Latinos make up 35 percent of Orange County’s population, but account for about 43 percent of both COVID-19 cases and deaths in the county.

Dr. América Bracho is the executive director of Latino Health Access. The organization noticed that Latino communities in Anaheim and Santa Ana were experiencing a far higher COVID-19 transmission rate than the rest of Orange County and decided to do something about it.

“What is happening really is that the ZIP codes with the low income Latino community is overrepresented in a horrible way to the point that we are having 18 percent positivity rate in a ZIP code versus seven percent positivity rate in the county. COVID-19 is concentrated in very low-income neighborhoods, and it’s affecting families in disproportionate ways. Death rates are also higher in these ZIP codes, in Anaheim and Santa Ana particularly,” she said.

Dr. Bracho said the coastal cities in Orange County that tend to be more affluent were more prepared to handle the virus than the inland communities were.

“In Orange County, the disease got to us in the coastal cities. So it started there, and then people there were able to manage that for many reasons because they can work at home, because they have access to healthcare, because they are not afraid of saying, ‘I’m sick,’” Dr. Bracho said. “And then after that, the virus started moving toward central Orange County where Anaheim and Santa Ana are. And there wasn’t a level of surveillance that could have deployed a fast response, so their response was not on time.”

These neighborhoods also didn’t have testing for a long time, and people weren’t as aware of the severity of the novel coronavirus due to the digital divide—namely, a lack of internet or computers that could be used to check for COVID-19 updates.

“So you find a vulnerable community in many ways that is due to inequities that come prior to COVID,” she said. “I mean this has to do with lack of access to healthcare, living in overcrowded conditions, having to work no matter what. And it has been demonstrated that if you cannot stay home, your chances of getting infected are higher.”

In order to get more information about the spread of COVID-19 in these communities, Dr. Bracho requested data by ZIP code.

“When you don’t have data that can actually demonstrate the issue—the problem—you are making that community invisible. So the first fight has to do with fighting the invisibility,” he said. “Desegregate Orange County. You are not going to just fight COVID in Orange County. You have to go community by community.”

Latino Health Accesss—in partnership with the school districts in Anaheim and Santa Ana, various community clinics, and the University of California, Irvine's School of Public Health—started doing “epidemiological fencing," which Dr. Bracho described as targeting "hot spot" communities to try to mitigate the spread of COVID-19.

“We selected the ZIP codes that have the highest impact and recruited many community workers that are actually leaders from those communities to be the leaders in education and outreach. So these moms are actually reaching out to other families. And what are they saying? We are saying to people that if you don’t need to get out, stay home. But if they need to get out, they need to take precautions. And those precautions again—you have heard these many times—have to do with the mask, the physical distance, and the cleaning your hands.”

To some Orange County residents, this information has been prevalent. But to others who might not have regular access to a computer or the internet, door-knocking is the most effective way to let them know how to protect themselves against COVID-19.

For the past five weeks, Latino Health Access has sent “promotores,” or community workers, into these central Orange County neighborhoods to talk to residents about COVID-19 and build relationships with them.

“Community workers are people that are trusted in communities,” Dr. Bracho said. “It could be your grandma, your auntie, the teacher in your neighborhood. And we have many of these community workers. They are leaders, they are trusted, they are committed, they care. And they would do this work even without us.”

Promotores have existed within Latino Health Access for nearly 30 years, informing people about diabetes, obesity, hypertension, mental health, and domestic violence.

“So we had, prior to this project, 40 promotores, 40 community workers,” Dr. Bracho said. “And these are individuals that will create a relationship, that will call you, that will go the extra mile. This is not just about COVID. This is about the relationship because what makes people open their mind is a relationship, not a message. If they don’t trust you, they don’t trust the message.”

If someone gets sick in one of the identified high-risk ZIP codes, Latino Health Access will provide them with a room and food while they isolate themselves.

“Testing was almost non-existent when we started four weeks ago—four to five weeks ago. Today we have testing capacity in all of these ZIP codes. But then what happens if you are positive and you cannot stay isolated? So we support isolation. The county also contracts with hotels and motels, and we being the promotores, our team, connect people to these isolation centers or places where people can quarantine,” Dr. Bracho said. “But then what do you do if you dn’t have food? So we take food to them, to the hotels and to their homes.”

There’s even a call center where residents can connect if they need anything. The number is (714) 805-7838.

“We just started contact tracing, because now we are getting the results in two days. So last week we started calling people and asking them two things: One, to connect with their contacts and let them know that they are positive, or tell us who they are so we’ll connect with those contacts,” Dr. Bracho said.

“And we are having a mixed response. Some people prefer to do it themselves. Some people are asking us to help. So this is only going to be stopped if we can identify the people that are positive, isolate them, take care of them, identify the contacts, quarantine them, and take care of them. And ‘Take Care’ with capital letters because if people know that this is about caring for each other, then they’ll open their minds.”

Much like everywhere else in the U.S., Dr. Bracho said people in Orange County are either participating in masking and distancing, or they’re not.

“Some people are open-minded, following the science, and setting aside differences. And some people have taken a position that is more, ‘I don’t believe in science. I don’t need to do this. This is my individual right. I want my kids to go to school because nothing is going to happen.’ And I think that’s problematic, and it’s problematic in the sense that you cannot have individual rights at the expense of the majority of people in the world,” Dr. Bracho said. “These individualistic positions in the middle of a pandemic are detrimental, are negative, are not helpful. And I can respect individuals, but I will not accept those positions.”

Dr. Bracho said Orange County is not ready for schools to reopen.

“The World Health Organization says that community transmission should be less than five percent. Orange County today is at seven. And the ZIP codes are between 18 and 22 percent. That high level of community transmission is not the best environment to open schools. And again if you want your kid to just go outside and go to places in an irresponsible way and you call that freedom, I have a difference with your definition. And I don’t have time to fight. We will probably have conversations after we control the pandemic. Not now," she said. "Our energy needs to be in getting united and lowering the transmission for the good of the collective.”

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