Juan Ramon Guillen sits on a portable speaker, microphone in hand, on First Street in downtown Calexico on Wednesday morning, April 21, trying to get the attention of people coming through the pedestrian port of entry and those in the downtown to let them know COVID testing and vaccines are available at the Calexico Wellness Center. Although no vaccine was available Wednesday, there would be doses there on Friday, April 23. | CAMILO GARCIA JR. PHOTO
CALEXICO — Local healthcare providers and public health experts understand “vaccine hesitancy” is a problem not just across the country but at home, although Blanca Morales Grijalva questions how widespread it is in communities like Calexico.
Calexico leads or is tied in many county COVID-19 indicators, including communities hardest-hit since the start of the pandemic, cities with the most deaths, most current active COVID cases, and most vaccinated residents, both fully and partially.
Morales, chief executive officer of the grassroots-driven Calexico Wellness Center on the edge of the city’s downtown, sees this mix of statistical data as an example of how the national issue of “vaccine hesitancy,” or the reluctance to become vaccinated, against the SARS-CoV-2 virus that causes COVID-19 is not as prevalent in Calexico as some of the other areas of the county.
“We go out to the people, we reach out to the community, the county (Public Health Department) doesn’t do that; they sit in their offices,” Morales said of the issues with vaccine demand that the county is experiencing.
“People don’t have smartphones and computers (to register for clinics online), some don’t even have phone numbers,” she said on Tuesday afternoon, April 20. “We’re out there on First Street letting people know we have the vaccine.”
County Public Health explained on Tuesday morning that it has seen what appears to be a significant drop-off in demand for vaccine locally since the state and county rolled out its vaccination efforts some 18 weeks ago.
“We started noticing two weeks ago or so that appointments weren’t being filled as fast,” Imperial County Public Health Director Janette Angulo said. “Before, it took 45 minutes to fill 1,000 appointments.”
Now, she said, it’s taking from three to five days to book anywhere from 200 to 500 slots.
Case in point was the mass vaccination clinic that was to occur at Dr. Vincent Soun’s Sarin & Tao Family Medical Clinic in Holtville on Thursday morning, April 21.
Although Soun’s clinic was just about at capacity with registered patients on Wednesday afternoon at 910 slots accounted for, Soun told the Calexico Chronicle that registration started three weeks ago.
Still, Morales isn’t seeing it, but Dr. Tien Tan Vo is.
In a separate interview on Tuesday evening, Vo said he has seen the drop-off, not as much in Calexico, but across the Valley for certain.
Vo, county Public Health, and Pioneers Memorial Healthcare District have done the lion’s share of the inoculation of those Imperial County residents who have received more than 93,900 doses since late February. Vo said he accounts for more than 20,000 himself, many of those in the south end of the county.
Part of the waning demand might be tied to fear and anxiety of the safety of the vaccine in the wake of the single-dose Johnson & Johnson/Janssen brand being paused more than a week ago by federal officials following reports that six women developed rare blood clots in their brains of some 6.85 million doses administered in the United States so far.
Vo, for one, sees the roots of the slowdown predating the pause and having everything to do with religion, politics, and “personality,” he said.
This comes as Imperial County entered its second week of not meeting all three of the state’s statistical metrics for the Orange Tier of the state’s Blueprint for Recovery, although Angulo stressed that moving backward is predicated on several other factors besides the number of positive tests and testing percentages, and that new COVID-positive cases have been on the decline, with hiccups, since an April 5 mini-spike.
Gov. Gavin Newsom’s goal of moving beyond the state’s color-coded system by June 15 and fully reopening California with some mandates still in place like mask-wearing and distancing is heavily dependent on hitting as-yet unstated vaccination goals.
Calexico, the Unicorn
Just about every morning, Blanca Morales Grijalva’s Calexico High School chum, Juan Ramon Guillen, can be seen posted on First Street with a microphone, calling out to those milling about downtown Calexico or arriving through the downtown pedestrian Port of Entry, many of whom have dual citizenship.
Calexico Wellness received 400 doses, a combination of first and second doses, on Wednesday afternoon as part of her weekly allocation from county Public Health, so Guillen will likely be out there pulling in the people not already on Calexico Wellness’ wait list of about 400. She expects to be able to take some walk-ins this week.
“I have more people than I have vaccines,” she said, and Morales believes Calexico Wellness should have been receiving more from the start.
“We are the highest in positive COVID cases and the highest in vaccinations. What does that tell you?” Morales said of Calexico. Her clinic has only done 2,000 inoculations to date despite requesting at least 1,000 doses a week for several weeks now.
“We’re out here. We’re in the trenches. We’re in a border town,” Morales continued.
Just before midday Tuesday, Public Health officials brought Morales 48 doses of leftover Pfizer-BioNTech vaccine, the fussy version that can quickly go bad if not used in a certain amount of time. Morales was advised of the doses on Monday afternoon, April 19, so she scrambled to call some of the hundreds of patients of her clinic on standby.
