This reporting is a collaboration between El Tímpano and The Oaklandside. Originally published in The Oaklandside on January 11, 2021.
It was the Monday after Christmas that Maria González first felt sick. “At noon, my bones began to hurt,” she recalled in Spanish. She went to the market near her home in East Oakland to pick up a few vegetables, then made dinner for her husband, her two kids, and herself.
“After we ate, I sat down in the chair and I didn’t know what to do. I trembled, I ached, I had a headache. I was cold, really cold.” She went to lay down, and when she got up a few hours later to take a painkiller she found herself “soaking in sweat, as if I had just come out of the bath. Just completely soaked, and with a pain inside that wouldn’t go away.”
González, 47, recounted those early symptoms a week later. By then, the fever had subsided, but the body aches remained, and she had lost her appetite and her senses of taste and smell. A test result on New Year’s Eve had confirmed that she’d contracted COVID-19, becoming one of more than 23,000 confirmed cases in Alameda County in December. It’s a surge that has overwhelmed county staffers tasked with case investigation and contract tracing, leaving many sick residents like González almost entirely on their own to figure out what to do to keep themselves and their communities safe after getting a positive diagnosis.
Alameda County public health officials have worked with community-based service providers and health clinics like Lifelong Medical Care, Clínica de la Raza, Roots Community Health Center, and others in Oakland to establish a coordinated system of care to ensure that residents have a way to get tested and receive information and resources to help slow the spread if they test positive. This is particularly important for low-income and immigrant residents who may not have health insurance or a primary care doctor to seek medical help if they think they have COVID.
But González was not contacted directly after testing positive, and county health officials acknowledge that the protocols haven’t been followed for everyone due to the wave of cases that have flooded Alameda County since November.
“When case rates are as high as they have been over the last four to six weeks, the sheer number of cases reported every day makes it very difficult for us to reach every single person,” said Dr. Nicholas Moss, the top health officer for Alameda County, in an interview with The Oaklandside.
Jamie Harris, who helps coordinate case investigations and contact tracing for the county in partnership with community organizations, said anytime someone tests positive for COVID-19 anywhere in the county, the result is supposed to trigger a multi-step process. First, the clinic that administered the test will notify the patient of the result. Then the clinic notifies the county health department, which in turn sends the information to CalREDIE, the statewide infectious disease database. The data is then entered into the state’s COVID-tracking system, CalCONNECT.
From there, case investigators working for the county and its consortium of community partners are supposed to reach out directly to sick residents to start the contact tracing process and coordinate services for those who need help with things like food, housing, legal aid, and direct financial assistance.
The problem, said Harris, is that despite this plan and the county ramping up staffing levels to support it—there are currently well over 200 county and community staffers following up directly with people who test positive, she said—the immensity of the current surge that began in November has made the task of making human contact with everyone who tests positive essentially impossible.
“It’s just a matter of sheer numbers,” said Harris. “We are all suffering a lot in not being able to fully implement the system that we’ve spent the last nine months building.”
The number of new COVID cases in Alameda County rose sharply in December. Of the roughly 59,000 total cases that have been recorded in the county since the start of the pandemic, over 47% occurred after December 1. To put that in perspective, 1.7 percent of all county residents—more than 28,000 people—tested positive for COVID-19 since December.
Katie Cobian, the contact tracing supervisor at La Clínica de La Raza in Fruitvale, one of the community clinics coordinating with the county, said her team of resource navigators makes phone calls all day, but it simply isn’t enough. “It just really isn’t possible to get to everyone the way we’d like to. It’s just the numbers, the surge.”
Slipping through the cracks
González, the East Oakland resident who got sick after Christmas, falls into several of the high-risk categories that the county’s free testing sites and follow-up protocols were designed to target. She lives in East Oakland, which has the highest infection rates in the county. She lacks a primary care doctor and is struggling to pay the bills after losing her job at a restaurant last year, and is facing a rent increase from her new landlord. Like approximately half of those who’ve contracted the virus in Alameda County, she is also a member of a Latino community—a Mexican immigrant who has called Oakland home for the past 20 years.
Prior to getting sick with COVID-19, González followed public health guidelines, remaining inside with her kids, ages 9 and 11, nearly all year to avoid exposure to the virus. Still, it was impossible for the family to completely avoid crowds. Her husband works in construction and goes out several days a week to job sites. Without a washing machine at home, González relies on the neighborhood laundromat. She also left home to buy groceries every week or two, and occasionally visited a food bank.
Two days after the onset of symptoms, González went to the West Oakland Health Center, one of the clinics that coordinate with the county to provide free COVID-19 testing. It’s not the closest to her home, but González had heard she could get her test results back quicker there. Twenty-four hours later, a text message arrived with the result: positive.
“It didn’t say anything more, just that someone from the county would call me,” said González. But no one called that day, or the next. For a full week after becoming sick, El Tímpano, a Spanish-language news service that she’d contacted to learn about where to get tested, was the only source that provided her with guidance from the health department. (El Tímpano, which is led by one of the authors of this report, receives funding from the Alameda County Health Services Agency to provide public health information to its audience.) Only after El Tímpano contacted county health officials about her case did she receive a call.
County officials who spoke with The Oaklandside on Friday were unable to put a number on how many people have, like González, tested positive with no subsequent direct follow-up from county or community health workers. What is clear, however, is that additional capacity for case investigations and tracing is not expected to happen soon, if at all.
