Chino Y Chicano

Ep 25 Dr. Leo Morales, Adios Covid

June 16, 2021 Enrique Cerna-Matt Chan
Chino Y Chicano
Ep 25 Dr. Leo Morales, Adios Covid
Show Notes Transcript

 Seattle and King County officials are proudly touting a 70 percent Covid-19 vaccination rate. But Dr. Leo Morales says there is more work to be done especially among Latinos and other communities of color where the vaccination rate hovers at 50 percent. Dr. Morales joins the Chino Y Chicano to talk about the pandemic's impact on health disparities and Adios Covid, a project aimed at helping Latinos get vaccinated.  Dr. Morales is a Professor and Assistant Dean at the University of Washington School of Medicine and co-director of the Latino Center for Health at the University of Washington. 

Speaker 1:

Welcome to Chino eat Chicano. I met Chan the Chino. I met Erica CRNA , the Chicano, well, things are starting to loosen up as more and more folks get the COVID-19 vaccinations. People are getting out. They're going to restaurants again, getting together with friends and traveling. And Matt here in Seattle and king county officials are touting that , uh, more than 70% of people have gotten vaccinated.

Speaker 2:

That's a good thing. I mean, you know, because for a long time, communities of color were lagging, but being fully king county, 70% means that we're on the right track. I don't know about you though. I'm still, I'm so used to wearing a mask and I see some without one, and I just gives me pause. That's going to take a little while for me to get used

Speaker 1:

To that. I'm still going to wear a mask. Anytime I go into , um , any grocery store or a building or whatever, and I'm going to wear the mask until this thing is really over. I mean, I probably won't wear it when I'm outside walking and things like that, but definitely when I go into a crowd around , uh, people and, and especially if I don't know if someone's been vaccinated or not. And you know, I also think we have some concerns here as we're going to talk about in this episode that even though we've reached the 70% or somewhere in there, communities of color have not, and that's a big concern. Yeah.

Speaker 2:

I mean, there's going to be the vaccinated and then the infected, because apparently, you know, what I've read so far is that COVID is still raging in unvaccinated communities. Um , and the levels are like they were in January, but they just don't show it because enough of the country has had a vaccination that they don't impact the hospitals like they were,

Speaker 1:

You know, there's a big concern though about getting the vaccinations in the communities of color, because we know the COVID is hit hard in communities of color, Latinos have a higher rate of infections and any other racial or ethnic group they've also experienced hospitalizations and death rates exceeded only by those among native Americans and Alaska natives. And all of this is , uh , made it even more difficult by the health disparities that existed before COVID and coming up, we're going to talk to Dr. Leo Morales . He's been working on all of this, the , the testing, the infections, the vaccinations, he's been really looking at this. And I think , uh , one of the reasons we wanted to talk to him and Matt, it was to get this longer perspective and deeper perspective.

Speaker 2:

Life is going to be like host vaccines.

Speaker 1:

Esther Morales is a professor and assistant Dean at the university of Washington school of medicine. And he's also the, co-director the Latino center for health that the UWU here is our conversation with Dr. Leo Morales ,

Speaker 3:

Dr. Leo. Miralis welcome. Thank you. Yeah . And Matt, I'm glad to be here. Thanks for inviting me. Tell us a little , a bit

Speaker 1:

About your work and how the pandemic impacted what you do.

Speaker 3:

Sure . Well , um, it's changed my life , uh, essentially , um, I think , uh, as I became aware of , uh, the pandemic becoming well, identifying it as a pandemic, and then also seeing very early on how , um, there are differential rates and testing , uh, identifying cases , uh, initially in our state and in our region. Um, particularly I was concerned about , um, the negative impact or the lack of access to testing among Latinos in our, in our region. I really pivoted my work and my attention to initially , uh, identifying cases, testing and, and more recently vaccinating , um, and really focusing on community community-based organizations and working with them, understanding that the health care systems were excluding , um, many, many, many folks who, who , you know, needed , uh, the services that were being provided.

Speaker 1:

All of this is , is something that communities of color have had to deal with for so long. So I found it interesting that it was almost like people were amazed that they're finding out that there's these disparities, but really that they've been there.

