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Hospitals in Chula Vista are seeing far higher rates of coronavirus patients than the rest of the county as it has become increasingly clear the South Bay has been disproportionately hit by COVID-19.
Not only are most of the ZIP codes in the county with the most cases located in the South Bay, but a far greater share of coronavirus tests administered to patients there are coming back positive.
Chris Van Gorder, chief executive officer of Scripps Health, said an average of 6 percent of coronavirus tests administered across the Scripps system come back positive. But at Scripps Chula Vista, the average rate of positive tests is 17 percent and has spiked as high as 29 percent. It’s the same picture in the Sharp HealthCare system, which is treating approximately 40 percent of all San Diego County’s hospitalized COVID-19 patients. Roughly 12 percent of people tested for coronavirus in that system end up testing positive, but in the Sharp Chula Vista Medical Center in particular, 20 percent of people suspected to have coronavirus end up as positive cases, said Dan Gross, an executive consultant leading Sharp’s coronavirus efforts.
Sharp currently has 106 positive patients, and 38 who are under investigation. Nearly half of those are in its Chula Vista facility.
“All that started to tell us that the South Bay is a little different than the rest of the county,” Gross said.
Most of the county’s ZIP codes with the highest numbers of cases right now right now are located in the southern part of the county. As of Wednesday, Otay Mesa had the highest number of confirmed county cases, with more than 300. Two Chula Vista ZIP codes and National City follow. On a per capita basis, Chula Vista and National City trail only El Cajon for coronavirus cases countywide.
The bleak picture in the South Bay has been influenced by a host of factors, from the region’s comparatively lower socioeconomic status to the presence of the Otay Mesa Detention Center, home to one of the country’s largest outbreaks in an Immigration and Customs Enforcement facility. But the unfolding crisis in Baja California has played a role, too, Gross said.
“I don’t think anyone can say with certainty what the absolute influences are,” he said. “I think we can extrapolate the known variables that influence the South Bay experience, and one of those things is Tijuana.”
Local officials and hospital leaders have reached out to the federal government pleading for help along the border.
County Supervisor Kristin Gaspar sent a letter to Vice President Mike Pence, asking for federal assistance to combat the spread of the virus across the border. Gross and Van Gorder sent a letter Tuesday to the Department of Homeland Security and the Department of Health and Human Services asking for assistance. Mayors of South Bay cities have called for more testing and contact tracing.
“There is a misperception that San Diego and Southern California are flattening the curve and therefore supplies and attention can go elsewhere,” wrote Gross and Van Gorder in their letter. “That is not the case. Hospital COVID‐19 cases in the southern part of our region continue to rise. Any impression that we are flattening our curve ignores the threat south of the border and the fact that providers in the San Diego region do not have adequate supplies to meet the projections we anticipate as a result of the increasing cases in our border communities.”
The Border
Diseases know no borders. The novel coronavirus is no exception.
On Tuesday, Van Gorder said there were nine COVID-19 patients in the Scripps Chula Vista emergency room. Five of the nine said they had traveled across the border recently.
“There are an increasing number of individuals with recent travel or residing to Baja California who are presenting,” said Dr. Eric McDonald, the county’s epidemiology director, at a press conference Wednesday. “We are tracking that carefully. It is an increasing trend and is certainly part of the increasing cases being seen in Baja California.”
Gaspar said she thinks, on average, about 10 coronavirus border-related cases are added to San Diego hospitals each day.
“Due to the nature of our dynamic region, any time we see an increase in cases in San Diego, most likely Tijuana will also experience an increase as well,” said Justine Kozo, chief of the county’s Office of Border Health. “We have seen this happen in the past, including during the rise of meningococcal disease in our region in 2013.”
But the coronavirus outbreak has been unique, especially in the way it’s been impacting Tijuana, Kozo said.
“The difference with COVID-19 is that Tijuana is facing a different kind of crisis,” Kozo said. “While San Diego is reviewing its various indicators and metrics to possibly dial down restrictions, just a few miles south of us, Tijuana is experiencing immense challenges, including shortages of personal protective equipment and ventilators, tests, health care personnel and a lack of hospital beds and staff to care for sick patients. Their hospitals are at or near capacity.”
As of Monday, there were 1,301 confirmed coronavirus cases and 167 deaths in Baja California. The death rate for COVID-19 patients in Tijuana is 15 percent; in San Diego it’s less than 4 percent. Hospitals in Tijuana are “a war zone” and on the brink of collapse, Telemundo reported. Doctors and nurses in one Tijuana hospital told the Union-Tribune that often by the time they get test results back, their patients are already dead.
