Thirteen community leaders in Oakland, Berkeley and Alameda County are pushing back against the loosening of shelter-in-place rules, and asking Alameda County health officials to release more data before making decisions that they say will increase risks for vulnerable residents.
In a letter sent to county officials Thursday, June 18, the authors — including four medical doctors, several community organizers, religious leaders, violence prevention experts, and homeless advocates — wrote that the reopening of retail, outdoor dining, and religious services could “squander” the progress Alameda County has made in fighting the coronavirus.
The Alameda County Public Health Department announced the easing of the shelter-in-place order June 17, and the rules went into effect June 19. Berkeley, which has its own health department, did the same. The new rules allow all retail stores, outdoor dining, and religious services to reopen but limit how many people can be at each site at once and require social distancing and masks everywhere.
While restrictions loosen up in Alameda County, coronavirus cases have shown no sign of slowing down. Daily numbers fluctuate wildly, but the two highest single-day case counts recorded in the county since the pandemic began — 167 and 184 — were seen in the last week. Some of the highest daily hospitalization rates were also recorded in June.
Deaths decreased in May and June, but haven’t stopped, and some of the higher daily case counts could be attributed to an expansion in testing. California has also seen a spike in cases, breaking daily case records multiple times this week.
“The numbers are going in the wrong direction, and pretty fast,” said Dr. Noha Aboelata, CEO of East Oakland’s Roots Community Health Center.
“The numbers are going in the wrong direction, and pretty fast,” Dr. Noha Aboelata
Aboelata was one of the Oakland health practitioners who signed the letter to the county. She said there could be a logic to reopening some types of businesses and spaces where people gather, but she hasn’t seen the county release any data suggesting as much.
“We need to hear that clearly: ‘These are the metrics that let us know we’re prepared,’” she said. “We’re asking, what kinds of tradeoffs are you making? No one has shown us the model that’s being used.”
In early March, The Oaklandside filed a public records request with the Alameda County Public Health Department seeking, among other things, modeling reports showing the spread of the coronavirus and predictions about future rates of infections. The health department has refused to release any records and ignored a request for an interview.
Among the other advocates who signed the letter were Gloria Crowell, executive director of Allen Temple Health & Social Services, Pastor Michael McBride of Berkeley’s The Way Christian Center, Donald Frazier, executive director of Building Opportunities for Self-Sufficiency, and Candice Elder, executive director of the East Oakland Collective.
Their letter lays out a number of specific questions, many about contact tracing, which is the process of identifying, notifying, and analyzing all the recent contacts made by a person who tests positive for COVID-19. The advocates also ask the county to collect and release detailed information about contract tracing, such as how soon after an outbreak a person was contacted, how many contacts tested positive and were placed under quarantine, and how long the county takes to complete an investigation.
On Monday, the county’s top health officials — Health Care Services Agency Director Colleen Chawla, Public Health Director Kimi Watkins-Tartt, and Health Officer Dr. Erica Pan — responded to the advocates and health experts with their own letter.
“Decisions to open or close different activities and sectors weigh COVID-19 risks against the harms associated with wage and job loss, social isolation, educational loss, delayed medical care, and negative impact on mental health,” they wrote.
The officials said the county is 80% of the way toward its goal of 3,100 coronavirus tests a day and has boosted the number of staff focused on contact tracing and investigation from seven to almost 100. But they acknowledged the need to strengthen each program. (Berkeley is currently testing about 165 people a day, short of its goal of 245 tests a day).
According to the county’s letter, progress is tracked through several indicators including: “rates of new cases and hospitalizations, sufficient hospital bed and surge capacity, sufficient testing, sufficient disease containment, and sufficient personal protective equipment for the health care workforce.” These indicators are listed in a general “reopening plan” released by the county last Friday.
Most of those indicators, except for the rates of cases and hospitalizations, have shown improvement, county health officials noted, and some data is available to the public through the county’s online dashboards. (One has data on case rates, and the other has data on deaths.) The county health officials attributed the recent increase in COVID-19 cases to both the expansion of testing availability and the previous loosening of shelter-in-place restrictions in May. They said they felt confident in “cautiously” moving forward with further reopening.