Speaker 3:

Absolutely. So , um, you know, this is nothing new and , uh, and , and , and , and , and in fact, you know, we've in my office, we talk a lot about social determinants of health and a historical perspective, really, you know, based on , uh, issues of discrimination and racism that have existed in the country for centuries. And , um, so all of those historical factors play a role in creating the circumstances that we see playing out with COVID-19. So absolutely nothing new. And in fact, one of my early concerns was let's not be too targeted about our approach here, because you know what, this pandemic is gonna come to an end, but the health disparities that are in these communities will continue to exist. So let's not just be here for this, let's be here for the long haul, and let's be here to solve the health issues that are, that are in our communities. Has

Speaker 2:

There been an impact made in the Latino community from when the pandemic was identified as a real threat to everyone, to , to where it is now? So

Speaker 3:

I , I think the one thing I've seen that happened that I think is , um , fantastic is the community has organized itself in ways that , um , it wasn't before the pandemic. So , um, in our area, there's been , uh, the formation of a , uh , Latino civic Alliance, for example, which is made up of a number of different community-based organizations throughout the state. And they really came together to address COVID, they've been there, they're grassroots organizations in slightly bigger ones , some 5 0 3 C some not , um , but they've come together and they're starting to talk to one another and they're , uh , collaborating. Uh, and I think that's a very positive outcome. Now. I'm hope I'm hoping that we will continue to have those sorts of coalitions and , uh, and, and, and working together to solve, you know, different health problems.

Speaker 2:

Is , is there still a hesitancy in communities of color to get the vaccine, or was it mainly access and education? Yeah, that's a tricky,

Speaker 3:

Aye . Aye , aye . You know, I think that, you know, I think the hesitancy, there are different perhaps different reasons for hesitancy. And so , um, you know, some of them could be around , uh, issues of concern around cost , um, and issues of concern around , um, protections , uh, you know, legal or otherwise. Um, some of them could be because people are concerned about, you know, whether the vaccines are safe , um, whether they're effective, whether they're necessary. Um, I think in the Latino community, and there are some recent data that came out of the Kaiser family foundation that showed of those Latinos who were unvaccinated and ready to be vaccinated, something like 50% were saying they were concerned about the costs. And so , um, you know, there's a lot of misperceptions out there. I'll say the other big factor, I think, is a breakdown in trust between , um, public health, any sort of , uh , governmental organization and communities, Latino communities in particular , um , because of all the issues of , uh, around immigration and concerns about deportation and, you know, families with mixed statuses and real concerns about approaching, you know, anybody who wants to collect information and works for the government. And that has been a huge barrier.

Speaker 2:

Yeah. And it kind of peaked during the last administration.

Speaker 3:

Absolutely. And that, and that fear and that, that , uh , that chilling effect has had, it continues to have an effect to this day. I can give you an example. So, you know , um, we had through the state, we were able to access national guard resources to go vaccinate. They were well-resourced, they were available, but many communities rejected their assistance. Um, just out of fear, out of what it meant to have a uniformed individual in the community, even though it was, they were there only to vaccinate. Um, so people delayed , uh, and, you know, delays in vaccination means , uh, lives and , and, and health. And so , uh, you know, it's a real cost , uh , to that, to that , uh, uh , lack of trust,

Speaker 1:

Is that a combination of what they experienced, not only in , in worrying about their immigration status and all of those things here, but what they experienced in their own native countries, where there's so much corruption and, you know, you, you have to fear the police or anybody in a uniform.

