D.C's health director has responded to a probe from the D.C. council to investigate why the health department didnt update its COVID-19 data to the Centers for Disease Control for almost two weeks.
The Districts health director has responded to calls from the D.C. council to investigate why the health department didnt report its COVID-19 data to the Centers for Disease Control for almost two weeks.
Six members of the D.C. Council last week wrote a letter calling for an investigation after D.C.s health department didnt update COVID-19 data to the CDC from April 27 to May 8.
DC Health director Dr. LaQuandra Nesbitt said in a letter that D.C. had been providing manual and automated reports to the CDC. She said that for those two weeks starting April 27, the manual reporting from D.C. Health to the CDC was stopped; she said its back in sync.
The council also requested that D.C. Health increase the frequency of its posts on its own website for better public planning.
Nesbitt said that they wont be changing that, citing a high degree of burnout from public health workers.
The current public health workforce is experiencing a high degree of psychological stress, commonly referred to as burnout, having experienced over two years of 12+-hour workdays, attacks both verbal and physical on public health professionals, and significant misinformation about public health and our work. In response to that, and shifting goals of the pandemic response, public health agencies throughout the United States have reoriented how they share data to effectively inform the public of their risk without straining an already reduced public health workforce, Nesbitt said.
She said they switched to the new reporting process in March and report a full week of data from each Wednesday through Tuesday.
Nesbitt said the request from the council to report data from Wednesday through Monday would not improve the publics ability to understand their public health risk.
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Chicago is expected to increase to a high community level of COVID-19 next week as positive cases continue rising across the city and suburbs, public health officials said Friday, mirroring the surge of infections around other parts of the country.
While we remain in medium, I expect that we will reach a high level as soon as next week given ongoing COVID trends, Chicagos public health Commissioner Allison Arwady said in Fridays statement. Even if Cook County moves to high, as long as the healthcare system in Chicago remains stable, we likely will not automatically reinstate a mask mandate. We may, however, advise high-risk people to consider limiting non-essential indoor gatherings.
As of Thursday, eight counties in central and northern Illinois though none in the Chicago area met the CDCs criteria for high community levels of COVID-19. The criteria include having more than 200 new cases per 100,000 residents over the previous week, 10 or more new hospital admissions for COVID-19 per 100,000 residents, and an average 10% or more staffed hospital beds occupied by patients with the virus over the previous week.
At the high community level, state and federal health officials recommend wearing masks in indoor public places, including schools, regardless of vaccination status. People who are more vulnerable to the virus, including older residents and those with compromised immune systems, are encouraged to consider avoiding nonessential indoor activities.
People eat inside Willis Tower on May 19, 2022, in Chicago. (Erin Hooley / Chicago Tribune)
In the Chicago area, Cook County and all the collar counties remain at the medium level, where the CDC recommends vulnerable people mask indoors. In all, 39 of the states 102 counties are at the medium level, up from 23 the previous week.
Statewide, there have been 315 new COVID-19 cases per 100,000 residents over the past week, or an average of 5,742 new cases per day. The official count likely underestimates the total number of cases because home tests are not included.
Hospitalizations have been rising statewide, with the number of COVID-19 patients in Illinois hospitals surpassing 1,000 on Monday for the first time since late February. On Thursday, there were 1,060 coronavirus patients in the states hospitals, up from 909 a week earlier and 568 the previous month. Hospitalizations reached an all-time high of 7,380 on Jan. 12, the height of the omicron surge.
State health officials on Friday reported 11 coronavirus-related deaths, bringing the average number of deaths to eight per day over the past week. The average number of daily deaths has remained in the single digits for more than a month, the longest stretch since the pandemic began.
While Arwady had suggested earlier this month that a high level risk designation could trigger new mask mandates and other restrictions, this week she said that they wont be reinstated as long as hospitalizations remain manageable and death rates low.
In the past week, an average of 1,172 Chicagoans tested positive for COVID-19, up from an average of 922 new daily cases the week before, according to the Chicago Department of Public Health. Meanwhile, hospital admissions have stayed the same the past two weeks, with an average of 18 hospitalizations a day, and deaths have averaged one to two a day, still the lowest rate of the pandemic, the statement said.
The city currently has 4.9 new COVID-19 hospitalizations per 100,000 population per week and less than 4% of hospital beds are occupied by COVID-19 patients, CDPH said. For the city to consider reinstating a universal indoor mask mandate, approximately twice as many Chicagoans would need to be hospitalized.