But Morales was not happy early Tuesday afternoon when the doses arrived after some or her patients had waited for hours before deciding to leave. By late Tuesday afternoon some 20 doses remained and no one was there to get them.
To hear Morales speak, April 20 was an anomaly, as she said she usually makes quick work of the 100 doses she has received each week for several weeks, save for the rare instance where the county provided her clinic 200 doses once. This week’s allocation was the largest so far.
Such has been Morales’ struggle to be on the frontlines of helping vaccinate Calexicans, where she has received drips and drabs — and the leftovers — from Public Health.
By next week, after what she said has been a lengthy onboarding process and steep learning curve for inclusion in the online vaccine portal, MyTurn.ca.gov, Calexico Wellness will start to receive direct allocations from the state’s third-party administrator, Blue Shield of California, from which most of the major providers in the county are getting their doses.
She hopes that injects new life and more doses in her weekly allocation.
Morales knows the demand is high in Calexico, because both residents and healthcare providers understand how dire the situation has been for the county’s southernmost city.
Earlier this week, Morales made a case to the city of Calexico’s administrative team to keep vaccinating people at the Carmen Durazo Cultural Arts Center across the street from her single-suite location, with its limited space in the parking lot for vaccination clinics.
After staging several days’ worth of clinics in the Durazo center, including the vaccination of city staff, U.S. Postal Service employees, and local healthcare union workers, Morales was told the city would need the center for an upcoming art exhibit.
Morales said Calexico City Council member Camilo Garcia has gone to bat for her with city administration, but she had yet to hear back as of Wednesday afternoon.
For Calexico, the numbers don’t lie. While the city was tied for active COVID-infected patients with El Centro on April 21 at 39 cases, just last week Calexico had nearly double the active cases of El Centro.
Cumulatively, Calexico, which has about 5,000 fewer residents than El Centro, leads with 228 of the county’s 716 deaths and accounts for 7,101 of the county’s total 25,684 cases — 27.6 percent.
Although Dr. Tien Vo, who has clinics in Calexico, El Centro, and Brawley, and has been one of the mass vaccinators in Imperial County, he said it is clear the vaccine demand is concentrated in the south and dilutes as one moves outward from Calexico.
Three Sides to the (Hesitancy) Story
At the very moment county Public Health officials discussed the lessening demand during its weekly report to the Imperial County Board of Supervisors, Dr. Vo, his staff, and some volunteers were trying to burn through 200 leftover Pfizer doses during an impromptu clinic at the Jimmie Cannon Performing Arts Theatre at Southwest High School in El Centro.
When Vo found out he had the doses left, Southwest High Principal Matt Phillips said the school was contacted late Monday afternoon and the clinic was quickly put together for the benefit of Southwest staff, students age 16 or 17 who were accompanied by their parents, and the public.
Phillips said the two-hour clinic had a line several students’ deep before by 9 a.m., an hour before its scheduled start time. But Vo said late Tuesday, only 180 doses were administered.
Phillips was pleased, though, and said he and Central Union High School District Superintendent Ward Andrus are more than happy to provide future clinics at the theater, which is spread out, air-conditioned, and has an expansive lobby for registration purposes.
“If we could, in essence, be a hub for youth vaccination, we’re ready, willing, and able to do that,” Phillips said on April 20.
Vo’s leftover vaccine, and even the inability to finish all 200 at Southwest theater, is emblematic of the vaccination issues rearing its head in pockets of the country, with some areas of the South and Midwest worse than others.
Through the pandemic, Dr. Anthony Fauci and the U.S. Centers for Disease Control have said that 85 percent of the population would need to be fully vaccinated for herd immunity to start to take hold.
Yet recently, public health officials have pulled back on that number.
On Tuesday, Imperial County Public Health Officer, Dr. Stephen Munday, indicated 70 percent is the new 85.
“We expect to get to that herd immunity concept that we’ve talked about in the past … 70 percent at least” would have to be fully vaccinated, Munday said.
Herd immunity is the resistance to the spread of an infectious disease within a population based on pre-existing immunity of a high proportion of individuals as a result of previous infection or vaccination.
As it stands, 18 weeks into the national vaccine rollout, only 26.4 percent of the U.S. population is fully vaccinated and 40.5 percent partially vaccinated.
Munday acknowledges it is fear rooted in things other than science, including the fear stoked by the Johnson & Johnson pause, that is slowing things down.
Dr. Vo, however, is much blunter in his assessment, stating there are three reasons for the lagging demand.
Religion. Politics. Personalities.
Vo sees it among faith-based groups, especially at a recent 1,170-dose Pfizer clinic at St. Mary’s Catholic Church on April 17. Although it was a mass drive-through clinic for the general public, early registration was open to the congregation, only 50 members of which signed on, he said.
County board members on Tuesday also referenced members of local Evangelical churches also being hesitant toward taking the vaccine.
That leads to the politicization of the COVID vaccine, Vo added, which he pointedly stated: “If you’re anti-Biden, many are anti-vaccine, and pro-Biden are for the vaccine.”