That’s largely due to budgets, the time it takes to train and onboard new community outreach staff, and a growing sense that existing county resources and personnel will be better deployed at hospitals and supporting vaccination efforts, said Moss. “We need to move away from setting the expectation that every single person who tests positive is going to get a call from the health department,” he added.
What this surge has shown, Moss explained, is that “we need to have other strategies beyond just case investigation and contact tracing to try to prevent disease transmission,” such as encouraging people to continue quarantining, washing hands, and wearing masks.
In the meantime, for those who test positive, the county has had to rely on stop-gap measures and focus its case investigations on high-priority populations. A tiered system was developed, said Harris, which prioritizes people living in zip codes with the highest case rates—including East Oakland and pockets of Hayward—and people living in congregate residential settings such as nursing homes, homeless shelters, and health care facilities where infection is more widespread and the number of COVID-related deaths has been higher.
For everyone else, said Harris, the county has devised other ways to relay important information. Everyone who tests positive should at the very least receive a text message, she said, followed by a physical packet mailed to their home containing guidance about how to quarantine and keep loved ones safe, a list of community resources, and numbers to call. If residents list a language other than English or Spanish (those languages are mailed out as a matter of routine, said Harris) during their test intake, they should receive the packet materials in their preferred language. “Theoretically, everyone should get contacted or reached,” said Harris. “Just not with a phone call.”
Still, she said, communicating via text message and paper packets, which can take days to arrive by mail, isn’t ideal. Phone numbers and mailing addresses collected at testing sites are sometimes missing or incorrect, and the overwhelming number of cases can result in people being missed completely.
“I feel like every single day we’re troubleshooting, building solutions for a problem that we’ve never seen before of this magnitude,” said Harris. “There’s no magic system. It’s people that make up these teams, and they are all working so hard to try to do whatever is possible. It’s a huge indictment on the failing of the ways that we fund health care in this country.”
Community members in search of resources
It’s not just information and contact tracing that impacted residents are missing out on due to the backlog. It’s also resources. Last August, Alameda County supervisors approved the ARCH program, a $10 million economic relief package for low-income residents who test positive for COVID-19. At the time, the director of the Alameda County Health Care Services Agency, Colleen Chawla, stated that it would “help us reduce the spread of COVID-19 by providing financial assistance to residents who test positive and do not have the means to safely isolate.”
For eligible residents to receive the $1,250 stipend, they would need to get tested at a community clinic and answer their phone when a health worker called.
In early January, two weeks after Araceli Montano tested positive at a Lifelong Medical Care community testing site in West Oakland, she was still awaiting that call. Montano, 44, her husband, and their 11-year-old daughter all tested positive on December 14. After the family emerged from their 10-day quarantine, Montano was still trying to contact the county to access financial relief, as she’d lost two weeks of work and pay while sick.
“I called 2-1-1 for information, and they told me that there weren’t funds there.” Her sister, who was also sick, gave her a Sacramento number, but no one answered. Only after El Tímpano contacted the county about Montano’s case did someone from the county follow-up with her.
The ARCH program, which was funded by the federal stimulus bill passed last March, officially ended on January 8, and county officials told The Oaklandside that there is currently no plan to extend it. Cobian, the contact tracing supervisor at La Clínica, said her team was able to submit 339 applications on behalf of community members before the program closed.
Relying on home remedies, family, and neighbors as official outreach slumps
In lieu of information from local health officials, Maria González did what she could to care for her family, contain the virus, and determine where she may have contracted it and who she potentially exposed.
The second day she felt ill, González told her husband, “Go sleep in the kids’ room because I feel like this is more than a fever.” But he refused to believe she had COVID-19 and slept by her side. The next day, his body began to ache, and the following week he tested positive as well.
After that, everyone in the house wore masks and gloves, and González and her husband stayed in their room as much as they could. Whenever she used the bathroom, she wore gloves and disinfected it with Clorox afterward. Her kids remained in their own room, and González told them to keep away from her. “My greatest concern is that my kids might get this.” She’s especially worried about the youngest, who has asthma.
As their symptoms evolved, González and her husband sought medical advice from relatives. A cousin of González who is a doctor in Mexico City checked in via WhatsApp and told her how to treat the aches and nausea. Her brother in San Mateo had COVID a few months ago, and his wife shared the recovery methods that seemed to work for him.
“She told me to make a tea with cinnamon, lime, ginger, red onion, and oregano, and to drink it really hot with honey,” she said. The couple consumed a pot every day, and although there is no medical evidence that the drink is effective against COVID-19, she thinks it might be helping.
What González does know is that sifting through tips from friends and family isn’t the best way to treat a serious virus. If she were contacted by a county health worker a week into her illness, she said, “I’d have a lot of questions,” such as what medicine to take. “People just hear things, and do what they do because they don’t have any information.”
With El Tímpano’s help, Gonzalez is now in contact with the county health workers about her illness. She also has her family advice line on WhatsApp, a sister who drops off groceries when they’re running low, and neighbors who have cooked soup for the family, leaving it outside for González’s husband to pick up, masked and gloved, without making contact.
“It’s a horrible illness,” González said. “I don’t want my children to get it, or anyone else.” Despite her best efforts to quarantine, it may be too late to stop the spread. The day we spoke, her husband’s colleague went to take a test. He had been feeling the chills.