by Enrique Cerna and Matt Chan

A couple of retired guys that spent their careers making television dish on the good, bad, and ridiculousness of life for People of Color in America. They tear apart the news of the week, explore the complexities of race, and talk to people far more interesting than they will ever be.
Seattle and King County officials are proudly touting a 70% COVID-19 vaccination rate. But Dr. Leo Morales says there is more work to be done, especially among Latinos and other communities of color where the vaccination rate hovers at 50%. Dr. Morales joins the Chino Y Chicano to talk about the pandemicโs impact on health disparities as well as โAdios COVID,โ a project aimed at helping Latinos get vaccinated. Assistant dean of the University of Washington School of Medicine, Dr. Morales is also a professor and the co-director of the Latino Center for Health at the University of Washington.

Enrique Cerna:
Welcome to Chino Y Chicano.
Matt Chan:
Iโm Matt Chan, the Chino.
EC:
Iโm Enrique Cerna, the Chicano. Well, things are starting to loosen up as more and more folks get the COVID-19 vaccinations. People are getting out. Theyโre going to restaurants again, getting together with friends and traveling. And Matt, here in Seattle and King County, officials are touting that more than 70% of people have gotten vaccinated, so far.
MC:
Thatโs a good thing. I mean, you know, because for a long time, communities of color were lagging, but being fully King County, 70%, means that weโre on the right track. I donโt know about you though, Iโm still โ Iโm so used to wearing a mask and I see someone without one, and it just gives me pause. Thatโs going to take a little while for me to get used to that.
EC:
Iโm still going to wear a mask anytime I go into any grocery store or a building or whatever, and Iโm going to wear the mask until this thing is really over. I mean, I probably wonโt wear it when Iโm outside walking and things like that, but definitely when I go into a crowd around people and, and especially if I donโt know if someoneโs been vaccinated or not. And you know, I also think we have some concerns here, as weโre going to talk about in this episode, that even though weโve reached the 70%, or somewhere in there, communities of color have not, and thatโs a big concern.
MC:
Oh yeah, I mean, thereโs going to be the vaccinated and then the infected, because apparently, you know, what Iโve read so far is that COVID is still raging in unvaccinated communities. And the levels are like they were in January, but they just donโt show up because enough of the country has had a vaccination that they donโt impact the hospitals like they were.
EC:
You know, thereโs a big concern though about getting the vaccinations in the communities of color, because we know that COVID has hit hard in communities of color, Latinos have a higher rate of infections than any other racial or ethnic group. Theyโve also experienced hospitalizations and death rates exceeded only by those among Native Americans and Alaska Natives. And all of this has made it even more difficult by the health disparities that existed before COVID. And coming up, weโre going to talk to Dr. Leo Morales. Heโs been working on all of this โ the testing, the infections, the vaccinations โ heโs been really looking at this. And I think one of the reasons we wanted to talk to him, Matt, was to get this longer perspective and deeper perspective.
MC:
Yeah, what life is going to be like post vaccines.
EC:
Dr. Morales is a professor and assistant dean at the University of Washington School of Medicine. And heโs also the co-director of the Latino Center for Health at the UW. Here is our conversation with Dr. Leo Morales.
Dr. Leo Morales, welcome.
Dr. Leo Morales:
Thank you. And Matt, Iโm glad to be here. Thanks for inviting me.
EC:
Tell us a little, a bit about your work and how the pandemic impacted what you do.
LM:
Sure. Well, itโs changed my life essentially. I think as I became aware of the pandemic becoming, well, identifying it as a pandemic, and then also seeing very early on how there are differential rates and testing identifying cases, initially in our state and in our region. Particularly I was concerned about the negative impact or the lack of access to testing among Latinos in our region. I really pivoted my work and my attention to initially identifying cases, testing and, more recently, vaccinating. And really focusing on community-based organizations and working with them, understanding that the health care systems were excluding many, many folks who, you know, needed the services that were being provided.
EC:
Of course, all of this is something that communities of color have had to deal with for so long. So I found it interesting that it was almost like people were amazed that theyโre finding out that thereโs these disparities, but really that theyโve been there.
LM:
Absolutely. So you know, this is nothing new and in fact, in my office, we talk a lot about social determinants of health and a historical perspective, really, you know, based on issues of discrimination and racism that have existed in the country for centuries. And so all of those historical factors play a role in creating the circumstances that we see playing out with COVID-19. So absolutely nothing new. And in fact, one of my early concerns was letโs not be too targeted about our approach here, because you know what? This pandemic is gonna come to an end, but the health disparities that are in these communities will continue to exist. So letโs not just be here for this, letโs be here for the long haul, and letโs be here to solve the health issues that are, that are in our communities.
