COVID-19 rates in eastern valley continue to outpace region as vaccine, testing gaps persist
Nicole HaydenSonia Bautorini migrates from one Coachella Valley farm to the next in one- to three-month intervals, harvesting chiles, onions, oranges, lemons and dates.
Between the rows of fruit and under the relentless sun, the single mother can hear people sneezing or coughing. There isn’t always room to socially distance. But they are people just like her, she said: heads of households who can’t afford not to go to work, even if they are sick.
Bautorini has had three known exposures to co-workers who contracted COVID-19 during the month of November alone. But she didn't want to get tested herself.
“I didn’t get tested because I didn’t have symptoms, but I also knew if I tested positive, I wouldn’t be allowed to come to work,” she said.
She's not alone: Of nearly 100 individuals in the eastern Coachella Valley surveyed by The Desert Sun, two-thirds said they were not interested in being tested for COVID-19.
The Desert Sun conducted a face-to-face survey of random individuals throughout the unincorporated communities of Thermal, Mecca and Oasis as well as the cities of Indio and Coachella from August to December. Participants were promised anonymity so they could speak freely about their experiences throughout the pandemic, from testing to health protocols at work, and asked a standardized list of questions in either English or Spanish.
Of those surveyed, nearly 20% said they didn’t trust the COVID-19 information they received. Some said they felt it was “being over-exaggerated.” Others thought the “election tilted the information,” “some articles contradicted themselves” or some of the information shared was “fake.”
Those results were not surprising to some local health officials.
“We are in times of great uncertainty, and uncertainty leads to speculation, and speculation leads to anxiety,” said Conrado Barzaga, CEO of Desert Healthcare District, which provides funding and planning for public health initiatives in the Coachella Valley.
The pandemic has already taken an economic toll. About 65% of Desert Sun survey respondents said they feared they would lose their job if they tested positive for COVID-19. More than half said they'd never been tested.
Agriculture workers are near the top of the vaccine priority list in California, right after health care workers and long-term care residents and staff. As a resident of Riverside County, Bautorini could get the shot right now. But she's not sure if she will.
“I have heard many things that people have shared with me, like that the ... (former) President (Donald Trump) has placed COVID-19 in the vaccine to intentionally make people get it,” she said in Spanish through a translator. “It also doesn’t sit well with me because when my daughter was younger, I got her the flu shot and she got the flu the next day.”
'A lot of people are scared':Groups work to educate farmworkers about vaccine
FYI:Riverside County seniors, teachers and farmworkers can get COVID-19 vaccine
None of the vaccines in development in the U.S. use the "live" virus that causes COVID-19, according to the Centers for Disease Control and Prevention. Most of the vaccines under development introduce the "spike" protein found on the surface of the virus. They train the immune system to recognize this protein and attack in case of infection.
Bautorini has no primary care doctor to rely on for accurate information — she doesn't have health insurance. The fliers she has received about COVID-19 are all in English, she said. So, she gets most of her information about the coronavirus from friends, family and national Spanish-language TV news.
Local leaders and nonprofits have been working for months to close resource and information gaps in the eastern Coachella Valley, where communities continue to experience the region's highest COVID-19 infection rates. The pandemic has only further illuminated the chasm of public health care in this underserved area where a large number of Latino, farm-working and mixed-documentation status families live.
As COVID-19 vaccines begin rolling out, officials are faced with a familiar challenge: overcoming health care hesitancy amid a year of misinformation, and loss. It's not going to be accomplished with a one-size-fits-all approach; it starts, officials say, with one-on-one relationships that meet residents where they are.
For essential workers, not clocking in isn't an option
Sonia Bautorini does what she can to stay healthy. She stays inside as much as possible. She wears a mask when she is out. She relies on home remedies to keep her immune system healthy, mixing ginger, sliced red onion, cinnamon and lemon in her water to stay strong.
She also keeps up on her diabetes medication, hoping her blood pressure doesn't creep too high. Bautorini is afraid she will get sick each day she goes to work in the fields — but not clocking in is not an option. She has bills to pay and a daughter to support in her early years of college.