While an opinion, it’s a fairly astute observation according to national polling, which has seen those who identify with conservative politics much more resistant to getting vaccinated than those who identify with more progressive or Democratic ideologies.
As for “personality,” Vo said, this is playing to people’s fears and anxieties over the vaccine, and even education levels or influence of friends and neighbors.
Vo said he thinks that life does need to open, and restrictions be removed despite vaccination levels, and if more people need to get ill, so be it.
“Mortality has gone way down because of vaccine and (treatments like) monoclonal antibodies,” he said, referring to an infusion that COVID patients are encouraged to take in the first seven to 10 days of testing positive.
“Herd immunity will be established, not because of the vaccine, because of more infection,” Vo said.
Back to Orange … And the Data
Each Tuesday at noon the state posts it weekly average of adjusted numbers and tier assignments for California’s 58 counties. On April 20, for the second week, Imperial County did not meet at least one of the metrics.
All three were off on Tuesday: the county was at 12.3 (11.9 adjusted for tier assignment) new cases per 100,000 residents, 5.6 percent for the seven-day average positivity rate; and 5.9 percent for the health equity quartile positivity rate.
Orange Tier metrics are 5.9 to 2 cases per 100,000 residents, less than 5.3 percent for the health equity quartile, and 4.9 percent to 2 percent for the seven-day average positivity rate.
Public Health Director Angulo explained that after the Orange metrics were adjusted by the state three weeks ago when a trigger of 4 million vaccinations among the state’s poorest zip codes occurred, so too were the criteria that would send a county backward into more restrictive tiers.
No longer are the three metrics the sole determinant but are part of a larger case that takes into account hospitalization rates in a community and whether that region is trending up or down.
“We’re coming back down slowly, so that’s the trend we want to see again,” Angulo said, adding that the crest was seen April 5 in daily new COVID cases, when 76 positive tests were recorded.
To that end, she said hospitalization rates are low as well. So low, in fact, that neither Valley hospital consistently post their counts. At last update, El Centro Regional Medical Center had seven COVID patients on Tuesday and Pioneers Memorial Hospital in Brawley had eight on April 14.
To send Imperial County back into the Red Tier, there would have to be two consecutive weeks of all three metrics not met, increasing and higher hospitalization rates, and an upward trend.
“If the county’s most recent 10 days data does not show objective signs of stability or improvement, the county must revert to the more restrictive tier,” according to the state’s most recent guidance on tier assignments.
County Public Health did send out a cautionary press release on the issue on Tuesday afternoon, but Angulo on two occasions has said improving case data and a more holistic picture is showing that there is no immediate concern of a return to Red.
It is on the vaccination front that will make the most difference and the county is doing what it can to educate the public based on science and firm data, Dr. Munday said.
Yet demand problems is an issue that seems to be gaining ground, especially when the public sees figures like President Joe Biden make pleas to get the shot at critical junctures in the slowdown.
With vaccination eligibility open to all Imperial County residents as of April 9, and all state residents as of April 15, of the 93,915 doses administered countywide as of Wednesday morning, April 21 (55,905 partially, or 29.17 percent; 38,010 fully, or 19.83 percent), some 16,733 people in Calexico were partially vaccinated and 10,940 were fully vaccinated.
Data for comparable population centers show El Centro (a larger population than Calexico) at 15,681 partial vaccinations and 10,539 full vaccinations. Brawley, which has fewer residents than Calexico or El Centro but is the Valley’s third-most populated city, shows 7,803 partial vaccinations and 5,623 full vaccinations.
Partial vaccination means at least one dose of the two-dose regime of Pfizer or Moderna vaccines.
All the data is forever changing, but, by and large, the trends per region have stayed relatively consistent.
Percentages for individual communities based on their populations were not available for Wednesday’s data, but Angulo said Tuesday, based on numbers from Monday, April 19, Calexico was the leading city with 41.9 percent, and leading unincorporated communities and cities were Ocotillo (46 percent), Niland (45 percent), Palo Verde (36 percent), El Centro (30 percent), Seeley, Holtville, Imperial, Brawley, and Heber (ranging between 24 percent and 28 percent), Salton City (15 percent) and Winterhaven (less than 1 percent; which might be off due to Winterhaven residents often seeking medical care in Yuma County).
On Tuesday, Imperial County District 1 Supervisor Jesus Escobar, also vice chair of the county board and Calexico’s representative, was his usual inquisitive self, engaging Public Health officials and adding his own opinion on the lagging demand of late and relating a telling story.
“I had two interesting conversations yesterday (April 19),” Escobar said, one with (an) “elected official who was adamant about not getting the vaccine,” and another with a good friend who had lost his father to COVID yet “he was adamant about not getting the vaccine and so is his family.”
“This type of attitude is rampant, whether your ethnicity is Mexican, Mexican American, American, it doesn’t matter,” Escobar said incredulously. “There is a rampant avoidance of taking the vaccine.”