MC:
So, has there been an impact made in the Latino community from when the pandemic was identified as a real threat to everyone to where it is now?
LM:
So, I think the one thing Iโve seen that happened, that I think is fantastic, is the community has organized itself in ways that it wasnโt before the pandemic. So in our area, thereโs been the formation of a Latino civic Alliance, for example, which is made up of a number of different community-based organizations throughout the state. And they really came together to address COVID. Theyโve been there, theyโre grassroots organizations and slightly bigger ones, some 503c, some not, but theyโve come together and theyโre starting to talk to one another and theyโre collaborating. And I think thatโs a very positive outcome. Now,Iโm hoping that we will continue to have those sorts of coalitions and working together to solve, you know, different health problems.
MC:
Is there still a hesitancy in communities of color to get the vaccine, or was it mainly access and education?
LM:
Yeah, thatโs a tricky question. I think that the hesitancy โ there are perhaps different reasons for hesitancy. And so you know, some of them could be around issues of concern around cost and issues of concern around protections you know, legal or otherwise. Some of them could be because people are concerned about whether the vaccines are safe, whether theyโre effective, whether theyโre necessary. I think in the Latino community โ and there are some recent data that came out of the Kaiser family foundation that showed that of those Latinos who were unvaccinated and ready to be vaccinated โ something like 50% were saying they were concerned about the costs. And so, thereโs a lot of misperceptions out there. Iโll say the other big factor, I think, is a breakdown in trust between public health โ any sort of governmental organization โ and communities, Latino communities in particular because of all the issues around immigration and concerns about deportation and, you know, families with mixed statuses and real concerns about approaching anybody who wants to collect information and works for the government.
And that has been a huge barrier.
MC:
Yeah. And it kind of peaked during the last administration.
LM:
Absolutely. And that fear and that chilling effect has had โ it continues to have an effect to this day. I can give you an example: So, you know we had through the state, we were able to access National Guard resources to go vaccinate. They were well-resourced, they were available, but many communities rejected their assistance, just out of fear, out of what it meant to have a uniformed individual in the community โ even though they were there only to vaccinate. So people delayed and, you know, delays in vaccination means lives and health. And so you know, itโs a real cost to that lack of trust.
EC:
Was that a combination of what they experienced, not only in worrying about their immigration status and all of those things here, but what they experienced in their own native countries, where thereโs so much corruption and you have to fear the police or anybody in a uniform?
LM:
I would assume so. I donโt know that for certain. It makes sense to me. Itโs unfortunate that now our government is viewed like governments in Latin America, you know, you have to be fearful of them because thereโs so much corruption.
EC:
But more than anything else, it was the rhetoric that we heard in the last four years โฆ
LM:
Yeah. And, you know, there were a lot of missteps. So at one point in our state I think law enforcement was sharing information with ICE and, you know, that was stopped and condemned, but the damage was done. And so that creates fear. And itโs not unjustified fear. But you know, itโs very hard to change that once itโs there,
EC:
So what was done to change that, so that those communities, so the people in the community could then feel some sense of, well safety, but also that they needed to get this done. So at the grassroots level, what had to happen?
LM:
So, you know, that the reality is I think the only approach that works is really to work through the community-based organizations that have the trust that have been in the community for a long time, that have personal relationships. And and so thatโs really been the way. Iโm working with another professor in the information school whose name is Frank Martinez. Weโve created a project called Adios COVID โ which I love โ Adios COVID!
MC:
Yeah, I love it. Get the hell out of here!
LM:
Yeah, so our approach has been simply to fill the gap between larger institutions that have resources and small community-based organizations that need them, and in particular, the efforts around initially testing and then vaccines. Because I think theyโre really the only ones who can reach these pockets of the community that are hard to reach. Theyโre substantial in size.
Theyโre not connected to healthcare systems. These are people who are not necessarily insured. Or even if they have the potential for being insured, donโt seek it and donโt seek out healthcare. And so, because of concerns around costs. And so the community-based organizations I think are key., Itโs really about us going to them. Healthcare organizations are historically very passive. We open the doors, but we donโt really do much to bring people in those doors outside of some very targeted marketing. Thatโs not targeted to the segments of the population weโre talking about. We need to be in the community, we need to be present there. And so thatโs really been the efforts of Adios COVID has been to be present in the community, work with those smaller organizations and make vaccines more accessible.