As of Monday, all Chicago hospitals combined reported fewer than 200 hospitalized patients with confirmed COVID-19, CDPH reported, including 153 non-ICU patients and 18 ICU patients across the whole system.
In Chicago Public Schools, case numbers have been rising since students returned from spring break last month. The district reported 1,900 new student cases and 700 new adult cases last week, according to online CPS data. The case numbers are rivaling those in January during the peak of the omicron surge, when the district was reporting about 1,800 new student cases and 1,100 new adult cases a week.
As of Thursday evening, nearly 2,000 students and about 300 adults were in isolation because they tested positive for COVID-19 or in quarantine because they are an unvaccinated close contact of an infected person. In February, the district cut the quarantine and isolation period for students and staff members from 10 to five days. In March, the district dropped its universal mask mandate.
CPS CEO Pedro Martinez said in Fridays newsletter to families that the districts regional vaccine clinics and mobile teams will begin offering booster shots to 5- to 11-year-olds next week. CPS says around half of the students in this age group who are enrolled in district-run schools have received at least one COVID-19 dose. About 42% of 5- to 11-year-olds in CPS charter schools also have had their first shot, according to district data.
While 76% of Chicagoans age 12 and up have completed their primary COVID-19 vaccine series, just 41% have also had the recommended vaccine booster, CDPH said. People age 50 and over are also eligible for a second booster, but even among Chicagoans age 65 and older, just 58% have had even one booster.
After federal officials approved a booster dose of the Pfizer coronavirus vaccine for children ages 5 to 11, the Illinois Department of Public Health on Friday endorsed the third shot for school-age children.
We encourage every parent or guardian of children five and older to consider a booster vaccination for their eligible child, Public Health Director Amaal Tokars said in a statement. And if your children have not yet received their primary dose, its not too late to start now. Especially with cases rising throughout the state, everyone who is eligible for vaccination should be taking advantage of the opportunity to get vaccinated and boosted. Vaccination remains the strongest way to protect yourself and your loved ones from COVID-19.
Additionally, the federal government is offering a third round of free COVID-19 at-home tests for every home in the U.S., the CDPH reminded in its announcement. Each order now includes eight rapid antigen COVID-19 tests and people can order them at covid.gov/tests or by calling 1-800-232-0233.
First baseman Joey Votto will rejoin the Cincinnati Reds for this weekend's series against the Toronto Blue Jays after missing 16 games following a positive COVID-19 diagnosis.
Votto, who has been out since May 3, said he dealt with symptoms for more than a week after getting the virus.
The 38-year-old previously tested positive for COVID-19 in March 2021.
The six-time All-Star is hitting .122 with no home runs and three RBIs, and had played in all 22 Cincinnati games this season. Votto has struck out 29 times in 74 at-bats.
The Associated Press contributed to this report.
WILLIAMSPORT - A Juniata County woman has become the first individual charged in the U.S. Middle District with possessing a fake U.S. Department of Health and Human Services COVID-19 vaccination record card.
Amy R. Leister, 55, of Mifflintown, was charged Wednesday by criminal information with possessing/making an unauthorized identification card and insignia.
This is alleged to have occurred May 17, 2017, in Union County, but the charge does not state the circumstance.
The card contained the insignia of that department and the Centers for Disease Control and Prevention, the document states.
Leister has signed an agreement to plead guilty. The maximum sentence for the charge is six months in prison and a $5,000 fine but the plea agreement recommends probation.
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With coronavirus cases on the rise, California finds itself in a familiar, if frustrating, position with the threat of another wave looming as summer fast approaches.
Coronavirus cases are increasing, in many areas at an accelerating pace. Authorities have not yet expressed alarm about the state of Californias hospitals or imposed far-reaching new rules to blunt the virus spread.
But officials say it is possible healthcare systems could once again come under strain unless the transmission rate is restrained underscoring how vital it is for residents and businesses to make use of the protective tools at their disposal.
Residents, workers and businesses need to not shy away from reinstating or adhering to safety practices that are known to reduce transmission, said Los Angeles County Public Health Director Barbara Ferrer. This includes indoor masking, testing when people are sick, exposed or gathering, and staying up to date on vaccinations.
L.A. County on Friday extended its order requiring mask use on public transit, including in rail and bus stations; in indoor areas of airports and seaports; and in ride-sharing vehicles. Vaccine clinics this week also began making available COVID-19 booster shots for children ages 5 to 11, following the U.S. Centers for Disease Control and Preventions recommendation Thursday that these youths should get one.