“When I started thinking about (the possibility of getting COVID), I can’t begin to imagine what it would look like to keep up with bills and rent,” she said.
In the eastern Coachella Valley, nearly 40% of families live below the poverty line, according to the U.S. Census Bureau. While the median household income across the valley as a whole is $55,402, that drops to about $25,000 in unincorporated communities such as Thermal, Mecca and Oasis.
Nearly three-quarters of survey respondents said they were either laid off or lost work hours due to the pandemic.
"Why (COVID-19) is rampant in the (eastern valley) is the fear about not being able to go back to work," said U.S. Rep. Raul Ruiz, D-Coachella.
Bautorini lost a significant amount of income in the spring because her work hours were reduced as businesses shut down.
“This past year has been really rough and very ugly,” she said. “There was a time when there was no work."
Amid the financial fragility, many essential workers continue to clock in. Nearly 30% of survey participants said they are not able to keep 6 feet of distance from others at work; 45% said someone at their workplace has tested positive for COVID-19.
The policy at the farm where Bautorini works is to get tested only if symptomatic. Just under 40% of survey participants reported workplace screening practices such as fever screenings.
Initial test avoidance largely due to job fears
At some farms throughout the valley, owners are taking more precautions than required. One, for example, requires testing every morning, provides a new mask each day and instructs workers to social distance as best they can, said Rosa Lucas, a founding member of the nonprofit Coachella Valley Volunteers in Medicine, which provides free or reduced cost health care in Indio.
“The last thing they want are their workers getting sick because then there would be no one there to pick the crops,” she said.
Still, of the individuals who said they had not or were not interested in getting tested:
- 39% didn’t believe it was necessary;
- 23% were afraid to be exposed to positive COVID-19 patients at testing sites; and
- 3% feared the test would be costly.
Martin Rascon, who is a family physician in Mexico but grew up in the Coachella Valley, has been working with the nonprofit Coachella Valley Volunteers in Medicine to provide COVID-19 education, including linking people to testing opportunities. He visits people’s homes to talk about the virus.
“I used to work in the fields here, starting when I was 13,” Rascon said. “My family is still involved in the fields, so I know the people. I know what it means to wake early in the morning and work a 12-hour shift and come home tired and not want to drive to get tested or get a vaccine.”
Rascon said he has spent a significant amount of time doing individual, one-on-one outreach to dispel misinformation. Without the facts, people “will fill in those gaps with information they see on Facebook or hear from neighbors … that’s where the misinformation spiral begins,” he said.
Lack of testing — or a lack of vaccine acceptance — can lead to continued transmission of COVID-19.
“What really changes people’s minds away from rumors and falsehoods that have been spread causing fear about the COVID vaccine is personal contact,” Lucas said
The Coachella Valley Volunteers in Medicine offered targeted COVID-19 testing to eastern valley residents in the fields, while Riverside County initially offered drive-thru testing, Lucas said. When county officials scheduled theirs in the morning, "we kept telling them people work in the morning and many don’t have cars," Lucas said. "The reality of the farmworker community needs to be understood before you can go out and talk to them about getting vaccinated or doing any health care education because first, they have to be present.”
While there was a learning curve at first, Riverside County Supervisor V. Manuel Perez said he is proud of how far the county has come since the start of the pandemic. The county has now diversified where and when it offers testing to these communities.
"Yes, we learned over the course of time how to do our testing sites and now we plan to deploy some of those efforts with our vaccinations, which means working with community partners that have links within the east valley," Perez said.
More:It could take up to 2 years to vaccinate Riverside County if supply issues persist
More:California COVID-19 vaccine rollout marred by issues
Lucas pointed to a shift in December, when Father Francisco Valdovinos, who led Our Lady of Guadalupe Church in Mecca, fell ill with COVID-19. After being placed on a ventilator, he died last week.
Soon after the news broke of his illness, hundreds of people began showing up for testing appointments at pop-up events coordinated by the Desert Healthcare District, Lucas said. Because of this, Lucas said she believes many more people have been tested in the time since The Desert Sun’s survey was conducted.
Similarly, she pointed to the moment when Pope Francis endorsed the COVID-19 vaccine, which he received on Jan. 13.