MC:
Right now Mayor Durkan has taken a victory lap, saying 70% of the residents in Seattle have been vaccinated. That may be true, but I think I got to think, the disparities donโt tell the truth there.
LM:
You got it. These are small population problems, right? So whatโs true for the average is not true for different segments. And, you know, we know, for example, in King County, 50% of Latinos and African Americans are vaccinated compared to the, whatever it is, 60, 70% of the non-Hispanic white population. In our state, there are counties that have vaccination rates in the thirties, which are largely Latino counties in Eastern and Central Washington.
Iโll tell you another little story. One thing that we saw very early on with testing โ or actually with infection rates โ if you look at the average infection rate, like what [the] IHME, the Institute for Health Metrics [and Evaluation], was publishing these rates, right? You saw these graphs with infection rates going up.
And then there was the institution of stay-at-home and, and the rates started to come down. Then it was lifted and they kind of stayed low until the next surge. But if you just aggregate those infection rates by race, ethnicity in our state, Pacific Islanders and Native Hawaiians and Latinos did not โ the surge did not stop with stay at home. In fact, it accelerated during the whole period of stay-at-home, during the whole period of shelter-in-place. They actually didnโt start to come down until after shelter-in-place was lifted. So if you didnโt look deeper, the story you would tell is, well, this worked and everybody got better. But no, in fact, some people, you know, we donโt know, I wouldnโt say go as far as to say you know, these populations who were harmed, but they certainly were not helped.
And that has everything to do with who has the privilege of being able to work at home and โ not go to work. Or, you know, participate in shelter-in-place. And for these communities, it just did not show up that way.
MC:
How much did multi-generational households play into that?
LM:
Thatโs, Iโm sure thatโs a factor, right? So, you know where infections take place mostly is in the home. Thatโs what we learned in the pandemic. So a lot of the spread actually happened within households. And if you have a multi-generational household, especially where you have smaller houses, so thereโs more dense family living โ you canโt really avoid each other. The idea of isolating and quarantining within your house is really โ if thereโs one bathroom and eight people, you know, thatโs just not a reality. And so there was a lot of transmission in households.
EC:
So, where are we now with vaccinations? I mean, as Matt pointed out, the mayorโs touting that 70% number. You point out the fact that if you look into these kind of specific populations and communities, not so much โ how then do we get those folks up to 70% or beyond?
LM:
Our big concern, and I say โour,โ I mean Frank Martinez and I, who have been working on Adios COVID, is that June 30th is the date when everything goes back to normal. And weโre not anywhere near being done with communities of color being vaccinated. And our real concern is that the attention will be lifted. The message will be sent that weโre done with this, and any sort of momentum in terms of vaccinating communities will, well itโll evaporate or it will be very much harder to do โ as will the funding and other resources that are currently mobilized may, you know, become scarce. This is not a problem thatโs done, and we have a long ways to go. I mean, within King County, which is a well-resourced county, itโs 50%. That means half of Latinos. And we havenโt started with the younger, less-than-12-year-olds โ which will happen in the fall, or early next year. We havenโt even started with them. And with the group that weโre currently vaccinating โ 12 and older โ weโre only at about 50%. Thatโs still 50% of people that need to be reached. And so the hard work needs to be done.
EC:
So what do we know about Central and Eastern Washington, where you have the agricultural community and the people that are working in the fields, that we depend on?
LM:
Absolutely. I donโt have access to race-, ethnicity-specific data by county. But we know that some of the counties that have low vaccination rates are 60, 70% Latino, and they have low vaccination rates. Theyโre not as big a part of the population, because these are sparsely populated counties. So if you look at the statewide average, thatโs going to be driven by Seattle, King County, Pierce County, Snohomish County. But within those [Latino] communities, the vaccination rates are low. And so you can presume that I think accurately that the vaccination rate among Latino communities in those counties is going to be also low.
MC:
Whatโs the world going to look like? Because thereโs going to be the vaccinated and the unvaccinated, or as one doctor said, the vaccinated and the infected. What Iโve read lately is that the infection rates, the death rates of hospitalization rates are as high as they were in January in unvaccinated communities.