The Berkeley public school system announced Friday a new order to reinstate an indoor mask mandate for students and staff for the remainder of the school year, effective Monday, including indoor graduations. Berkeley schools are seeing an increase in clusters of coronavirus cases, and the surge has proved so disruptive that we have only been able to fill about 50% of our teacher absences with substitute teachers, the school district said in a statement.
This means that in schools across the district administrators are, once again, working in our classrooms as teachers while teachers are forgoing their planning periods to fill in for colleagues who are ill, the school system said.
Fourteen of Californias 58 counties are at the medium COVID-19 community level outlined by the CDC.
Counties in this category, the middle on the agencys three-tier scale, are experiencing elevated levels of coronavirus transmission. In those counties, residents should consider taking prevention measures based on their own risk, like avoiding crowds, wearing a mask, increasing their testing, especially before gathering with others indoors, according to CDC Director Dr. Rochelle Walensky.
Los Angeles moved into the medium category on Thursday, and is the only Southern California county at that level. Also in the medium category are eight of the nine counties in the San Francisco Bay Area (the lone exception is Napa County) and the coastal counties north of the Bay Area, as well as Santa Cruz County and Yolo County.
Reaching this category is concerning, since it could signal that the increases that were seeing in our COVID cases may soon put pressure on our healthcare resources, Ferrer said Thursday.
So far, no California counties are in the worst, or high, community level, which denotes a heightened level of coronavirus transmission and hospitals seeing significant impacts from COVID-19.
We need to do everything we can to stay out of high, Ferrer said. Nobody here wants to see us move to any categorization that could possibly cause stress on our healthcare system or result in more people getting sick or dying.
Being in the medium category does not trigger any new widespread rules or health guidance. However, L.A. County officials have said reaching high would prompt the return of a local universal public indoor mask mandate which hasnt been in place since early March.
Other counties in California have not outlined specific plans to reinstate a local mask order if cases or hospitalizations continue to worsen.
Masks are still required in healthcare settings, nursing homes, jails and homeless shelters and in certain other settings in some areas of the state. The San Francisco Bay Area Rapid Transit system has enacted a mask mandate. Oakland requires patrons attending indoor events with 2,500 or more people to wear a mask.
On Tuesday, a number of speakers at a health commission meeting urged San Francisco officials to reinstate a universal mask mandate.
But the citys health officer, Dr. Susan Philip, indicated she was not inclined to pursue that at this time, given the widespread availability of high-quality masks, vaccinations and boosters and anti-COVID drugs.
San Francisco has been at the medium COVID-19 community level for three weeks, sent into this tier because of its high case rate. But coronavirus-positive hospitalizations remain relatively low, Dr. Grant Colfax, the citys public health director, told health commissioners this week.
Our hospital capacity ... remains relatively robust, Colfax said.
Even though a face covering requirement hasnt been on the books for months, officials at the California Department of Public Health have consistently strongly recommended residents mask up indoors in public.
Ferrer has also urged residents to wear high-quality masks like KF94, KN95 and N95 respirators while indoors, get vaccinated and boosted, get tested when feeling sick or potentially exposed to the coronavirus, and prioritize gathering in well-ventilated areas or outdoors.
Despite the recent increases, Ferrer reiterated that she feels people can enjoy gatherings and activities, though she suggested taking prudent precautions.
While we are disheartened that the pandemic hasnt ended, I am reassured that with the tools at hand, we can continue to enjoy our time with each other and our participation in those activities we love, she said.
The situation elsewhere in the United States is more concerning.
Nationwide, 297 counties have a high COVID-19 community level including those that are home to New York City; Long Island, N.Y.; Detroit, Honolulu; and Milwaukee, Wis. Other areas in the high category include large swaths of upstate New York, New Jersey, Delaware and New England, including Boston; northern and eastern Pennsylvania; and all of Puerto Rico.
In these areas, which are home to 18% of the nations population, federal health officials recommend people wear masks indoors while in public.
While they havent ordered a new mask mandate, officials in New York City warned that pressure on the healthcare system is increasing and urged seniors and others at high risk of severe COVID-19 to avoid gatherings and wear a mask in crowded outdoor settings.
Officials have said the the dramatic rise in coronavirus cases and hospitalizations in New York City is being fueled by BA.2.12.1, one of a family of Omicron subvariants spawned in the wake of last winters surge.