“People were believing a lot of rumors, like the vaccine would make you sterile and things like that,” Lucas said. “The majority of Latinos in the east valley are Catholic so that made a big impact.”
Addressing information gaps
Bautorini didn’t know there were resources that could assist with her late rent payments. All she knew was that she was not eligible for much of the federal and state aid, including unemployment benefits or the pandemic stimulus check, because she is an undocumented immigrant without a social security number.
Since the start of the pandemic, Riverside County has set aside free, empty hotel rooms for individuals who cannot safely isolate at home due to overcrowding.
Three-quarters of survey respondents were not aware of this housing resource.
Additionally, a new initiative called Housing for the Harvest, which is a collaboration between the county and nonprofit TODEC, provides temporary isolation housing for farmworkers who test positive in addition to grocery delivery, a dedicated caseworker that provides daily wellness checks and a $2,000 check to make up for lost wages. Bautorini was not aware of this resource, either.
Eventually, she connected with local housing nonprofit Lift to Rise to obtain assistance. The Riverside County Board of Supervisors in May approved federal CARES Act funding to be distributed to help with past-due rent payments for anyone in the community, including undocumented residents. She was able to catch up on her bills and eventually returned to regular hours at work.
While Riverside County distributes educational materials in both Spanish and English, writing “in Spanish is not enough,” Rascon said. The Volunteers in Medicine have spent time re-writing Spanish-language materials from the county's health department because they are too confusing, Lucas added.
“We need to consider the reality of people we are trying to reach,” she said. “It is difficult enough for people who are not college educated to understand COVID-19 information in English, and then that complicated information gets translated to Spanish. That doesn’t work. The average farmworker has a second or third grade education level. To make it effective, we have made our own fliers using little cartoons and very simple words.”
Additionally, there are many farmworkers and other essential workers in the eastern Coachella Valley that speak neither Spanish nor English, but either a dialect or an indigenous language, requiring the need for additional translators.
“People who don’t work in (the eastern Coachella valley) community every day believe that everyone speaks Spanish and that’s all you need to get through,” Lucas said. “But you really need people who can help connect to all of the communities within our community. We have to get on those levels.”
Second doses:Too few COVID-19 vaccines as California ramps up appointments
Biden immigration plan:Undocumented farmworkers could apply for green cards
The Desert Healthcare District, the University of California-Riverside School of Medicine, the California State University-San Bernardino nursing school, outreach workers and many other organizations like Coachella Valley Volunteers in Medicine continue to work together to host video Q-and-A events, provide materials in several languages and advocate for resources to be brought directly to residents, even testing right to the fields.
While Ruiz appreciates that the Coachella Valley Equity Collaborative, organized by the health care district, is leading many conversations about outreach and education, and he knows this work can't be done without countless hours devoted by area nonprofits, he said it is still Riverside County that should be taking the greatest responsibility.
“I have yet to really see a robust effort of (public service announcements) in both English and Spanish on this topic with culturally relevant messages to the hardest hit communities in our county," he said.
Crowded homes can hinder social distancing
On the edge of the Thermal, surrounded by neat rows of date palm trees stretching multiple blocks in each direction, Bautorini and her daughter live in a two-bedroom trailer with enough space to allow them to isolate from each other, if it came to that.
In the trailer park, families play outside and are in “very close contact” with each other without wearing masks, Bautorini said. She politely waves “hello” to those neighbors each day before quickly sliding into her car to head to work or the grocery store.
“Multiple people have tested positive in front and back and to the left and right of our house,” she said. “Whole families are testing positive in our trailer park from newborns to the older ones because lots of people here can’t isolate from their family.”
More than 40% of survey respondents said multiple people shared bedrooms in their homes due to overcrowding — over 20% said it would not be possible to isolate from each other if necessary. Many of these were the same individuals who reported not knowing about county resources.
While some said they had room to isolate, nearly 60% said it still wouldn’t be possible because of the demands of caring for their family.
“Honestly, I do not feel secure where I live,” Bautorini said, adding that many families in her neighborhood continue to host parties. “I only go outside to get in my car and to feed my dogs.”
