When COVID-19 first became publicly available, demand overwhelmed supply, prompting urgent, even desperate, online searches for scarce appointments, followed by long lines and hours of waiting at super stations and clinics.

But after the initial, eager throngs had bared their deltoid muscles to needles inoculating them against the SARS-CoV-2 virus, crowds thinned and in time super stations — temporary facilities erected to vaccinate large numbers of persons quickly and safely — were closed.

Hundreds of millions of Americans have received at least one dose of vaccine. Roughly half of the nation’s population has been fully vaccinated. But early data also exposes a stark truth: Underrepresented groups in the United States are bearing a disproportionate number of COVID-19 cases and deaths and are accessing vaccines at much lower rates.

“There is no genetic predisposition to COVID-19. People of color are severely impacted because of social determinants of health and disparities that have not been addressed,” said Argentina Servin, MD, MPH, assistant professor in the Division of Infectious Diseases and Global Public Health at UC San Diego School of Medicine. “In a high-income country, like the U.S., we should not see these disparities and gaps.”

After watching friends and family suffer, and nearly losing her 80-year-old grandfather, Servin applied for and received a $3 million grant from the National Institute on Minority Health and Health Disparities, part of the National Institutes of Health, to design a program to increase outreach, access and use of COVID-19 vaccines among Latinx and Black communities in six of San Diego’s most heavily affected neighborhoods.

Dubbed “Project 2VIDA!,” Servin and colleagues formed an intervention working group comprised of representatives from community and academic organizations to address challenges in the communities of San Ysidro, Chula Vista, National City, Logan Heights, Lincoln Park and Valencia Park.

The approach was founded on community-based participatory research. Rather than sit behind computers, the team donned their most comfortable walking shoes and canvassed homes and greeted patrons at cafés, grocery stores and other local businesses, engaging residents with questions related to vaccine hesitancy, addressing widespread misinformation and encouraging them to be vaccinated at one of the Project 2VIDA! mobile vaccine units or with its collaborator San Ysidro Health.

But public confidence in vaccination is fragile, especially among communities long suspicious about historical or institutional motivations. Servin said Project 2VIDA! is fighting an uphill battle against myths. Individuals say they do not want to be immunized for fear that the vaccines carry microchips that track their movements. They fear vaccine-induced infertility or safety due to a “rushed” launch. These misconceptions are all false, yet unfortunately common, experts say.

“We have to remind community members that vaccines have helped save millions of lives. Just a few generations ago, people lived under the constant threat of deadly infectious diseases, like smallpox, polio, hepatitis and the flu,” said Adriana Bearse, promotion manager in the San Ysidro Health Research and Health Promotion Department.

Because the COVID-19 vaccine is an important part of stopping the pandemic, Servin said Project 2VIDA! seeks to implement and assess a COVID-19 vaccination protocol and establish a model for the rapid vaccination of Latinx and Black adults that can be implemented in other impacted communities.

Beyond community
borders

Since no virus, recognizes borders, the binational region comprised of San Diego and Baja California, Mexico is significantly impacted by the pandemic.

Linda Hill, MD, MPH, professor and interim assistant dean for Community Border Health Partnerships in The Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego, has spent most of her career addressing the public health needs of migrant workers, immigrants and refugees.

In late-2018, Hill began supporting government agencies with health screenings for asylum seekers entering the U.S., using a congregate sheltering model. At the time, she and a team of community and UC San Diego Health doctors were treating infectious diseases, such as scabies, chickenpox and influenza, but nothing as severe as COVID-19.

Since starting the asylum program in 2021, qualifying persons are now housed in hotel rooms to reduce the risk of contracting and spreading COVID-19. Hill and her team of community health workers and medical providers screen for COVID-19 and conduct house calls for approximately 250 guests per day, checking on pregnant women, providing hypertension medicine and other medications, and caring for acute illnesses. The team has been working seven days a week since March 1, 2021.

It’s a labor of love made up of a community of students from UC San Diego, San Diego State University and the University of San Diego; community health workers; medical residents from UC San Diego Health, Kaiser Health and Scripps Health; and clinicians from UC San Diego Health and the community.

“With 200 arrivals a day, and the challenges of travelers in a pandemic, in no time at all you have 600 people under your care,” said Hill. But Hill said the long hours are worth it, with the added bonus of having trainee participation.

“We are building future public health professionals who will understand and care for displaced populations, who will be committed to providing culturally competent care and who will address diversity and equity,” she said.