By comparison, 483 U.S. counties home to 28% of U.S. residents are in medium., while the vast majority 2,444 counties, home to 54% of U.S. residents remain in low.
As were currently seeing a steady rise of cases in parts of the country, we encourage everyone to use the menu of tools we have today to prevent further infection and severe disease including wearing a mask, getting tested, accessing treatments early if infected, and getting vaccinated or boosted, especially if youre over 50 and if your last dose was more than five months ago, Walensky said during a briefing this week.
Statewide, officials have reported an average of roughly 12,900 new coronavirus cases a day over the last week a 63% jump from the previous weeks average, according to data compiled by The Times.
In L.A. County, officials have reported an average of about 3,200 cases per day over the last week. Thats a level not seen since mid-February, when the region was still on the downslope of last winters Omicron surge.
And officials say these numbers likely fail to capture a large amount of infections, as many people are using at-home tests the results of which are not reliably reported to health agencies.
Test positivity remains low, but has been creeping upward. Over the last week, that metric has risen from 2.6% to 3.7% in L.A. County.
The seven-day statewide test positivity rate was 6%, according to the California Department of Public Health data made available Friday. Thats up from 3.1% at the start of the month.
As of Thursday, the number of coronavirus-positive patients hospitalized statewide was 1,708. While still significantly lower than at many other points during the pandemic, the count has jumped 28% just in the last week.
The rate of week-over-week increases in hospitalizations is accelerating. The previous statewide week-over-week increase was 19%.
In L.A. County, the most recent coronavirus-positive patient count was 401, an increase of 35% from a week ago. The prior week-over-week increase was 20%.
Many of those patients arent necessarily hospitalized for COVID-19, though. On Tuesday, L.A. County Health Services Director Dr. Christina Ghaly said most of those who were are hospitalized with a positive coronavirus test within the countys public hospital system were there for some other reason such as a heart attack or stroke and happened to incidentally test positive upon admission.
However, an increase in hospitalizations, Ferrer said, is an important reminder that, for many, getting infected with COVID-19 does pose a serious risk.
COVID-19 deaths remain stable and low at an average of about 38 per day statewide, according to data compiled by The Times.
Deaths are a lagging indicator of coronavirus spread and often dont rise until weeks after a region starts recording an increase in infections. However, officials have expressed some optimism that the widespread administration of vaccines and availability of therapeutics might blunt and potential uptick in fatalities.
Our hope is that as more people take advantage of the protections that continue to be offered by vaccinations and boosters, the daily deaths will remain low, Ferrer said.
Masks are now recommended indoors and on public transportation in 10 New Jersey counties, after coronavirus levels increased in Salem County and pushed it into the high transmission category, the Center For Disease Control and Prevention said on Thursday.
Atlantic, Burlington, Camden, Cape May, Gloucester, Monmouth, Morris, Ocean, Salem and Sussex counties are considered high community levels of the virus, the CDC says. Cumberland County is the only level with low counties; the others are all considered medium.
Just five weeks ago, all New Jersey counties were considered areas of low community levels. But virus levels have increased sharply, with the seven-day average of new cases increasing 138% from a month ago.
The seven-day average for new cases was 4,034 as of Thursday, the highest seven-day average since February.
Community levels of the virus are recalculated every Thursday based on virus levels from the preceding week. Levels are calculated based on admissions to hospitals and the percent of inpatient beds used by COVID patients.
Cant see the map? Click here.
Hospitalizations remain below the peak levels seen in January during the height of the omicron wave. The rate of transmission stands at 1.29, meaning the outbreak is expanding.
The BA.2 strain of COVID-19 has been spreading in New Jersey for weeks, though at much lower rates than the Omicron surge in December and January. Officials have said the Omicron stealth sub-variant appears to spread more easily but generally does not cause more severe illness.
Community levels are calculated differently from transmission levels, the latter of which should only be used by health care facilities, the CDC says.
There is no mask advisory for residents living in low or medium transmission areas if they are not at high risk of serious illness, the CDC says.
Those who are a high risk for severe illness should discuss if they should mask up with their doctor when transmission rates are medium, the CDC says. Wide-spread masking is not recommended unless transmission levels are high.
At all transmission levels, the CDC recommends staying up-to-date with vaccinations and getting tested if you have COVID symptoms.
With reporting by NJ Advance Media staff writer Deon Johnson.
