The first time I interviewed Dr. Gerard Jenkins, the chief medical officer at Native American Health Center in Fruitvale, it was mid-June and we were already three months into sheltering in place. Still, things felt a little brighter then. It was before COVID-19 case rates began to rise even more rapidly across the U.S., before OUSD schools announced campuses would be closed for physical instruction in the fall, and well before late-summer wildfires scorched over 3 million acres of the West Coast, leaving the Bay Area and much of California covered for days in blankets of dangerous smoke.

The pollution began to lift yesterday, mercifully. But the emergence of clear skies marked the end of a difficult week for the region. Nearly 14 people per day died from COVID-19 in the Bay Area during the seven days following Labor Day weekend, one of the deadliest weeks so far according to data compiled by The Mercury News. Meanwhile, Alameda on Monday became the first Bay Area county to record over 20,000 coronavirus cases, and roughly 40% of those are in Oakland. Nearly a quarter (4,704) of all coronavirus cases in the county are now concentrated in three East Oakland zip codes: 94601 (Fruitvale), 94621 (East Oakland), and 94603 (deep East Oakland). And within the last month, wildfire smoke derailed two large-scale COVID-testing events in those areas.

If ever there was a time to circle back to Dr. Jenkins, it seemed to be now. The NAHC clinic he oversees on 29th Avenue and International Boulevard serves Oakland residents with diverse health needs and from each of the three most-impacted zip codes. We spoke about the reasons for the high COVID rates in those areas, how community-based health providers are adjusting to meet the challenge, and what can be done to move the needle on COVID and underlying inequities impacting the health of residents in East Oakland. 

Our conversation has been edited for clarity and length.

When we spoke back in June, I imagined that the worst part of the pandemic would be behind us by now. But here we are, still in the thick of the crisis. Are you surprised by how the pandemic has unfolded over the last few months?

My feeling was that by the time the summer comes, the pandemic would be more controlled. That just didn’t happen, and there are a lot of reasons for that. Personally, I think it’s due to things we could have done legislatively to require people to wear a mask and other things—that just wasn’t done. And now we have a situation with air pollution and wildfires—and orange skies—that is highly unprecedented.

When you think about where we are now with the air quality and with COVID, and adding in the fact that flu season is just around the corner, we still have more battles to face. As a health care provider, that’s scary. Especially if the air quality doesn’t get back to normal quickly, because you’ll have people with symptoms not knowing: Is this COVID? Is this influenza? Is this asthma from pollutants? Chronic obstructive pulmonary disease? Is it something else? 

The complexity of what we’re heading into this fall is much more significant than where we were, even three months ago.

So we’re dealing with this complicated mesh of health issues, and all of them are hitting communities of color and low-income communities hard. The three Alameda County zip codes with the highest COVID infection rates, by far, are all in East Oakland. How do you see race and poverty intersecting with these public health crises?

In the area where I work there is a huge need already of people who need support with things like diabetes, hypertension, COP, congestive heart failure. And unfortunately what COVID and the wildfires have done is put more stress on those symptoms and that population. 

The wildfires and this smoke are hitting these communities hard, not because of their race or ethnicity but because there have been fewer resources traditionally put into these communities to make them healthy. 

And it’s the same with COVID. We know that traditionally, even prior to this, communities of color are more impacted by pollution—they tend to live in areas that have more exposure to pollutants and emissions—and it just compounds things even further. That’s the big picture.

From a medical standpoint, what needs to happen for us to see progress, particularly with COVID in East Oakland?

So that’s the next question: What do you do about that? And I’m going to be honest with you, I don’t have a silver bullet for that answer. But what I will say is that this is where putting in some extra time and resources makes a difference. Because if you have disproportionate health impacts in communities of color, then you need to put back in a disproportionate amount of resources and time to have a positive impact.

Now that being said, there are initiatives in the works—and Native American Health Center has been a part of some of them—to do further testing and offer support to some of those Black and Hispanic communities in East Oakland. We’ve partnered with UCSF to increase testing here in the Fruitvale, and we’ve been trying to enhance that with contact tracing.

What about individuals? Are there more things that people can do to protect themselves?