Hill has also been involved in projects managing the impact of COVID-19 on vulnerable populations in Mexico. Early in the pandemic, the Mexican border town of Tijuana was devastated by severe cases of COVID-19 and local hospitals experienced shortages of personal protective equipment for health care providers treating critically ill patients.

UC San Diego Health formed Aliados por Salud, a volunteer team of critical care doctors, nurses and respiratory therapists who collaborated daily with counterparts at Tijuana General Hospital to combine their knowledge and experience on how best to treat patients diagnosed with COVID-19.

For six months, the two hospital systems worked and learned together to manage severe cases and to secure donations of masks, face shields, goggles, pulse oximetry units and other supplies for Tijuana General Hospital.

In 2021, Hill and other UC San Diego colleagues, including Timothy Rodwell, MD, PhD, MPH; Richard Garfein, PhD, MPH; and Steffanie Strathdee, PhD, joined the Consulate General of Mexico in San Diego and various health agencies and universities in Baja California to conduct a survey of the prevalence of COVID-19 in the Mexican cities of Tijuana, Mexicali and Ensenada.

“This project is an example of binational cooperation and collaboration — government, academia and non-governmental organizations coming together to design public policies for the prevention, management and eventual eradication of COVID-19,” said Hill.

“Working directly in the communities most affected by disease or illness allows us to find innovative solutions that address unique challenges and have the greatest impact where it is needed most.”

Down on one knee in pristine white coats, UC San Diego School of Medicine students rallied against a public health emergency — systemic racism — that had been catapulted into the public eye by the death of five African Americans in five separate incidents over a five-month period in 2020.

Ahmaud Arbery was gunned down while jogging. Breonna Taylor was shot and killed during a botched police raid on her apartment. Daniel Prude and George Floyd both died while under police restraint: Prude while suffering from a mental health episode, Floyd for suspicion of using a counterfeit $20 bill. Rayshard Brooks was fatally shot by police responding to a call of a man asleep in his car at a fast-food restaurant.

Betial Asmerom, a fourth-year medical student and one of the organizers of the student protest, said that for years Black, Latino and Indigenous medical students had been organizing to call attention to racism and disparities in medical education and health care.

The deaths of Arbery, Taylor, Prude, Floyd and Brooks resulted in wide-scale demonstrations protesting police abuse and racial injustice in the United States.

Students like Asmerom choose medical education as a way to learn how to heal. In a country roiling with anger, racial tensions and despair, they felt the call to heal even stronger. But it would not be an easy task, and the concurrent COVID-19 pandemic, which was disproportionately impacting communities of color, would only make things harder.

“My family are immigrants from Eritrea. I chose medicine because I want to serve my community and all communities impacted by inequity,” said Asmerom, who is enrolled in a dual-degree program called the UC San Diego School of Medicine Program in Medical Education – Health Equity. She has already earned her master’s degree in public health, with her medical degree soon to follow.

The collision of the anti-racism movement and glaring health care inequities sharpened by the pandemic prompted Asmerom to speak out louder and more boldly.

“When we first started hearing about the pandemic and all the data coming out, one of the first things I said was ‘I can’t wait until data on the pandemic is published by race. I already know what it’s going to say,’” said Asmerom.

“These events really lit me up to keep my focus on equity and advocacy work because we’ve seen, in the pandemic, how people of color have been disproportionately impacted, and yet not prioritized in the solutions to mitigate the impact of the pandemic.”

Black medical students at UC San Diego did not mince their words. In a publicly published letter, they wrote that they were “tired of asking our institutions to be better for us and for society.” They called for a commitment from both the university and the health system to become anti-racist institutions.

Leadership heard the concerns, fears and worries of not just students, but the echoing words of faculty and staff. They identified four immediate actions to foster an environment supportive of Black and underrepresented minorities in medicine.

Among the steps was mandating an anti-racism training program; implementing a new policy to address racism and discrimination from patients and visitors at UC San Diego Health hospitals and clinics; hiring leaders in equity, diversity and inclusion for UC San Diego Health Sciences and the health system; and the creation of an Anti-Racism Task Force.

Because of her leadership roles in regional and national student organizations and her commitment to equity, UC San Diego Health CEO  Patricia Maysent hired Asmerom as a project consultant on anti-racism initiatives for the health system.

Among Asmerom’s proudest achievements as a consultant is her role on the COVID-19 vaccine committee.

