Sonoma County challenged to get coronavirus vaccines into Latinos’ arms

Hugo Tinoco, 41, has worked in Sonoma County vineyards for the better part of 18 years, harvesting grapes, driving a tractor, pruning and weeding.

After the coronavirus pandemic penetrated the county’s borders last spring, Tinoco said he continued working, even as his wife and two daughters took shelter in their Sonoma home. For Tinoco, that was not an option because his job requires him to toil with his hands, tending to the area’s prized wine grapes.

Tinoco realizes he could bring the highly contagious virus home from work with him. Not wanting to add to his risks, he has avoided gathering with friends and extended family. Now that the county has inoculated health care workers and many of its oldest residents, he wants the chance as an essential worker to join them and receive his two shots against COVID-19.

“I’m the one (in my family) who gets out to go to work, the one who goes to the store for food and other things,” Tinoco said. “Once I get the vaccine, I’ll be less at risk and not putting my family in danger.”

Tinoco is among thousands of farmworkers and tens of thousands of “essential workers” in the county waiting to be vaccinated. Like him, many of them are Latino residents.

How soon they get their first injections depends on the success of county and state officials to dramatically alter the defining unfair characteristic of the ongoing pandemic: racial, ethnic and economic inequality. Latinos have taken the brunt of widespread local virus infections, and some fear they could also be struggling near the back of the long line for inoculations.

Early vaccine ethnic disparity

The county’s vaccination campaign, hampered by a severe lack of vaccine and the bungled beginning of public inoculation sites, is still in its infancy. Last week, local public health officials received 7,425 more doses, excluding the supplies at the three large area hospitals.

Most of the vaccine doses, which started arriving here in December, thus far have been injected into the arms of health care workers, first responders, residents of senior care homes and people aged 75 or older. Officials say these factors are likely skewing the demographics of early vaccinations.

There has been plenty of community outcry about the clear ethnic gaps in the pandemic, and county officials have pledged to do better with its vaccination programs. The county’s first disclosure of demographic data for those vaccinated gives an early look at who has received the vaccine thus far.

Latinos represent only 9% of the 33,070 residents who have received a first vaccine dose and only 10% of the 10,303 residents who have received a second dose, as of Feb. 4, the most recent data available. Illuminating the disparity, Latinos comprise 27% of the county’s 490,000 residents.

By contrast, white residents, who account for about 64% of the population, comprise 52% of locals who have gotten the first COVID-19 shot and 59% of those that have received both shots of the two-shot regimen for either Pfizer-BioNTech or Moderna vaccines.

Nonetheless, county officials said it’s too early to draw any conclusions about the vaccination inequity between ethnic and racial groups.

Dr. Urmila Shende, the county vaccine chief, said at this point the data is heavily tilted by inoculated health care workers, who are among the first groups locally and statewide to get immunized against the infectious disease that has gripped the nation.

“I think as we move further ... we're going to see those numbers even out quite a bit, and that's something that we'll be monitoring,” Shende said, during a press briefing Friday announcing the county next week would expand public vaccination sites and start inoculating residents aged 70 to 74 at three clinics plus at 11 local Safeway supermarket pharmacies on a limited basis.

As the county opens its vaccination supply to more people in the general population, public health officials, health care advocates and providers are accelerating efforts to try to ensure a more equitable distribution of vaccine doses. They say it’s an opportunity to beat down a virus that has taken the lives of 275 residents and already has taken advantage of decades of deep-seated socioeconomic inequality in the county.

Since March, the coronavirus has disproportionately infected the county’s Latino residents, who have comprised 65% of 26,600 confirmed COVID-19 cases. That share was as high as 75% at one point.

During a recent county forum on vaccine equity, Lynda Hopkins, chair of the county Board of Supervisors, said food and agriculture workers have a higher risk of contracting the virus because they are forced to work every day “to make sure that food makes it to the grocery stores, to make sure that food is growing in the fields.”

“These folks are also at risk for extreme outcomes of COVID, like severe illness that has long-lasting consequences, job loss, wage loss that can lead to homelessness,“ Hopkins said. ”We know that many of these people who help keep our world turning in Sonoma County are Latinx.“

Alegria De La Cruz, director of the county’s new Office of Equity, said equity needs to be aggressively “designed“ into the county’s vaccination plans to overcome the structures in our society and local economy that put Latinos at risk — crowded housing, the need to work multiple low-wage jobs and inadequate, if any, access to health care.

"It took a long time for the state to begin really tracking equity metrics during the (pandemic) reopening process, and we saw the toll that took on communities who did not have the resources to really carry that burden,“ De La Cruz said.

That is one of a host of challenges coupled with the tight vaccine supply that has Gov. Gavin Newsom and state health officials scrambling to vaccinate California residents. In doing so, Newsom abruptly on Jan. 13 said all state residents aged 65 and older — 6.6 million people — were immediately eligible for COVID-19 shots. Between then and now, Sonoma County officials have still stuck largely with inoculating residents aged 75 and older, saying that’s the best approach with the small weekly vaccine shipments arriving.

