A frontline view of COVID’s disparate impact

Latinx and low-income communities are suffering the most, says Dr. José Mayorga of UCI Health’s Family Health Center

November 24, 2020

By Aaron Orlowski

José Mayorga
“This pandemic is impacting every aspect of our community,” says Dr. José Mayorga, executive director of the Family Health Center at UCI Health. Courtesy of José Mayorga.

Dr. José Mayorga has witnessed firsthand the disparate impacts of COVID-19 on different communities in Orange County. As executive director of the Family Health Center, a federally qualified health center that is part of UCI Health, he serves the low-income and Latinx patients who have been disproportionately exposed to the virus. 

“These workers are people who are working in food industries, such as fast food places, housekeeping, janitorial services. So they have no choice,” Mayorga says on this episode of the UCI Podcast. “They have to come into work. And, you know, on top of that, they’re getting exposed. There’s no ability for them to socially distance in some of these workspaces.”

Virus cases are surging, and local leaders continue to face choices about how to respond. Dr. Mayorga urges decision-makers to consider these most vulnerable communities as they formulate plans and policies.

“This pandemic is impacting every aspect of our community, and it will eventually impact them as well,” Dr. Mayorga says.

In this episode:

UCI study: Finding OC’s true COVID-19 rates: UCI antibody study finds infection prevalence seven times higher than previously estimated.

Family Health Centers in Santa Ana and Anaheim: These federally qualified health centers serve, mostly, low-income and Latinx patients in Orange County.

Dr. José Mayorga, executive director of the Family Health Center

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Transcript

AARON ORLOWSKI, HOST

In Orange County, Latinx and low-income communities have borne the brunt of the impacts of the COVID-19 pandemic. The data show it clearly: They have the highest positivity rates and the highest exposure levels. As debates about mask requirements and lockdowns rage on, and as virus cases rise again, these groups will be the ones that suffer the most.

Why have these communities been disproportionately affected? And how has UCI helped ease that burden?

From the University of California, Irvine, I’m Aaron Orlowski. And you’re listening to the UCI Podcast. Today, I’m speaking with Dr. José Mayorga, who is the executive director of the Family Health Center at UCI Health and an assistant clinical professor in the Department of Family Medicine here at UCI.

Dr. Mayorga, thank you for joining me today on the UCI Podcast.

JOSÉ MAYORGA

Hey Aaron, it’s a pleasure. Thank you so much for having me.

ORLOWSKI

Well at the Family Health Center, you serve a lot of underserved communities and in Orange County that means that you work with a lot of Latinx and low-income groups. So in a lot of ways, you and your organization have been on the frontlines of the COVID-19 pandemic and cases are currently rising again. So what are you seeing at the family health center?

MAYORGA

The interesting impact that this pandemic has had is very, very much seen as an impact in those underserved communities, as you mentioned. You know, the first wave of this pandemic was felt in the summer and it disproportionately impacted certain cities in Orange County, specifically Santa Ana and Anaheim. And both those locations are very important because that’s where our Family Health Centers are located. They’re located in the heart of those cities. And so back in the early stages of the first wave, the week of July 5th, we had a positivity rate peak at 37.8 percent. Yeah, pretty significant. And in all honesty, I must have checked those numbers two or three times because I could not believe how impactful this was. But sure enough, unfortunately, it was at that level. In comparison to our other sites that were also doing testing, those sites were under 10 percent. And over the past several weeks, as we’re starting to see this uptake in cases just last week, our positivity rate now is at 8.9 percent. And with comparison to the county’s overall rate, which is currently sitting at 3.2 percent. So again, very disproportionately impacted.

ORLOWSKI

Well, and we’re also seeing that some of the other types of metrics are confirming exactly what you just said. UCI researchers recently published a study finding that the exposure rate of COVID-19 was significantly higher among Latinx and low-income groups compared to white communities. The study said that it was 11.5 percent of people in Orange County had COVID-19 antibodies this summer, but 17 percent of Latinos and 15 percent of low-income residents did. So this is a huge difference in exposure and a huge disparity in the impact. So from your perspective as a physician, why is that? Why are these communities so disproportionately impacted?

MAYORGA

Well, I think we have to go back and look very closely at some other data. So the U.S. Bureau of Labor Statistics back in 2018 published that only 16.2 percent of Latinx can work from home. In other words, they could do remote work, like some folks have been able to do. And so that is a significant percentage given that, that classifies a lot of Latinx individuals, particularly here in Orange County, as essential workers. These workers are people who are working in food industries, such as fast food places, housekeeping, janitorial services. So they have no choice. They have to come into work. And, you know, on top of that, they’re getting exposed. There’s no ability for them to socially distance in some of these workspaces.