Speaker 3:

I , I would S I would assume so. I don't know that for certain, it makes sense to me, it's unfortunate that now our government is viewed like governments in Latin America, which are, you know, you have to be fearful of them because there's so much corruption, but more

Speaker 1:

Than that, anything else, it was the rhetoric that we heard in the last

Speaker 3:

Four years. Yeah . Yeah. And, you know, the sort of, there were a lot of missteps. So at one point in our state , um, I think , uh, law enforcement was sharing information with ice and, you know, that was stopped and condemned, but the damage was done. And so , um, that creates fear. Um, and it's not unjustified fear. Um, but you know, it's very hard to change that once it's there,

Speaker 1:

What was done to change that, so that those communities, so the people in the community could then feel some sense of , um, well safety, but also that they needed to get this done. So at the grassroots

Speaker 3:

Level, well , what had to happen. So, you know, that the reality is I think the only approach that works is really to work through the community-based organizations , um, that have the trust that have been in the community and , you know, for a long time , uh, that have personal relationships. And , um, and so that's really been the way , uh, so I I'm , uh , I'm, I'm working with a, another professor in the information school who , um, whose name is Frank Martinez. We've, we've created a project called audio's COVID, which I love ideals called get the hell out of here. Yeah . So , um, and our approach has been simply to fill the gap between , um, you know, larger institutions that have resources and small community-based organizations that need them, and in particular, the efforts around initially testing and then vaccines. Um, so , uh, because I think they're the, really, the only ones who can reach these pockets of the community that are hard to reach they're substantial in size. They're not connected to healthcare systems that , you know, these are people who've not necessarily insured, or even if they have the potential for being insured, don't seek it and don't seek out healthcare. Um, and so because of concerns around costs , uh, and , um, and so the community based organizations, I think are key, it's really about us going to them. So healthcare organizations are , uh , you know , historically very passive. We open the doors, but we don't really do much to bring people in those stores outside of some very targeted marketing. That's not targeted to the segments of the population we're talking about. We need to be in the community, we need to be present there. Um, and so that's really been the efforts of ideals COVID, hasn't been to, to , um, be present in the community, work with those smaller organizations and , um, you know , uh, make, make, make vaccines more accessible. Now ,

Speaker 2:

Mayor Durkan has taken a victory lap saying 70% of the residents in Seattle have been vaccinated. That may be true, but I think I got to think the disparities don't tell the truth there.

Speaker 3:

So yeah, you got it. So, you know, there's, there's , uh , you know, these are, these are small population problems, right? So , um, what's true for the average is not true for different segments. And, you know, we know, for example, in king county , uh, 50% , uh, of Latinos and African-Americans are vaccinated compared to the , whatever it is, 60, 70% of the non-Hispanic white population in our state, there are counties that have vaccination rates in the thirties. So , um, which are largely Latino , uh, counties in Eastern and central Washington. So, you know, I'll, I'll tell you another little story. So one thing that we saw very early on with testing, or actually with infection rates. So if you look at the average infection rate, like what IHM me , the Institute for health metrics was publishing these rates, right? You saw these graphs with , uh, infection rates going up. And then there was the institution of stay at home and , and the rates started to come down and then it was lifted and they kind of stayed low until the next surge. But if you just aggregate those infection rates by race, ethnicity, in our state , um, native , uh, Pacific Islanders and native Hawaiians and Pacific Islanders, and Latinos did not date, the search did not stop with , stay at home. In fact, it accelerated during the whole period of stay at home during the whole period of shelter in place, they actually didn't start to come down until after shelter in place was lifted. So if you didn't look deeper, the story you would tell is , well, this worked in everybody got better, but no, in fact, some people, you know, we don't know, I wouldn't say go as far as to say , um , you know , these populations who were harmed, but they certainly were not helped. Uh, and that has to do everything to do with , um , who has the privilege of being able to work at home and not go to work or, you know , uh , uh, participate in shelter in place. Uh, and for these communities that just did not show up that way , how much did multi-generational households play into that? That's, I'm sure that's a factor, right? So, you know , um, where infections take place, mostly it's been the home that's , that's what we learned in the pandemic. So a lot of the spread actually happened within households. And , uh , if you have a multi-generational household , um, you know, you're gonna , it's , especially where you have smaller houses, so there's more dense , uh, you know , um, family living , um, you can't really avoid each other. You can't really , uh, the idea of isolating quarantining within your house is really, if there's one bathroom and eight people, you know, that's just not a reality. And so there was a lot of transmission in households. So

Speaker 1:

Where are we now with vaccinations? I mean, as Matt pointed out, the mirror's touting that 70% number, you point out the fact that if you look into these kind of specific populations and communities , um, not so much, how then do we

Speaker 3:

