Patterns of where people are exposed to COVID-19 differ for communities of color and across geographic areas

For many communities of color and for communities in south King County – who have been suffering from higher rates of COVID-19 since last spring – a new report shows additional differences by race and geography. 

The new report on outbreaks and exposure settings from Public Health—Seattle & King County describes where people may have become infected with the novel coronavirus. The report finds King County’s most commonly reported sources of potential exposure in recent weeks are in households and in community or social gatherings. Gatherings include get-togethers with family and friends, house or dinner parties, larger celebrations such as weddings, activities at a place of worship, or visiting restaurants and other businesses. This is different from early in the pandemic, when most cases were concentrated in long-term care facilities. (Please see a detailed discussion of the report in our companion blog)

However, the data reflect that in communities with higher rates of COVID-19, workplaces and households are more frequently reported as a potential exposure setting, in addition to community or social gatherings. This helps show why it’s important that employers take steps to help protect workers and that everyone takes steps to reduce their risk and COVID-19 spread in the community.

The pandemic has hit four racial/ethnic communities particularly hard (American Indian/Alaska Native, Black, Hispanic/Latinx, and Native Hawaiian/Pacific Islander), as reflected in Public Health’s race/ethnicity data dashboard. These racial inequities are rooted in factors such as work, housing, healthcare access, and wealth – factors impacted by structural racism that require deep investment and commitment to address.

These inequities are major drivers of where people live and work – and the fact that not everyone has the same options to limit their exposure to the coronavirus. It’s the latest example of how racism is causing persistent harm to the health of residents, which is why King County has declared that racism is a public health crisis.

Communities are taking extra measures to support residents because of this underlying racism. For example, with support from King County, they have been distributing additional masks to residents, providing food and food vouchers so people can stay at home, and providing extra assistance with rent and utilities payments.

Reviewing the data: Where and how communities of color are impacted

Across different communities, people are getting exposed to COVID-19 in many of the same ways, but to different degrees. This is noticeable when looking at a section of the report on “most likely” exposure settings. It compares settings such as households, workplaces, and community or social gatherings over the most recent 60-day period (Sept. 22 to Nov. 20).

• Disproportionate impact in Workplace Settings (not including healthcare workers):  Hispanic/Latinx residents had the highest proportion of likely exposures in non-healthcare workplaces (with 29% of exposures in these locations). The proportion of workplace exposures was 26% among American Indian/Alaskan Native residents. Among Black, Asian, Native Hawaiian/Pacific Islander and White residents, approximately 22% of cases had likely workplace exposures.

• Disproportionate impact in Healthcare Settings (healthcare workers as well as patients and visitors, including long-term care facility outbreaks): Among Black residents, 15% of cases had likely exposures within a healthcare setting (with 52% of these being healthcare workers). This is a higher proportion than any other race/ethnicity group.

• Community/Social Gatherings: White residents more often had community/social settings, outside of workplaces or healthcare, as the likely source of their exposure (25%) than other race/ethnicity groups. For communities of color, social gatherings were likely exposure settings for American Indian/Alaska Native residents at 23% and Native Hawaiian/Pacific Islander residents at 16%. The county average was 18%.

Most likely exposure settings within the past 60 days (Sept. 22-Nov. 20) by race/ethnicity

Data for geography also shows different exposure patterns

This report shows differences in exposure settings as experienced by residents depending on where in the county people live.

For example, in the north Seattle/Shoreline area, 35% of the likely exposures are at community or social gatherings – settings that are typically optional to visit. That’s more than double the rate for community or social gatherings in the Auburn/Federal Way/Kent area and the Renton/Burien/SeaTac/Tukwila area (at about 14% each).

But when it comes to workplaces (not an optional setting), in north Seattle/Shoreline only 13% of likely exposures were in a non-healthcare workplace, while the rates are almost double that in south King County cities. 

How common are exposure settings in three geographic areas?

	North Seattle/Shoreline	Auburn/Federal Way/Kent	Renton/Burien/ SeaTac/Tukwila
Community/social gatherings	35%	14%	14%
Non-healthcare workplaces	13%	22%	25%

Reinforcing what we suspect about root causes

This report adds detail about two of the key root causes identified early in the pandemic for why communities of color carry a disproportionate burden from COVID-19:

• Living in larger and/or multi-generational households, making it harder to limit exposure within households
• Over-representation among essential workers who have to be at job sites and commute during the pandemic

These two root causes may compound each other, when multiple residents work as essential workers in different locations, or at multiple jobs, and return home under one roof. That increases the likelihood that someone could expose someone else in the household. 

There are additional underlying root causes that don’t directly relate to where people are getting exposed to the virus but are likely contributing to the racial and geographic inequities. These include access to health care, testing, and social determinants of health, such as quality education and healthy foods. These in turn impact people’s underlying health status. These challenges make it even more difficult for people to protect themselves and their families from COVID-19. To learn more about the impacts of the pandemic in these areas, please view the Economic/Social/Health impacts dashboard.

Importantly, many immigrant families have also been excluded from unemployment benefits and federal stimulus payments, adding to the pressures of having to work in-person.

Support for workers, employers, communities

King County is committed to supporting and protecting communities most impacted by COVID-19.

Preventing COVID-19 spread among workers and at workplaces:

• Public Health has published a list of resources and frequent questions for workers. 
• Employers should be requiring face coverings and keeping six-foot separation or physical barriers between workers in all interactions at all times.
• Public Health strongly encourages employers to offer sufficient paid sick leave for any employees who test positive for novel coronavirus, or who need to quarantine because they were exposed to someone with COVID-19 or need to care for a loved one who has COVID-19. It’s very important that anyone who tests positive or has been exposed to COVID-19 completes their full isolation/quarantine period. Employers should ensure that policies regarding staying home when sick or exposed are clearly communicated to all employees, especially supervisors.
• Workers can file a complaint about employers violating COVID-19 safety standards by calling the Washington State Department of Labor and Industries at 360-902-5800.
• Public Health’s SSTAR program for restaurants and bars is providing technical assistance for preventing COVID-19 in restaurants and bars based on the geographic and racial/ethnic communities facing the biggest inequities. 

Strategies to support communities have included:

• Making a large investment in creating free and open access COVID-19 testing sites in south King County and south Seattle, to make it easier for people of color to get tested. Getting tested is a key step in limiting the spread of coronavirus.
• Purchasing hotels to temporarily house people who don’t have an adequate space to isolate or quarantine.
• Providing supports to individuals and households who need to isolate and quarantine (e.g., groceries, connection with medical care, and stipends for eligible low-income workers). 
• Hiring staff for contact tracing who have language skills and represent communities most negatively impacted.
• Creating a Pandemic and Racism Community Advisory Group and task forces, and hiring Community Navigators to serve as community liaisons. These groups and individuals are trusted messengers in the community. They bring information and requests from communities to Public Health—guiding decision-making and strategy development for the pandemic response.
• Creating a Business and Community Call Center (206-296-1608) that provides support and answers questions for employers (especially small businesses) and employees.
• Communicating through local ethnic media and targeted social media to bring information to communities. Communications have included co-creating messaging with community members, a Spanish Facebook page, translations of resources into Spanish and other languages, and weekly live discussions in Spanish via Zoom and Facebook.  

Additional Resources

• If you believe your employer is violating COVID-19 safety standards, you can get more information and report a complaint with the WA State Department of Labor and Industries (L&I), by calling 360-902-5800. Complaints will be investigated regardless of the immigration status of the employee.
• COVID-19 Prevention in the Workplace (L&I factsheet)
• King County’s Safe Start for Businesses and Workplaces – website with resources

  Originally posted November 25, 2020