It took until just before Thanksgiving for the COVID-19 death toll to reach 1,000 in San Diego County. But since then — a period of less than two months — the number of deaths has surpassed the 2,000 mark.
And experts expect the number to continue rising rapidly for at least another month if not two. "We're probably six to eight weeks out," said Dr. Tom Lawrie, the chief medical officer at Sharp Memorial Hospital.
Lawrie said a spike in infections leads to a surge in hospitalizations two weeks later, which leads to another surge in deaths two weeks after that. So even if infections plateau in the region — which so far they have not— deaths will continue to rise rapidly for weeks to come.
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However, Lawrie said even though infected people are straining hospital capacity, he does not think the rising death numbers can be attributed in any way to a lack of medical resources in the county.
"We're not at that point," he said. "Throughout the pandemic, we've been able to move resources to absorb any influxes. We're so good at doing these things, being able to absorb, that people may not even realize what's going on inside the hospital, so even as we get more patients, we're able to maximize resources so people haven't suffered."
For example, he said, Sharp Memorial Hospital has expanded from the usual 48 intensive care beds to 73 beds.
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But the pandemic continues to impact people disproportionately, depending on their race and ethnicity and where they live in the county. Almost half of the people who died lived in East and South County, while just 11% lived in the north coastal areas.
The county’s Latino community is still being hit the hardest, accounting for 44% of deaths even though Latinos make up 34% of county residents.
The disparities become even more pronounced among people under 40 who’ve succumbed to COVID-19. Consider that 73% of people in that age group who died were Latino and none were white. Among those in their 40s and 50s who died, 68% were Latino and 15% were white.
Advocates for underserved communities say these numbers are dismaying, but not unexpected.
"The fact that things haven't changed hasn't surprised us, when you look at where infections are coming from, from front line workers, that hasn't changed," said Nancy Maldonado, the CEO of the Chicano Federation of San Diego County. "When you look at the numbers of infections among grocery store workers, people who work in pharmacies, those are going up, and of course they are. Those are the people at risk of exposure."
Lower-income workers who do frontline work are more likely to be Latinx, and are less likely to feel confident demanding protections from their employers, Maldonado said. In addition, she said the Latino community struggles with access to healthcare.
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"People hesitate to go to a medical provider, get medical treatment when they've been exposed," she said. "That's problematic because, by the time they do go, the situation has progressed."
Maldonado said there are also often discrepancies in the way people of color are treated by doctors.
"In how their symptoms are being interpreted, people are sent home even though their symptoms indicate they should not be sent home," Maldonado said. She added that low-income Latino patients are more likely to have diabetes, hypertension and other underlying conditions that made the disease more deadly.
All of these inequities contribute to a tragedy that people are still not fully grasping, Maldonado said.
"Part of what's frustrating in seeing the increasing numbers of deaths is we become immune to the numbers," she said. "But those lost touch people. Every single one of those numbers is a mother, son, daughter, father. Unfortunately, it doesn't hit people until it impacts them directly."
Low-income, frontline workers are most at risk because both their living and working conditions put them at higher risk, said Rebecca Fielding-Miller, an epidemiologist at UC San Diego.
"People went out, saw family, had a perfect incubation period between Christmas and New Year's, then saw other people for New Year's Eve, and the virus spread," she said. "Then all those people started walking around the world, going to work, going to stores."
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As a result, they increase the chances that servers and grocery workers who interact with those people get sick, Fielding-Miller said.
"Grocery workers, pharmacy staff, they might have also gathered themselves over the holidays, and then they're interacting with people coming into public spaces who are at higher risk of being infected, and so you have two different waves crashing into each other," she said.
While vaccines offer a glimmer of hope on the horizon, Fielding-Miller said the region won't see any substantial dip in deaths due to vaccinations for at least a few months. And, she said, the concern is that the same inequity in medical treatment will play out in who is vaccinated.
"We talk a lot about social and structural determinants of health, like race and gender, how these things affect your health, affect your job," she said. "They also affect your access to vaccines and how much you trust the process vaccines happen in."
For that reason, the Chicano Federation and other community organizations are planning to act as vaccine ambassadors in the Latino community, and their employees are already signing up to receive the vaccines themselves, said Maldonado.
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For doctors and nurses working in hospitals, the daily death toll of the virus is very visible, said Lawrie with Sharp Memorial Hospital.
"I work in the ICU Saturdays and Sundays, and I'm always impressed with how calm, cool, and collected they are, confident they are able to provide care to patients," he said. "These last three to four weeks, they're still calm, but the morale is wearing thin. We've been subjected to a continual onslaught of patient care that we have never had to do in our careers."
While most doctors and nurses are now vaccinated, and there is hope that numbers will begin to slowly go down, Lowrie said there is still a long race that needs to be run.
"Even if numbers calm down, it's really hard for them to look at the next month or two and know they have to keep doing this," he said. "It's demoralizing."
