Sacramento County pays $13M to reduce coronavirus inequities

By working as a COVID-19 case investigator, Melissa De La Cruz is seeing firsthand how

By working as a COVID-19 case investigator, Melissa De La Cruz is seeing firsthand how quickly things can go south for families facing this illness in the Sacramento region.

One of her clients told her that an employer promised a paycheck for the quarantine period and that they wouldn’t need any resources, De La Cruz said, but that didn’t work out.

“They haven’t gotten paid, and it’s been over three weeks,” she said. “It just goes to show you how things can change within a few days or within weeks. … Financial hardship is really taking a toll on a lot of these families. Along with the disease, they’re concerned about housing, utilities, food.”

The Sol Collective, a Sacramento-based nonprofit that celebrates the Latinx culture and educates people about it, hired De La Cruz to work on reducing the disproportionately high number of COVID-19 cases in Sacramento’s Hispanic community.

Thanks to a new partnership, Sacramento County has appropriated $13 million to Sol Collective and 12 other community-based organizations to ensure that the racial and ethnic groups and businesses hardest hit by COVID-19 have what they need to mount a better defense.

Sierra Health Foundation will actually manage how the funds are spent, said Chet Hewitt, Sierra Health’s president and chief executive officer. The project is known as the Sacramento County COVID-19 Collaborative — The Collab for short — and it’s funded by money the county received as part of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.

“The project really comes after a lot of advocacy on the part of concerned citizens who pushed the county to do more than they had originally planned to do around the CARES funding in response to COVID-19,” Hewitt said. “The plan is really about livelihoods. How do you really support people who we know will experience potentially an illness or who were being affected by the pandemic because of a loss of employment?”

Why Sacramento is teaming with this organization

Sacramento County’s public health officer, Dr. Olivia Kasirye, said Sierra Health was chosen because the county had successfully worked with the foundation and community-based organizations to reduce mortality rates for African-American children as part of the Black Child Legacy Campaign.

Public health officials knew Sierra Health had the community contacts and trusted relationships to get the work started quickly, Kasirye said, and that was important because rates of COVID-19 infection have been disproportionately high in communities of color.

As of Oct. 10, Sacramento County residents of Hispanic origin are getting the illness at a rate of 1,175 per 100,000; African Americans at a rate of 1,152 per 100,000; and Pacific Islanders, 1,400 per 100,000, Kasirye said. That compares with a rate of 711 per 100,000 among white people.

Just after Kasirye and other county leaders inked a deal on The Collab with Sierra Health, state public health officials announced that counties would have to demonstrate they were making efforts to improve COVID-19 infection rates for racial or ethnic groups and geographic areas showing the most pronounced impacts before they could advance to one of California’s less-restrictive COVID-19 color tiers.

“It ties in really well because the state required that we identify communities that have been disproportionately hit hard by COVID-19 and show how we were providing services,” Kasirye said. “We want to do outreach and provide the prevention message of using face coverings, providing 6 feet of separation and then also avoiding gatherings.”

The county also has been stressing the availability of free COVID-19 testing at 10 sites, Kasirye said, and her team uses these test results to provide data to the state that will determine how Sacramento is doing.

The goal is to get positivity rates for census tracts in disadvantaged neighborhoods as close as possible to the county’s overall positivity rate. That will determine whether the county is doing enough testing in those tracts and whether the infection rate is higher.

This places a lot of responsibility on De La Cruz and others at the 13 community groups that have contracted with Sierra Health. Over the last four weeks, Hewitt said, Sierra Health and community group leaders have hiring and educating nearly 80 people to trace contacts, help infected individuals work with small businesses to make the changes needed to get back up and running.

The case investigators, contact tracers and business navigators have made 1,000 connections with business owners and 775 with households, Hewitt said, and Sierra Health also provided funds to the Sacramento Food Bank & Family Services to ensure those in need get a well-rounded diet and to the United Way to help with rental assistance for people who lost wages because of a COVID-19 illness.

“We’re watching the contacts they’re actually making,” Hewitt said. “We’re monitoring the breadth of languages that we’re actually covering to make sure we’re getting out to all communities. We’ll be tracking how many businesses actually come online with the support of the business navigators as well.”

He added: “We’ll be tracking, if we isolate somebody from their family, whether or not anybody else in that family contracts COVID-19 to see how effective that intervention was and whether that intervention actually prevented some of that from actually happening.”

Reaching out and building relationships

De La Cruz said she’s been called an “angel” as she has reached out to families dealing with the illness. Some families, she said, have financial resources, but the illness causes such overwhelming fatigue that they literally cannot even peel a potato. They are so grateful for arrangements to have food delivered.

Others are living in tight quarters with elderly people who are more likely to die if they contract the illness, she said, so the sick individual needs to have somewhere to stay until they get better. She can arrange hotel vouchers and ensure they can get food so the don’t have to leave their room.

However, she said, she’s had families of five or six living in tight quarters who so successfully implemented the CDC guidelines for washing dishes, distancing themselves and other measures that the disease was never transmitted beyond the two or three people who initially tested positive.

She identifies people with whom the infected individuals had contact and works to get to them soon after she has their information, she said, but she also provides each person with a website, tellyourcontacts.org, where they can anonymously report contacts.

The nice thing about having 13 different types of organizations to work with, De La Cruz said, is that there is always someone who has expertise others don’t, allowing for help on issues with health care or language barriers.

People are reassured, she said, just because you reached out and they are surprised to learn that some information they’ve received about the illness isn’t true.

The most difficult thing, Hewitt and Kasirye said, is having to maintain a heightened vigilance. They plan an advertising campaign to stress good hygiene habits, the availability of free testing and the need to get flu shots.

Separately, Sierra Health also joined the California Endowment and 11 other philanthropic organizations have pooled together their own funds to support a $20 million initiative that will support county health departments and community-based organizations in their fight against COVID-19.

The nonprofit Public Health Institute, based in Oakland, will run the new initiative which the partners are calling Together Toward Health.

Susan Watson, the Public Health Institute program manager who will manage the initiative, said the plan is to find gaps in what is being done and to fill them, whether that’s in building awareness, outreach, education, workforce development or other issues.

“A lot of people have not been able to go back to work or have lost jobs, and at the same time there is a need for contact tracers who should reflect the diversity of the communities of need,” Watson said. “For those who wind up with jobs through this effort, they may have longer-term opportunities and new directions for their lives and for their families. A the end of this, we want to be doing things to make the community organizations, the community members, the relationships between organizations and health departments even stronger.”

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Cathie Anderson covers health care for The Bee. Growing up, her blue-collar parents paid out of pocket for care. She joined The Bee in 2002, with roles including business columnist and features editor. She previously worked at papers including the Dallas Morning News, Detroit News and Austin American-Statesman.

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