Could There Be COVID Outbreaks in Unvaccinated Communities?

Uneven Vaccination Rates Could Lead to COVID Outbreaks in District Neighborhoods that Have Already Paid the Highest Price During Pandemic

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Dr. Anthony Fauci and Mayor Muriel Bowser canvass the streets of Fairlawn during the Community Corps Day of Action June 19, sharing information about how to get the COVID-19 vaccine. Photo: E.O'Gorek CCN

Taking a walk along the commercial streets of the District, it certainly looks like the pandemic is behind us. People stroll past diners on patios, all of them without masks for the first time in more than a year.

On June 15, Mayor Muriel Bowser (D) joined President Joe Biden in inviting Americans to celebrate July 4th in the nation’s capital, and thousands accepted, gathering to watch fireworks on the National Mall. Others gathered in their neighborhoods, some in the hundreds and thousands for parades in the Pallisades and on Capitol Hill or for fireworks, parties and cookouts with neighbors.

“DC is open and ready to welcome back visitors to celebrate the way we came together as a city and as a nation this year,” said Mayor Bowser June 15.

As of the day prior, June 14, DC reported that 58.6 percent of the population had received at least one dose of a COVID vaccine; nearly half the population was fully vaccinated.

But those people are not evenly distributed across the District. The vaccination rate in Wards 3 and 4 was nearly double the rate in Ward 8 —51 percent in Northwest versus 26 percent in Ward 8. The District rate overall masks the danger to unvaccinated people living in communities with low vaccination rates, said Matthew Ferrari, Director Penn State University’s Center for Infectious Disease Dynamics.

For those people, the risk of getting COVID right now is greater than in January —and due to emerging variants, more dangerous than ever.

According to the CDC, the far more dangerous and contagious Delta variant is spreading quickly and is likely to become the dominant strain in the United States. While current vaccines provide protection against the variant, recent projections from the COVID-19 Scenario Modeling Hub, used by the CDC to predict the disease’s course indicate there could be extremely localized outbreaks of COVID-19 where vaccination rates are low.

That means that in the fall there could be outbreaks of COVID in the District neighborhoods that have already paid the highest price for the pandemic.

Uneven Vaccination Rates, Uneven Risk
As the District moves to welcome visitors back to the city, more than half of the District’s population is vaccinated. However, those people are not evenly distributed across the city, or across demographic groups. There’s one exception: seniors. Across nearly every neighborhood in the District, more than half of the residents 65 years old and better are vaccinated; in some, it is more like 90 percent.

As Mayor Bowser and Dr. Anthony Fauci canvassed Ward 8 neighborhoods June 19, 51-year old Nate Ward told them that he was suspicious of both the pandemic and the vaccine. Photo: E. O’Gorek/CCN

But the numbers skew more widely for the rest of the eligible population, aged 12 to 64. In Woodley Park in Northwest, 52.72 percent of eligible residents (those aged 12 and above) are vaccinated, and 60.86 percent in NoMA But only 18.14 percent of the eligible residents of Bellevue, in Ward 8 and 22.19 percent of those living in Historic Anacostia have been vaccinated. As of June 14, no neighborhood in Wards 7 or 8 had a vaccination rate higher than 35 percent.

Communities with low levels of vaccination are not limited to the east side of the river. The neighborhoods around both Georgetown and George Washington Universities have vaccinated less than 30 percent of residents 12 and over —23.44 and 29.8 percent; in Ward 5, Trinidad reports 35.5 percent are vaccinated.

It is the historically Black and Latino neighborhoods in those wards that have reported the highest case rates. According to data from OpenDC, Bellevue alone has reported 148 new cases since April 12, when vaccination opened to District adults. That’s compared to five new cases in Barnaby Woods and seven in Capitol Hill.

Fifty-four people have died of COVID in DC since April 12; 33 of them lived in Ward 5, 7 and 8; one was homeless.

Black communities have also suffered the greatest loss during the pandemic, adds Ambrose Lane of the Black Coalition Against COVID. While the District does not provide data on COVID casualties by neighborhood, Ambrose said that more 80 percent of the lives lost since the vaccine was introduced have been Black.

Skewing Younger
With seniors largely inoculated against the disease, serious infections are skewing lower. Data from the DC Hospital Association (DCHA) shows that, of the patients suffering from COVID admitted between April 16 and June 16 of this year, 51 percent of cases were in patients younger than 49 years old; 10 percent of cases were in kids under 18.