LM:
Yeah. Thereโs some interesting dynamics, even though the absolute number of deaths is coming down, but within certain segments of the population, you still see fairly high infection rates. And I guess the way to understand that is older people have been well-vaccinated for the most part. Iโm not so sure. I have not seen a breakdown of race, ethnicity by age to know for sure whatโs going on in Latino communities in terms of the elderly. But nonetheless, the risk I think is going to change. So what are the risks to getting infected when youโre younger? I think the long haul-er issue still needs to be elucidated. Even though mortality rates are coming down, getting infected has health impacts and some of them may persist for months or longer. And thatโs only now being understood. So younger people, theyโre not going to show up as a concerning statistic in terms of mortality or hospitalizations, but the longer-term health effects โ whether itโs persistent effects with memory or heart effects or lung effects โ are not yet clearly elucidated. So my concern is thereโs going to be an invisible part to this that weโre not going to see for a while. And, you know, because people continue to get infected and are unvaccinated.
MC:
Are we going to have a surge in those communities? I mean, cause thereโs states where, you know, theyโre just vaccine resistant because of the politics and whatever, but I mean, theyโre gonna, theyโre gonna keep infecting each other.
LM:
Yeah. And so whatโs going on right now is, you know, weโre having good โ I mean, clearly the vaccines are having an impact in terms of infection rates. Seasonality is having an impact. So weโre in the lower season right now for COVID and all, you know, like influenza virus as well. So weโre watching surges happening in South America โฆ the southern continent, where theyโre in the winter. And we donโt know what the fall is going to look like. And in communities where thereโs a lot of uninfected people still that are unvaccinated, you know, we can see a rise in the infection rates again. And we probably will. Itโs probably going to be smaller groups of people. Itโs probably going to be isolated in communities that have low rates of vaccination. And of course thereโs the issue of the emergence of variants that may be more infectious and more [drug] resistant. So this is going to turn into โ we need to get a booster out there following on the vaccines weโve currently received. Thatโs going to be the next step.
MC:
You think thatโs inevitable.
LM:
I donโt know for sure, but it sure looks that way. I mean, it stands to reason that weโre going to need to continue to adapt our vaccines to the emergence of variants that may be more problematic.
EC:
As you see things opening up right now, and people getting out and, you know, socializing again, getting in bigger groups and all of that โ what is your reaction? Do you have this sense of, โOkay, yeah, thatโs great, and Iโm happy to see it โฆ โ but like, youโre maybe holding on for dear life, wondering if somethingโs really gonna โ you know what I mean?
LM:
I mean, you know, itโs really hard to know โ I mean, you know, I feel safe โ Iโm vaccinated, right?
EC:
Me too.
LM:
So I feel okay. Iโm like, all right. But I worry that weโre going to see more people, like you said, perhaps more infection among โ especially among those who are unvaccinated who are, you know, going along for the ride thinking everythingโs okay. We havenโt reached a state of sort of โ so thereโs a couple of factors that influence safety, right? One is the proportion of the population thatโs been vaccinated. So the more a community is vaccinated, the less circulating virus there is, the less likely you are to get infected, whether or not youโre vaccinated, right? Fifty percent โ weโre not just a homogeneous community, weโre kind of little pockets. And within those pockets where thereโs less vaccination, thereโs going to be a higher risk of more infections and, you know, deaths and morbidity associated with long-term effects of COVID.
EC:
Do you fear that government, government officials, arenโt concerned enough or taking seriously the need to address whatโs happening in communities of color, especially โ since the numbers are different?
LM:
Yeah I do. I think everybodyโs ready for the parade.
MC:
Yeah.
LM:
And you know, thereโs a lot to be happy about.
EC:
Yeah but they may be ready for the parade, but for us and our communities, that means weโre in the back. You know, we may not even have joined yet.
LM:
Yeah, thatโs right. And I worry about that. Definitely. I think, you know, weโre not done with this and on the one hand, I understand the desire to get back to normal and celebrate. We have a fantastic vaccines, record โ I mean, new science that has made it possible. And we have vaccinated a lot of people in a short period of time. But for communities of color, thereโs still work to do, and weโre not done with it. I donโt think we should be celebrating completely until weโve really vaccinated everyone. Right? We need to get everyone vaccinated. All communities need to take advantage of the benefits of these vaccines, have that opportunity.
MC:
You know, a lot of people like to ask health officials and doctors, like, how do you conduct yourself in your daily life now that youโre vaccinated? I mean, so whatโs your life like? Do you go out to restaurants? What do you do?
LM:
And again, this is me. I donโt want to say this is appropriate for everyone. I donโt want to say that what I do is necessarily best for everyone. Hereโs what I do: I wear a mask when Iโm in spaces with other people in close spaces and buildings. If I go to a grocery store, I wear my mask. And part of that is just to, to promote a sense of safety for people who may not either a) be vaccinated or even be vaccinated, but still be vulnerable, you know, because they may have immune deficiencies, they may have cancer. There may be things that prevent them from fully being advantaged by the vaccine. So Iโm still doing that. But Iโm, in my family โ weโre all vaccinated, and we donโt wear masks.
