Disturbing COVID data is a call to action, UC Santa Cruz professor says

During Black History Month, a published study co-authored by a UC Santa Cruz sociology professor is a direct demonstration of how far California has to go to provide equitable health care access and education to its Black constituents. 

SANTA CRUZ — During Black History Month, a published study co-authored by a UC Santa Cruz sociology professor is a direct demonstration of how far California has to go to provide equitable health care access and education to its Black constituents.

“In some ways it’s so easy to feel pessimistic,” Professor Alicia Riley said, pulling from the communicated experiences of her students. “Often when I check in with them about how (they feel) they are really sad and overwhelmed. It can feel heavy, like there’s nothing we can do. But these kinds of results can be a call to action. We can be responsive in our policy choices, even some that we make in the short term.”

Understanding the data

Riley explained the findings pulled from citizen death certificates. In the beginning of the pandemic, Latino people across the state were dying of COVID-19 at an accelerated rate in comparison to other populations — even California’s Black community. Then, with the arrival of vaccines, California focused on “equity” as a main vaccine rollout metric and targeted the Latino population. Latinos were naturally prioritized for vaccine appointments because of their high risk circumstances — be it multigenerational housing or a frontline customer service job.

Riley suspects from her data, published in the Journal of General Internal Medicine, that this is one of a few key elements that, in spring 2021, helped to close the equity gap in relation to proportional death rates for Latinos — particularly middle-aged individuals, the focus of the study. The vaccination period helped white Californians too, bringing their mortality back into a proportionate death ratio in comparison to the age group across the state’s four main ethnic groups — Latinos, non-Latino whites, Blacks and Asians.

However, Riley and her colleagues from Stanford and UC San Francisco noticed that the gap did not close for middle-aged Black Californians. As many other populations started to go about their activities again between March and July of last year, the movement of recovery left Black Californians unprotected.

“Mortality disadvantages persisted or grew for Black Californians, highlighting the need for attention to unchanged structural inequities,” the researchers explained in their report on Feb. 2.

In residents aged 40 to 64, the fraction of Black decedents increased from 6% to 21% during the four-month period when the fraction of Latino decedents dropped from 66% to 30% and white decedents held a proportionate mortality rate at a final 38%. The mortality disadvantage for Asian Californians experienced a lower fraction of COVID-related deaths than the percentage of the population they make up, across all age groups, since May 2021, the study says.

This made Riley curious, as Black and Latino Californians held similar vaccination rates through the window of study at 26% and 24% respectively.

“For so long when the racial inequities in COVID deaths first emerged, people tried to make sense of it. It’s really easy in the absence of data to point to individual or even biological explanations for them (such as) preexisting conditions,” Riley said. “This shows us that whatever is driving these trends is not as fixed and biological as we thought.”

Who is dying, the Santa Cruz professor argues, depends on a combination of factors fluctuating from regional policy implementation to individual behaviors. Across the board, Riley feels as though a well-intentioned messaging about the importance of vaccination in older adults yielded an unforeseen consequence: A lack of prioritization of getting one’s shots in the age group just below it.

“We don’t have the evidence to speak to exactly what combination of factors drives this but vaccination is an important part of the story,” Riley said. “Natural immunity is complicating this story also, as the Latino communities were hit hardest by the (2020) winter surge especially in Los Angeles County. There was probably behavioral change as a result of that. If three people in your family die, you’ll take COVID seriously.”

Riley emphasized that natural immunity, which has miniscule research in relation to the virus, is not a strategy one should use to protect themselves.

“There are so many possibilities of reinfection,” she added.

Building on the data

Because the doctors concluded gathering data in July, there is no insight provided on the Delta and Omicron variants. Riley knows they have plausibly shifted racial disparities in who is dying once again. She is looking to study this phase of the pandemic in the future, when Omicron’s heaviest impacts have subsided. In the meantime, Riley is studying the work of her fellow scholars who are studying trends around infection, serious illness and death across many demographics including age.

When the second study takes place, Riley and her team will further explore how vaccination rates are not enough information to lean on in understanding who is and is not protected from COVID-19.

“There is a mismatch between who is vaccinated and who is really at risk of dying because of all kinds of factors from exposure to whether or not (someone) is going to use masks and if they can isolate themselves or protect themselves or if they have access to testing and, if they got sick, whether they’d go to the doctor right away and not delay it,” Riley said. “Maybe the (vaccinated) were pretty well protected through other measures and maybe the unvaccinated (population) is where overlapping risk factors are.”

Putting data to work

Riley said this is a wake-up call that the state can do better in terms of bringing vaccination and its true importance to those who are at risk of getting severely ill if they were to contract COVID-19. Officials can identify and target at-risk populations by monitoring their own individual jurisdiction’s disparities, such as by studying who is dying and at what age.

“They would be alerted to crises,” Riley said, mentioning that with the knowledge could come more investment and outreach in middle-aged Black Californians.

For good reason, media coverage of disadvantaged communities has revolved around the Latino population because it was so astronomically affected for so long, she said. Today, however, white Californians are entirely losing their mortality advantage they had during the majority of the pandemic in comparison to their population percentage. It’s not about comparing one race or even one age group to another: It’s finding those in need and lifting them up with critical information.

“It’s possible that certain communities made assumptions about how safe they were that didn’t hold,” Riley said. “We are all at risk here.”