UC San Diego Health collaborated with community-based organizations to deploy mobile vaccine clinics into the San Diego communities most impacted by COVID-19 in order to reach more patients more effectively, and help ease barriers, such as access, lack of transportation to vaccine appointment sites and distrust in health care providers outside of local communities.

“Being able to help with equitable vaccine distribution, and doing it in a way that intentionally centers on the needs of minoritized communities, represents the kind of care I want to provide as a physician, and I get to do it while still in medical school. I see the impact on communities that look like me. I see the gratitude on their faces. I get to use these platforms to ensure that my community is taken care of in a meaningful way,” said Asmerom.

“I hope that this momentum is not lost, that we continue to center equity and talk about racism in a really honest and authentic way so that we continue to make strides toward making UC San Diego, the medical school, the health system and the country a more equitable place for Black, Indigenous, Latinx and other minoritized groups. We cannot fall back into a pattern of ignoring the people who are the most marginalized and hurt by inequitable systems.”

One adverse side effect of pandemics is the corresponding outbreak of misinformation and scams, the latter both medical and financial. They are as inevitable as, well, the pandemics themselves.

The spread of misinformation, intentional or not, has been rampant during the COVID-19 pandemic.

A Brookings Institution study in late-2020, using monthly data from the Franklin Templeton-Gallup Economics of Recovery Study, found significant variation in understanding of COVID-19 facts which, in turn, distorted public policies and behaviors.

Not all of the misinformation, particularly on social media, was promulgated by human beings, however. At least not directly. For example, in a research letter published June 7, 2021, in JAMA Internal Medicine, a diverse team that included UC San Diego scientists found that significant misinformation about face masks and COVID-19 was spread by “bots,” autonomous software programs that allow individuals to generate content and share it broadly via numerous automated accounts, amplifying messaging.

Specifically, first author John W. Ayers, PhD, associate professor in the Division of Infectious Diseases and Global Public Health at UC San Diego School of Medicine, and colleagues measured how quickly links were shared in a sample of 300,000 posts to Facebook groups that shared 251,655 links. They found that links shared by Facebook groups most influenced by bots averaged 4.28 seconds between shares, compared to 4.35 hours for Facebook groups least influenced by bots.

One in five of the posts made to Facebook groups most influenced by bots claimed masks harmed the wearer, contrary to scientific evidence. The World Health Organization has called the phenomenon an “infodemic of misinformation.” While the purpose of misinformation is to give it freely and often, the COVID-19 pandemic also provoked an abundance of efforts to essentially take, mostly money in the form of bogus COVID-19 products and therapies.

Writing in the August 25, 2020 issue of the Journal of Medical Internet Research Public Health and Surveillance, UC San Diego School of Medicine researchers found thousands of social media posts on two popular platforms — Twitter and Instagram — tied to financial scams and possible counterfeit goods specific to COVID-19 products and unapproved treatments.

Lead author Timothy Mackey, PhD, associate professor in the Department of Anesthesiology, and colleagues surveyed the internet between March and May 2020 using a combination of Natural Language Processing and machine learning to identify nearly 2,000 fraudulent postings “likely tied to fake COVID-19 health products, financial scams and other consumer risk.”

Mackey’s research team continues to do research on fake COVID-19 products, including vaccines and vaccination cards, through a sponsored project with Google.

“We’re in a post-digital era and as this boom of digital adoption continues,” said Mackey, “we will see more of these fraudulent postings targeting consumers as criminals seek to take advantage of those in need during times of a crisis.”

UC San Diego entered 2020 in growth mode, well-positioned to advance progress toward the goals outlined in its long-term strategic plan to drive the physical, intellectual and cultural transformation of the university.

But the emerging public health crisis in Wuhan, China led renowned infectious disease expert Robert “Chip” Schooley, MD, professor of medicine and chief of the Division of Infectious Diseases at UC San Diego Health to ask UC San Diego Chancellor Pradeep K. Khosla what the university would do if forced to shut down for a prolonged period of time in response to the crisis.

While some universities took a wait-and-see approach, Khosla recognized the seriousness of the situation and knew that thoughtful and immediate action was necessary. He considered the university’s vast human, research and infrastructure resources, and knew UC San Diego was uniquely suited to address this challenge head-on.

Early action
was key

Khosla embraced the university’s deeply ingrained, interdisciplinary ethos to assemble experts from UC San Diego’s faculty, administration and staff to form a task force that could evaluate the rapidly changing situation, regionally and globally. “We assembled our emergency operations centers (EOC) for our campus and for our hospitals. The EOCs explored options and models for impacted operations,” said Khosla. “So, when the state mandated the shutdown in March 2020, we were already a step ahead.”