ORLOWSKI

That is a huge difference in the types of work they’re doing and how those impacts really are felt. So, but let’s backtrack just a little bit here. The Family Health Center, which you’re the executive director of, is a Federally Qualified Health Center. And like you mentioned earlier, there’s two locations, one in Anaheim and one in Santa Ana. So what does that mean to be an FQHC?

MAYORGA

Well, and FQHC is very unique. As I like to say, they’re the best kept secret in healthcare. And here’s why. FQHCs have been around since the mid 1970s. And they’re really unique organizations that are focused on working in medically underserved areas. And so across the country, for example, back in 2019, over 30 million people were served at these locations. That’s quite a bit, and that’s across all of the U.S. states and its territories. So there’s not a single place in the U.S. that doesn’t have an FQHC. Here in California, we have the vast majority of them, three times more than any other state. So that kind of gives you some perspective of the population.

ORLOWSKI

So what is the demographic makeup of the communities that the Family Health Center serves?

MAYORGA

The population that we serve here at these two locations, first, to start off with, about 90 percent of them are Medi-Cal. So they use government insurance. This is designated by a level of poverty that they live in. Then as we break it down further, 80 percent of this is of Latinx descent. And so most of those patients are actually monolingual Spanish. So that kind of gives you some perspective of the individuals we care for in the clinic.

ORLOWSKI

And as we talked about COVID-19 has impacted that community really severely. So how do you think that these disproportionate impacts have influenced the public debate about the coronavirus?

MAYORGA

It’s unfortunate the way it is actually impacting the public debate. I think as you look at Orange County as a whole, Orange County as a whole is very unique. Different cities have different representations of their socioeconomic status. And the two most populous cities in this county are in Anaheim and Santa Ana. And those two individual cities have the vast proportion of minorities in particular Latinx, as well as all the cases predominantly within the county. And so when you look at individuals outside of those cities, they’re not feeling that same impact. They’re not seeing it. So it’s hard for them to grasp the magnitude of this infection, the magnitude of this pandemic, because they don’t know anyone, they don’t directly know anyone. And unfortunately, in the two cities that we serve, those individuals do. They have direct links to people who’ve had the infection and/or have been hospitalized, and in some cases, unfortunately have succumbed to this infection.

ORLOWSKI

So if you could just have a conversation with some of the leaders in those communities who haven’t seen the direct impacts the way that you have and the way that your patients have, what would you tell them?

MAYORGA

I really want them to understand that this infection is out there. This pandemic is impacting every aspect of our community, and it will eventually impact them as well. They’re going to travel through various areas, through various cities, or even seek services such as going to restaurants or wanting to do other social things. They’re inevitably going to get exposed in some capacity. So we really need to take into account how these communities, specifically those underserved communities, are impacted. And then the other thing that we really need to think about as we’re moving forward through this and trying to come up on the other side, is the social determinants of health that are really at play. And that’s a really important piece that most people just sometimes can’t appreciate.

ORLOWSKI

Well, what are those social determinants of health? Can you expand a bit on that?

MAYORGA

Sure. It’s easier to explain as socioeconomic challenges or things that people face. But the social determinants of health are related to places where people work, live or play, and they’re directly correlated with the healthcare disparities that we see amongst our communities. So what do I mean by that? Let me give you some examples. So if someone’s living in poverty or someone has issues securing food, such as not knowing a good place to get healthy food options, or let alone actually have access to food due to financial constraints — those are the things that we talk about social determinants. Other examples of that are lack of access to healthcare, maybe having unsafe environments to go out and play for children. Those are, again, some things that are associated with social determinants.

ORLOWSKI

So when the pandemic first hit back in the spring, UCI Health and the School of Medicine really sprung into action to help underserved communities. Can you tell us a bit more about some of the specific things that those two organizations and you and your group did to help those communities?

MAYORGA

You know what, I take great pride in speaking about this, because I’ve never seen such mobilization of an entire institution, as well as a school, come together and really, as I like to say, just all hands were on deck. Every single person was trying to figure out what’s the best approach to not only address the situation that we were seeing, but also how to support all those individuals on the frontlines, specifically our healthcare workers in the clinics as well as in the hospital. So it was really impressive to see the response. Now, UCI Health, for example, stood up the first drive-through testing sites of the county. We’ve basically been called upon by numerous organizations, both public and private organizations, to support them in the evaluation of how they respond to the pandemic. Our experts have been out in the community, speaking about it, trying to educate.