For patients, if you have questions or concerns, reach out to your health care provider for answers. And I know that seems obvious, but I’ll say this: There are a lot of patients I come across who have health providers but they don’t reach out for care. And I’m not saying that as a broad stereotype, but it does happen a lot. This is my opinion, also, from having grown up in Detroit, Michigan. There’s not always a push from people of color to address their health needs. 

There’s also an education component for those communities to say, “Hey, people care about you and care about your well being, so take the opportunity to reach out or call if you have a question.” And that’s something I’ve done a lot of recently—encouraging patients to touch base and follow up if they’re feeling ill, or short of breath, or coughing, so that we can do something to help. It does create a little more work on the health provider side to reach out, and that’s why I’m also saying we need more support and resources to help decrease those gaps. 

Are fewer patients physically coming into the clinic due to concerns about COVID and the air quality? Have you seen a drop off in the amount of care you’ve been able to provide?

When we switched over to telemedicine [since the pandemic] we actually had increased success with people who were willing to have those encounters, which is great. We wanted to limit the traffic here, for our safety and for the safety of the patients, however, there are some things you can‘t stop or minimize the number of people coming in for. 

What we found is that when we ask them to come in now, they’re coming in because they know it’s for a specific reason. Instead of saying, “Ok, you have to come back and see me in two months,” we’re saying, “Ok, Ms. Jones, I want to have you come back in two weeks because of a concern I have about your breathing on this visit,” or, “You have fluid in your lungs and I’m concerned about it.” 

So yes, we’ve had a decrease in people coming in due to COVID but I’ve found people have been more willing to come in for specific reasons when called, and have otherwise enjoyed the flexibility of having both video and telephone visits.

Are there other urgent public health issues you’re seeing now in the communities you serve that are flying under the radar because we’re so hyper-focused on COVID and the air quality?

Absolutely. If you don’t take care of the patient’s social issues, making a true impact on their health is just that much harder. If you look at homelessness and unemployment and those other social factors that have affected a lot of the African American, Latino, and Native American community in Oakland—when the economy was hit [by the pandemic], it adversely impacted them first and put them at a disadvantage. 

As a provider, how do you make an impact for someone who has heart failure, or has diabetes, or has pulmonary disease, and they don’t have a way to pay their rent? Or they just got evicted? Or they’re trying to make ends meet and can’t cover the cost of certain medications? Or blood pressure cuffs, which aren’t covered by Medicare, for example? Then you throw in COVID, and it just makes it incredibly hard. So I’m a firm believer that if you don’t take a multi-factorial approach to patient care that includes those social challenges they face on a daily basis—unless you’re really working on those in addition to the health, you can only get so far. 

People are worried about where they’re going to live, where they’re going to eat, how they’re going to take care of their kids. Diabetes, or even the air quality, is just a secondary thing for someone who can’t pay the rent. 

We’re also definitely having more people come in with anxiety and stress. And with the uncertainty of things in life, that’s to be expected to some extent. Thinking about 2020, there is just so much going on. Even for me, I’m like, what the hell happened this year? So there’s an increased need for mental health services, and there is going to continue to be an increased need for those skill sets in the near future here. 

What can our public institutions and health providers do better, that they aren’t already doing?

One thing to ask is, how do we improve testing? And not necessarily longer lines of people waiting for tests outside. Can we bring testing into homes, with testing kits? Can we develop things that are more rapid? Are we willing to invest the time, energy, and finances to support initiatives that help people adversely affected by COVID and wildfires? And do we have the ability and discipline to think about solutions that are more long-term and not just a patchwork for today? My opinion is that COVID is probably going to be here for another two to three years, unless we can develop a vaccine or we have a much better way to do testing. And wildfires, what you saw this summer, what you’re seeing right now with AQI, I don’t think that’s just going to go away, because of global warming. So I’m thinking two, three, four years out—what are the types of things we can start doing now to lay the groundwork for the future? 

I know that we’re thinking about that for our patients here at Native American Health Center. But in general, as a society and as an East Bay community, how do we get there? That’s something I’d love to participate in, but it’s also something that you need to have legislation or administration at a senior level to really work on. 

My criticism at the national level is that we never truly invested in ways to improve testing and contact tracing. It’s been very piecemeal and there’s been no national strategy. Yeah, that’s a political comment, but it’s also just the truth. And unless we have some of those things then I think we’re going to be treading water, unfortunately.