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Opinion: In one year of the pandemic, here's what I've learned as a health care provider in San Diego
San Diego Union-Tribune - 3/19/2021
Ramers, M.D., is a specialist in infectious diseases and the chief of population health at Family Health Centers of San Diego. He lives in Burlingame.
This week marks one year since public health officials confirmed the first deaths of COVID-19 in San Diego County. As I reflect on this exhausting and highly unusual year, a few themes emerge over the din of arguments, controversies and anxieties.
We are in this together.
More than simply a rallying cry to motivate altruistic behavior or a call to action for collective sacrifice, these words have proven accurate repeatedly. Whether it be the air we breathe, the indoor spaces we inhabit or our collective status in the color-coded reopening system, our interests are inevitably intertwined. As such, the sacrifice of foregoing social activities, postponing travel, staying home when sick and wearing masks even when inconvenient has yielded immense societal benefit in the form of decreasing case counts and relatively contained outbreaks.
While the county has among the highest COVID-19 vaccination rates in California, our Mexican neighbors have watched their response stumble, logging the third highest COVID-19 death tally of any country in the world. As we contemplate increased transborder mobility, it will be critical to consider strategies that address our unique binational community. The U.S. has already bought or contracted to buy enough doses of the coronavirus vaccine to protect 750 million people, more than three times the number of American adults. It would be mutually beneficial to share this bounty with our neighbors. It is impossible to separate our fates as none of us are safe until all are safe.
Trust the science, not the scientist.
Many confuse science with a scientist's opinion, but in actuality, science is a process — endlessly critical of itself, iterative, demanding empirical evidence to support claims. The science behind wearing masks to decrease airborne transmission of SARS-CoV-2 took time to mature, but now there is no doubt that close indoor contact without masks is a risky activity for viral transmission. Likewise, treatments did not come as quickly as we would have liked, but there are now several highly effective drugs targeted to different stages and aspects of the disease. If diagnosed and treated early, death from COVID-19 could be a rare event — even in high-risk individuals — if all had access to these treatments. And ultimately, it was the extraordinary scientific process that supported the rapid development and massive safety and efficacy testing and rollout of vaccines, which now lead us out of this pandemic.
Look through a lens of equity.
Infectious disease epidemiology often serves as a mirror, reflecting the realities of our societal failings. Through it we see the neglect experienced by the most vulnerable in our society, and we witness the horrendous physical and emotional harm to its victims. The SARS-CoV-2 virus has shown us in vivid and gruesome detail how our society works. By lingering in our most public spaces, thriving in crowded apartments and selecting victims by occupation, it has divided the haves and the have nots. Those in lower castes with little power to telecommute — who happen to be largely Brown and Black people — must continue to pick, process and serve food, pick up trash and clean toilets, deliver our Amazon packages and mind the cash registers, and, in so doing, risk their lives in service of those with wealth and power who can afford to stay home.
To me, as a frontline provider in a community clinic, the most striking and traumatic aspect of the pandemic has been the relentless, pervasive and disproportionate impact of COVID-19 cases, hospitalizations and deaths on communities of color, and in particular on Latinx families in the South Bay. The immense and overwhelming power of structural inequities has prevailed despite efforts forming equity task forces, carefully locating vaccination sites in the hardest-hit communities, demanding transparency in vaccine statistics, and making painstaking efforts to reserve spots for those from the most affected ZIP codes. With only 20.5 percent and 2.7 percent of San Diego's 1.2 million vaccines going into arms of Latinx and Black San Diegans respectively — two of the most impacted populations — there is so much more work to be done.
Hope is on the horizon.
The horrors of the pandemic cannot be unseen, and we will not be the same San Diego as we lick our wounds, bury our dead and move to close this painful chapter in our history. But thanks to the ingenious vaccines starting to shield our communities, there is a brighter future ahead. I am hopeful that these painful disparities will inspire our leaders to lay the groundwork for a more equitable path ahead. One in which we are all informed, protected and lifted up by one another. Wherein we can soon gather again in public spaces, embrace and imbibe in solidarity, reflecting on the good within us that has carried us through.
This story originally appeared in San Diego Union-Tribune.
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