The Hidden COVID Crisis in Los Angeles

The mortality rate among Latinos in Los Angeles increased by 48 percent during the pandemic. And even now, when so many people want to put COVID in the rearview, Black, Native, and Latino Americans are about twice as likely to die of the virus as white Americans.

Dr. Don Garcia, medical director of Clínica Romero in L.A., knows this in his bones. His clinic gets some federal money, but for the most part it works on a shoestring budget, with high-needs patients—a lot of essential workers, some undocumented. He says many of them won’t seek COVID testing even if they have symptoms because they’re afraid to jeopardize their immigration status or employment. It’s just one of many challenges facing Garcia’s community. On Thursday’s episode of What Next, I talked to Garcia about disparities in access to COVID vaccines and treatment, how the federal government fell short in its pandemic response, and why he still wears a mask. This conversation has been condensed and edited for clarity.

Dr. Don Garcia: What made me angry [early in the pandemic] is that I was receiving health care services that were 180 degrees opposite than what my patients were receiving. I mean, how could it be that I could go home and receive services and care, but I could not deliver that care to my own patients? How can I be there with my patients, who had a higher morbidity, mortality rate than myself, a higher positivity rate, yet they did not have the access to the services that were required for a pandemic, as I did?

Mary Harris: What kind of services? Are you talking about a COVID test, for instance? You could just get one?

Yeah, COVID testing, the vaccine, monoclonal antibody. All the services that were being initiated were not available to the community of families and patients that I was serving. Yet I had access to that. So I had a difficulty coming to our federally qualified health center every day and knowing that these services were not always available in the way that they were available to myself personally, in my own health care system.

What was the difference? Just the fact that you had insurance? Because I think some people would say, like, there were testing sites at Dodger Stadium or something. It was supposed to be open to everyone.

Just because you have access to Dodger Stadium does not mean that that’s a solution for a community that has transportation insecurity. How are they going to get to a stadium 5 miles away? They have no car. They have no gasoline. They’re limited in their finances. They have employment insecurity. They don’t have opportunity to leave their work for a vaccine or a test or for illness. They have family care insecurities. Who’s going to take care of the children? Who’s going to take care of the elderly at home? Not only that, can they wait in line for four or five hours the way that you and I can? No. Their life is not the life that you and I have, where for you and I it’s just an automatic reflex.

You’ve described your clinic as being in the eye of the storm when it comes to COVID, like last year, the COVID testing you did and how it differed from what L.A. County was finding. Can you explain the differences in your positivity rate?

Yeah. The L.A. County rate was ranging from 3 percent to the highest, maybe 13, 15 percent. But here in our federally qualified health center in Boyle Heights, East Los Angeles, and over in the Pico Union Westlake area, we were seeing a positivity rate consistently of 35 to 40 percent. For 13 months beginning in January of 2021 to February of 2022, that’s how it was different. Yet the vaccines were not available. Yet the testing was not available as readily as it was in those communities that had the lower infectivity rate. In other words, the formula was upside-down.

What I like about your “eye of the storm” analogy is that it made me think about the pandemic a little differently, as like a physical place rather than just an amorphous blob that maybe was affecting everyone. If I think about the pandemic as a hurricane rather than a virus, like, FEMA would send help right to the center of the devastation. What happened instead?

Yeah, you’re very correct. I mean, if it was a forest fire that we witness here in Southern California, the eye of the catastrophic emergency immediately sees FEMA coming in, having major press conferences with the major political decision leaders, with the major resources being brought in. Yet in this situation, we had the fire, and you did not see a similar response that you would have seen with a natural disaster. Why?

You talked about how in the beginning when the vaccines were just becoming available, you got a shipment of just a hundred vaccines, and you have thousands of members. What happened when you asked for access to more and said “our people need this”?

There was a shortage of vaccines because what was happening is that the vaccines were being sent to the megacenters. They were being sent to the Dodger Stadiums, they were being sent to Cal State universities, they were being sent to the fair complexes. That’s where the priority was. And then whatever was leftover available was then sent to the outlying federally qualified health centers or certified sites that were out in the neighborhood.

