By Angela de Joseph | Contributing Writer
California is known for sunshine and earthquakes. Today, in the middle of summer, we are being shook to our core by a global pandemic that is showing no signs of subsiding. Our state recorded the highest number of deaths from the novel Coronavirus in a single day,158, bringing the total number of COVID-19 related deaths in our 58 counties to over 8,000. California had been celebrating having the virus under control only to see a frightening turn of events that put us over 413,576 confirmed cases of COVID-19 surpassing the 408,886 recorded in New York.
Governor Gavin Newsom had to make the difficult call to reverse and implement restrictions and re-closing of non-essential public businesses such as bars, hair salons and gyms. The most difficult call was his decision that schools will not be opening in the fall. Minority communities where those deemed, “essential “workers, live and work are most impacted by the devasting health and economic havoc of the highly contagious Coronavirus.
African Americans are disproportionately affected by the pandemic nationally, and here in San Diego County there are 580 positive cases per 100,000 among Black residents compared to 355.4 per 100,000 among white residents. It still took a substantial effort to get testing sites in the Black community. And, the response has exceeded expectations.
In Southeast San Diego, the newly opened walk up testing site at Tubman-Chavez Community Center is now the most trafficked location in San Diego County having tested over 5,000 since it’s opening in May.
I sat down with Dr. Rodney G. Hood, CEO and Managing Partner at Careview Health Center, and president of the Multicultural Health Foundation to discuss the underlying reasons for the disparity in the number of positive cases among the African American community in San Diego and the high mortality rate in other cities. Careview Health Center recently merged with San Ysidro Health.
Dr. Hood is one of the founders of the San Diego COVID-19 Equity Task force along with city and county public health representatives; Dr. Suzanne Afflalo, Dr. Robert Gillespie, Regina Evans, Minister Waliullah Muhammad, and Reese Jarrett. The task force was responsible for convincing the state to open testing sites in Southeast San Diego and pushing for data on the rates of COVID-19 infections and fatalities in San Diego County.
Q & A with Dr. Rodney G. Hood
Q Before the Coronavirus, African Americans nationally have faced health disparities and poorer health outcomes. Was San Diego any different?
A. San Diego is unique. The Black population is a little less than 5% and we are more diffused throughout the county than twenty years ago. And this gives a different view of how Black folks are doing versus other cities like Oakland or on the east coast where the Black community is more densely populated.
Q. Has racism been a factor in medical care and subsequent health disparities in the Black community in San Diego?
A. I have tracked health disparities in San Diego for thirty years. African Americans have the worst health outcomes compared to other ethnic groups and yes racism has been a persistent contributor. Although I’ve seen improvement in the last ten years, we are still highly impacted disproportionately by what I call structural racism, not only in healthcare but in education and the justice system. And Blacks have always had those chronic barriers to overcome.
Q. What has been the prevalent factor?
A. There are 3 factors that cause Blacks to suffer worst health status and outcomes; 1) disproportionate pre-existing conditions such as hypertension, diabetes, obesity, lung disease, etc. 2) social determinants in health such as poverty and poor life styles, and 3) structural racism. There is a difference between what I call, “racialized” poverty and poverty, similar to, “Black lives matter” and “All lives matter.” Poverty for Blacks has been structured due to redlining causing a wealth gap, and mass incarceration rates. When you compare the Black population in zip codes 92114 or 92113, Blacks are about (20-22%), Hispanics (45-60%), Whites (10%) and look at the health statistics by race and ethnicity, we find that Black health statistics are worse than Hispanics and poor whites that live in that area.
Q. If the median income in those neighborhoods is the same across racial groups why would African Americans have greater health disparities?
A. That question is the basis for the lecture I developed, “Post Traumatic Slavery Disorder.” Even if we are poor and living in the same poor areas, our health outcomes are still worse because of the stressors of being Black in America. This has become evident with the recent awareness through Black Lives Matter.
Q. Did the Affordable Care Act have an impact on the Black community by providing more access to health care?
A. Yes, access is critical. The first evidence that access is critical was in the 1960s. We saw a tremendous improvement in African Americans health outcomes after the Civil Rights Act when Medicaid and Medicare were created, and we gained [some] access to the healthcare system. And, the Obamacare legislation did further increase access to healthcare for African Americans but, it is not enough and will never be enough to eliminate the disparities caused by structural racism.
