Editor’s note: This is story is part of a week-long series by the Reno Gazette Journal exploring the many ways COVID-19 has changed our lives since it first arrived in Nevada one year ago. You can find the full series here.
Sparks resident Claudia Ramirez’s father isn’t scared of many things. The man, however, is absolutely terrified of COVID-19.
The fear is warranted. One year after the pandemic first exploded across the globe, COVID-19 has exacted a heavy price on the Ramirez family. These days, Ramirez’s parents have mostly stayed in their Sparks home in order to avoid COVID’s dangerous touch. Her mother Maria, 72, retired from her hotel-casino job due to fears about the virus and only leaves the house to buy groceries or see the doctor. Her 74-year-old father Antonio “doesn’t go out at all.”
“My dad is super scared,” Ramirez said. “It’s mostly because he’s lost a lot of his friends — a lot of his compadres — and family back in our hometown in Mexico.”
‘They don’t even let you say goodbye’
For Ramirez, three of the deaths in Mexico were especially personal. Two involved cousins in their 40s, including one of “the healthiest men” she knows. That cousin died six days after being diagnosed with COVID. A third cousin who succumbed to the virus in early February was even younger.
“He was just 29,” said Ramirez, the pain palpable in her shaky voice as she struggled to fight back tears. “He lasted four days.”
COVID didn’t just rob their family of lives, it also robbed them of a proper farewell. For a culture that prizes familial bonds, it was akin to adding one final insult to heartbreaking injury.
“They don’t even let you say goodbye,” Ramirez said. “The ambulance just picks them up and after they die, they’re cremated right away.”
“We don’t even know if they handed (our family back home) the right ashes,” she added.
Ramirez remains concerned, and for good reason. Across the state, families in underserved communities such as Ramirez’s are bearing the brunt of COVID’s onslaught.
A new Reno Gazette Journal analysis found the area where the Ramirez family lives has the second-highest case rate for COVID-19 in Washoe County. According to the analysis, Washoe ZIP codes with the highest infection rates have a higher proportion of lower-income residents and a larger share of minorities — Hispanics in particular. Data acquired from the state through a public records request also show every single minority group receiving a disproportionately smaller share of the vaccines administered so far.
‘We just can’t get an appointment’
The challenges faced by these communities are made worse by barriers limiting their access to vaccines. Vaccine clinics are too far away to reach for those without a car. Those who struggle with technology literacy or don’t own a computer struggle to make appointments, which is mostly done online. Seniors are especially struggling with figuring out where to sign up and how.
Then there’s the issue of work. Ramirez, for example, must frequently interact with the public in her job as a food server. And with Gov. Steve Sisolak recently easing some COVID restrictions, including loosening capacity restrictions in Nevada restaurants from 25% to 35%, she is even more desperate to sign up her parents for a COVID shot.
Skipping the line:Lack of oversight plagues COVID vaccine deployment in Northern Nevada
Ramirez does not fall under the list of priority groups and has yet to be vaccinated. Her biggest fear? Unknowingly infecting her mom and dad if she catches COVID from work. Ramirez lives with her parents.
“When I first started working again (after the moratorium was lifted) I was scared to go home,” Ramirez said. “I would come home and say, ‘wait, don’t touch me, I’ve got to change first.’”
Ramirez struggled for weeks to get her parents scheduled for the vaccine. She doesn’t have a personal computer and admits that she isn’t good with technology. Instead, she enlisted the help of her daughter and other relatives.
Ramirez says she can’t even imagine her parents trying to make sense of the various options for signing up.
“Every time my mom talks to my daughter, she’s like, ‘grandma, I’m still trying,’” Ramirez said. “We’ve all been trying but we just can’t get an appointment.”
“I’m just worried about my parents. I’m just wondering, ‘Oh my God, if they get it, are they going to pull through? I would love to see a way that makes it easier for the elderly to get a COVID shot without too much running around,” Ramirez lamented.
