free housing.”
The county has set aside vacant hotels for COVID positive patients that don’t have a place to quarantine.
“Basically once you’re there, you cannot leave until you are safe to go until they tell you, you are safe to go, which is usually for at least 10 days .”
Roberts says most of her patients prefer to stay with their families.
In that case, she works to minimize the fallout of being sick. Most have to miss work, so she helps sign patients up for grocery delivery services or apply for government assistance.
“I’ve made a lot of referrals to our social workers who can help to see if we order meals on wheels or some of my patients are getting groceries delivered to their home.”
Even for those who aren’t sick with the virus, the pandemic has brought undue hardships.
One of Roberts’ patients had to quit her job working at a fulfillment center for a large online retailer.
When she was required to wear a mask to work, her asthma flared up.
“She needed the money and was trying to work, but just couldn’t keep the mask on without feeling extremely short of breath and having a panic attack, so we had to remove her from her work because she was at the point of almost passing out working in the situation she was in.”
Roberts helped her apply for disability so she could afford to stay home.
Now, she’s living on a fraction of her regular paycheck. But, Roberts says, it’s something.
This transcript has been edited for clarity.