Health in California two years after the start of the pandemic

This article is part of a series reflecting California’s experience with the COVID-19 pandemic.

The rapid spread of COVID-19 two years ago led California to declare a public health emergency, a state of emergency that remains in effect until March. The heaviest burdens of the pandemic — death, disease and economic hardship — have fallen disproportionately on Californians who are low-income, black, Latino or frontline workers. The pandemic has not only exposed entrenched health disparities among certain groups, but it has also underscored how critical insurance coverage and access to health care is for all Californians.

The death rate of COVID-19

Nearly 84,000 Californians have died from COVID-19 since the pandemic began, or about 212 deaths per 100,000 people, according to state data. Older Californians died at much higher rates than younger adults, with about 985 deaths per 100,000 people aged 65 and older, compared to about 102 deaths per 100,000 for adults under 65.

Disparities were also marked by race and ethnicity. Black residents died at a 37% higher rate than white residents; for Latino residents, death rates were 20% higher.

The higher death toll among Latinos is particularly troubling given their younger age profile compared to whites. Latinos account for 44% of COVID-related deaths, but only about 36% of California residents over the age of 18, masking larger disparities for certain age groups, including some younger Latinos. For example, nearly two-thirds of COVID-related deaths among adults under 50 are Latinos, who make up less than half of the state’s population in that age group.

COVID vaccination

Less than a year ago, in May 2021, Californians over the age of 12 became eligible for a free COVID vaccine — older Californians and those with certain health conditions were eligible earlier. California has since made good progress on vaccinate residents; about 83% of eligible Californians (ages 5 and older) had received at least one dose of the vaccine by March 1, 2022, although only about 57% of eligible people had received a booster shot.

Vaccination rates vary among various regions and communities in California. Small northern counties have some of the lowest overall rates – in some places less than 50% of the population has been vaccinated. San Joaquin Valley counties and other inland areas have lower vaccination rates than the Bay Area and coastal counties.

Medi-Cal’s role in the pandemic

Medi-Cal now covers more than a third of state residents. As of October 2021, 14.3 million low-income residents were registered. Program enrollment has increased as the state suspends periodic eligibility checks due to COVID-19, a decision the federal government demanded from states in exchange for increased funding during the public health emergency .

There is also new flexibility around reimbursement during the pandemic, where patients can switch to telehealth if in-person visits appear to be a risk. And Medi-Cal covers COVID-19 treatment for all low-income Californians who get sick, regardless of immigration status. Currently, COVID vaccination rates among those covered by Medi-Cal are more than 25 percentage points lower than those of all Californians.

Changes in the health workforce

After layoffs at the start of the pandemic and the departure of workers as the crisis persisted, health care now faces a staff shortage. Nurses exhausted by COVID-19 quit their jobs, leading to a shortage of nurses in California hospitals.

The profession is also losing some of its most experienced workers. Numerous retired older registered nurses in 2020, or said they intend to retire or leave nursing within the next two years, furthering the shortage.

Look forward

California public health emergency could end at the end of March, while the federal declaration could end in mid-April. Medi-Cal will then resume eligibility reviews, and many Californians could lose their coverage if their income or family situation has changed or if they fail to complete the required forms. The state will also lose increased federal Medi-Cal funding received throughout the pandemic.

Even as pandemic policies fade, projects stalled by the pandemic return – the Healthy California Commission for All again analyzes how the state can provide affordable health coverage to all state residents. Information from the commission’s next report will be invaluable in providing Californians with access to the medical care they need.

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