Californian special report: The pandemic may be over but symptoms linger | News

People and institutions have responded to the pandemic in ways helpful and not. Adaptations were forced on people that maybe should have happened long before, like greater use of telemedicine and a frank discussion of mental health, while scars remain in areas like health care staffing and educational achievement.

Some of these impacts are expected to linger for years before they are finally resolved. Others will likely remain, locally and across the country, as the vestiges of an event that shook the foundations of modern life.

The health care industry, as the front line of humanity’s struggle against the coronavirus crisis, has emerged fundamentally different than it was in 2019. Burned-out workers fled in droves and hospital budgets all but collapsed under the strain of the pandemic — but there, too, perseverance bore fruit.

President Jason Wells of Adventist Health’s Central California network said it was “an amazing thing” to see hospital workers cooperate as they did during what proved to be a very long three years. Even competing medical centers have learned to collaborate to reach their shared goal of a healthier local community, he noted.

“Those who have stayed, I think there’s a resilience and a teamwork,” Wells said. “People have pulled together.”

The pandemic’s continuing impacts reach well beyond medical and mental health care. Schools around the county have embraced new modes of student and community support, while local government has accomplished priorities that otherwise would have been deferred indefinitely.

For some, office life has been upturned by a new willingness to let employees work from home. Social distancing and improved sanitation practices have redrawn workplaces, as has consumers’ shift to greater use of takeout and drive-thru options.

Churches have had to make adjustments, too, along with small local businesses that in many cases survived the pandemic only to encounter new challenges such as inflation, higher interest rates, and difficulties getting crucial materials and services.

One of the biggest pandemic impacts Brynn Carrigan has seen as director of the Kern County Public Health Services Department is fallout from large-scale neglect of physical and mental health. She said preventive care suffered when people lost their personal medical providers, either because their physician retired or burned out. As a result, conditions requiring regular treatment worsened.

Even now, Carrigan said, many patients rely on emergency services, evident in an increase in calls for ambulances. She noted the county tries to mitigate the surge by having paramedics persuade patients to speak by phone with a physician who can assess the severity of the situation. The idea is to decide quickly whether primary care might be more appropriate than tapping understaffed emergency medical crews.

The widespread shortage of clinical and nonclinical health care workers has raised labor costs by 20 percent as supplies have risen by the same amount, said Wells, who recently assumed his position at Adventist. And yet, he said reimbursement rate increases by private insurers have been limited to single digits.

“It’s not covering the gap,” Wells said.

Another lingering effect of the pandemic relates to security: Hospitals have had to spend heavily on new systems and training to help staff deal with patients and other visitors whose pent-up frustrations, Wells said, have resulted in verbal and even physical abuse.

Like Adventist, Dignity Health, another faith-based hospital chain operating locally, is doing what it can to not only recruit nurses and other medical workers but also work more closely with the schools that train them.

“We are doing what we can to address this challenge, including partnering with nursing schools across the state to grow and diversify the workforce,” President and CEO Ken Keller of Dignity Health Bakersfield Memorial Hospital said in an email statement.

Medical Officer Ghassan Jamaleddine at Adventist Health Kern County said the pandemic’s pivot to telehealth has widened access to medical specialists without unduly limited government reimbursement for services.

Another priority that has become more pronounced during the last three years, Jamaleddine said, has been attention to socioeconomic health disparities. He said the entire industry has recognized that poorer communities — Hispanic and African American, in particular — suffer disproportionately from ailments like obesity, diabetes and hypertension.

“It’s going to be very important in our future to really address health care disparity, and to look at health care in a different lens,” he said.

Along with physical illness, the pandemic took a big toll on mental health as people — especially adolescents — suffered from the effects of isolation.

Stacy Kuwahara, Kern County’s behavioral health director, said depression and anxiety rose markedly during the pandemic. She blamed limited social interaction, remote learning and inability to carry out normal daily routines.

The good news, she said, is that less stigma is now attached to reaching out for mental health care.

“People are much more comfortable and the conversation around mental health is much more socially acceptable,” Kuwahara said.

Telehealth has helped widen access to care, she noted, but unmet needs remain. Calls to the county’s crisis phone line have increased, she added, while people with private insurance struggle to find counselors available to help them, leading to greater use of smartphone apps designed to address mental illness.

Another bright spot she pointed to was government intervention. County government has expanded the range and depth of services it provides, especially those geared toward youth.

Schools are playing a bigger role in filling that gap, said Kern County Superintendent of Schools Mary Barlow. After having a harder time assessing students’ mental health, and therefore failing to make necessary referrals, local schools are now doing more to provide the behavioral health care students need, she said.

That said, returning to in-person classes has proved a big help.

