Was Oregon’s COVID-19 Pivot Enough To Address Racial Inequities?
Oregon's case and mortality data show COVID-19 has been particularly hard on some communities of color. Have public health changes improved the outlook?
This is the second article in a three-part series on Oregon’s COVID-19 response, as we enter the pandemic’s second year. Part one looks at the double-edged sword of Oregon’s COVID-19 success.
When the coronavirus pandemic broke out last winter, public health systems across the country were dealing with something they’d never encountered before. They were scrambling amid emergency closures, widespread shortages of facemasks and testing supplies, a confused and ultimately incompetent national response and so many unknowns about how the virus would behave.
Early on, there wasn’t much attention given to ensuring the COVID-19 response would account for long-standing inequities experienced by Black and Indigenous people, and other people of color.
And a year later, those communities have continued to experience a disproportionate impact of the pandemic in the United States.
Oregon is no different. Communities of color have had higher case, hospitalization and death rates from COVID-19. And while state officials pivoted to shift more resources and attention to these communities, the data from last fall’s statewide coronavirus spike shows more will need to be done going forward.
Oregon's case history
Number of COVID-19 cases per 100,000 population over the course of the pandemic.
“I would say that the Oregon Health Authority, at the start of the pandemic, didn’t really have either a plan, initiative or the right people in place,” said Kristin Yarris, director of the Global Health Program at the University of Oregon, of the state’s ability to serve communities of color.
Yarris has been studying how Oregon officials have been communicating pandemic information with Latino communities. She said when the order came down from the state to stay at home, people in Latino communities sometimes didn’t understand their options, feared reprisal or weren’t working in the kinds of jobs that would allow that to happen.
“I think for Latinx folks, they kept going to the workplace, particularly agricultural workers — but not just agricultural workers: construction workers, domestic workers, care workers,” she said.
Almost immediately, case numbers in Oregon reflected some of the same historic health inequities in the United States. Black people, Native Americans and other people of color are generally hit hardest by heart disease, diabetes, HIV/AIDS and other chronic and infectious diseases.
For coronavirus, infection rates among some communities of color outpaced those of white Oregonians by up to 30 times when adjusted for age.
COVID-19 cases in Oregon
A comparison of case rates by community to overall population in the state.
After May 25, when George Floyd was killed while in police custody, social justice protests began across the country. In part as a side effect of those protests, more people took note of these disproportionate effects of COVID-19.
“Long-standing health and social inequities have resulted in increased risk for infection, severe illness, and death from COVID-19 among communities of color,” the Centers for Disease Control and Prevention said on its website in June, as case rates nationally for Native Americans, Hispanic/Latino and Black people exceeded white rates by up to five times.
In Oregon, the disparities in case numbers have shown up most prominently in Pacific Islander and Latino communities. Both groups have seen COVID-19 case rates that are nearly double their share of Oregon’s population.
“To watch these inequities pop up from a brand new virus … and then when you add the racial justice movements,” said Oregon Health Authority Public Health Director Rachael Banks. “We now have to take accountability for those inequities (where previously) some of the other (disease) data we’ve seen maybe allowed people off the hook.”
And things have started to change – at least in terms of approach. The state began formalizing partnerships with community groups that had strong ties within communities of color and other traditionally underserved populations.
“I saw a real pivot about July, August last summer. [The Oregon Health Authority] started having targeted grants to community-based organizations to craft messages. They have this whole community partner initiative they’re doing now,” Yarris said.
Health officials say they entered into about 170 contracts with these groups to perform contact tracing and outreach.
“In the public health world, that was a big shift,” health authority Director Patrick Allen said. “It’s actually a shift that is going to persist past the pandemic, because it is really such an effective way to not go in as an outsider into a community and say, ‘Here’s what we think is best for you.’ But to work with people who serve that community and are members of that community every single day.”
How many times more likely are Oregon’s communities of color to have been hospitalized or to die of COVID-19 compared to white populations? (Adjusted for age)
Has it worked?
Oregon’s strategy to serve communities of color has shifted during the pandemic, but it’s not clear from case, death and hospitalization rates how much the change has moved the dial. When adjusted for age, non-Hispanic white Oregonians are less likely to be hospitalized or die of COVID-19 than are Oregonians who are Black, Indigenous and people of color (BIPOC).
Pacific Islanders in the state have been nearly 16 times more likely than their white counterparts to die from COVID-19. Hispanic/Latino people have been more than four times more likely than non-Hispanic people to be hospitalized.
And the case rates by relative population continued to be higher for BIPOC groups, even after the community partnerships were formed.
Still officials say they’re better-positioned now, as year two of the pandemic commences.
“I don’t want to paint a rosy picture because we have so much work to do. But I think we now have more people with us who can help partner to really address these issues and not throw up their hands,” said State Epidemiologist Dr. Dean Sidelinger. “There’s more momentum there.”
A big trial for the state’s new strategy could come in the next few months. Last summer there were several COVID-19 outbreaks around the state among agriculture and food processing operations, where Latino people often make up a large portion of the workforce.
The state is moving into the agricultural season once again. The state will once again be tested — not only how well it serves BIPOC communities when it comes to disease prevention, safety and resources, but how effective they are getting vaccines to these communities.
“I wonder if we’re going to see a spike - hopefully not - this spring again where those case numbers start to rise,” said UO’s Yarris. “Especially as white folks start to get vaccinated at unequal rates.”
Copyright 2021 Oregon Public Broadcasting