SAN DIEGO — Ana Melgoza remembers vividly the pandemic’s early days in South County.
“When you look at who died because of this, and also in terms of the impact at ER rooms and ICU rooms — I mean, we were seeing waits of like three days to get into a hospital,” said Melgoza, vice president of external affairs at San Ysidro Health. “We were very much in high turmoil.”
The South Bay quickly became the hardest-hit part of San Diego County as COVID-19 shut down schools and businesses almost two years ago. Now, it boasts the highest vaccination rates in the region and has served as a model for administering doses to vulnerable populations.
But that hasn’t quelled transmission. As the vast majority of the county continues to grapple with high or substantial COVID-19 numbers, the most vulnerable neighborhoods — including those in the South Bay — are still being disproportionately impacted.
Nearly all eligible residents in San Ysidro’s 92173 ZIP code have received at least one COVID-19 vaccine dose. But the area is still reporting daily an average of more than 30 cases per 100,000 residents, the highest rate in the county.
Other areas that were deemed vulnerable by state officials during the pandemic have the county’s second-highest rates: A combination of six ZIP codes comprising the backcountry communities of Jacumba, Campo and Boulevard, along with the 92113 ZIP code that includes Lincoln Park, Logan Heights and Barrio Logan, are reporting about 23 cases per 100,000 residents a day.
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Those who have worked in the county’s early hotspots say the cases show which residents remain at highest risk: essential workers, public transit users, undocumented residents and members of multigenerational households.
Most often, they’re people of color, said Elisa Sobo, professor and chair of anthropology at San Diego State University.
“And in San Diego, of course that means Hispanic people,” she said. “The chance for exposure, whether you’re vaccinated or not, it’s much, much higher than for someone who’s able to telecommute.”
While vaccinations clearly play a role in keeping people out of the hospital and avoiding severe infection, even in highly vaccinated ZIP codes there are people at risk: immunocompromised residents, children who until recently didn’t have access to vaccinations, and those who haven’t received any of the shots.
“I worry about all of those people,” said Corinne McDaniels-Davidson, director of SDSU’s Institute for Public Health. “On top of that, I also worry because when you have high transmission, that’s when the variants can emerge.”
As health officials across the U.S. continue to monitor the omicron variant — with the first case in San Diego confirmed last week — experts say the answers may lie in successful efforts first started in South County: Community partnerships helped boost vaccination rates there, and could be exported to parts of the backcountry where numbers are lagging even amid high transmission.
But vaccinations still will need to be coupled with other public health interventions, McDaniels-Davidson said, like well-ventilated buildings and masks. Citing a 47% increase in infection rates since Thanksgiving, the state announced that residents — even those fully vaccinated — must again wear masks in all indoor public settings. The mandate is in place until Jan. 15.
“Vaccines are critical,” McDaniels-Davidson said. “They are so critical and they are so important at stopping the disease — meaning the terrible sickness that can happen after someone is infected — but they can’t be our only strategy to stopping infection.”
Where transmission is high
As COVID-19 vaccines became more widely available, the state in March rolled out a new equity plan to provide extra doses in some of the most vulnerable communities. At the time, they had suffered 40% of cases and deaths during the pandemic.
Officials cited their status as having among the poorest access in the state to healthy conditions: They fell in the bottom 25% of the state’s Healthy Places Index, which considers factors such as employment, educational level, air quality and household crowding, among others.
A dozen ZIP codes were identified in San Diego, spanning from the county’s rural neighborhoods like Warner Springs and Dulzura to densely populated areas such as City Heights and San Ysidro.
But as of Dec. 8, seven of the 12 ZIP codes were experiencing high transmission, and three others were faring slightly better with substantial transmission. (Rates for the remaining two ZIP codes were censored by the county due to their small case numbers.)
Just six areas in San Diego were reporting moderate transmission: Coronado; Hillcrest; 92111 in Kearny Mesa, Clairemont and Linda Vista; La Jolla’s 92037, Carlsbad’s 92011; and two ZIP codes that include Bonsall and Vista. There is no part of the county that is reporting what would qualify as low transmission.
McDaniels-Davidson said even in areas with the highest vaccination rates, many still “don’t actually have a lot of choice in those other things that they’re doing.”
“They don’t have a choice in where they work or how safe that workplace is, or how much of the public they come into contact with,” she said. “So when you’re talking about lower wage workers, they don’t have a lot of protections against transmission.”
As experts and advocates had feared, the South Bay and its large share of Latino residents suffered some of the worst numbers as high transmission coupled with poverty and disparities in preexisting health conditions. Several months into the pandemic, a CalMatters report found Latino children were testing positive at higher rates than other groups of kids, with experts citing more crowded living conditions and close contact with essential workers.
The pandemic amplified an economic crisis that many South Bay families were already experiencing, San Ysidro Health’s Melgzoa said. San Ysidro is one of the region’s poorest neighborhoods, with a median household income 40% less than that of San Diego citywide.
“We have a lot of families that are barely making it, and there’s a lot of ingenious ways to get ahead,” Melgoza said. “A lot of it can be a very, health-wise, unstable setting.”
All of San Ysidro and much of Chula Vista remain under high transmission, meaning the average daily case rate equals or exceeds 14.3 cases per 100,000 people and that more than 10% of COVID-19 tests are coming back positive.
High transmission also is being reported in the county’s backcountry, where most ZIP codes are reporting that fewer than half of eligible residents have been vaccinated. That’s despite clear data showing vaccines are crucial: Since March, nearly 83% of the county’s COVID-19 deaths have been among people who weren’t fully vaccinated.
McDaniels-Davidson said communities with lower vaccination rates are more likely to suffer from “high, severe disease.” And unlike South County, other parts of the region may not have a strong system of trusted organizations for engagement and vaccine outreach.
“Those are the places that we really do need to do more work, to have conversations with people about getting vaccinated, to try to kind of stem the tide,” she said.
Lessons learned
Today, health care providers in the county are no longer struggling with limited protective equipment or testing access. Hospitalizations are drastically down from a year ago. Three-fourths of eligible residents are fully vaccinated against COVID-19, outpacing the statewide rate. Hispanics and Latinos, disproportionately impacted by the pandemic, are reporting a nearly 73% vaccination rate in the county.
“What we have learned from COVID is that thinking outside the box, breaking down barriers and creating interventions that really work for communities that are on the front lines can really make a difference,” said county Supervisor Nora Vargas, who represents the southern region and took office in January.
South County became a starting point for several successful initiatives during the pandemic: One of the first local supersites for vaccinations was set up inside a former Sears at the Chula Vista Center mall. Promotoras, or community health workers who are well-trusted in Latino communities, worked closely with local supermarkets to make vaccines available without appointments.
Experts credit the well-established relationships that community organizations had with residents, some of them wary of interacting with government officials or lacking prior access to health care. An October report by CommuniVax, a national coalition of educators and advocates that includes SDSU’s Sobo and McDaniels-Davidson, recommended other regions with a high proportion of Hispanic and Latino residents follow South County’s successes.
Sobo, the SDSU professor, acknowledged the differences among communities but said some of the strategies that worked in South County can be borrowed for other parts of San Diego, too.
“If you’re talking about a population that’s not Hispanic, you can still have the promotora model,” she said. “You just wouldn’t call it that. It’s just a matter of having people who are insiders be there to provide information, to provide assistance and help get questions answered.”
McDaniels-Davidson admits that work may be harder in other parts of the county.
“Especially in rural parts of the county,” she said. “You have to figure out who’s trusted and why they’re trusted. And then you have to work through them.”
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