I had an opportunity to testify at the White House task force on COVID-19, and I brought this concern. I said, why have you not brought in those of us who are down in the eye of the storm, where the fire is existing, federally qualified health centers who are part of the federal health care system? Why have you not brought us in as the experts to give alternative solutions and options to the communities of highest risk?

What’d they say?

There was no response. I never had a response to this day.

I wonder if you see any evidence that people in positions of power have changed their approach as time’s gone on. Like, now that antivirals are available or monoclonal antibodies, is it easier for you as a clinician to access those treatments for your patients?

No, it’s not, because we’re still not updated with the recent monoclonal antibodies, by providing financial support to acquire the necessary medical equipment, technology. Number two, the medication is in a shortage because of the volume of need. I don’t have access to that. We requested access two weeks ago and we’re still waiting on our supply to be delivered because there’s a shortage of that medication.

So it still becomes frustrating. There’s no concern, when we know there’s going to be a spike of this viral infection in July and a larger spike in January of 2023. Are we going to revisit the same inadequacies, the same unpreparedness?

Was there ever a moment where you thought the way COVID is working, the way it’s devastating everyone, might change things for you, like a kind of “rising tide raises all boats” thing? I know your clinic has the tagline of “health care is a human right.” Did you ever think maybe now everyone’s going to see how vital what we do is?

I had a moment in time when I approached the medical association, the local medical society, and they were very, very attentive and listening to the needs of our federally qualified health center.

This was during the beginning days of COVID.

Yes. They’re the ones who took my voice, my concern, my advocacy to those decision leaders, because they had the access, they took me to the local county department of public health director. They took me to the Region 9 administrator for the Department of Health and Human Services, to the state level.

You must have felt like you were getting things done.

Yes, we were. We were working collaboratively, and because of that, vaccines were delivered. FEMA came in and did a pop-up tent vaccine administration. But that was short-lived. It was only there for a moment, and then it was gone. So to me, it was disappointing because it was like, all right, we’re given you your candy, be satisfied, and we don’t want to hear more from you or hear back from you.

I mean, they call on the academic experts, and I understand that. … But we also need those who are actually the ones that are fighting the fire. They haven’t come down to the firefighters and said, hey, tell us, what does it feel to be there in the heat, to be there in exhaustion, to be holding the hoses and see this fire decimating your community?

I want to fast forward to now. You talk about how when you show up for work every morning, there’s a line outside of people looking to get in, getting checked, seeing if they have their vaccinations. What’s your positivity rate like these days?

There’s been a downtrend on access in testing. There’s been a downtrend on the number of vaccines that we’re administering because of the health literacy. Our community has not had an increased rate of literacy to this pandemic or just to health care in general.

So you’re saying that the positivity rate, even if it was going down, there aren’t as many tests, so it’s hard to know what to make of it.

Correct, because everyone believes that the virus doesn’t exist, it’s not around anymore. It is around, but there has not been an educational literacy campaign ongoing, just as you would do with the flu or the polio or measles or mumps.

Last week, the mask mandate was struck down on public transportation by a judge, and I’m sure you saw those videos of people putting their masks in the air and celebrating on planes. But I wonder if you saw those videos a little differently, given that your patient population, it sounds like they’re the people driving buses and subways and doing all of that essential work in Los Angeles.

Yeah, I see that very different. I see it as destroying our community. I see them as what I call the “yo, yo” theory. “Yo, yo” in Spanish means “I, I.” Yeah, it’s their freedom of speech. But they’re thinking about the I, I, I. They’re not thinking about the us and the we.

I still wear a mask as a role model to display, to demonstrate that there is still a pandemic, that we still need to be aware of it, we still need to follow protective measures. Now, they may think I’m silly, but I need to be a role model to my patients, to my community, wherever I go and say, “We still need to wear the mask. If you’re not wearing it, I’m wearing it. Maybe it will tell a story for you.”