‘They can’t isolate’
Since the beginning of the pandemic, Washoe County neighborhoods with lower incomes and a higher percentage of minorities have been disproportionately affected by COVID-19, according to a Reno Gazette Journal analysis. The RGJ looked at infection numbers from the Washoe County Health District as well as demographic data from the Census Bureau’s 2019 American Community Survey for 30 ZIP codes in the area.
The demographic differences between the hardest-hit and least affected neighborhoods were stark. Overall, the most impacted areas primarily consisted of working-class white and Latino households.
Topping the list was the 89512 ZIP code in northeast Reno, which includes North Wells Avenue, Sutro Street and Evans Avenue. The area posted the highest infection rate to date with 110 cases per 1,000 residents as of Feb. 9.
The median household income there is $38,120. It is the lowest among all neighborhoods analyzed with a population of at least 8,000 residents. Its ethnic makeup, meanwhile, is 43.8% white and 35.5% Latino or Hispanic — significantly higher than the 25% share that Latinos make up for all of Washoe County.
Map: Each ZIP code for Washoe county shows the rate of COVID-19 infections. The darker the color, the higher the rate of COVID-19. Click on each ZIP code for more details. – Brian Duggan/RGJ
The second-highest rate of infection was seen in the 89431 ZIP code, which includes downtown and old Sparks. The area, which is where Ramirez and her parents live, saw a case rate of 104 per 1,000 people. Its median income is $45,722 per household with an ethnic mix that includes 46.9% Latino and 41.5% white residents.
In contrast, the lowest infection rates were seen in more affluent neighborhoods such as Incline Village, Caughlin Ranch and Skyline.
Incline Village posted the lowest case rate since the beginning of the pandemic at 43 per 1,000 residents. The area had a median household income of $99,203 and is 77% white. The Reno ZIP code of 89519, which includes Caughlin Ranch and Lakeridge, tied with Cold Springs for the second-lowest rate with 56 cases per 1,000 residents. The 89519 ZIP code posted a median income of $113,125 and is 84.2% white.
The numbers are not surprising, said Reno Councilman Oscar Delgado.
Communities hardest hit by COVID-19 struggle to get vaccines
Delgado represents Ward 3, which includes parts of northeast Reno as well as the 89502 ZIP code — a diverse community that includes Wells Avenue and the area around the Reno-Tahoe International Airport. The ZIP code has the fourth-highest COVID-19 rate at 92 cases per 1,000 people. Residents in 89502 include people with lower-paying service jobs that also have a higher exposure to the public.
In cases of potential exposure, isolating or quarantining can be a challenge for such households, particularly when they have generations of people packed in a small space out of necessity. Health guidance suggesting individuals stay more than six feet away from each other doesn’t exactly work, Delgado said.
“Try telling that to three families sharing a two-bedroom apartment with one bathroom. Try telling that to a bunch of kids staying in the same bedroom as their parents the entire time,” Delgado said. “They can’t isolate.”
While these communities are the hardest hit by the virus, data is indicating they aren’t getting their share of the vaccine.
The disparities are showing up in the vaccination rates. Data acquired by the Reno Gazette Journal through a public records request show all minority groups receiving less COVID-19 vaccine compared to their share of the population. Of the first 97,463 doses administered in Washoe County, for example, 9.1% went to Hispanics. The rate is less than half of their 25% share of the population.
A look at other ethnic minority groups tells a similar story:
- Black Americans represent 2.8% of Washoe residents but received just 1.1% of the COVID vaccines administered.
- Native Americans account for 2.2% of the population but received less than a percent of all COVID shots.
- Hawaiians and Pacific Islanders represent a small share of Washoe residents at just 0.7% but an even smaller share of the vaccines administered at 0.2%.
- Asians did relatively better but still received fewer shots than their share of the population — 4.5% vs. 5.8%.