Get those folks up to 70% or beyond? So our, our big concern, and I say our, I mean , uh , Frank Martinez and I who have been working on just COVID is that, you know, June 30th is the date when everything goes back to normal, right? And we're not anywhere near being done with communities of color being vaccinated. And my real concern is that , um, the attention will be lifted. The message will be sent that we're done with this, and any sort of momentum in terms of vaccinating communities will well it'll evaporate, or it will be very much harder to do as will the funding and other resources that are currently mobilized , uh, may, you know , become scarce. And so , um, you know, this is not a problem that's done, and we have a long ways to go. I mean, within king county, which is a well-resourced, you know , uh, county it's 50%, that means half of Latinos. And we haven't started with the younger, less than 12 year olds, which will happen in the fall, you know , um, or early next year, you know, we haven't even started with them and with a group that we're currently vaccinating 12 and older, we're only at about 50%. Um, that's still 50% of people that need to be reached. And so the hard work needs to be done. So

Speaker 1:

What do we know about central and Eastern Washington, where you have the agricultural community and the people that are working in the fields, it depend

Speaker 3:

On ? Absolutely. And that's some of those counties that have, I have not been able, we don't have access. I have don't have access to race, ethnicity, specific data by county, but we know that some of the counties that are have low vaccination rates are, you know, 60, 70% Latino, and they have low vaccination rates. They're not as big a part of the population because these are sparsely populated counties. So if you look at the average, that's going to be driven by Seattle king county, Pierce county, you know, Snohomish county. Um, but within those communities, the vaccination rates are low. And so you can presume that , uh, I think accurately that the vaccination rate among Latino communities in those counties is going to be also low what's

Speaker 2:

World going to look like because there's going to be the vaccinated and the unvaccinated, or as one doctor said, the vaccinated and the infected. What I've read lately is that the infection rates, the death rates of hospitalization rates are as high as they were in January in unvaccinated communities.

Speaker 3:

Yeah. There's some, there's some interesting dynamics, even though the absolute number of deaths has coming down, but within certain segments of the population, you still see fairly, fairly high infection rates. Um, and, you know, I guess the way to understand that is , um, younger people, older people have been, have been well vaccinated for the most part. I'm not so sure. I have not seen a breakdown of race, ethnicity by age , uh , to know for sure what's going on in Latino communities in terms of the elderly. Um, but nonetheless, the risk I think is going to change. So what are the risks to getting infected when you're younger? I think the long holler issue is still needs to be elucidated. So even though mortality rates are coming down, you know, getting infected has health impacts , um, and some of them may persist for months or longer. Um, and that's only now being understood so younger people, they're not going to show, they're not going to show up as a concerning statistic in terms of mortality or hospitalizations, but the longer term health effects, whether it's, you know , um , persistent effects with memory or , um, heart effects or lung effects are not yet , um, clearly elucidated. So my concern is, you know, there's going to be an invisible part to this that we're not going to see for a while . Um, and, you know, because, because people continue to get infected and are unvaccinated ,

Speaker 2:

Are we going to have a surge in those communities? I mean, cause there's VAT there states where, you know , they're just vaccine resistant because of the politics and whatever, but I mean, they're gonna, they're gonna keep being infecting each

Speaker 3:

Other . Yeah. And you know, so what's going on right now is, you know, we're having good. I mean, clearly the vaccines are having an impact in terms of infection rates, seasonality is having an impact. So we're in the lower season right now for COVID and all, you know, like influenza virus as well. And you know, so we're watching surge is happening in south America, the Southern continent where they're in the winter. Uh, and so we don't know what the fall is going to look like. And in communities where there's a lot of uninfected people still that are unvaccinated , you know, we can see a rise in the infection rates again. And we probably will. It's probably going to be smaller groups of people. It's probably going to be isolated in communities that are, have low rates of vaccination. Um , and of course there's the issue of the emergence of , uh, of variants that may be more infectious and more resistant. Um, so this is going to turn into, we need to get a booster out there following on the vaccines we've currently received. That's going to be the next, the next step. And so you feel that's inevitable. I, I don't know for sure, but it sure looks that way. I mean, I, I, it stands to reason, you know, that we're going to need to continue to adapt our vaccines to the emergence of variants. That that may be more problematic as you see

Speaker 1:

The things opening up right now, and people getting out and, you know, socializing again, getting in bigger groups and all of that. Uh , what is your reaction? Do you have this sense of, okay. Yeah, that's great. And I'm happy to see it, but like you're maybe holding on for dear life.