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Katie Kausch may be reached at kkausch@njadvancemedia.com. Tell us your coronavirus story or send a tip here.
PITTSFIELD Why, we asked three local experts, did Berkshire County find its way this weekto the top of a national list for highest rates of COVID-19 by population?
Well, its because, they said.
Because once its here, the more highly transmissible omicron variant now circulating, with the shorthand BA.2, is easy to spread.
Because once here and spreading, the virus is staying for a while, increasing the number of those who test positive. So much so, in fact, that Berkshire County led all other Massachusetts counties for new COVID-19 cases per 100,000 population in a recent seven-day period.
Thats the essence of the propagation of a surge, said Dr. James Lederer, chief medical officer and chief quality officer at Berkshire Health Systems. Once a surge has established itself in a region, the higher transmissibility of the variant means one sick person is likely to expose four more people to the virus. Thats why we see more.
Dr. James Lederer, chief medical and chief quality officer at Berkshire Health Systems.
Because the state of Massachusetts, on Feb. 15, updated its face covering advisory to say, a little obliquely, that people who are fully vaccinated dont need to wear masks inside public spaces unless they have other health risk factors.
Because people are taking fewer precautions in gatherings, including a relatively chilly Easter that may have encouraged indoor gatherings.
Laura Kittross, public health program manager with the Berkshire Regional Planning Commission, says the public health nurses she works with report many new cases within families, including children too young to be vaccinated. It takes a while to run through a group, she said. I start to get worried when the hospitalizations go up.
As of Friday, Berkshire Medical Center had 22 inpatients with COVID-19, up from 20 on Wednesday.
Amy Hardt, the lead public health nurse with the Southern Berkshire Public Health Collaborative, says the rise of the BA.2 variant, and whats known as its daughter sublineage, is proving adept at getting past the protection of vaccination and even boosters, in some cases.
Amy Hardt, center, organizes rapid COVID-19 antigen tests as they are sent out in January to waiting cars at a drive-thru testing clinic organized by the Southern Berkshire Public Health Collaborative in Lee.
It means people arent as well-protected as they expect to be, she said. Were just kind of having a ratcheting up. Its no longer as many older people. Instead, many cases are affecting school-age children and young adults.
Transmission is almost a given, with the BA.2 variant and the lack of precautions, Hardt said. Theyre not masking. Theyre doing their thing.
Or as the public health people put it: Less mitigation and more exposure. Of 10 recent cases of COVID-19 reinfection in South County, all were 25 or younger and showed no symptoms or mild symptoms.
This week's appearance by Berkshire County at the top of a list isn't the first of its firsts. In early 2020, Berkshire Medical Center cared for Rick Bua of Clarksburg, the first inpatient with COVID-19due to community spread.
And then there are the because maybe answers to why.
Because maybe Berkshire County residents are using PCR tests, to some degree, more than residents of other U.S. counties, elevating it on rankings of new cases by population.
This week, Berkshire County rose to the top of a list generated by data collected by The New York Times, behind only counties in Puerto Rico and the Virgin Islands. It fell back the next day behind Middlesex County in Connecticut as having the highest number of new daily cases of the coronavirus per 100,000 population.
Because maybe fewer people who received the initial one- or two-shot vaccine regime have gotten boosters. And use of boosters, a recent study by the Boston University School of Public Health found, is lower in Massachusetts in less affluent counties. However, boosters aren't foolproof in protecting oneself from infection, officials note.
Because maybe the new omicron variant took hold in the Berkshires during the recent public school vacation week.
It certainly hasnt gone down, Lederer, the Berkshire Medical Center doctor, said Friday. In a more troubling sense, its staying very stable.
What does the future hold? Is this a long, drawn-out plateau? Are we going to start to see some resolution?
Dr. James Lederer, Berkshire Health Systems
Lederer wasnt alone among local experts in thinking even just a few weeks ago that the case rise Hardt described in a Facebook post as a possible blip would fade.
Today, Lederer admits he isnt sure what lies ahead for case numbers. What does the future hold? Is this a long, drawn-out plateau? Are we going to start to see some resolution?
Hardt said that in the past week, cases are off 1 percent in the groups 10-town service area. If the data shes now seeing holds up, its possible the area may have reached a peak in new fifth-wave cases.
Tests for viral particles in Pittsfield wastewater were down about 10 percent from May 11 to May 18, a finding that points to a falling off in new cases.
Thats another good indicator, Hardt said.
