What county health leaders are doing to bridge COVID-19 testing gaps

People of color have been the most impacted by the COVID-19 pandemic, and San Mateo County is working on reducing disparities through testing initiatives, county health officials said in a panel discussion hosted Nov. 19.

The virtual event also included an announcement that the county recently created a health equity officer position to be filled by Shireen Malekafzali of Get Healthy San Mateo County, focused on bringing together existing equity efforts, identifying needs and listening to community leaders in the hardest hit areas.

The discussion, moderated by Henrietta Burroughs, executive director of East Palo Alto Today, convened health leaders and other community members to share what they’ve learned and what they’re doing to reduce the pandemic’s toll on communities of color.

Redwood City resident Hector Alvarado shared his experience of contracting the coronavirus at work and how it spread quickly to his family members.

In early September, he said, he and his coworkers had been mostly following safety protocols but let their guards down around a trusted colleague, who wasn’t masked. Within days, he had contracted the virus, along with his wife, her parents and her sister, he said. Although he began quarantining away from other family members as soon as he felt symptoms, isolating himself in his kids’ bedroom while the kids were relocated to an air mattress in the living room, it was too late, he said.

“I didn’t know I had already put them at risk before,” he said.

While he experienced fevers, his wife experienced more severe symptoms, including body pains, a fever for 10 days, dehydration and fainting, he said. Both she and Alvarado’s colleague also experienced severe insomnia for days while they were in recovery, he added.

“This virus is not a cold, it’s not the flu,” he said. “It’s something completely different.”

Testing barriers

Justin Mates, deputy county manager, described some of the obstacles that the public health department has worked to overcome to make testing more accessible to residents. For instance, although the county established a stationary large-scale testing site in San Mateo, many residents had a hard time getting there. In response, the county has set up rotating drive-thru sites throughout the county, as well as walk-up sites in neighborhoods to make it more convenient and accessible. As a result, the county has doubled its testing rates, he said.

Another barrier to testing is the question of trust, Mates said. Some testing vendors require people to make appointments online in advance and may ask a lot of questions, and some people are inclined not to trust vendors or the government with such information, he said.

One contractor the county is working with is Verily, a subsidiary of Google. It was reported in the L.A. Times that Alameda and San Francisco counties had ended their contracts with Verily in response to concerns that the company requires people to have a Gmail account, does not provide information in many languages, and can ask enrollees sensitive personal information. However, after this story was published, a spokesperson representing Verily told The Almanac that the contracts in Alameda and San Francisco counties were not ended, and that people are not required to have a Gmail account to enroll in testing services.

Critics of the contracts have also raised concerns that although funding for some testing sites is intended to help low-income, Latino or Black neighborhoods, there had been some instances of higher rates of higher-income residents registering for drive-thru tests through the Google-linked system.

Mates confirmed that his office had also heard those concerns and noted that the county’s standing testing site is state-sponsored and the decision is not at the county level.

“Verily has responded to some of the concerns folks have had about how the information is used,” he said. “There are clear opportunities for people to opt out of the Verily system.”

The privacy concerns, he added, should be balanced against the “values testing vendors bring to the table,” Mates added.

Other barriers to accessing testing may be cultural, said Melissa Aliu, a first-generation Samoan and Tongan scholar. In the family-oriented Pacific Islander community, many households are multigenerational, and quarantining in isolation may not be a realistic option, she said. While earlier outreach efforts didn’t necessarily resonate with her community’s values, she said that testing outreach efforts should focus on the importance of getting tested in terms of caring for one’s family’s health.

“If I care about the people that I love … getting tested should be a norm I practice,” she said.

Mitigating the spread of COVID-19

“We now know that half of COVID cases are infected by people who don’t have symptoms,” said Dr. Curtis Chan, deputy health officer in San Mateo County, who offered additional guidance for how to reduce the spread of COVID-19.

Within your own household, he advised, start wearing a mask in the house as soon as you feel symptoms or think you might need to go get a test.

COVID-19 is much more infectious than the flu and much more deadly for older adults, particularly those over 60, he said.

The positivity rates among Spanish and Vietnamese speakers are currently about four times that of the general population, between 11% to 15%, so the county plans more outreach to these communities in particular, said Dr. Kenneth Tai, the chief health officer at North East Medical Services, a nonprofit community health center.

He emphasized the need for people to stay safe during Thanksgiving by spending it with one’s immediate household. “The message is to spend the holidays in your own bubble,” he said.

Prevention

“Our key strategy is to test more people,” said Tai. People who are vulnerable, elderly, or don’t speak English as their first language are priorities for increased testing, he added.

When the vaccines become available, Burroughs asked, who will get them first?

Generally, it will be essential health care workers, then people who are over 65 or who have underlying medical conditions that make them more vulnerable to developing complications from COVID-19, Tai said. These conditions include cancer, heart conditions, a weak immune system and Type 2 diabetes, according to the Centers for Disease Control and Prevention.

Gov. Gavin Newsom has also put together a task force that will evaluate vaccines even after they are approved at the federal level to make sure they are safe.

“From what we hear from manufacturers, these are very, very safe vaccines,” Tai said.

Editor’s Note: This story has been modified since it was first posted in response to information received from a spokesperson from Verily. According to the spokesperson, Alameda and San Francisco counties did not end their contracts with Verily and people are not required to have Gmail accounts to sign up for testing.