And the other thing that we did is we really had to, as a collective group, figure out what’s the best approach to provide care, because guess what, you know, other diseases still are occurring, right? We’re still having heart attacks. We’re still having appendicitis. We have to respond to that. We have to make sure we’re able to do this in a safe manner while still addressing the issue at hand of the pandemic. Now, the other thing that was very interesting: I could only imagine what was going through the minds of our medical students, who are learning to become physicians, right. And they had to be asked to step away because early on in the pandemic, as we know, there was a shortage of PPE (personal protective equipment). There was still not a clear understanding of how this infection impacted individuals, specifically those caring for individuals with the infection. So we asked them to step away, but yet they still managed to come together and support the healthcare workers in their time of great need.

ORLOWSKI

Yeah, that’s really inspiring to hear for sure. And I think that they did some things, including donation drives for PPE and offering some childcare services. So it was really a huge diversity of assistance that those medical school students gave.

MAYORGA

They did. And I am extremely proud of how they just stepped up. They were trying to figure out numerous tactics and innumerate ways to support every part of the infrastructure that we delivered. And I personally also had them help me here at the clinic. We had to deliver care in a different manner. We had to pivot. And so we started doing virtual care and that virtual care to a population that we serve in the Family Health Centers is very different, of course, because now we’re having to do it via the internet via the use of translation/interpreter services. And so these students, specifically the PRIME-LC students, were wonderful enough to come to me and say, Dr. Mayorga, we want to help, how can we do that? And I said, please help me translate all this patient-facing material. We need to move this forward so that our patients aren’t disenfranchised more than they already are.

ORLOWSKI

As the pandemic has progressed, how has your response at the Family Health Center evolved? How has the way that you deliver treatment and care changed?

MAYORGA

Knowing that our community was at highest risk, we stood up a drive-through testing site at our Santa Ana location. And again, it was one of the busiest that we’ve seen. I mean, we were seeing close to anywhere from like 40 to almost 90 people a day getting tested at the peak. And unfortunately, I won’t be surprised that we’ll get back to those numbers just at the rate that we’re moving into here in the fall and the winter. The other really interesting things we did, I mentioned the virtual care. Now we wanted to keep people safe, but we also needed to continue to provide that primary care service. And so we did those things, safely and effectively. And we continue to offer those services now.

Now the other areas where we’ve put a lot of emphasis is, okay, so if you’re going to come into the clinic, how do we assure that everyone is comfortable walking in? And so implementing various tactics from remote paging systems to communicating with patients via text to ensure that they can now safely enter the building once their appointment was ready to start. And then lastly, the one thing I’m actually really proud of, is some of the things that we recognized that’s happening during this pandemic. And that was specifically around the behavioral impact, the behavioral health impact. And so we took the opportunity to reach out to all of our known, diagnosed patients with anxiety and depression, and we proactively reached out to them to make sure they were doing okay. And that again is a big effort on the team that was willing to take that on and did wonderful with that.

ORLOWSKI

So as a physician, what has the pandemic taught you about how to care for the whole patient? You just mentioned that you and your team have been reaching out about behavioral health and mental health. So what kind of lessons have you learned from the pandemic about caring for the whole patient?

MAYORGA

As a family physician, I personally take into account the whole picture of the patient, including their family. And it’s innately ingrained in my mind, in my heart, to really take into account all those struggles, specifically, those social determinants of health that we talked about. Those issues impact more of our health than anything else. And as long as we keep that in mind, we’re able to hopefully address the medical condition that’s in front of us at that point in time. And so that’s something I’ve learned a lot about. And that’s something we continue to teach all our trainees to really focus on. And again, as physicians, we’re not experts in that area. I mean, I am not a social worker that knows all the wonderful resources our community has. And so I have to lean on those professionals, on those experts and knowing where to find them, how to contact them is really important. And at times even more important than me prescribing a prescription for high blood pressure, because there’s no point in me prescribing a blood pressure medication, if I know that person doesn’t have healthy access to food, for example.

ORLOWSKI

Dr. Mayorga thank you for joining me today on the UCI Podcast.

MAYORGA

Thank you so much, Aaron. It’s been a pleasure.