Lederer recalled the initial COVID-19 cases that hit the hospital in March 2020. Four people from northern Berkshire County who had attended a basketball tournament in Springfield all came down with the illness, becoming the first COVID-19 inpatients in Massachusetts and staying for months of care in serious condition.
This is not the same kind of disease, Lederer said of the current cases, compared to the initial wave.
Half of the 22 now being cared for at BMC with COVID-19 are incidental, meaning they came into the hospital for another reason and were found, through routine testing, to be positive.
Since the pandemic began in 2020, 380 deaths in Berkshire County have been attributed at least in part to COVID-19. That's up one since Tuesday. This month, the U.S. passed one million deaths.
Lederer said that while current COVID-19 cases can be dangerous for those with other health issues, the omicron subvariant is more like the kind of coronaviruses that moved through the population before the 2020 arrival of the novel kind.
By that he means the virus strains present are not routinely overwhelming peoples immune responses with devastating lung and respiratory ailments.
For the most part, it's more of a mild, ambulatory disease, he said.
But not in all cases. While the clinical condition of those hospitalized with COVID-19 is generally better that earlier in the pandemic, with no one no in intensive care as of Friday morning, some patients are still needing supplemental oxygen.
Were starting to see an uptick in the number of people who have significant respiratory complaints, Lederer said.
Kittross, the planning commissions public health program manager, said people need to make their own judgments about masking and social distancing. It makes sense, she said, to be tested before visiting an elderly relative.
Though the states Stop the Spread program has ended, people can arrange PCR tests by calling 855-BMC-LINK, or 855-262-5465, daily from 8 a.m. to 4:30 p.m. Callers can ask the BMC hotline whether their insurance will cover the testing.
Public sentiment may resist a return to mask use, in Kittross' view. I dont think there is a ton of tolerance for that any more.
I would remind people that if you can, wear a mask for a week or two," she said. "And try not to be inside with a larger group. Hopefully, in a couple of weeks. well start to see the cases go down.
Project overview
This study was carried out from August2020 to January 2021, with focus groups conducted from November to December 2020. We used principles of community-based participatory research (CBPR), an approach that draws on the strengths of diverse partners, shares resources, and fosters shared decision making and knowledge creation [26]. Aligning with this approach, we convened a community advisory board of 10 members with representation from healthcare systems, healthcare providers, growers, community health workers, and medical and premedical students that met monthly to oversee the project, facilitate relationship building, and offer advice. The leadership team also met regularly with partnering public health officials and healthcare leaders to discuss COVID-19 testing service delivery (e.g., location of testing sites, hours of operation) and the engagement of more vulnerable communities in testing services.
The larger project included three aims: 1) support the delivery of COVID-19 testing services, 2) broadly disseminate COVID-19 public health information, and 3) conduct research on perceptions of the coronavirus and COVID-19 testing and vaccination among Latinx/Indigenous Mexicans in rural agricultural communities in Inland Southern California. As reported elsewhere, the larger project was successful in carrying out Aims 1 and 2 of the study [27]. The teams leadership established access to routine COVID-19 testing for rural, immigrant communities partnering with a federally qualified health center and county public health to conduct 26 testing clinics providing approximately 1470 tests. Additionally, community health workers orpromotores de salud disseminated COVID-19 related public health information via social media, at COVID-19 testing events, and in-person socially distanced community talks. These efforts resulted in 22 virtual COVID-19 community talks (Plticas de COVID-19) livestreamed on our Facebook page @Unidoporsalud and 10 in-person COVID-19 community talks (Plticas en el Pueblo).
For the purposes of this article, we focus on the findings from our third aim involving research on the coronavirus and COVID-19 perceptions. Prior to the start of data collection, we obtained ethical approval for the study from the University of California Riversides Institutional Review Board.
Our study focused on the effects of the coronavirus pandemic amongst Latinx and Indigenous Mexican immigrant communities in the rural desert region of Inland Southern California. Our research was carried out in Riverside County, an area of California in which racial-ethnic minority populations have been disproportionately impacted by the pandemic. At the time of the study, Riverside County had the second highest number of confirmed cases and deaths in the state [28, 29]. There are over 2 million Latinos in Riverside County, a majority minority population that outnumbers all other racial and ethnic groups in the region [30,31,32]. Most Latinos are of Mexican origin, with smaller numbers of Puerto Ricans, Salvadorans, and Guatemalans, and Indigenous Nations [33]. Latinos in this region suffer health disparities due to low income and education, limited English proficiency, and undocumented status [34,35,36]. Unsurprisingly, the pandemic has severely impacted this population in the region: At research inception in fall 2020, which aligned with wave two spread of the coronavirus in California, county level data indicated the Latinx population accounted for 57% of COVID-19 cases and 46% of deaths in Riverside County [28, 29, 37, 38].
