by Enrique Cerna and Matt Chan

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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 pandemic’s impact on health disparities as well as “Adios COVID,” 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:
I’m Matt Chan, the Chino. 

EC:
I’m 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. They’re 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:
That’s 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 we’re on the right track. I don’t know about you though, I’m still — I’m so used to wearing a mask and I see someone without one, and it just gives me pause. That’s going to take a little while for me to get used to that.

EC:
I’m still going to wear a mask anytime I go into any grocery store or a building or whatever, and I’m going to wear the mask until this thing is really over. I mean, I probably won’t wear it when I’m outside walking and things like that, but definitely when I go into a crowd around people and, and especially if I don’t know if someone’s been vaccinated or not. And you know, I also think we have some concerns here, as we’re going to talk about in this episode, that even though we’ve reached the 70%, or somewhere in there, communities of color have not, and that’s a big concern.

MC:
Oh yeah, I mean, there’s going to be the vaccinated and then the infected, because apparently, you know, what I’ve read so far is that COVID is still raging in unvaccinated communities. And the levels are like they were in January, but they just don’t show up because enough of the country has had a vaccination that they don’t impact the hospitals like they were.

EC:
You know, there’s 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. They’ve 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, we’re going to talk to Dr. Leo Morales. He’s been working on all of this — the testing, the infections, the vaccinations — he’s 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 he’s 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, I’m 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, it’s 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 they’re finding out that there’s these disparities, but really that they’ve 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 let’s 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 let’s not just be here for this, let’s be here for the long haul, and let’s 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 I’ve seen that happened, that I think is fantastic, is the community has organized itself in ways that it wasn’t before the pandemic. So in our area, there’s 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. They’ve been there, they’re grassroots organizations and slightly bigger ones, some 503c, some not, but they’ve come together and they’re starting to talk to one another and they’re collaborating. And I think that’s a very positive outcome. Now,I’m 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, that’s a tricky question. I think that the hesitancy — 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 they’re effective, whether they’re necessary. I think in the Latino community — 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 — something like 50% were saying they were concerned about the costs. And so, there’s a lot of misperceptions out there. I’ll say the other big factor, I think, is a breakdown in trust between public health — any sort of governmental organization — 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 — 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 — 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, it’s 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 there’s so much corruption and you have to fear the police or anybody in a uniform?

LM:
I would assume so. I don’t know that for certain. It makes sense to me. It’s unfortunate that now our government is viewed like governments in Latin America, you know, you have to be fearful of them because there’s so much corruption.

EC:
But more than anything else, it was the rhetoric that we heard in the last four years … 

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 it’s not unjustified fear. But you know, it’s very hard to change that once it’s 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 that’s really been the way. I’m working with another professor in the information school whose name is Frank Martinez. We’ve created a project called Adios COVID — which I love — 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 they’re really the only ones who can reach these pockets of the community that are hard to reach. They’re substantial in size.

They’re not connected to healthcare systems. These are people who are not necessarily insured. Or even if they have the potential for being insured, don’t seek it and don’t seek out healthcare. And so, because of concerns around costs. And so the community-based organizations I think are key., It’s really about us going to them. Healthcare organizations are historically very passive. We open the doors, but we don’t really do much to bring people in those doors outside of some very targeted marketing. That’s not targeted to the segments of the population we’re talking about. We need to be in the community, we need to be present there. And so that’s 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 don’t tell the truth there.

LM:
You got it. These are small population problems, right? So what’s 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. 

I’ll tell you another little story. One thing that we saw very early on with testing — or actually with infection rates — 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 — 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 didn’t start to come down until after shelter-in-place was lifted. So if you didn’t look deeper, the story you would tell is, well, this worked and everybody got better. But no, in fact, some people, you know, we don’t know, I wouldn’t 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 — 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: 
That’s, I’m sure that’s a factor, right? So, you know where infections take place mostly is in the home. That’s 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 there’s more dense family living — you can’t really avoid each other. The idea of isolating and quarantining within your house is really — if there’s one bathroom and eight people, you know, that’s 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 mayor’s touting that 70% number. You point out the fact that if you look into these kind of specific populations and communities, not so much — how then do we get those folks up to 70% or beyond? 

LM:
Our big concern, and I say “our,” 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 we’re 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 we’re done with this, and any sort of momentum in terms of vaccinating communities will, well it’ll evaporate or it will be very much harder to do — as will the funding and other resources that are currently mobilized may, you know, become scarce. This is not a problem that’s done, and we have a long ways to go. I mean, within King County, which is a well-resourced county, it’s 50%. That means half of Latinos. And we haven’t started with the younger, less-than-12-year-olds — which will happen in the fall, or early next year. We haven’t even started with them. And with the group that we’re currently vaccinating — 12 and older — we’re only at about 50%. That’s 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 don’t 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. They’re not as big a part of the population, because these are sparsely populated counties. So if you look at the statewide average, that’s 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:
What’s the world going to look like? Because there’s going to be the vaccinated and the unvaccinated, or as one doctor said, the vaccinated and the infected. What I’ve 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. There’s 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. I’m not so sure. I have not seen a breakdown of race, ethnicity by age to know for sure what’s 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 you’re 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 that’s only now being understood. So younger people, they’re not going to show up as a concerning statistic in terms of mortality or hospitalizations, but the longer-term health effects — whether it’s persistent effects with memory or heart effects or lung effects — are not yet clearly elucidated. So my concern is there’s going to be an invisible part to this that we’re 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 there’s states where, you know, they’re just vaccine resistant because of the politics and whatever, but I mean, they’re gonna, they’re gonna keep infecting each other.