Bautorini said she already knows a handful of individuals who have died from COVID-19 — a custodian at her work, a neighbor’s cousin, a cousin, another family member, and few other people within her neighborhood.
Bautorini fears what would happen if her name were added to the growing list of the dead. She knows she would have no money for her daughter, Stephanie, leaving the burden of paying for a funeral and a new home on her shoulders.
Stephanie is in her second year of studying for a career in criminal justice and social work. With no internet at home and campuses shut down, she does all her schoolwork using data on her cellphone. Together, the mother and daughter have a dream that once she graduates from college, she can provide them both with a better home.
“She told me that she is trying her best to create that future for us,” Bautorini said.
When asked what would help her and others in her community the most, Bautorini said simply: “access to health care."
Underserved more likely to miss vaccines
About 120 miles west of Thermal, a mass COVID-19 vaccination site is underway at Disneyland in Orange County, similar to others that are popping up around the state.
That type of site won't work for the eastern Coachella Valley, Barzaga said.
“From my perspective, those are not appropriate because it will just give access to people who typically have access and it doesn’t ensure an equity lens for our community,” Barzaga said.
Looking ahead to COVID-19 vaccine distribution in Riverside County, Barzaga said he believes the approach should target community members who don’t have the home life, career or money to make it easy to access health care resources, or who live in communities with increased exposure.
Eastern Coachella Valley communities continue to have a higher rate of COVID-19 cases than the rest of the region, as they have throughout the entirety of the pandemic. Thermal has the highest rate with 276 COVID-19 cases confirmed per 1,000 people, followed by Oasis at 241, Coachella at 144, Mecca at 133, and Indio at 110.
In Palm Springs, 61 COVID-19 cases per 1,000 people have been confirmed. Indian Wells, one of the most affluent cities in the valley, has fared best with 29 cases confirmed per 1,000 individuals.
Across Riverside County, 71% of confirmed COVID-19 cases are Latino individuals, even though they make up only 47% of the county's population, according the data from the county health department.
“When we talk about equity, we talk about everybody having a fair and just opportunity to be as healthy as possible,” Barzaga said. “That requires us removing barriers that traditionally have caused a barrier to health care for some of our community members. Removing those barriers means you will no longer be at the back of the line; we will move you to the front.”
To do so would require a restructure of what Riverside County is already doing. Previous vaccination events involved a mad dash to sign up for an appointment time online — many eastern valley residents may not have that kind of technical or internet access.
Perez, the county supervisor, said he expects "at one point we will eventually have mobile (vaccine) sites at the east end, at a school site or a ranch where many farmworkers are, so we can vaccinate as many as possible."
Additionally, vaccine partners in the community, including Ralphs and Albertsons, can help meet some equity goals by placing the resource in a location where residents might already frequent. But those appointments are also difficult to come by.
Building an infrastructure that creates equitable access for all will only work if built on a foundation of trust and safety. Nearly 43% of Latino adults surveyed by the Public Policy Institute of California said they were likely to not get the vaccine because they felt it wasn’t yet “safe and effective.”
More:Father Francisco Valdovinos, priest in Mecca, dies of COVID-19
More:Riverside County supervisor in talks with Goldenvoice about mass vaccinations
Lucas suggested working with farm workers to educate residents about the vaccine, “as they have already been educating their workers about other aspects of the pandemic."
According to The Desert Sun’s survey, 50% of respondents said they received their information about COVID-19 from either local news stations like KESQ or KMIR, or from Spanish-language national news stations; 47% from social media; 29% from family and friends; 29% from radio; 24% from print or online newspapers; and 15% from church. Many turned to a variety of sources to get information about COVID-19, often including a combination of friends, social media and TV.
Rascon said building on already established trust is key. For example, asking leaders to get vaccinated on TV stations that people already tune into could be a piece of the information campaign.
“We cannot remove the uncertainty people experience in their daily lives," Barzaga said, "but we are making the effort to make resources as easy as possible for community members to access.”
Desert Sun reporter Nicole Hayden covers health in California. Follow her on Twitter @Nicole_A_Hayden.