The only group to get more than their fair share of vaccines are non-Hispanic whites. They received 63.8% of the initial doses while accounting for 62.3% of the population.
Initial data — which includes shots administered by the health district and partners such as Renown, Saint Mary’sand Community Health Alliance — is likely skewed by the fact that the bulk of initial doses went to first-responders and frontline workers, said Washoe County Health District Officer Kevin Dick. The agency is still waiting for data from the state showing numbers for seniors added as part of the second tier of vaccinations, which should paint a more accurate picture of vaccine equity efforts in the county, according to Dick.
“We know that the initial types of occupational groups that received vaccinations as essential workers may not represent the demographic makeup of Washoe County and affects the demographic statistics of those who have received the vaccine,” Dick said.
“It’s extremely important that we be fair and equitable when vaccinating the general population.”
The problem is not unique to Reno-Sparks.
As of Feb. 18, Hispanics received 11.7% of vaccine doses administered in Nevada — far below the 30.2% share of the population they represent. Blacks received 4.6% of doses given in the state. They account for 8.9% of the population. White residents, on the other hand, received 57.6% of doses while accounting for 49.8% of Nevada’s population.
On Feb. 5, Sisolak unveiled a new vaccine equity initiative after data from Southern Nevada cities such as Las Vegas showed that the hardest-hit communities had the lowest rates for vaccination.
“That makes no sense,” Sisolak said. “These ZIP codes represent Southern Nevada’s working-class families, lower-income households and communities of color.”
“Clark County is facing an equity crisis. It must stop,” Sisolak added.
COVID-19 casts spotlight on long-existing health disparities
The access issues faced by underserved communities in Reno-Sparks represent a microcosm of the disparities that have plagued lower-income and minority communities in the United States for generations.
Whether it be a smaller city such as Reno or a large metropolis such as New York City, health barriers inflict the same familiar list of inequities on the nation’s most vulnerable communities. These include higher morbidity and mortality rates from various diseases, not just COVID-19.
“You see this a lot in access to care, you see this a lot in health outcomes and how it plays out in terms of access to resources and quality of life and how people live,” said Regina Davis-Moss, associate executive director of health policy and practice for the American Public Health Association.
One challenge faced by the health district in its vaccination efforts is hesitancy among Hispanic communities, particularly among undocumented immigrants. Dick assured members of the community that there will be “no questions asked” when they come in for a shot.
“We don’t collect any information related to immigration status and you don’t need health insurance since it’s free as well,” Dick said. “In addition, the federal government has put out an announcement that they don’t want ICE interfering or using any of the vaccination locations in their activities.”
Throw in generations of negative experiences and outcomes, including cases of medical experimentation on minorities such as Black communities in the past, and the higher levels of skepticism in those populations — including against vaccines — come as no surprise, Davis-Moss said.
“This hesitancy and mistrust against health research and the healthcare system in communities of color is well warranted,” Davis-Moss said. “We really must be able to have a conversation about this and answer these questions.”
Although health disparities have been a longstanding issue, the advent of COVID-19 has magnified them, Davis-Moss added.
In a sense, the pandemic has provided a rare opportunity for the nation to face the uncomfortable health inequities in its communities that have lingered for so long. At the same time, it could also further stoke those feelings of doubt if minorities and lower-income communities find themselves left with the short end of the healthcare stick yet again.
Part of the challenge is addressing the issues that disproportionately impact underserved communities, said Delgado, who also serves as CEO for the federally approved health center Community Health Alliance.
Many people in lower-income neighborhoods, for example, work multiple jobs and might not be able to leave work easily to get a shot, which makes expanded clinic hours important. Others don’t have access to transportation, making it difficult to reach vaccination clinics that are located far from their neighborhoods.
CHA is currently putting the finishing touches on a medical van that it plans to use for outreach and mobile vaccinations. The health district is also working with RTC Washoe to ensure access to its COVID-19 POD clinic.
