Black and Indigenous Oregonians have been infected, hospitalized and killed by COVID-19 at rates about two-to-three times higher than white Oregonians. Hispanic/Latino Oregonians are twice as likely to contract COVID-19 compared to non-Hispanic Oregonians.
Advocates say disparities caused by a culturally incompetent early response to COVID-19 were compounded by disproportionate exposure in the workplace, rates of underlying health conditions and other systemic inequities.
Disparities peaked in Spring 2020 and have trended down since. Advocates attributed the improvement to community-based organizations’ work, partnerships and targeted funding from public health agencies.
In addition to the funding and partnerships, the Oregon Health Authority recently announced plans to distribute 6 million at-home tests to at-risk groups.
Racial disparities
Since the start of the pandemic, COVID-19 infection rates among Black, Indigenous and other people of color are twice as high as white Oregonians. The grave finding is reflected in outcomes with the same populations. Black, Indigenous and other Oregonians of color face a COVID-19 hospitalization and death rate two-to-three times greater than white Oregonians, cumulative age-adjusted data from Oregon Health Authority shows.
Disparities were at their worst Spring 2020 when age-adjusted rates of infection, hospitalization and death were around three-to-five times higher for Black, Indigenous and Hispanic/Latino Oregonians than for whites, according to an OHA quarterly report from October 2021.
Between Spring 2020 and September 2021, rates trended downward, though significant racial disparities persist, the report showed.
Rates for Pacific Islanders were consistently higher than all other groups. The rate of cases among Pacific Islanders was nearly 20 times higher than for whites, the rate of hospitalization nearly 10 times higher and the rate of death nearly 8 times higher during Spring 2020. The Pacific Islander population in Oregon is undercounted which inflates the rates, the Portland Mercury reported last September.
Between 75% and 80% of white and Asian Oregonians completed their vaccination series as of Jan. 18. Black Oregonians (68%), Indigenous Oregonians (60%) and Hispanic/Latino Oregonians (58%) are all substantially below that mark.
These disparities grow for vaccine booster shots. Between 40% and 45% of white and Asian Oregonians received a booster as of Jan. 18, in sharp contrast to Black Oregonians (27%), Indigenous Oregonians (26%) and Hispanic/Latino Oregonians (20%).
While these trends paint a stark picture, within groups there is significant variance. Though Asian people at large have fared better than all other racial and ethnic groups in their higher rates of vaccination and lower rates of infection, hospitalization and death, there have been disparities between nationalities.
Per capita, Vietnamese Oregonians were 6.13 times more likely to be infected with COVID-19 than Chinese Oregonians according to 2018 Oregon population data and the OHA COVID-19 Race, Ethnicity, Language and Disability report released last February.
While the same trends in racial disparities exist on a national level, Oregon’s racial disparities are larger almost across the board, CDC data reveals. Though CDC data also shows vaccination rates for all racial and ethnic groups are significantly higher in Oregon than nationally.
Immediate causes
Advocates with non-governmental organizations in communities impacted by disparities describe a mixture of immediate and long-term problems combining to create and sustain the disparities.
To Sharon Gary-Smith, President of the Portland branch of the NAACP, early state and local public health responses to the pandemic were a guarantee of disparities.
Gary-Smith said the initial response was built for a white default, and then when health officials noticed the racial disparities, they scrambled to address them.
“They realize, ‘Oh, we need to retrofit this and then we need to hire some people of color to get out there amongst the people who’ve been ignored or silenced or invisibilized,”’ Gary-Smith said. “And we expect something dramatic to change our stats?”
Lorena Mosqueda, interim director of Latino Network’s Health And Wellness Department, described a similar pattern with the vaccine rollout.
“If you remember when you were first eligible to sign up for vaccines, the OHA website was all in English,” Mosqueda said. “It took about four months for Spanish (to be added) as an option.”
In picking a system of vaccine distribution based on age, the rollout also failed to take into account already present racial disparities in considering who got the vaccine first, said Mosqueda, adding that because the white population of Oregon is older than Latino and other non-white populations, it meant people of color got the vaccine last.
STREET ROOTS NEWS: Why are COVID tests and vaccines still so hard to find?
Once Latinx people were eligible, Mosqueda said barriers like language, limited access to health care services, being uninsured, lack of transportation, lack of sick leave and difficulty finding childcare all further hampered efforts.
In April 2021, Latino Network criticized the state’s vaccination efforts. The criticism spurred initial progress in the form of weekly meetings with the state and a promise from Gov. Brown to get 80% of Latino Oregonians fully vaccinated. The efforts stalled, according to Mosqueda.
“We were having these meetings weekly, they moved to bi-weekly, as of lately, they stopped, which is where my frustration is,” Mosqueda said.
The impacts of those barriers were compounded by the fact people of color were disproportionately on the frontlines of the pandemic, facing increased exposure through high-exposure jobs.
“Latinos are oftentimes in the essential worker field of roles, so they weren’t able to take time off,” Mosqueda said. “And if they did take time off, they would lose their job or be at risk of losing their jobs.”
Once exposed to the virus, Mosqueda said her community faced serious issues accessing testing, and that has worsened with Omicron. In February 2021, the Oregon Health Authority’s COVID-19 Race, Ethnicity, Language and Disability Report came to this conclusion, noting Latino people may have “insufficient access to testing and this warrants further investigation.”
Alyshia Alohalani Macaysa-Feracota, Executive Director of the Oregon Pacific Islander Coalition, echoed this.
“Economic hardship (drives) our people into working in conditions that may expose them to COVID-19,” Macaysa-Feracota said.
Pacific Islanders — people from more than 30 nations throughout Oceania and their descendants — face unique challenges and disparities.