“They (students) came back and it was drastic — the difference we were seeing and the overall wellness,” Barlow said.

Apart from mental health outcomes, Barlow sees two sides to the pandemic’s effects on local education: good and not-so-good.

She said there has been a new, communitywide appreciation for the integral role schools play in a well-functioning community. Services like free meals have filled unmet needs in poor neighborhoods, she added, and local school districts’ provision of electronic devices and mobile internet hot spots have benefited students and parents alike in ways likely to promote academic success well into the future.

But local data on testing and attendance makes clear the scope of challenges that still lie ahead.

In the three years leading up to the 2021-22 school year, the share of Kern County students meeting or exceeding math standards dropped from 28.8 percent to 21.3. That’s a decline 1.2 percentage points worse than California students as a whole fared during the same period.

The data shows local students’ English and language arts learning also suffered during the pandemic, going from 43.4 percent proficiency to 37.9 over those three years. Again, the corresponding statewide differential was less, by 1.5 points.

Data also shows student attendance at schools in the county slipped 1.4 percent in the two years after 198,910 students were in class on the first Wednesday of October 2019.

But in a more positive sign, attendance has recovered, year-to-date, to 93 percent after year-end enrollment dropped in the last school year to 90 percent from 96 in the 2019-20 school year.

Barlow said work being done to address the gap ranges from extended, more flexible school hours and added classroom time during intercession periods like winter, spring and summer breaks.

“It’s going to take time. It’s not a quick fix,” she said. “It’s going to take, in some cases, two years.”

Barlow pointed to other changes stemming from the pandemic, like a closer focus on hand-washing and custodial practices that have helped in controlling communicable diseases. And while it has become apparent most students do much better with in-class instruction than online education, she said such modes still offer benefits for certain applications and forms of advanced learning.

When the economy more or less shut down about three years ago because of pandemic restrictions, and the federal government responded with a pair of massive spending packages, money flowing through local programs proved vital in some ways. Those dollars continue to ripple through local communities.

Kern County received about $157 million in 2020 from the federal Coronavirus Aid, Relief and Economic Security Act, known as CARES. Because the money wasn’t intended to support regular government business, it went elsewhere, including a $30 million fund that helped local businesses stay afloat and an additional $1 million for struggling nonprofits countywide.

County government responded in other ways, too, giving out masks, gloves and other personal protective equipment, launching COVID-19 testing programs and vaccination clinics when the vaccine became available.

As noted by Kern’s chief operations officer, James Zervis, the county gave $114 million to local hospitals as reimbursement for the cost of keeping nurses in local intensive care units. It also gave $2 million to local special districts that had otherwise received no federal monetary support.

The second major federal program, the American Rescue Plan Act, provided about $175 million in local financial support in 2021 and 2022. While much of that money remains to be spent, what has already been invested has gone to projects ranging from sidewalk and drainage improvements, park upgrades and expanded shelters for people living on the street.

“We’re very busy right now,” Zervis said, noting that the county continues to update how it is spending the federal money on a public portal online.

The city of Bakersfield also received federal money — $20.4 million in CARES for a rental assistance program and $94 million from ARPA — in addition to $33.5 million from the state of California to support pandemic recovery.

City Manager Christian Clegg said Bakersfield was able to avoid the budgetary impacts other cities experienced because of the area’s income from ag and oil activities. That allowed it to put more money toward priorities such as affordable housing and improving underserved neighborhoods, giving them new sewer lines, putting their utility lines underground and sprucing up rundown business districts with new facades.

“These are projects that would have taken us a really long time to get to,” he said.

The city, like the county, devoted some of the money to providing PPE and giving grants to nonprofits and small businesses in need. Some of the money has stayed with the municipal government, however, as it deals with higher costs related to supplies, contractors and employee wages.

The pandemic’s impact on local business has varied widely, from supply chain and labor force problems to a surge in entrepreneurship. Often overlooked is the somewhat surprising outcome that so many businesses survived at all.

Kelly Bearden has kept busy through the ordeal providing business owners with information about recovery programs and other opportunities as director of Cal State Bakersfield’s Small Business Development Center.

Although government efforts helped many businesses pull through the pandemic, Bearden said there was a sense that smaller operators weren’t able to seize their fair share of the money. Demand was so high among hard-hit restaurants that an assistance program set up specifically for them fell short, he said.

Even now, as hospitality businesses like hotels and eateries enjoy strong sales, he said many have been clobbered by inflation and minimum-wage increases.

“Labor-intensive businesses continue to express quite a bit of concern,” Bearden said. He added that businesses that received federal emergency disaster loans are now having to deal with tough economic conditions as their first payments come due.