Our study focused on engaging Latinx and Indigenous Mexicans in rural agricultural communities in the eastern part of the Coachella Valley in Riverside County. The Coachella Valley, a 45-mile-long valley encompassing nine cities and rural agricultural communities, is an area of particular racial-ethnic disparity. This area is home to several vulnerable communities including the unincorporated rural communities of the Eastern Coachella Valley (ECV): Mecca, North Shore, Oasis, and Thermal, home to many Latinx and Indigenous Mexican immigrants living below the poverty line and working in the nearby agricultural fields. This region is home to the Purpecha community, an Indigenous Mexican population from the state of Michoacn [34]. At the start of the pandemic this region was identified as a hotspot, with some reports indicating a COVID-19 infection rate in the ECV 5 times higher than other Coachella Valley communities [39].
During the time of our study, these unincorporated rural communities (Mecca, North Shore, Oasis, and Thermal) consistently reported the highest rates of COVID-19 cases per 1,000 residents in the Coachella Valley. For instance, in September 2020 Thermal reported>130 cases/1,000 residents, which increased to>250 cases/1,000 residents in January 2021. This is significantly higher than case rates in Palm Springs (also in the Coachella Valley), which reported>20 cases/1,000 residents in September 2020 and>50 cases/1,000 residents in January 2021 [40].
This pattern of increased total confirmed cases of COVID-19 in these ECV communities continued throughout the study period. In September 2020, Mecca had 455 cases increasing to 1079 cases in January 2021; North Shore had 136 cases increasing to 331 cases; Oasis had 333 cases increasing to 826 cases; and Thermal had 185 cases increasing to 440 cases [40]. An increase in deaths due to COVID-19 accompanied the increased cases. In September 2020, Mecca had 9 reported deaths increasing to 16 in January 2021; North Shore had 1 reported death and remained stable; Oasis had 5 reported deaths increasing slightly to 6; and Thermal had 0 reported deaths increasing to 4 deaths [40].
During community advisory board meetings, meetings with partners (e.g., public health, healthcare leaders), and attendance at meetings with growers we made ethnographic observations and jotted down key discussion topics [41]. Team members reflected on these observations and used this information to inform the focus group interview guide and analysis and interpretation of the data.
Promotores de salud recruited community members into the focus groups by distributing study flyers with eligibility criteria and study contact information to individuals and families in their social networks. Eligibility criteria were met if a community member: 1) was 18years of age or older, 2) lived in the ECV and/or farm-working community along the Salton Sea, 3) self-identified as Latino/Hispanic, Latinx and/or indigenous from Latin America, and 4) spoke Spanish and/or Purpecha. Monolingual English-speaking Latinos and monolingual speakers of an indigenous dialect other than Purpecha were excluded from participation.
A focus group is a group interview that allows qualitative researchers to gather collective data about a specific phenomenon of interest. This method of data collection allows participants to build on each others ideas [42], providing collective (rather than individual) knowledge about the structural andsocio-cultural factors shaping perceptions of the coronavirus and attitudes and behaviors around COVID-19 testing and vaccination. From November to December 2020, we conducted seven virtual focus groups (of six to ten people each) to elicit information on sharedstructural stressors and socio-cultural factors shaping attitudes and behaviors around COVID-19 testing and vaccination. For nonprobability samples, 80% of themes can be identified within two to three focus groups and 90% within three to six focus groups [43].
Promotores de salud facilitated the focus groups with assistance from medical and pre-medical students. All facilitators received training on qualitative data collection and data analysis. Facilitators used a semi-structured interview guide with open-ended questions to elicit information on shared beliefs and attitudes around the virus, its spread, and COVID-19 testing and future vaccination, as well as risk-reduction behaviors such as social distancing and use of face coverings. We prompted discussion about themes emerging from our ethnographic observations and conversations with community members during public health outreach and testing events, including trust in public health officials, the government, and providers/healthcare systems, as well as strategies and tools to support those with COVID-19 and increase risk-reduction behaviors and use of COVID-19 testing services. At the end of all focus groups, participants were asked to complete a socio-demographic survey, either by using a link to a Qualtrics (online) version of the survey, or by having a team member administer the survey to them via phone.
