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Part One: ECM interviews Dr. Suzanne Affalo, Medical Director, Alliance Health Clinic and retired Kaiser Permanente physician 

By Angela de Joseph

Photo courtesy of Dr. Suzanne Affalo

July 3, 2020 (San Diego) There is a saying, “When America catches a cold, Black America gets pneumonia.” In the case of COVID-19, this old adage is true. The national coronavirus mortality rate for African Americans is about 2.3 times as high as the rate for Whites and Asians, about twice as high as the Latino and Pacific Islander rate, and 1.5 times as high as the Indigenous rate. But, not in San Diego. 

In April of this year, when the mortality rate for the pandemic in the United States began to skyrocket, cities such as Chicago reported a disproportionate number of African Americans were dying. An alarming 72% of the city's residents who died from COVID-19 were Black. And according to the public health commissioner, 52% of those that tested positive were Black.

After weeks of delay and a public outcry by civil rights activists, San Diego finally released its first breakdown of COVID-19 mortality rates by race/ethnicity on April 8th. San Diego County Public Health Officer Dr. Wilma Wooten spoke at a press conference and released the demographics for the mortality rates and positive cases by racial background. The shock was not how high but how low the number of reported cases (79) and percentage of deaths in the Black population from the coronavirus in San Diego was, an unbelievable 0.0%

Questions were raised by local civil rights leader Reverend Shane Harris, Black medical professionals; Dr. Rodney G. Hood, CEO and Managing Partner at Careview Medical Group, Inc., and Dr. Suzanne Afflalo, retired 23-year family physician at Kaiser Permanente, and medical director for the Alliance Health Clinic in San Diego. Was that number accurate? Were African Americans being tested or turned away? Did racism play a part in the location of the testing sites?

Dr. Afflalo and Dr. Hood spearheaded the formation of the COVID-19 Equity Task force along with city and County public health representatives, Dr. Robert Gillespie, Regina Evans, Minister Waliullah Muhammad, and Reese Jarrett, to determine the most effective strategy for getting members of marginalized communities tested. I was able to attend a Zoom meeting hosted by the Indivisible group Change Begins With ME, where Dr. Afflalo and Dr. Hood gave a presentation on, “Disparities in Health Care in San Diego.” This week I was able to sit down with Dr. Afflalo for an enlightening conversation on the progression, impact, and increased threat of the coronavirus. She shared the current statistics and resources now available in the Black community. 

Q & A with Dr. Suzanne Afflalo

Q When did you first become aware of the seriousness of the coronavirus?

A. In early February, I noticed that the coronavirus was spreading in countries like China, Japan, South Korea, and Italy and was concerned about how those countries were being affected.

Q. Did you think the United States was at risk?

 Yes.  When the state of Washington reported the first cases of COVID-19, my antenna was up. My pastor called me in early March and asked me, “Do you think we should have church services this Sunday?”  I said, “No, I don't think so,” and he started doing online services about a week or so before the stay at home order went into effect in California.

Q. Why do you think the numbers of coronavirus cases are so much lower in San Diego than cities such as New York?

A. I believe the virus spread like a wildfire in New York because everybody uses public transportation (subways) and live in close quarters like high-rise buildings and projects, where thousands of people live on top of each other. There is no way to stay six feet away from anyone in those situations. San Diego is more spread out and we don’t have [many] large 20-story high-rise buildings and projects. 

Q. Wasn’t there a delay in testing for COVID-19 during February and March in San Diego?

A. Yes, I believe there was a shortage of testing across the nation, not just in San Diego.  There was a shortage of test kits, swabs, reagents, companies to process the tests and actual testing sites for people to go to. Initially, because of the shortage of test kits, every state was only testing people who were symptomatic.  Many people were turned away from clinics and hospitals if their symptoms were mild.

Q. When the first San Diego County Health and Human Services report breaking down the cases by race was released, African Americans had a zero-mortality rate from COVID-19. Was that realistic?

A. I don't necessarily believe that data because African Americans in San Diego have similar behaviors, medical conditions, health care concerns and other health disparities as African Americans across the nation. We had zero deaths for several weeks, then there were four deaths for a few weeks. The mortality count jumped up to nine and today we have 11 African American deaths listed as attributed to the coronavirus in San Diego. We don’t know how many Black people were extremely sick, didn’t get tested and died at home. That is why Dr. Hood and I began pushing to get testing in our community.

Q. How did the County respond to your requests for testing?

A. Initially, Dr. Hood requested coronavirus test kits and only received 10 tests for Careview Medical Center and the Alliance Health Clinic requested tests and was promised 10 test kits also, but never received them. That was just inadequate for the populations those clinics served.

Q. How were you able to get the state to open testing sites in the Black community?

A.  Dr. Hood and I started by talking with Dr. Araneta at UCSD School of Medicine about asking UCSD to set up a testing site in Southeast San Diego. It was ridiculous we didn’t have a testing site near the Black and Brown community, who are the highest risk population, but there were testing sites in the affluent communities of La Jolla, Encinitas, Eastlake, etc. We had several virtual meetings and correspondence with community leaders and public officials. We reached out to Dr. Wilma Wooten- Public Health Office, HHSA Director-Nick Macchione and County Supervisor Nathan Fletcher. They were all very supportive and agreeable to establish testing sites in the Southeastern San Diego area.