President and CEO A.J. Antongiovanni of Bakersfield-based Mission Bank said most of his customers are back to “business as usual” after experiencing steep challenges during the pandemic. Even so, some continue to wrestle with supply chain issues and construction delays related to electric utility connections.

Maybe the biggest lasting pandemic outcome, he said, is related to remote work. Some companies can’t accommodate such arrangements, but others have settled into a hybrid schedule in which staffers spent three workdays in the office and two in their home.

“I think that’s been a difference that still remains,” he said.

Consumers get some of the credit for the recent increase in spending on going out for meals and such. President and CEO David King at Bakersfield-based Safe 1 Credit Union has watched as his members saved up economic stimulus money, then started loosening their purse strings last summer.

Another post-pandemic trend he has noticed lately is how managers have demonstrated greater awareness of what their employees are going through.

“COVID weighed heavily on a lot of people,” he said, “and I think, overall, most employers have become more compassionate toward their employees out of work.”

There’s been positive member feedback recently at the Greater Bakersfield Chamber, interim President and CEO Hillary Haenes said in an email statement. That hasn’t come to the exclusion of staffing and supply chain challenges, she added, but there has been another big positive also noted by Bearden: greater entrepreneurship.

“We are seeing new businesses open and expand, which is exciting,” Haenes wrote.

The continuing practice of working from home has been hard on the local office market, but people in the industry locally say Kern has avoided vacancy rates as high as 50 percent in some big cities.

Executive Director Jeffrey Andrew at the local Cushman & Wakefield office said Bakersfield office vacancies have increased from 8 percent to 12 percent at the start of the pandemic to about 15 percent. As leases come up for renewal, he suspects that number will edge upward.

“I believe we will be seeing it climb even a bit higher in the next year,” Andrew said.

How landlords cope with the transition to remote work will make a difference in how things play out, noted CEO David Bynum at Bakersfield property developer, owner and manager Bynum Inc.

Office space owners will need to invest in converting large spaces to smaller ones, as Bynum said by email his company has had to do. Those who don’t may be left with space that sits on the market empty.

Tenants may try to push for lower rents, he added, but there’s no guarantee they’ll get them at a time when high labor and materials costs have made new construction prohibitively expensive.

Besides, he wrote, “the jury is still probably out” on whether remote work will continue to be as widespread as it is now. He added that there continues to be a push-and-pull between employees and their bosses over how much time workers are able to work from home.

Bynum’s view was that, with isolation and screen time at historic highs, more time in the office might be a good thing.

“A good office environment is still a great thing to be a part of,” he said.

A separate outcome the pandemic has had on real estate regards retail space. Drive-thru lanes that were invaluable to restaurants’ survival the last three years now dominate new shopping centers. Clegg said he has noticed a jump in permits for drive-thru and takeout restaurants.

Local congregations have come out of the pandemic changed as much as any other part of Kern County society, having suffered no less than others.

A question that haunted church leaders during the past three years was whether their flocks would return after on-again, off-again restrictions that left pews empty.

“The answer is yes, they come back a lot,” said the director of communications for the Roman Catholic Diocese of Fresno, Chandler Marquez. “We can see it in the collection plates.”

“I think we were kind of reminded we need each other,” he added. “We need a community.”

Many parishes overseen by the diocese have been able to do more with livestreaming of services than they did prior to 2020, he said, including broadcasting on local cable channels.

“It allows us to really minister to those communities in a unique way that we really weren’t thinking about before the pandemic,” Marquez said.

Another outcome has been greater sensitivity and courtesy with regard to protecting elder parishioners from exposure to colds, flu and the coronavirus, he said, as well as increased enrollment at Catholic schools across the diocese.

Richard Thompson, pastor at First United Methodist Church of Bakersfield on Stockdale Highway, said in-person attendance has not fully recovered since the pandemic. On the other hand, livestreaming of services has increased, mainly among older church members, and there are now more people tuning in from outside the area.

Collections have increased somewhat, he said, but contributions arrive less frequently — quarterly rather than weekly, in some cases.

Specific ministries have only recently regained momentum, Thompson said, and initial indications are that activity is returning to earlier levels. He is trying to get more people involved in activities like helping people at homeless shelters.

“Those had been on hold since COVID,” he said. “This year I’m hearing more from small groups they want to do this or do that.”

Attendance at First United Methodist’s preschool is down noticeably, he said. He suspects it’s because parents working from home don’t feel a need to drop off their child every morning.

Probably the biggest change Thompson has seen is people seem to feel more comfortable participating from home instead of in person, which brings its own challenges.

“We have to make extra effort to connect personally with people because we don’t see them on Sunday,” he said.