Now slowly finding its footing and gaining momentum with the unprecedented and complicated task to get residents immunized, county officials are coordinating with the big area hospitals and community health centers to execute the monthslong mission. The warning flags are already visible, that if low-income and Latino neighborhoods are overlooked the mission can’t succeed.

“We have an obligation to really take a close look at the level of control and discretion that we have in the County of Sonoma to make sure that our vaccines are equitable,” De La Cruz said. “And that we do everything we can to get those vaccines to the people who most need them.”

Kaiser Permanente, which operates a Santa Rosa hospital and extensive health care network in Northern California, is working with local health officials and clinics in trying to reach underprivileged groups with vaccinations. The state also tapped the health care provider, along with health care insurer Blue Shield, to help distribute vaccine doses faster and more equitably statewide.

Dr. Kendal Hamann, Kaiser’s assistant physician in chief for care experience and outpatient quality in Santa Rosa, said Kaiser is collaborating with community health centers, its Latino Advisory Council and Latino neighborhood groups to ensure equitable access to the vaccines.

“Kaiser Permanente is committed to getting the COVID-19 vaccine to our members and communities as soon as possible, in accordance with state guidelines, equitably, and as vaccine supplies allow,” Hamann said Saturday in a statement.

Relying on health centers

Key players in the county’s effort to get more vaccine doses into the arms of essential workers are community health centers, a robust network of primary care providers that for decades have served low-income residents, many of them Latino.

Ken Tasseff, who leads vaccine logistics for the county, said the health centers recently have secured 138 full-time staff paid for by the state to assist with inoculations.

On Friday, West County Health Centers held a vaccine clinic at Guerneville School for people 75 and older, health care workers and farmworkers, including dozens who labor in the vineyards.

The county supplied vaccine doses to the clinic, and county public health officials said they specifically put no age requirement on farmworkers’ eligibility for shots because of their high risk of contracting COVID-19.

County figures show public safety and health care workers have the highest likelihood of contracting the virus at work. But essential food, manufacturing and agriculture workers are also at high risk.

According to the latest county figures, 33.8% of local food and beverage production workers, 33.3% of manufacturing employees and 26.8% of agribusiness workers have contracted the coronavirus on the job.

“We’re leveraging deep relationships in our community, working with businesses to bring workers into those sites, working with churches,” said Dr. Jason Cunningham, CEO of West County Health Centers. “We’re finally getting our systems in place to be able to act locally with equity as a driving principle.”

Deploying mass vaccination sites

Gabriela Bernal-Leroi, chief operating officer of Santa Rosa Community Health, the county’s largest system of local health clinics, said her team is coordinating with the county to set up a mass vaccination site at the Sonoma County Fairgrounds in the next couple of weeks.

Bernal-Leroi said that undertaking, which is expected to run Monday through Friday, is modeled after a successful COVID-19 vaccination clinic it held on Jan. 30 at its Vista Campus in northeast Santa Rosa. More than 900 people were vaccinated in a day.

“We also want to set up Saturday or evening hours, so that essential workers and other people who can’t come in during the workday also have access to the vaccine,” she said.

The demographic breakdown of the community health system’s vaccination data shows how effective the health care provider has been vaccinating Latino residents. Of all the people who have been vaccinated thus far at Santa Rosa Community Health clinics, 45% has been Latino. Overall, 47% of the provider’s patients are Latinos.

“Those numbers are reflective of the amazing work that they do in terms of equity,” said Denia Candela, the county’s health equity manager.

Letting essential workers go first

Health care advocates say that if ramped-up vaccination efforts between the county and local health centers and clinics fail, privileged county residents will continue receiving scarce vaccine doses and the pandemic will continue to disproportionately hurt low-income residents and people of color.

Dr. Jenny Fish, a family medicine physician who helped start the local health care advocacy group H-PEACE, or Health Professionals for Equality and Community Empowerment, commended the county’s efforts to get more essential workers inoculated.

However, Fish said she’s worried that when the county makes the coronavirus vaccine widely available to tens of thousands of residents aged 65 and older, that move could potentially push aside essential workers — many of them Latino — who need shots. Some people 65 or older have started to get vaccinated at local hospital clinics or have traveled out of the county for inoculations.

No doubt in the coming days and weeks there will be increasing pressure from several quarters on Sonoma County officials to finally align with the state and Centers for Disease Control and Prevention and make all local residents 65 and older eligible for COVID-19 vaccinations at public inoculation sites.

At this critical juncture, the vaccination equity question will pose a bigger challenge for county leaders and residents.

“There are 65-year-olds and older who are healthy with privilege that are still going to get vaccinated way before the farmworkers are,” Fish said.

De La Cruz, the county equity office director, affirmed that concern.

“What that means is that somebody who is in their 60s, and who may not have underlying health conditions, and who has the ability to stay home safely, we’re asking that person to wait a little longer for the vaccine,” De La Cruz said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.