Health Advice



Q&A: When the surges just keep coming - A view from the COVID vortex

Jenny Gold, Kaiser Health News on

Published in Health & Fitness

Dr. Rais Vohra has impeccable timing. He stepped into his role as interim health officer of Fresno County just months before the start of the COVID-19 pandemic. Almost immediately, he found himself navigating the treacherous tensions between public health messaging and a skeptical population in a hub of industrial agriculture that is also one of the most politically conservative regions of California.

First came the anti-mask protests, amplified by vows from the county sheriff that her deputies would refuse to enforce the state’s mask mandate. Next was the vocal resentment of COVID-related business restrictions. Cap that off with roiling distrust of the new COVID-19 vaccines and a large migrant farmworker population with long-standing challenges accessing health care. Little surprise, then, that as of Dec. 3, about 55% of Fresno County residents were fully vaccinated, nearly 10 percentage points lower than the statewide average. In some rural pockets of the county, less than 40% of residents are fully vaccinated.

For almost two years, Vohra and the rest of the county’s health care system have struggled to keep up with what has felt like an unrelenting series of COVID-19 surges. The current wave has overwhelmed area hospitals, with emergency rooms so packed that ambulances line up for hours waiting to offload patients. Nearly 160,000 cases of COVID-19 have been recorded, and more than 2,200 residents have died.

Fresno County stretches over 6,000 square miles and includes the city of Fresno — the Central Valley’s urban core — as well as vast expanses of farmland. The county is home to about 1 million residents, a little more than half of whom are Latino.

Vohra, who is also a professor of clinical emergency medicine at UCSF Fresno, spoke with KHN’s Jenny Gold about the “why” behind the persistent surges and the toll on Fresno’s health care system. The conversation has been edited for length and clarity.

Q: Fresno County’s COVID hospitalization rate is four times what Los Angeles County is seeing and eight times San Francisco’s rate. Why?


A: The whole state experienced a surge in the fall. And when the surge resolved in the rest of the state, unfortunately our numbers did not come down. We plateaued. We may be having another surge this winter, so not to be able to recover our resources and give people time to debrief and think about how to prepare for the next one is obviously very concerning.

Our vaccination rates are not where we need them to be. The amount of masking that we have is definitely lower, and we weren’t able to get a mask mandate. We also have a lot of essential workers. A remote worker who can “Zoom in” is very different from someone who works at Foster Farms, who has to show up and doesn’t have any time off left. Every little thing is connected to every other little thing.

Q: Why does the county’s vaccination rate continue to lag behind rates in much of the state?

A: There are some people who are still struggling with access, and we’re absolutely trying to address that. Then there are other people who are just not accepting the science, and I don’t know how to get those folks to buy in. I think that the emotion comes first and the reasoning comes later.


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