Q. We know that African Americans have a higher mortality rate for many diseases that are preventable and are diagnosed at a late stage. Why are we reluctant to seek preventive healthcare?
A. Historically, Blacks have a distrust of the medical system even when we do have access. There are multiple injustices that have been done to Blacks in the healthcare system such as unjust experimentations and chronic lack of respect.
Q. What would be an example of different treatment?
A. I started looking at the data twenty years ago on the way Blacks were treated differently for pain. There was a study done in Los Angeles where Blacks, Hispanics and Whites come into the ER who were all diagnosed with bone fractures, but the Black and Hispanic patients were prescribed less pain medication by the White physicians. They did the same experiment in Atlanta and found the same difference in the pain prescriptions for Blacks. The perception of Black patients is [biased], even those with Sickle cell [anemia] who require more pain medication are treated like drug addicts. This is just one example.
Q. Would this treatment include the high incidence of Black women dying in childbirth and not being acknowledged when they are suffering?
A. Yes, they are treated differently when they complain of pain and the high mortality rate is an example of Post Traumatic Slave Disorder. Black women have a higher allostatic load of chronic stress that is internalized and regardless of their economic status this leads to a higher infant mortality rate and increase incidents of maternal death than their white counterparts and it’s not genetic.
Q. What factors lead to the greater health disparity in African Americans overall?
A. The high incidence of morbidity in Black populations tend to develop from the 3 causes I mentioned earlier, excessive pre-existing diseases, social barriers and underlying societal racism and the emotional stressors caused by these factors.
Q. In terms of the COVID-19 virus, we saw extremely high incidents among African Americans in the urban cities, but in San Diego we did not have those numbers. Why did it take so long for us to get testing in Black community here?
A. It was the lack of having an equity focus . We were getting calls in my office from community members who needed to get tested. We had no test sites in Southeast San Diego so I had to refer them to the county and to call 211. They were referred to places in other communities and many did not meet the criteria to receive a test. They put the testing in areas that were convenient for them but not for the populations at greatest risk for exposure.
Once Dr. Afflalo and I went to county [representatives] and brought to their attention that it was necessary to have testing sites in Southeast San Diego, they responded in a positive way.
Q. What was the impetus for starting the COVID-19 Equity Task force?
A. On April 15th The San Diego Union-Tribune published my Op-Ed, “Why so many black Americans are dying from COVID-19 and how to make health care equitable.” In the article I pointed out that we needed testing sites that were accessible to minorities and the Black community. I laid out strategy for a public health equity approach that involved free testing and contact tracing with a focus on the most vulnerable and high- risk populations, including blacks, Hispanics, and immigrants.
Q. What was the response to your commentary?
A. I got a great deal of responses from that, but we still didn’t have a testing site. This led to my assembling friends and colleagues to meet and work for health equity and not only testing for COVID-19, because I knew we were going to have the virus with us for a year or more. There were about six of us; Dr. Suzanne Afflalo, Dr. Robert Gillespie, Regina Evans, Minister Waliullah Muhammad, and Reese Jarrett and we developed a strategy and petitioned the county to open a test site in Southeast San Diego.
Q. What was the response?
A. The first one was a drive through at the Euclid Medical Center where I practice and that site did well. There was a demand for a walk-up test site because in our area many community members use public transportation or have to get a ride. So, they finally started one at Tubman-Chavez and from what I understand, it is now the most popular COVID-19 test site in the entire county. In the past couple days, they had over 500 people per day.
Q. Also, wasn’t the Tubman-Chavez testing site changed from by appointment to no appointment needed, which is more convenient for working people?
A. Yes, when it started it was run by the state and there were 120 appointments available a day and 25-30% no show rate. They were thinking of pulling the location because they thought the people were not interested. I told them to focus on the solution to the problem; either overbook like airlines or eliminate appointments and just have walk ups which is working very well.
Q. Now that there is testing available in Southeast San Diego, has the number of positive cases recorded for African Americans gone up?
