This story is part of our reporting series, “Covid Year Two: After the Vaccine.” See the full series here.
The path Covid-19 tore through San Diego was as tragic as it was misshapen, but the lines it carved were not random. By and large, the death toll bypassed the scenic coastal roads, steered away from gated communities and veered south at the Coronado Bridge.
The pandemic in its first year did not hit Whiter or wealthier communities as hard as it hit communities of color and poorer communities, as death rates nationally and locally show. But in the second year of the pandemic, Covid changed its shape, according to a new analysis of local death certificates by Voice of San Diego.
The number of deaths, across the board, fell drastically. And the way those deaths were distributed across many different populations — though not all — equalized dramatically, as well.
White people were much less likely to die than Black and Latino people in San Diego County during the first year of the pandemic. But the gap in death rates closed significantly during the second year.
The death disparity between Latino and White people, for example, was cut almost in half during the second year, though not eliminated.
Latinos were more than four times as likely to die as Whites during year one, age-adjusted figures show. During the second year, that gap was cut nearly in half, but Latinos were still twice as likely to die as White San Diegans.
The gap also began to close between Black and White people locally, Voice’s data shows.
“Latinos and Blacks were disproportionately affected because the vaccine wasn’t available in the first year, and they were more likely to be essential workers and [live] in multigenerational housing,” said Arturo Bustamante, a professor of health policy at UCLA. “After the vaccine, it seems that so far what has emerged is the disparity is slipping.”
Voice was unable to measure several racial categories, such as Asian and people who listed multiple races. With the exception of White, Black and Latino, many death certificates listed a person’s nationality rather than race.
The age-adjusted death rate for Asians since the pandemic began is only slightly higher than for Whites, according to data compiled by the county Health and Human Services Agency.
The number of deaths among those who listed their race as Native American only (17 in year one and 14 in year two) was too small to form a reliable age-adjusted death rate — but those figures suggest Native Americans in San Diego died at a rate similar to White residents during years one and two.
With all other things being equal, one would expect virus and disease to wreak havoc equally across different populations. But health outcomes in the United States don’t work that way, as Voice documented in its series about the first year of the pandemic, “Year One: Covid-19’s Death Toll.”
Viruses exploit the incongruities in American life. Working-class people are more likely to have access to a McDonald’s than a Whole Foods, more likely to have underlying conditions like diabetes and hypertension, more likely to work in frontline jobs, more likely to live in cramped housing where illnesses spread more easily — and more likely to be people of color.
Health disparities existed long before the pandemic, so it was no surprise when Covid affected poor people and people of color differently. The question is why did disparities decrease during the second year?
Black and Latino people were more likely to be on the front lines of the pandemic during the first year, said Bustamante. They were also more likely to live in multigenerational housing, meaning they weren’t just risking their own lives to keep society running.
But all that was true during the second year too. Only those same frontline workers in grocery stores and restaurants and warehouses were also more likely to have the vaccine, by that time.
Because people of color were more exposed to the virus from the beginning, the vaccine, in other words, had a bigger impact in their communities.
During the first year of the pandemic, for instance, Voice identified 32 addresses in San Diego County where multiple people died related to covid. Of those homes, three-quarters were occupied by immigrants. A full 52 percent of people who died were immigrants — despite immigrants comprising just 23 percent of San Diego County’s population.
During the second year, the percentage of immigrant deaths began to equalize. It dropped to 40 percent, Voice’s analysis found.
Another reason death rates may have begun to narrow was the way in which vaccines were distributed across the county, said Rebecca Fielding-Miller, a professor of public health at UC San Diego.
“The county did a really great job of prioritizing equity and making sure vaccines made it to communities being hit the hardest,” she said.
South County was one of the primary targets for vaccine distribution, and according to officials an estimated 94 percent of residents 6 months and older who live there are vaccinated. It’s considerably higher than any other geographic region.
To get there, San Ysidro Health, a nonprofit at the center of that effort, began hosting a variety of community sessions in 2021 where people could ask questions of medical experts. The point was to educate and raise awareness ahead of time because advocates on the ground were anticipating some hesitancy.
“There was a lot of misinformation and myths going around,” said Daniel Ramirez, a program manager at San Ysidro Health. But after talking it out, many people seemed inclined to press ahead.
Access to the vaccine was the bigger problem, Ramirez said, thanks to a widespread lack of transportation and childcare during typical work hours, and a feeling that the vaccine wouldn’t be available unless you had insurance or a primary physician. Many people also just couldn’t take time off work to get a vaccine.
To meet people where they were in early summer 2021, San Ysidro Health partnered with schools like Southwestern College and other organizations setting up mobile units in parking lots, shopping centers, churches and daycare centers.
“We were really going full throttle,” Ramirez said, targeting specific neighborhoods where the death rate had been highest during the first year.
Often, the advocates would visit a site multiple times, with the hope that consistency would go a long way for anyone still on the fence. Some people wouldn’t get vaccinated during the first visit, Ramirez said, but maybe the third or fourth. Participation rates began to increase over time.
The advocates also began training promotoras — a mix of Spanish-speaking health care professionals and volunteers — to become ambassadors for the vaccine and talk to people in their own neighborhoods to alleviate concerns.
While health disparities decreased between some groups, they stayed virtually the same by one important metric: income. Class was a powerful predictor of a person’s likelihood to die in year one and year two of the pandemic.
Voice compared the median income of each zip code in San Diego County to the death rate in each zip code. During year one, the rate of death went down by 10 percent for every $6,600 increase in median income in a given zip code. In year two, the death rate went down roughly 10 percent for every $6,000 increase in income.
Another important proxy for class — education level — did change substantially.
The share of those who died with Covid who had little education dropped significantly, while the share of those with middle levels of education increased. The share of deaths among those with a bachelor’s degree or higher remained unchanged.
Having a bachelor’s degree or higher continued to serve as insulation against death, just as it did year one. Only 16 percent of people who died held a bachelor’s degree or higher in year one and two — even though people with a bachelor’s and up comprise 40 percent of the population, locally.
Meanwhile, the share of people who did not have a high school diploma fell from 33 percent to 25 percent.
The share of deaths rose in the middle group: those with a high school diploma, some college or an associate’s degree. Their share rose from 45 percent to 54 percent of all deaths. It’s not immediately clear why, because the assumption among some public health professionals is that vaccine participation increases across the board as education levels rise.
“This might be the population that’s more susceptible to misinformation,” said Bustamante.
This series is supported by the Data-Driven Reporting Project. To request access to our data for research or reporting purposes email email@example.com or firstname.lastname@example.org.