Focus groups were conducted via Zoom video conference, audio recorded, transcribed, and analyzed using template and matrix analysis, a rapid qualitative analytic technique [44,45,46]. This technique involved summarizing all focus group transcripts using a template organized by the key topics of the semi-structured interview guide (template analysis). Key domains included: coronavirus, its spread, and ways to reduce virus propagation; attitudes and beliefs about COVID-19 testing, barriers to testing, and resources for people testing positive; and thoughts about COVID-19 vaccines and barriers to vaccination. A matrix was then created to organize the responses from each summary template (as rows) by key domains (as columns). Promotores de saludand students participated in a 2-part training on template and matrix analysis and led data analysis with support from experts in this analytic approach. Team members read transcripts line-by-line and inserted data, including illustrative excerpts from the interviews, in the templates. Next, a matrix (focus groupdomain) was created, and data from each template were inserted into the matrix. The matrix facilitated the identification of cross-case themes/patterns across the seven focus groups conducted.
Through this iterative process of theme identification and constant comparison across cases, we developed a conceptual model (Fig.1) grounded in the data that reflects the relationships among themes and their connection with COVID-19 testing and vaccination. We used exemplar quotes to substantiate these patterns. Participant quotes were translated from Spanish to English by the first author, a native English speaker proficient in Spanish. Graduate and PhD-level bilingual (SpanishEnglish) team members then checked participants quotes for accuracy and validated them.
Structural and Social Determinants of Health in COVID-19 Risk
In addition, eight other Northeast Ohio counties are currently at a 'medium' risk, meaning masks could be a good option for high-risk individuals.
CLEVELAND COVID-19 cases in Ohio have been climbing for weeks, and now, we're starting to see the effects of that increase on the community at-large.
According to the CDC's guidelines, Ashtabula and Lorain counties now have "high" community levels of COVID, the first time in months any part of the state has seen those risk assessments. This means health experts are advising all residents in those counties to wear face masks while in indoor public spaces, regardless of vaccination status.
Following a surge in cases last winter caused by the highly contagious omicron variant, the CDC updated its guidelines to better account for coronavirus hospitalizations after originally using case numbers as the overriding factor. While new infections per capita still play a role, new hospital admissions now help determine if doctors recommend face coverings or not, especially in counties where infections are under 200 per 100,000 residents in the past week.
When it comes to Ashtabula and Lorain counties, however, both regions have reported more than 200 new COVID-19 cases per capita over the last seven days, meaning the threshold of new hospitalizations per capita is now 10 instead of the usual 20. The CDC reports Lorain County has had 229.16 new infections and 10.4 new hospital admissions per 100,000 citizens in the last week, while Ashtabula is dealing with a whopping 332.16 new cases per capita and 10.7 new infections.
There is another indicator that could put counties with such levels of spread in the "high" zone, and that's if at least 10% of all hospital beds are occupied by COVID patients over an average of seven days. Thankfully, Ashtabula and Lorain's percentages sit at just 2.9% and 2.7%, respectively, but those figures could rise if community spread continues at its current pace.
The Ohio Department of Health says that of the state's more than 72,000 COVID-19 hospitalizations since the start of 2021, more than 93% have involved people who were not fully vaccinated against the virus. The CDC reports 64.2% of Lorain County's total population has been fully vaccinated, compared to just 53.3% in Ashtabula County.
In "high" counties, those who are immunocompromised or who have close contact with such individuals are also advised to avoid high-risk areas or gatherings, if possible. In addition, eight other Northeast Ohio counties have risen to "medium" risk for COVID-19, meaning masks could be the best option for high-risk individuals:
It should be noted that these guidelines from the CDC are merely recommendations and not necessarily required by law, although private businesses in Ohio are still free to implement their own policies. Despite issuing a statewide indoor mask mandate from August of 2020 to June of 2021, Gov. Mike DeWine has indicated he won't take similar measures this time around, partly due to a controversial new law that now largely limits his ability to implement health orders.
In new numbers released Thursday, Ohio reported more than 19,000 new coronavirus cases in the past week, compared to just over 3,000 seven weeks prior. Active hospitalizations have also been creeping up, but still sit at just 640, or less than 3% of all available beds. Nearly all of the state's cases are now caused by the omicron BA.2 or BA.2.12.1 variants.