Q. When did the first testing site open?

A. We got our first County run drive-up testing site in Southeast San Diego on Saturday, May 2nd and it was a pilot project. There were 24 available appointments between 10:00 am and 2:00 pm and all were booked, but only 17 people showed up. We pushed the envelope and kept saying it's not enough to have testing only one day a week. We also need a walk-up site because so many of our community members don’t have their own transportation.  A drive-up only site would be a barrier for so many people. We requested a walk-up testing site near the trolley and bus station, and one was established at the Tubman Chavez Center on Tuesday, May 19, 2020.

Q. Were you building support for expanding the testing site and hours?

A. We formed a COVID-19 Equity Task Force and we were successful in getting two locations--one in the Euclid Health Center parking lot at 292 Euclid Avenue, 92114, behind the Food for Less and the other at the Tubman Chavez Center, 415 Euclid Ave, 92114 on the corner of Euclid and Market Street across from the Malcolm X Library.

Q. How many people have been tested since opening the two sites in Southeast San Diego?  I saw there was a line around the block last week.

A. As of Thursday July 2, 2020, 4900 people have been tested at the two sites since the May 2nd opening. The no-show rate was high at the Tubman Chavez Center, so the County of San Diego converted that State-run site to a County-run site and removed a few barriers. That site is now open seven days a week and no appointments required. Since then, the amount of testing done has doubled.

Q. What are the days and hours?

A. Tubman Chavez Center is now open seven days a week, 8:30 am to 5:00 pm. If someone works during the week they can still get tested on the weekend.

Q. Since you began testing in Southeast San Diego, has the number of African Americans testing positive increased?

A. The number identifying as African American is still low compared to larger cities like Los Angeles and San Francisco. In San Diego County, 13,000 people have tested positive; 7,000 of those are Hispanic/Latinx and only 457 are African Americans. There are 2,500 positive tests that are listed as “race/ ethnicity unknown.” We don’t know how many of the unknown are African Americans.

Q. How long does it take to get tested for the coronavirus?

A. The test itself only takes about three to five minutes. It takes about 15 minutes to gather some necessary data such as your name, date of birth, email address and phone number.

Q. Does the test hurt?

A. No. They pass a swab in one nostril then in the other nostril, then you are on your way. At the drive-up sites, they have people doing the test themselves. If you feel squeamish about swabbing your own nostril, the nurse will do it for you. That is the difference between the drive-up sites and the walk-up sites where the nurse performs all the test.

Q. Which areas of San Diego have the highest rates of infection?

A. Chula Vista and San Ysidro have a high number of positive rates. They are probably the most impacted because the Black and Brown people who live in those communities are the ones who are the frontline workers, the essential workers. They can't afford to stay home or don’t the luxury of working from home. Many of them work minimum wage jobs, have no sick leave and no medical insurance. Some may even go to work feeling mildly symptomatic and reluctant to get tested.  Some may be afraid to say anything because they can’t afford to stay home 14 days and be quarantined.  They simply can’t afford to stay home.  They need money to provide food and housing for their families.

Q. What is causing the sudden uptick in cases?  

A. We're starting to see a significant increase of positive cases in the 20 to 35-year-olds since Memorial Day weekend. Once the city started re-opening, young people started gathering at bars, restaurants, beaches, etc. They were not wearing masks or social distancing. With the recent significant increase in cases, the city was forced to reclose bars and certain other businesses.  These young adults don’t realize that they can be an asymptomatic or pre-symptomatic carrier of the virus and spread it to their family and friends.  If they live in a multigenerational household or compacted household, everyone in that home is susceptible. If they live with a grandparent, or someone with pre-existing medical conditions, including asthma, those family members are at high risk of illness and death. 

Q. What can we do to protect ourselves and our families?

A. We're telling everybody to wear a mask or facial covering whenever they leave their home to block any particles from traveling from your mouth and nose when you cough, sneeze, speak, sing, or yell. Wash your hands often and practice social distancing of six feet from others. Stay home if you can and avoid any gatherings of more than 10 people.  People that work outside their home, especially with the public, are at risk for contracting the virus and bringing it home. They should be especially diligent about washing their hands before they get home, getting out of their clothes before coming in contact with their family (maybe change in the garage) and take a shower as soon as they get inside the home. 

Q. Any last recommendations for the Black community?

A. Get tested. We fought hard to get the two testing sites in Southeast San Diego. Now that we have the resources, utilize them. The test is free, quick, and will give you and your family peace of mind.

Angela de Joseph is the founder of Women of Color Roar Media and produces the annual Women of Color Roar Breakfast with a mission to support, nurture, and encourage Black women to run for political office and seek careers in public service. 

A life-long journalist, Angela is an Emmy-nominated filmmaker who began her career as an editor at Essence Magazine in New York. She hosts a weekly political talk radio show on KNSJ FM in San Diego. She is the chair of Indivisible Watu, a grass-roots community activist organization dedicated to voter education and engagement. Angela is also a Program Manager for GRID Alternatives the nation's largest nonprofit solar installer and training program that places low-income community members in clean energy jobs.

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