NASHVILLE, TN – Dr. David M. Carlisle remembers the outbreak of Severe Acute Respiratory Syndrome (SARS) in 2002. At the time, he was working for the California Department of Public Health.
“Those of us who are physicians or public health people were terrified because what we saw was a perfect storm situation,” Carlisle said. The worst type of pathogen any country could face would be an airborne respiratory one.
“Some pretty aggressive public health measures were taken in response to SARS. But SARS kind of went away,” he said.
It was never clear why it did. The SARS pandemic lasted about two years. It infected 8,110 people in 30 countries and 811 people died. There were only 27 cases in the U.S.
“We knew that we had dodged a bullet. SARS could reemerge and it did with the Mideast respiratory syndrome but it could be much much worse and that was the thing I was always worried about,” Carlisle said.
He was looking at news reports early one morning in late December 2019. He spotted an item about an unknown pneumonia surfacing in Wuhan, China, a city as large as Los Angeles.
“I really remember feeling ‘oh, no, here we go again’. I hope this is not going to be it. COVID-19 certainly is it, “ Carlisle said.
Nobody died from SARS in the U.S. between 2002-2004. This time there are about 30 million cases and nearly half a million people have died. COVID-19 is SARS on steroids.
“And what is concerning to me is that we weren’t prepared for COVID-19 in my estimation. When I left the State of California we had field hospitals standing by, we had ventilators stockpiled, we had facemasks. We were prepared for a SARS or some other type of bioterror event. I don’t know what happened to that material quite frankly or when it disappeared,” Carlisle said.
He left his state job ten years ago. Sometime between 2011 and 2020 in California, just like the Strategic National Stockpile and its 12 secret locations around the country, critical supplies of vaccines, antibiotics, chemical antidotes, and critical medical supplies, like ventilators, went past their sell-by dates and were either discarded or stolen. They were not replenished.
Some states maintain their own stockpiles of emergency medical supplies. Tennessee does not, according to the Tennessee Department of Health website.
Carlisle said vaccine rollout in California, like in other states, is increasing in a linear fashion. But it should be exponential. He said that’s a failure of public health policy.
Carlisle said Dodger Stadium and other mass vaccination sites in Los Angeles closed last Friday because they ran out of vaccine doses. These centers were vaccinating 5-12 thousand people a day. “Having to close your major population centers administering the vaccination doses, this is a disaster for Los Angeles. But it really reflects the failure of the federal government to deliver vaccines to where they are needed the most,” Carlisle said.
Another problem Carlisle noted was where a pharmacy chain(unnamed) opened five vaccine distribution sites in the L.A. area. Four were in smaller and less diverse cities like Newport Beach. Only one was in Los Angeles proper.
“Why are pharmacies in these far flung parts of L.A. where the population is not generally persons of color receiving vaccination distribution when there is only one location in Los Angeles? This is kind of the opposite of what we should be seeing, “ Carlisle said.
“What we have right now is the inequitable distribution of the vaccine,” said Dr. Daniel Turner-Lloveras. He is a founding member of Latino Coalition Against COVID-19. Turner–Lloveras said many doctors predicted the higher infection rates and the higher rates at which Latinos and Blacks were being hospitalized from COVID-19 and also dying. “Those numbers eventually became true,” he said.
And now, only 20 states are sharing data regarding the racial background of vaccine recipients. Turner-Lloveras said that if you can’t quantify the disparity, it’s difficult to craft an appropriate solution. He said the first step in fixing the problem is to have all states report the racial data on their vaccine recipients.
In those states that report race data the percentage of Black people who received the COVID vaccine is half or less than the proportion of Black COVID infections. The disparity is greatest in Delaware: Blacks have gotten only 6% of the vaccines but got 24% of the infections. In Louisiana, Blacks got 13% of the vaccines and 34% of the infections, Blacks in Mississippi got 17% of the vaccines and 38% of the state’s infections. As of February 1, 2021, Blacks in Tennessee got 15% of COVID infections, 18% of deaths, only 7% of vaccines, according to the Tennessee Department of Health.
“These are disproportionate numbers and these are the cases pretty much in every state that is reporting the numbers,” Turner-Lloveras said. See (COVID stats)
“No one can guarantee that another wave is not coming and as we saw in the prior three waves, it was Black and Latinos who were dying,” he said. Minorities should be at the table in discussions about opening up the economy because they are front line workers.
“We need to be aware of the fact that it is the minority populations who are working in these jobs and we have to be aware that these are the ones who are at the highest risk,” he said.
Turner-Lloveras said the country will have to confront vaccine hesitancy once there is more vaccine available. We’ll know it when people don’t show up to get their shot. The Kaiser Foundation has looked at the reasons people are hesitant to get vaccinated. Many are afraid of possible side effects. Others distrust the pharmaceutical companies and others distrust the government.
Turner-Lloveras said that the solution is having virtual town halls in every neighborhood with open nonjudgmental conversations where people can ask questions about their worries. “And these need to provide information in a way that is culturally sensitive in their native language. If we are able to do that, which is a gigantic digital patient engagement project––if we are able to do this well––then we’re going to be able to get herd immunity, which I think is the ultimate question that everybody is asking themselves: ‘When is life going to get back to normal?’ And this is the problem that needs to be solved for that to happen.”
This story was brought to you by the Blue Cross Foundation of California and Ethnic Media Services.