LM:
Yeah. And so what’s going on right now is, you know, we’re having good — I mean, clearly the vaccines are having an impact in terms of infection rates. Seasonality is having an impact. So we’re in the lower season right now for COVID and all, you know, like influenza virus as well. So we’re watching surges happening in South America … the southern continent, where they’re in the winter. And we don’t know what the fall is going to look like. And in communities where there’s 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. It’s probably going to be smaller groups of people. It’s probably going to be isolated in communities that have low rates of vaccination. And of course there’s the issue of the emergence of variants that may be more infectious and more [drug] resistant. So this is going to turn into — we need to get a booster out there following on the vaccines we’ve currently received. That’s going to be the next step. 

MC: 
You think that’s inevitable.

LM:
I don’t know for sure, but it sure looks that way. I mean, it stands to reason that we’re 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 — what is your reaction? Do you have this sense of, “Okay, yeah, that’s great, and I’m happy to see it … ” but like, you’re maybe holding on for dear life, wondering if something’s really gonna — you know what I mean? 

LM:
I mean, you know, it’s really hard to know — I mean, you know, I feel safe — I’m vaccinated, right?

EC: 
Me too. 

LM:
So I feel okay. I’m like, all right. But I worry that we’re going to see more people, like you said, perhaps more infection among — especially among those who are unvaccinated who are, you know, going along for the ride thinking everything’s okay. We haven’t reached a state of sort of — so there’s a couple of factors that influence safety, right? One is the proportion of the population that’s 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 you’re vaccinated, right? Fifty percent — we’re not just a homogeneous community, we’re kind of little pockets. And within those pockets where there’s less vaccination, there’s 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, aren’t concerned enough or taking seriously the need to address what’s happening in communities of color, especially — since the numbers are different?

LM:
Yeah I do. I think everybody’s ready for the parade. 

MC:
Yeah.

LM: 
And you know, there’s a lot to be happy about. 

EC:
Yeah but they may be ready for the parade, but for us and our communities, that means we’re in the back. You know, we may not even have joined yet.

LM:
Yeah, that’s right. And I worry about that. Definitely. I think, you know, we’re 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 — 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, there’s still work to do, and we’re not done with it. I don’t think we should be celebrating completely until we’ve 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 you’re vaccinated? I mean, so what’s your life like? Do you go out to restaurants? What do you do?

LM:
And again, this is me. I don’t want to say this is appropriate for everyone. I don’t want to say that what I do is necessarily best for everyone. Here’s what I do: I wear a mask when I’m 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 I’m still doing that. But I’m, in my family — we’re all vaccinated, and we don’t wear masks.

I have an 82-year-old mother, we were a part of her pod. Now she’s vaccinated and she can see other people — nd I feel comfortable with that — who are not in our pod. We’ve socialized with her without masks because we were sort of staying socially isolated. But that has opened up. So I would say, you know, it’s different. It feels better. I never really thought it was necessary to mask outside, but now I feel socially safe doing that. So people don’t think it’s weird, you can’t really get this stuff if you’re just walking around, unless you’re very tightly packed. 

[The three agree that this is “common sense.”] 

EC:
… 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 you’re concerned that we’re 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 let’s 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 didn’t build capacity, and you didn’t 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, we’re laser focused. And there’s 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 you’re just there for one purpose. Like if we show up and dump a bunch of resources, it’s 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 it’s, you know, mental health issues or diabetes or hypertension, you know, all the killers. 

EC:
Which exists in all communities, so …  

LM: 
… and they disproportionately exist in communities of color. 

MC:
You think if the underlying comorbidities weren’t as pervasive that maybe COVID wouldn’t have had such a large impact — because it’s 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, they’re higher for communities of color in addition to infection rates. So the mortality rate per a hundred thousand is higher. And that’s got to be due to pre-existing conditions. 

EC:
Okay, doc, I’m 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 — 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, I’m thinking about things, not just access to healthcare, but yes, every person should have — 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 can’t 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, it’s 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 shouldn’t 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 we’re at. 

LM: 
I would be happy to. 

EC:
Or sooner … you tell us, when’s a good time to reconnect, to revisit things. Cause we definitely want to keep an eye on this. Particularly since the work you’re doing is focusing on those communities that really all too often get ignored. And we can’t do that anymore. It pisses Matt off, so …  

Matt Chan:
Yeah it pisses me off. That’s why this whole victory lap thing really just kind of irks me, because we’re not there. 

LM: 
We’re not there. 

MC: 
But I think that what you said — they do that to make themselves feel good and feel safe. So that’s 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.

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📸 Featured Image: Monica Ruiz, Casa San Jose’s 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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