Speaker 3:

You know what I mean? I mean, you know, it's really hard to know. I mean, you know, I, I , if I feel safe, I'm vaccinated, right? Yeah . So I , I feel, I feel okay. I'm like, all right. Um, I, but I, but I worry that, you know, that we're going to see more people, like you said, perhaps more infection among, especially among those who are unvaccinated or, you know, going along for the ride thinking everything's okay. You know, we haven't reached a state of , uh, sort of, so there's a couple of factors that influence safety, right? One is whether the proportion of the population that's been vaccinated. So the more a community is vaccinated, the less circulating virus there is the less likely you are to get infected whether or not you're vaccinated. Right. You know, 50%. And we're , we're not just a homogeneous community, we're kind of little pockets. And so within those pockets where there's less vaccination, there's going to be a higher risk of more infections and, you know, deaths and morbidity associated with long-term effects of COVID. Do you fear that government government officials

Speaker 1:

Aren't concerned enough or taking seriously the need to address what's happening in communities of color, especially since the numbers ?

Speaker 3:

I, yeah, I , I do. Um, I think everybody's ready for the parade. Yeah. And , uh , you know, there's a lot to be happy about. They may be ready for the parade, but for us

Speaker 1:

And our communities, that means we're, we're

Speaker 3:

In the back, you know, we're w we may not even join yet. Yeah, that's right. And, and so I, that is, I , I worry about that. Definitely. I think, you know, we're not done with this and , uh, you know, on the one hand, it , you know, I understand the desire to get back to normal and celebrate. We have fantastic vaccines record. I mean, new science that has made it possible. Um, and we have vaccinated a lot of people in a short period of time, but for communities of color, there's still work to do, and we're not done with it. We shouldn't, I don't think we should be celebrating completely until we've really vaccinated everyone. Right. We need to get everyone vaccinated. All communities need to have , um, take advantage of the, of the benefits of these vaccines have that opportunity.

Speaker 2:

You know, a lot of people like to ask health officials and doctors, like how do you conduct yourself in your daily life now that your vaccine vaccinated? I mean, so what's your life like? I mean, do you go out to restaurants? Do you, what do you do?

Speaker 3:

And again, this is me. So I, you know, I , I don't want to say this is appropriate for everyone. Uh , I wouldn't want, you know, I don't want to , um , say that what I do is necessarily best for everyone. Here's what I do. Um, I wear a mask when I'm in spaces with other people in close spaces and buildings. If I go to a grocery store, I wear my mask. And part of that is just to , to promote a sense of safety for people who may not either a be vaccinated or even be vaccinated, but still be vulnerable, you know , because they may have immune deficiencies, they may have cancer. There may be things that prevent them from, you know , um, fully being advantaged by the vaccine. So I'm still doing that. Um, but I'm in my family , uh, we're all vaccinated and we don't wear masks. I have an 82 year old mother, you know, that I , we were, we were a part of her pod. Um, now she's vaccinated and she can see other people. And I feel comfortable with that who are not in our pod . Um, and we we've socialized with her without masks because we were sort of staying socially isolated. But , um, so that has opened up. Um, so I would say, you know, it's different. It feels better. I, I don't, I never really thought it was necessary to mask outside, but now I feel socially safe doing that. So people don't think it's weird, you know, like, can't really get this stuff if you're just walking around, unless you're very tightly packed, common sense, common sense, which we are in need of , uh, you know , as we talked earlier, you pointed

Speaker 1:

Out our disparities have been there. And you also said that you're, you're concerned that we're going to just lose

Speaker 3:

The focus about all of that. Yup . So the analogy in my mind is , um, you know , uh, there were, there has been in international work, this debate between , uh , what they call horizontal and vertical , um , interventions. So let's go eliminate polio. So you go in and you vaccinate everybody for polio, and you only focus on polio and you eliminate polio, but malnutrition is still there. So people are dying of other things now. So you took care of one narrow problem, but you didn't build capacity and you didn't address the other conditions that are affecting health, right? You took care of one very narrow thing. And I would say the same thing with COVID like right now, we're laser focused . And there's some sense to that urgency and need to do that. On the other hand, those conditions that create, you know, those health disparities are still there. And , um, and you know, I , I, it leaves a bad taste in communities if you're, if you're just there for one purpose, like if we show up and dump a bunch of resources, we're, it's about making ourselves safe, not about improving the health of communities. So to , we need to invest in those communities in a long, sustainable kind of way, that will lead to better health for all the different issues that are operating there, whether it's, you know, mental health issues or diabetes or hypertension , um, you know, all the killers yeah . Which exists in all communities and, and , and they disproportionately exist in communities of color. You think of

Speaker 2:

The underlying comorbidities weren't as pervasive that maybe COVID wouldn't have had such a large impact because it's sort of a pandemic on top of a pandemic. Yeah , absolutely.

Speaker 3:

Yeah. Fertile, fertile ground for bad, at badness to happen is, you know, having chronic conditions. So if you look at mortality rates, they're higher for communities of color , uh , in addition to infection rates. So the, so the mortality rate per a hundred thousand is higher. Um , and that's got to be due to pre-existing conditions. Okay, doc, I'm going to give you a soap box here.

Speaker 1:

And if you were speaking to the president and

Speaker 3:

Others that have an impact

Speaker 1:

On our lives at the top of the food chain, what would you tell them particularly when it comes to communities of color dealing with COVID. But also as we talked about these disparities,

Speaker 3:

I think, you know, our country needs deep reform. We need to really invest in, in our, in communities that are suffering from COVID and suffering from these health disparities. And I would, you know, and I'm here, I'm thinking about things, not just access to healthcare , but yes, every person should have, there should be universal access to healthcare. There should be no, I never understood why people ask for insurance cards for the vaccine. Like, why would you do that? Like, who cares? Like vaccinate people, right? Give them the healthcare they need. It should be universal education. We can't have two systems of, or more of a education. We need to give opportunities to young people. Communities of color are where the young people are coming from right now in our country. We need to educate them. And that will lead to good health. You know, the dirty word is redistributing income. In my mind, it's really about investing our communities, but we need to get rid of the wealth gaps that exist. We need to address that. And , uh , and reinvest in, in our communities, communities of color in particular, which are so disadvantaged right now, it is tough out there and people are just holding on and , uh , it shouldn't be that way in such a rich country.

Speaker 1:

Well, Dr. Leo Moralez thank you so much for your insights. Um, how about in about six months you come back and tell us where we're at. I would be happy to you tell us, you know, when when's a good time to reconnect, to revisit things. Cause we definitely want to keep an eye on this. Particularly since the work you're doing is focusing on those communities that , that really , uh, all too often getting Nord. And I can't do that anymore. If this is Matt off. So

Speaker 2:

This is me off. That's why this whole victory lap thing really just kind of irks me because we're not there. We're not there. We're not there. But I think that what you said, if they do that to make themselves feel good and feel safe. So that's where it needs to start. Thank you, Dr. Morales so much. Thank

Speaker 3:

You. Thank you both. And I really enjoyed speaking with you. Thanks for that . We want to hear from you. Reach

Speaker 2:

Out to us on Twitter at Enrique CRNA and at low find land for me, Matt Chan,

Speaker 4:

You can also email us@chinoechicanoatgmail.com and check out our Chino Chicano page on Facebook. Our theme music was composed and performed by Antonio Gomez. You can find the Gino each podcast on apple, Google, Spotify, Stitcher, and other favorite podcast platforms. Please take a listen, download, subscribe, and give us a review. If you'd like to watch our conversations, we're posting them to YouTube, go to search and type in Chino. Each Chicano. I met Chad, the Chino I'm Enrica Serta , the Chicano stay safe up there. Wear your mask and a crowd. Please get vaccinated. We'll talk more.