Public health officials to council: underlying social issues, variants make COVID-19 moving target

·6 min read

WORCESTER — By most measures, the omicron variant of the COVID-19 virus is on the wane, but an exchange during a presentation to the City Council Tuesday night showed that addressing deep-seated inequities that have led to less-than-stellar vaccination rates in the city may prove to be a tougher nut to crack.

City Manager Edward M. Augustus Jr., Dr. Matilde Castiel, the city's commissioner of public health, and Dr. Michael P. Hirsh, the city's medical director, walked the council through an update on the city's COVID-19 response.

Social determinants of health

As she has pointed out repeatedly over the past two years, Castile again told the council Tuesday there's an unmistakable alignment of where the most COVID-19 cases are, where the least vaccinated populations are, and where the most socio-economically vulnerable residents live — in the city's core and up through the northeast corridor including Belmont Hill and Great Brook Valley.

The omicron variant may be running its course. Case numbers are falling off and Castiel noted that sewage outflow data from the Upper Blackstone clean water plant, which handles waste from Worcester and several surrounding towns, indicates a steep drop off in recent weeks in the amount of COVID-19 detected in wastewater.

But after omicron and whatever variant comes next, the maps Castiel used to illustrate that Blacks and Latinos have been disproportionately impacted by the virus will remain. She explained that the COVID-19 maps reliably line up with several measures of social vulnerability factors. Those same areas where COVID-19 has wreaked havoc are the same areas where there are higher levels of poverty and unemployment. There are fewer residents there with high school diplomas, more residents who face language barriers and more multi-unit housing and mobile homes. She said there is more overcrowding, fewer vehicles and less access to transportation.

Those are the same areas where the highest concentrations of Black and Latino residents live and they are the areas public health officials have targeted to try to bump vaccination rates which consistently lag behind white and Asian-American vaccination rates. Castiel said equity clinics have administered 32,258 doses to nearly 16,000 people, and have tried everything from town halls to working with cultural organizations to going into barber shops and local grocers by foot with vaccines to get those numbers up.

Increasing vaccination rates has proven to be a daunting task. But at-large City Councilor Thu Nguyen asked Castiel the obvious question: How does the city reduce that social vulnerability in those communities hard-hit by COVID-19?

Castiel said addressing the root causes of the inequities that the virus has exploited involves reaching out into those communities. She said housing is an important piece of the solution, along with education. She said children should have equitable access to education; the same finances put into schools in wealthier areas need to be poured into schools in vulnerable areas. She said increased access to health care — and bringing that access to communities — is important. The city needs to look at where people live and think about jobs and the importance of transportation, Castiel said.

Youth vax rate far behind state avg.

Castiel said in the short-term, the city's public health apparatus continues to focus on younger demographics that fall significantly behind statewide averages. Only 18% of city children from 5 to 12 years old are fully vaccinated; the state average for the same age group is nearly 37%, Castiel said.

But overall, Castiel and Hirsh both said that the city recently hitting 60% full vaccination was a milestone and said that when only eligible populations are considered, that percentage goes up. And Castiel said the city is basically in the same boat as other gateway cities in the state like Lowell, Lawrence, Fitchburg and Springfield.

Hirsh told the council how public health has had to adapt and adjust based on developments in science and medicine and based on the moving target that the virus has proven itself to be.

Hirsh: virus may linger

He said people get confused and angry when regulations and guidelines change, often multiple times. But large pockets of unvaccinated populations have allowed the virus to mutate, Hirsh said. He said COVID-19 may never fully go away — it could continue to bubble under the surface and would be approached similar to typical flu outbreaks.

Still, the virus has proven to be much more than a flu outbreak and people are still getting sick and dying at much higher rates, Hirsh said. He said the flu, which "is no walk in the park," kills 30,000 to 50,000 Americans annually. But due to its extreme transmissibility, deaths due to the omicron have been clocking in at 2,000 daily, putting the country on pace for another 600,000 deaths this year. He said deaths are not likely to reach that number, but he said the level of disease in the community is still not acceptable, and you still don't want to get sick from it.

Hirsh, a pediatric surgeon, said he was in the UMass Memorial Medical Center neonatal intensive care unit last week and nearly "every other kid" was sick with COVID-19.

"You should care," Hirsh said, adding that he continues to have concerns about the long-term effects of COVID-19. He said the medical community does not yet know if COVID-19 could turn into a chronic condition similar to herpes, Lyme disease and other illnesses.

Hidden toll on mental health

At-large Councilor Khrystian King and District 1 Councilor Sean Rose both said they were concerned with the long-term effects of the pandemic on mental health, particularly among young people.

Castiel said the city's mental health task force is looking at how to increase the number of clinicians. Studies have shown increases in mental health struggles during the pandemic and Castiel said in communities of color those numbers are higher, owing again to social vulnerabilities. She said more clinicians would allow early intervention in schools to create an "early education pipeline" of access to mental health services that continues all the way up to sending clinicians out to certain mental health-related police emergency calls.

Rose said some studies have shown that social media has become more addictive for children than cigarettes. He said he supports a citywide look at how youth could become more engaged in sports, the arts, outdoor activities or other initiatives. As the father of four daughters, Rose said he has seen firsthand the impact of the pandemic on mental health.

This article originally appeared on Telegram & Gazette: Public health officials to council: underlying social issues, variants make COVID-19 moving target