A. Yes, they have gone up from 2.5% to 4.7% of African Americans testing positive in San Diego.
Q. Isn’t that in line with the Black population in San Diego which is about 5.5%, unlike Chicago which is 30% Black but 70% of the Coronavirus cases?
A. Yes, but there are a number of reasons for this. One is that the county does not have complete data on race and ethnicity. If you look at the number of positive cases, there are about 20% who are listed as race/ethnicity not identified. It would only take a couple of hundred of those unidentified to be African American to change that.
Q. How is that different from other cities?
A. If you look at COVID numbers go to Black populations that are more condensed for example back east or up in Oakland, they have more multi-generational families living together. That can have an impact on the spread of virus. In San Diego the African American population is more diffused.
Q. Is the county working on streamlining the data collection and demographic breakdown?
A. One of areas we are moving forward on the COVID Equity Task Force is to get more complete racial and ethnic data and we want to work with the county to do that. I told our County public health officer, Dr. Wilma Wooten, that for us to be that different from other Black populations not only on the east coast but in California, we either have a different population of Black folks or there is some outlier with the data. And I think it’s more outlier with the data, that’s my suspicion. But, until we get complete data, it’s going to be difficult to know.
Q. It is quite an accomplishment for a Black woman to be the top health officer in a city like San Diego. Can you speak to some of backlash that Dr. Wooten has endured and is it racially motivated? I know she has been sued by people who don’t want to wear masks and had other attacks.
A. In all fairness, throughout California there have been other public health officers who are not Black who received personal attacks to the point that some of them actually resigned. I’ve known Dr. Wooten for 30 years and I think she’s been dealing with issues around structural racism even before COVID. Many residents of SD County didn’t realize how powerful the Public Health Officer was until we had COVID and now she is on TV giving critical directive that affects all of our lives. Understanding the culture in San Diego I believe many quietly say, I didn’t realize this Black person had this much power. The other issue is that there are people in parts of the county that are just anti-science. And then when that science is being presented by a Black woman that makes it even less tolerable. This is interfering with their normalization of things. She just happened to be in the middle of it.
Q. What is causing the surge in Coronavirus cases in California?
A. We do not have a national strategy, that is key. We have 50 states, all operating independently. In New York Governor Cuomo developed a state strategy and worked with the bordering states and they were successful. Even if we did the right thing in California, we are bordered by Arizona which is taking off in infections. We also have a large population of essential workers, some of them are afraid to get tested. They don’t want to get tested because they can’t afford to stop working and take off if they test positive or feel sick.
Q. How could we reverse the rise in COVID cases?
A. We should clamp down until we get to a positive rate <5%, then reopen up based upon data and science. We opened back up too soon. We should have been expanded testing and provide funding to people so they could have stay at home. We should not place the economy over our health. We need a national strategy and work with bordering states and other countries.
Q. What do you suggest to Black families who have to work, and their children are not going back to school in the fall?
A. This is the time that the Black community needs to see how we can come together and help each other. Instead of each individual family needs to figure it out for themselves we need to look to groups such as a sorority, fraternity or organization that can help with childcare. Those that have resources will find a way and those that do not will suffer unless we find a way as a collective to help out.
Q. Should we be going to the doctor for our regular check ups and preventive care now?
A. Yes, people are still having heart attacks and although we are focused on COVID, we still have the chronic diseases that were killing us before COVID. Eighty percent of medical appointments can be handled through telehealth on a phone visit with a physician. There are some cases that require an in-person appointment and of course get your mammograms and x-rays. Make sure you are wearing a mask and the medical providers are wearing a mask.
Q. Some people are asymptomatic so having a normal temperature doesn’t mean you don’t have the Coronavirus, right?
A. I’m an advocate that everyone should get tested. Knowing what your status is especially imperative if you are going to get elective surgery that you have been putting off. The outpatient facilities have improved safety procedures. All the staff should be tested regularly. Access to testing and contact tracing is the key to getting the virus under control. The Tubman-Chavez testing site is located at 415 Euclid Ave, San Diego, CA 92114 Testing is free and available seven days a week between 8:30 a.m. to 4:30 p.m.
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