Of the 292 non-resident cases in San Diego County, only 15 are Mexican nationals, said county spokeswoman Sarah Sweeney. One-third of the 292 are cases related to cruise ships and the remainder are residents of other counties, states or countries.
But the big concern are U.S. citizens who may be living in Baja California or recently traveled there.
There are approximately 265,000 U.S. citizens living in Baja California. And while border crossings have decreased significantly because of restrictions put in place in March, tens of thousands of people still cross each day.
“At present, there is not a high number of individuals with suspected COVID-19 crossing the Baja California-California border in need of medical care, but it is increasing,” Kozo said. “Since the Baja California hospital system is facing significant challenges, this could influence an increase in individuals crossing the border in need of medical care at present and, even more so, in the near future. Still, currently, the number is small, and we have the capacity in our hospital system to support an increase in patients.”
Gaspar, Gross and Van Gorder agree that border-related cases haven’t yet reached a point where San Diego is greatly impacted, but they want to keep it that way. Their requests from the federal government include additional border screenings, like temperature checks, and quarantining border-crossers if necessary. Gaspar said some of the hotel rooms the county has accumulated could potentially be used to help quarantine people who don’t have a place to isolate on the U.S. side of the border.
They also proposed that the federal government provide aid to Mexico to treat COVID-19 patients and provide additional personal protective equipment and staffing.
Kozo said the county is facilitating fundraising to get more resources to Tijuana through the International Community Fund.
Van Gorder said there has been some talk of San Diego health care providers sharing equipment with Tijuana, but “but none of the health care systems have so much supply that they can give it away at this time. Our core responsibility is to help our patients in San Diego.”
Gross and Van Gorder also made a plea in their letter that more personal protective equipment be sent to San Diego.
Gaspar also proposed setting up a temporary hospital at the border, similar to a field hospital set up at Palomar’s Escondido Medical Center to accommodate additional coronavirus patients if regional hospitals start nearing their capacities or the triage tents set up by UCSD to assess suspected COVID-19 patients.
The Department of Homeland Security and the county are in active discussions on some of the requests made in her letter, Gaspar said.
“We think we’re moving in the right direction,” she said.
The Detention Center
Otay Mesa has the largest number of cases in the county, with 325 confirmed cases in the ZIP code that houses the Otay Mesa Detention Facility as of Wednesday.
The detention center is currently the site of one of the largest coronavirus outbreaks at an ICE facility in the country. There were 167 people in custody at the facility who’ve tested positive for the virus as of Thursday, according to the Union-Tribune. Of those, 103 are ICE detainees and 64 are U.S. Marshals Service inmates.
The Union-Tribune uncovered that when detainees requested masks, they were asked to sign a contract that would absolve CoreCivic of responsibility if they fell ill once they were given the masks, and threatened with pepper masks after refusing to sign. Detainees in several units in the detention center say they began hunger strikes because of their concerns for their safety.
U.S. District Judge Dana Sabraw ordered ICE to review whether to release certain detainees at high risk of serious COVID-19 symptoms at the request of the American Civil Liberties Union.
The Workers
Mayors of South Bay cities have also raised other concerns about why their residents are being disproportionately impacted by the virus.
Both National City and Chula Vista made it mandatory for anyone in those cities to wear face coverings while out in public prior to the countywide order that goes into effect on May 1.
Chula Vista Mayor Mary Salas told the Union-Tribune that the most impacted ZIP codes in her city were some of the lowest-income areas.
“If you’ve got a community that doesn’t have access to health care, doesn’t have access to good nutrition, those people are more vulnerable,” Salas told the U-T.
In general, the ZIP codes most impacted by coronavirus cases have also been experiencing some of the highest levels of unemployment, according to a new SANDAG report. National City, San Ysidro – which has over 100 cases – and parts of Chula Vista had over 20 percent unemployment as of April 11.
National City Mayor Alejandra Sotelo-Solis also told the Union-Tribune that many of her city’s residents are essential workers in hospitals, grocery stores and other places that expose them to the virus.
In New York City, for example, working-class, immigrant-heavy Queens has had far higher numbers of coronavirus cases than more affluent boroughs, like Manhattan, the Associated Press found.
South Bay leaders have called for more testing and contract tracing. A new drive-thru testing site opened in Chula Vista this week.
“This is not one population,” Gaspar said. “There’s a lot at play. In no way, shape or form am I suggesting that the border is the only reason. We’re trying our best to keep an eye on all scenarios.”