“Pacific Islander communities have been rendered invisible by government systems, and the use of aggregate categories like ‘Asian Pacific Islander,’” she said. “So many data collection and data reporting methods render us invisible or obscure our challenges and strengths as a community.”
Long-term causes
At a broader level, government efforts faced an uphill battle as the institutions of public health are forced to work against its own history of mistreating people of color.
Asked about challenges in responding to the pandemic, Gary-Smith pointed to “the history and even current history of exclusion, unwarranted and dangerous non-consensual testing and experimentation that is done on Indigenous people, and certainly documented on African-Americans.”
Echoed by both Mosqueda and Macaysa-Feracota, Gary-Smith said these problems impact current trust in public health. This history also makes COVID-19 misinformation particularly potent because it builds off real history, said Mosqueda.
“There’s still a lack of trust in these providers,” Gary-Smith said.
The history of public health doesn’t only show up in the collective memories of impacted communities, said Liana Haywood, Communications Manager for OHSU’s Moore Institute for Nutrition and Wellness.
That history of medical neglect for Black, Indigenous and Hispanic/Latino Oregonians presents itself in the form of underlying conditions which they have at higher rates than white Oregonians, explained Haywood.
In July 2020, the Moore Institute published an article titled “Racism and COVID-19.”
“We felt that there was some pretty clear understanding about why these health disparities had existed for decades that people hadn’t really been talking about,” Haywood said. “The very underlying conditions — like diabetes, obesity, hypertension — that put you at greater risk of getting COVID or having severe complications from COVID, were the same underlying conditions that these communities were experiencing at greater rates and had been for the past couple of decades.”
To Haywood, the causes of these underlying conditions are some of the same ones advocates pointed to: poverty, racism, housing instability, barriers to health care and other systemic inequities.
“Those coupled together greatly increase your chronic disease risk,” Haywood said.
The Moore Institute is not alone in these conclusions. In March 2021, the CDC updated its webpage on COVID-19 and underlying conditions to note “long-standing systemic health and social inequities have put people from many racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19.”
“COVID-19 (made visible) what many of our leaders already knew: post-colonial racism, inequitable access to the social determinants of health, and the rampant prevalence of chronic illness have left (Pacific Islander) communities vulnerable in the pandemic and that there was no government infrastructure to adequately support our community once the virus really hit,” said Macaysa-Feracota.
The consequence of racial disparities is COVID-19 functioning more like a direct attack upon communities of color than a virus.
“(We) lost a chief’s wife and she was a beautiful person. She was the first one and it hit home,” said Louie Pitt Jr., the director of governmental affairs for The Confederated Tribes of Warm Springs.
Speaking on the impacts of the pandemic on the Warm Springs Reservation, Pitt put it bluntly.
“Never been in war but it sure feels like it,” Pitt said. “It ruthlessly takes people.”
Why racial disparities have declined
While disparities remain, they have decreased since the beginning of the pandemic and advocates point to community-based organizations’ work, partnerships and targeted funding from local and state health agencies and other factors as the causes.
For Mosqueda, increased funding and a growing platform enabled the Latino Network to better address their community’s needs.
“We continue to provide services and them funding us has been a way of working together,” Mosqueda said. “We are now invited to spaces where we can speak on behalf of our community in state-level meetings.”
The funding allows the group to provide rent assistance, groceries, household essentials and other things allowing families to isolate when sick and to deal with the economic hardships COVID-19 often brings.
Gary-Smith similarly said while there are significant racial disparities and the state’s response has been systematically flawed, there are plenty of hopeful signs too.
Citing Governor Brown’s Racial Justice Council and Portland’s efforts to increase diverse participation in the Portland City Charter Review Commission in particular, she points to the growing realization in state leadership that impacted communities must have a seat at the table for these problems to stop repeating themselves.
Street Roots reached out to the Oregon Health Authority, asking for an interview or a statement on what has caused disparities, what they have done to address them and what future efforts Oregonians can expect, multiple times through emails and a phone call between early Tuesday Jan. 18 and close of business Jan. 20. The agency provided no comment.
When asked if it is their “responsibility to meet surges in demand for testing and vaccines,” a Public Information Officer for the agency said, “OHA’s mandate is to reduce health disparities by targeting populations for testing who do not have access through traditional channels,” Street Roots reported earlier this month.
The agency recently purchased 6 million at-home tests with the goal to distribute the tests to at-risk groups and communities. The Oregon Health Authority also provided funding and worked with a number of community-based organizations around the state to put on testing and vaccination clinics.
Looking forward
All parties agree the task ahead is daunting.
“Now we’re at a place where many of our organizations are rapidly scaling up and receiving funding to support the important work that they do,” said Macaysa-Feracota. “But, building relationships between community leaders and the government, and creating the infrastructure of non-profit organizations that did not exist a mere six months ago in the middle of a crisis is not an easy task.”
The solution goes beyond immediate actions to Macaysa-Feracota.
“We don’t just want partners and funders who will throw money at years of institutional neglect, we want community investments and partnerships with people who are committed to navigating this pandemic with us,” she said.
Mosqueda also called for more permanent measures.
“So when another crisis comes — which we are in public health crisis all the time — we are able to address it in a culturally responsive way,” Mosqueda said.
To Gary-Smith, what will make or break this effort is if agencies continue to listen to those impacted — and then move past talk to action.
“I think until these health systems, and these government programs and community programs include those most impacted — not at the ends of the development of a program, but like white influencers who get … to sit in those places of decision making — then we’re going to continue with the best of intentions (and) have the same outcomes,” Gary-Smith said.
But, noting her more than five decades in leadership roles in health care and racial equity organizing, she said change is possible.
“I’m hopeful,” Gary-Smith said. “People say ‘how in the world can I keep going?’ Because I’ve seen evidence that change can come, I’ve been a participant in making change.”