But the group of concerned community leaders say the relaxed rules won’t affect everyone in Alameda County the same way.
“Because marginalized communities suffer compromised health even in the best of times, it appears inevitable that the County’s Black and brown residents and workers will disproportionately bear the brunt of new infections, and increased morbidity and mortality,” they wrote.
According to county data, Latinx residents are overrepresented in infection rates, constituting 52% of cases but 22% of the population. Black residents make up 23% of deaths but just 11% of the population. Many of the cases in the county’s dataset do not include a person’s race, however, leaving some doubt about exactly how wide the racial disparities are.
The three ZIP codes in the county with the highest case rates—94601, 94621, 94603—are all in East Oakland, while some ZIP codes in Berkeley don’t even register on the map because they still have fewer than 10 coronavirus cases. (Those Berkeley ZIP codes have far fewer residents than the East Oakland areas, however, so they are bound to have fewer cases regardless of disparities.)
Aboelata, the CEO of Roots, said she’s not convinced it makes sense to have a uniform shelter-in-place policy for the entire county because of the differences in conditions from place to place. Patients who come to Roots tend to live in some of the hardest-hit areas, and they’re more likely to need to return to retail and food industry jobs because they’ll be ineligible for unemployment payments once those employers reopen.
Other parts of the county are home to more people with professional jobs, better housing, and higher incomes, allowing many of them to work from home and take other precautions to avoid the virus.
“We’re watching a future disparity in the making,” Aboelata said.
Roots’ East Oakland test site has found a 13-14% positive rate among the population it serves, compared to the state average of 5%.
Some of the same equity issues that created the health disparities have also drawn masses of people out to the streets for weeks of protests in Oakland, Berkeley, and beyond. Some of those protesters have said they recognize the health and safety risk, but that they’re protesting a different sort of health and safety problem — that of police violence and systemic racism. “First Amendment” activity was also permitted in Friday’s county order.
Even so, it’s a coronavirus concern to have crowds gather together right now, Aboelata said.
“The extent to which the virus is circulating in your community should be a factor in whether you go out and participate,” she said. “We have to protect the people who are most likely to have a poorer outcome.”
Aboelata said that while she’s most concerned about the virus spreading through indoor spaces like clothing stores and churches, “in the Fruitvale, I wouldn’t be sitting down to outdoor dining anytime soon.”
In Sacramento, which has also experienced a recent coronavirus surge, health officials said contact tracing revealed that the disease is mostly spreading within private homes during social and family gatherings, not at reopened bars or protests, according to the Sacramento Bee.
That may be the case in Alameda County too, but neither the county nor Berkeley has released anything like that level of granular analysis. Staff often cite privacy concerns as a reason for not releasing more data.
Sacramento’s health officer also theorized that the reopening of retail and bars might have sent the wrong message to residents, suggesting that it’s okay to see friends in their homes or forgo social distancing. The advocates who sent the letter in Alameda County said more explicit information needs to be provided to residents so they can make informed decisions about their own behavior.
County health officials said they’re actively pursuing more resources to expand testing in the most impacted communities, including mobile testing at long-term care facilities.
Alameda County Supervisor Wilma Chan also responded to the advocates’ letter, saying she shares concerns about equity and that the county is severely limited in its capacity to respond to the virus by the amount of federal aid it receives. Chan said the state has been asking counties to file formal declarations that they’re able to reopen at a rapid rate, and that she’s “proud” Alameda County has declined so far.
While Gov. Gavin Newsom warned the public about the statewide surge in cases this week, he attributed the numbers mostly to the behaviors of individuals who don’t wear a mask or social distance. But the San Francisco Chronicle reported this week that some Bay Area health officials—including in Contra Costa County, directly north of Alameda County—are already talking about walking back the relaxed rules.
If Alameda County is not planning to reverse course, decision-makers need to explain why, Aboelata said.
“At a minimum, the information has to be out there,” she said.