Data presented at a DC Council budget hearing by the Deputy Mayor of Education (DME) indicates that vaccination rates are particularly low for kids 12-15 in Wards 7 and 8, where only 8.3 and 5 percent have received even one dose of the vaccine. Thirty-seven percent of the District’s population under 18 live in Wards 7 and 8. For the same age group, Ward 2 is at 43 percent fully-vaccinated and Ward 3 at 40 percent for the youngest eligible. But those two wards together are home to only 14 percent of the District’s under-18 population.

While COVID vaccines have been approved for kids aged 12 and older, it could be as late as January 2022 before there’s approval for the younger crowd, said Dr. Tina Tan. She is a Professor of Pediatrics at Northwestern University whose research interests focus on the epidemiology of respiratory infections in children and preventative vaccines. After reports of myocarditis and pericarditis—the inflammation of the heart muscles and the sac that encases it—in a few adolescents and young adults after COVID-19 vaccination, particularly males, Tan said that the FDA has asked that the number of participants in clinical trials be increased.

“They [FDA] would like to see the number of children under 12 participating in the clinical trials increased,” Tan said. “Everybody’s being extraordinarily cautious, which I think is a good thing, given what we’re seeing now and given that we don’t know what the immune response of the younger kids is to the vaccine.”

The Mayor has vowed students will attend classes in person starting at the end of August, the first time more than half of them will return to school in a year-and-a-half. The extension of the vaccine trial period means that when they return to school in the fall, the elementary-aged children will not be vaccinated.

The COVID-19 vaccine is currently not required to attend public school next year, but a spokesperson for DC Public Schools said it will be encouraged. “To help meet our commitment to fully reopen schools for every student, every day in the fall, DCPS encourages all students ages 12 and older and their parents, caregivers, and eligible siblings to get vaccinated.”

Thelma Ruffin, 73, receives the Johnson & Johnson vaccine at a March 26 vaccine clinic at Mt. Moriah Baptist Church. Photo: E. O’Gorek/CCN

Risk Higher than Ever
Even as the District returns to normal, the COVID variants circulating now are more contagious than the viruses that were circulating eight months ago, Dr. Ferrari said. They are also deadlier than ever. “It may feel like we keep changing the goal posts, and that’s because the goal posts keep changing,” he said.

The new Delta variant is twice as transmissible than the Alpha variant, Ferrari said, and likely to become dominant in the US. Modeling of Delta’s spread by genomics company Helix predicts that in the fall, Delta infections could be up to 20 percent of the COVID cases in January 2021. The District’s case rate that month peaked Jan 11 at 46.76, or nearly 48 per 100,000.

Dr. Ferrari said that the pandemic is not gone —just “squeezed down” into those communities least equipped to cope with it.

“In cities or counties where there is a high variability in vaccine coverage, if policy makers relax the measures based on overall rates of vaccination, it triggers a dangerous situation for those neighborhoods or communities that are still vulnerable,” said epidemiologist Pedro Kremer, a Booz Allen Hamilton scientist working in public health programs and policy evaluation for clients including the US Federal Government. “[They’re doubly] vulnerable —biologically because of their vaccination status, and socially for their reduced access to health services.”

Equitable Health
Ferrari said that one goal of public health is to reach all —equitably. “Many of the policies that have been enacted as of late have shifted from broad-scale population responses and protective measures that affect everybody and have increasingly shifted the burden of protection to individuals.”

Unfortunately, not everybody has the same opportunity or ability to exercise those choices, Ferrari said, pointing out that hourly and service workers cannot easily make the choice whether or not to wear a mask or interact with strangers in the workplace.

National evidence appears to indicate that vaccine accessibility is the issue rather than hesitancy, he said, so governments need to focus on educating those communities on the benefits of vaccination, and where and how to get it, as well as do a good job of making sure all populations can easily get the vaccine by bringing it into their communities —their churches, community centers, schools and even their homes, if possible —at all hours of the day.

“We’re trying to achieve equity, not equality,” Ferrari said. “So we need to do more in the communities that historically have received less.”

However, those working on the ground in DC say that access might be a problem, but trust is still the major issue. “I think DC Health has done a great job of getting out the vaccine,” said Lane. “It’s trust that’s the issue.” Lane said people want to know more about the disease and about what’s in the vaccine, even to an ingredient list. Messaging needs to be focused and directed,” Lane added, pointing out that young people especially are subjected to far more disinformation than solid information via social media, which studies have shown increases vaccine hesitancy.

