Treatments for the flu and COVID-19 are effective and improving.
Ramers, M.D., M.P.H., is a specialist in infectious diseases and the chief of population health and medical director of the Laura Rodriguez Research Institute at Family Health Centers of San Diego. He lives in Burlingame.
As San Diego stares down the prospect of a “tripledemic,” the confluence of resurging COVID-19 cases, widespread influenza activity and an uncharacteristically severe RSV (respiratory syncytial virus) season, we must not lose focus on addressing health disparities.
Although each virus is unique, they all affect vulnerable populations disproportionately. Influenza can cause a severe respiratory illness particularly in the young and elderly, but we have safe and effective vaccines and antiviral treatments. RSV causes a mild upper respiratory infection in most adults but can be severe or fatal in infants in whom it manifests as bronchiolitis. The elderly may be hospitalized or die from RSV-associated pneumonia. There is no RSV vaccine yet, although several candidates in late-stage trials look promising. A preventive monoclonal antibody is used in the most vulnerable premature infants, but no treatments are available.
We should all be familiar with SARS-CoV-2, the virus that causes COVID-19 that has so unceremoniously interrupted our lives for the past three years. COVID-19 vaccines are safe and highly effective at preventing hospitalization and death. Likewise, an array of evidence-based anti-viral treatments are now available, and, when used within five days of symptoms, minimize the severity of disease, prevent hospitalizations and save lives.
However, if the COVID-19 pandemic has taught us anything, it is that not all communities benefit equally from these protective measures. San Diego County public health data show that from the onset of the pandemic, Latinos have had higher case rates, hospitalizations and death rates than non-Hispanic White San Diegans. These disparities are rooted in the social determinants of health: socioeconomic status, housing, educational attainment, membership in the essential workforce, as well as presence of underlying comorbidities and access to timely and appropriate medical care.
But a closer look at the data suggests that these disparities may be lessening. When calculated for the most recent three months, disparities in case rates and hospitalizations are narrower between Latino and non-Hispanic White people. A county analysis of age-adjusted death rates in Latino and White people during the delta and early omicron variants waves has shown smaller disparities during the most recent late omicron variant wave.
What might explain this unexpected trend? Some speculate that successful equity-focused public vaccination and treatment campaigns eliminated disparities in access to these lifesaving interventions. Alternatively, politicization through more prominent anti-vax and anti-science sentiment in conservative districts may have driven up mortality rates in predominantly White populations. This is not good news.
In San Diego County, data on receipt of COVID-19 vaccines may partially explain these changes, but also provide a warning that complacency could reverse the trend. Through intentional efforts, San Diego’s public health authorities focused vigorously on “health equity ZIP codes” — defined using 23 social determinants of health —in San Ysidro, Chula Vista, and National City to improve access to COVID-19 information, testing, vaccines, and treatment. This resulted in some of the highest vaccination rates in the county and essentially eliminated previously noted disparities. In health equity ZIP codes, 76 percent of Latino people versus 68 percent of White people received their primary COVID-19 vaccine series.
However, more recent evidence suggests that these efforts are losing momentum and may not be sustained without ongoing efforts. Rates of receipt of any COVID-19 booster vaccine redemonstrates the disparity (50 percent for Latino people versus 67 percent for White people) and it widens further for the newest bivalent COVID-19 booster dose (almost 10 percent for Latino people versus 23 percent for White people).
We are all exhausted, but public health and political leaders must carry forward the hard-fought equity lessons of the pandemic:
- The most vulnerable should be our focus. Society will be judged on how it treats its most vulnerable individuals and communities.
- Programs aiming to reduce disparities and increase access to critical health interventions work, particularly when led by trusted messengers.
- Without intentional, equity-focused efforts to address and minimize health disparities, we are at risk of slipping back to pre-pandemic patterns.
Let us not allow one of the unintended but important byproducts of the pandemic — a focus on equity — to fall from our vision. Only with sustained efforts to address systemic and structural barriers, alleviate medical mistrust, counter anti-science beliefs and ensure equal access to proven health interventions will we be able to take on the unfinished business of minimizing health disparities.