To truly reach underserved communities, however, it’s important to increase the number of clinics that are located in lower-income neighborhoods. The health district has plans in place to continue to increase the number of clinics by having community partners such as fire districts involved.
The health district is also looking at ways to ensure that vaccine distribution is as equitable as possible when it comes to shots made available to the general public. Older seniors are currently eligible alongside first responders and frontline essential workers to receive the vaccine.
“We’re actually looking at the waitlist we have assembled for the 70 and older population and we have the ability to call by ZIP code number as well … so we can make sure that we have people that are being selected out of some of our highest-need areas,” Dick said.
‘COVID doesn’t care’
Seniors are also having a hard time getting a COVID shot.
While scheduling her father for cataract surgery earlier this year, Sparks resident Lynn Larsen garnered a puzzled reaction from clinic staff after providing her father’s birth date. The reason quickly dawned on Larsen. She realized that she shortened her dad’s year of birth to just “21.”
“There’s this pause and I go, ‘Oh, it’s 1921 (not 2021),’” Larsen said with amusement as she recounted the story.
“He’s not two days old.”
For Larsen, it was a rare moment of levity in a year marked by COVID-19’s heavy hand.
As a nurse who works on pre-admission, pre-op testing and contact tracing for the VA Sierra Nevada Health Care System hospital in Reno, Larsen has seen evidence of the pandemic’s horrific handiwork firsthand. She’s lost several VA colleagues to COVID-19 last year, including fellow nurse Vianna Thompson.
“When it first came out, we all thought it was just like a strong flu,” Larsen said.
Larsen’s thoughts quickly turned to her dad. At 100 years old, he’s Exhibit A for someone at high risk from the virus. If there’s one thing that COVID-19 made abundantly clear as it tore through communities, it would be the virus’s penchant for hitting the elderly especially hard.
Last year, Larsen asked her father to move in with her, where he could safely shelter in place. The next order of business was to get him a COVID shot. As a frontline worker for the VA, Larsen received her shot quite easily. Like Ramirez, however, she would quickly find out that access to COVID vaccines for the public is a much different story.
Technical challenges stymied Larsen when she tried to register her father online through portals such as Renown’s MyChart site. Larsen spent the coming weeks signing up her father through various vaccine providers. Nothing seemed to work. While trying to make an appointment at Walgreens, for instance, she spent four hours on hold before finally hanging up.
“I just said, ‘OK, we’re not going to Walgreens,” Larsen said.
While Larsen is more tech-savvy than her father, the 64-year-old admits she’s not exactly a digital savant. Larsen was finally able to schedule her father through Community Health Alliance after reaching an actual person on the phone.
“Quite honestly, there’s just a lot of frustration with the way we’ve become as a society where it’s all internet and everything’s online,” Larsen said.
For now, Larsen is simply grateful that her father finally got his first shot in the books.
“He’s good,” Larsen said. “He comes from tough stock. I guess you don’t live to be a hundred if you don’t.”
Some miles away, on the other side of the city, Ramirez finally received some good news. A few days after she initially voiced her concerns to the Reno Gazette Journal, her parents were able to get an appointment at Community Health Alliance. Just like Larsen, Ramirez said her daughter was able to reach an actual person at the clinic.
For Ramirez, it was like getting a mountain off her shoulders.
“Most of the people I talk to, we’re all having trouble (to schedule a shot),” Ramirez said. “They’ve all been trying.”
Asked if she or her parents had any reservations about the vaccine, Ramirez did not think twice.
“COVID doesn’t care. It doesn’t care what the color of your skin is. It doesn’t care what you look like. If my parents have an opportunity to get a shot, they’re going to take it.”
Jason Hidalgo covers business and technology for the Reno Gazette Journal, and also reviews the latest video games. Follow him on Twitter @jasonhidalgo. Like this content? Support local journalism with an RGJ digital subscription.