Students, faculty and staff were sent home. Mechanisms and platforms were quickly stood up and communicated to ensure everyone was supported through the transition. Remote operations were stabilized. A newly-formed Campus Operations Group rolled up its collective sleeves. And the necessary work of understanding detection, intervention and mitigation of the COVID-19 virus began with a singular goal: to return to in-person learning, research and service to the community in the safest way possible.

Return
to Learn

On May 5, 2020, UC San Diego became the first university to announce a commitment to incrementally bring back a portion of its campus population in Fall 2020 through a flexible, multilayered and data-driven approach called Return to Learn or RTL.

RTL was built upon three key pillars: risk mitigation, viral detection and intervention. Khosla often referred to the approach as a “Swiss cheese” model. “Every layer has its holes,” Khosla told The New York Times in December 2020. “But put together, it’s a solid block.” Hundreds of employees and students successfully built and tested new systems and protocols on campus with a limited number of students, researchers, faculty and staff in advance of the fall quarter to ensure the feasibility and scalability of the plan. 

A Campus
reimagined

Faculty reconfigured instruction for remote and hybrid learning, ensuring that the academic rigor of the university was upheld. Staff reimagined nearly every service to ensure access to important resources. UC San Diego’s Facilities Management team, with help from the university’s engineering experts, reconfigured the campus environment, including traffic flow.

Academic buildings, residence halls and retail and dining facilities were adapted to provide one-way traffic into and out of spaces. Experts like Kimberly A. Prather, PhD, UC San Diego Distinguished Professor and Distinguished Chair in Atmospheric Chemistry, served as a resource to guide updates and adaptations to airflow in campus buildings, helping promote circulation of fresh air flow and reduce disease transmission risks.

More than 200 critical custodial staff were devoted to enhanced cleaning and sanitization protocols, disinfecting light switches, elevator buttons, desk tops and other surfaces twice daily. And 1,500 hand-sanitizing stations were installed across campus.

Ready to
return

With confidence built through practice, UC San Diego put its plan into action and successfully welcomed 5,730 undergraduate students back to a transformed campus for the Fall 2020 quarter. Returning students were introduced to new safety protocols, including mandatory testing during move-in. The Student Code of Conduct was updated to establish clear expectations for student behavior and to remind students of the health consequences of risky behaviors.

On-campus residence housing was limited to 50 percent capacity, with all students residing in single-occupancy rooms. More than 600 beds on campus were reallocated to serve as isolation and quarantine housing for students who received a positive COVID-19 test result. These students would receive special support and access to care.

Bright banners, flags and digital signage were placed on light posts, public transportation, buildings and elsewhere throughout campus to encourage students and to keep safety awareness high. Ground markings signaling physical distance were located where students tended to congregate.

Case rates
remain low

UC San Diego defied the odds and demonstrated that a successful return to campus was possible. The 14-day COVID-19 positivity rate for UC San Diego students on and off campus averaged between 0.12 percent and 0.87 percent throughout Fall 2020. During that time, the positivity rate in San Diego County averaged between 2.7 and 8.7 percent.

A surge was anticipated when students returned from winter break in 2021, but the university was willing to increase campus density because the data was clear: The approach was working, and new innovations, such as the vending machines, were making it easier for students to comply with testing requirements and adhere to safety protocols.

Nurturing
community

There was a fourth and critical element to the success of RTL: students. The weakest link in any plan is human behavior. The nation saw this play out as other universities struggled to contain the virus after reopening their campuses in the fall of 2020.

But UC San Diego’s commitment to inclusion and innovation meant that students were involved in RTL from its inception. They were empowered to own the issue, plan and implement approaches in ways that worked.

By making meaningful contributions, the student community was invested in creating and sustaining a safe and fulfilling on-campus experience for everyone. Student leaders and Student Affairs came up with novel ways to engage students, including the creation of Triton Health Ambassadors.

More than 400 trained peer ambassadors/educators, easily recognizable by their bright yellow shirts, positioned themselves across campus to personally engage with students and provide important support by “catching” and recognizing positive behaviors and serving as resources for students seeking information.

“Our students behaved in an exemplary manner. I mean it was unbelievable,” Khosla said in an April 2021 interview with KPBS-TV. “We were expecting it, and they beat our expectations and then some. To me, they were the reason we were so successful.”