District Efforts
The District has put forth an effort. In May, Bowser urged faith-based organizations, community groups, or employers to directly request a vaccine clinic from the city through a vaccine exchange program. In addition to walk-up and pharmacy vaccination sites, the city has been partnering with local churches and places of worship to host pop-up vaccine clinics, more recently, the city has advertised freebies, events and contests to boost interest in inoculations. A representative for DC Health said there will be a back-to-school vaccination push for COVID-19 and childhood vaccines for students and families this summer.

On June 19, the Mayor herself canvassed homes near Anacostia High School in Ward 8 where DC Health data shows only 33 percent of eligible residents —and 28.75 percent of the population — are vaccinated. She brought no less an authority with her than Director of the National Institute of Allergy and Infectious Diseases (NIAID) Dr. Anthony Fauci to answer questions about the vaccine.

People flooded out to take selfies with Dr. Fauci, many telling him that he was “the only one we trust.” Many residents answered the door assuring the Mayor that they had been vaccinated. Still, Fauci’s message still met resistance, with residents citing misinformation, conspiracy theories and questions about ingredients.

Mother and daughter Esther and Natisha Brighthaupt answered the door of their home, Natisha’s four children behind them. Natisha said she still had issues with the vaccine. She said that she had heard the vaccine would not cure the disease and that it didn’t work. Esther said that she worried that getting the vaccine would make her contagious, and she would give the children the disease. “No, not at all,” Dr. Fauci told Esther, also reassuring her daughter of the vaccine’s efficacy. “In fact we’ve got to get you vaccinated; if you get infected, you can pass it on.”

On another street, 51-year-old Marine veteran Nate Ward told Fauci and Bowser that he was skeptical of the pandemic and the vaccine. He said the vaccine had been developed too quickly to be safe. “They’ve been working on the groundwork for this vaccine for twenty years,” Dr. Fauci told him. “It’s too quick, it’s too quick,” Ward interrupted.

Ward said that he was suspicious of a pandemic announced by the government that was so swiftly followed by a vaccine touted by the same government. “It’s about fear and control,” he said.

If There Are Outbreaks
If there are are community outbreaks, it is not clear what would happen. Can neighborhoods be isolated for lockdown? Would a mask mandate be re-imposed citywide? Epidemiologist Pedro Kremer said that both solutions are problematic. Isolating communities is difficult to implement, he said, and would shut down stores in areas where the economic reactivation is even more critical, redirecting spending (and contagion) to communities that are open for business.

Kremer said the more effective way would be to base mandates on the worst, rather than best performance. “[One can] base the relaxation of the mandates and measures not on general rates of cases and proportion of vaccinated population, but instead, restrictions would be lifted for all, or not, based on the status of the stratum with the worse performance,” Kremer said. “Those that are already doing well will complain, but [it] would be a potentially effective way to protect the underserved until they achieve better vaccination rates.”

The District may have reopened but DC Health has not yet scaled back its COVID forces. Face masks are still mandated in healthcare facilities, schools, shelters, correctional facilities and public transportation. Although there have been fewer cases in the community overall and no outbreaks throughout late May and June, DC Health COVID-19 outbreak response activities have not scaled back. The contact trace force and epidemiology teams are functioning seven days a week, said a representative, and data is continuously reviewed to identify clusters.

But, while DC Health has released guidance on best practices to prevent COVID-19 transmission in community facilities and businesses, the guidance for the community is really guidance for the individual. “People can make choices on what activities are safe for them taking into account their own vaccination status and the risk of the activity,” said a representative for DC Health.

With so many of the more affluent communities vaccinated, the burden of exercising that individual choice is falling on historically disadvantaged groups. Even as other parts of the city throw off their masks, those in low-vaccinated groups may continue to sicken and die in localized outbreaks unseen by the rest of the city and a nation that considers the pandemic to be over.

Learn more about getting vaccinated in DC by visiting coronavirus.dc.gov/page/get-vaccinated. Find a vaccine near you at vaccines.gov.

Can’t leave your home? Call 1-855-363-0333 and DC Health will bring the vaccine to you.

**An earlier version of this article attributed comments made by Nate Ward to Ambrose Lane. These comments were made by Nate Ward, not Ambrose Lane. East of the River sincerely apologizes to Mr. Lane for the error.