I have an 82-year-old mother, we were a part of her pod. Now sheโs vaccinated and she can see other people โ nd I feel comfortable with that โ who are not in our pod. Weโve socialized with her without masks because we were sort of staying socially isolated. But that has opened up. So I would say, you know, itโs different. It feels better. I never really thought it was necessary to mask outside, but now I feel socially safe doing that. So people donโt think itโs weird, you canโt really get this stuff if youโre just walking around, unless youโre very tightly packed.
[The three agree that this is โcommon sense.โ]
EC:
โฆ which we are in need of. You know, as we talked earlier, you pointed out our disparities have been there. And you also said that youโre concerned that weโre going to just lose the focus about all of that.
LM:
Yup. The analogy in my mind is there has been, in international work, this debate between what they call horizontal and vertical interventions. So letโs go eliminate polio. So you go in and you vaccinate everybody for polio, and you only focus on polio and you eliminate polio, but malnutrition is still there. So people are dying of other things now. So you took care of one narrow problem, but you didnโt build capacity, and you didnโt address the other conditions that are affecting health, right? You took care of one very narrow thing. And I would say the same thing with COVID. Like, right now, weโre laser focused. And thereโs some sense to that urgency and need to do that. On the other hand, those conditions that create those health disparities are still there.
It leaves a bad taste in communities if youโre just there for one purpose. Like if we show up and dump a bunch of resources, itโs about making ourselves safe, not about improving the health of communities. So we need to invest in those communities in a long, sustainable kind of way. That will lead to better health for all the different issues that are operating there, whether itโs, you know, mental health issues or diabetes or hypertension, you know, all the killers.
EC:
Which exists in all communities, so โฆ
LM:
โฆ and they disproportionately exist in communities of color.
MC:
You think if the underlying comorbidities werenโt as pervasive that maybe COVID wouldnโt have had such a large impact โ because itโs sort of a pandemic on top of a pandemic?
LM:
Yeah, absolutely. Fertile, fertile ground for badness to happen is, you know, having chronic conditions. So if you look at mortality rates, theyโre higher for communities of color in addition to infection rates. So the mortality rate per a hundred thousand is higher. And thatโs got to be due to pre-existing conditions.
EC:
Okay, doc, Iโm going to give you a soap box here, and if you were speaking to the president and others that have an impact on our lives at the top of the food chain, what would you tell them โ particularly when it comes to communities of color dealing with COVID, but also as we talked about, these disparities?
Leo Morales:
I think our country needs deep reform. We need to really invest in our communities that are suffering from COVID and suffering from these health disparities. And here, Iโm thinking about things, not just access to healthcare, but yes, every person should have โ there should be universal access to healthcare. I never understood why people ask for insurance cards for the vaccine. Like, why would you do that? Who cares? Like vaccinate people, right? Give them the healthcare they need. It should be universal. Education. We canโt have two systems, or more, of education. We need to give opportunities to young people. Communities of color are where the young people are coming from right now in our country. We need to educate them. And that will lead to good health. You know, the dirty word is redistributing income. In my mind, itโs really about investing in our communities, but we need to get rid of the wealth gaps that exist. We need to address that. And reinvest in our communities, communities of color in particular, which are so disadvantaged right now. It is tough out there, and people are just holding on, and it shouldnโt be that way in such a rich country.
EC:
Well, Dr. Leo Morales, thank you so much for your insights. How about in about six months you come back and tell us where weโre at.
LM:
I would be happy to.
EC:
Or sooner โฆ you tell us, whenโs a good time to reconnect, to revisit things. Cause we definitely want to keep an eye on this. Particularly since the work youโre doing is focusing on those communities that really all too often get ignored. And we canโt do that anymore. It pisses Matt off, so โฆ
Matt Chan:
Yeah it pisses me off. Thatโs why this whole victory lap thing really just kind of irks me, because weโre not there.
LM:
Weโre not there.
MC:
But I think that what you said โ they do that to make themselves feel good and feel safe. So thatโs where it needs to start. Thank you, Dr. Morales so much.
LM:
Thank you both. And I really enjoyed speaking with you.
EC:
Thanks, doc.
๐ธ Featured Image: Monica Ruiz, Casa San Joseโs Executive Director, giving a check of $700 to a Latino immigrant who has been negatively impacted by the COVID-19 pandemic. (Image attributed to Governor Tom Wolf under a Creative Commons 2.0 license.)
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