Como mesera en el restaurante y bar Navy Proof, covid ha pesado mucho en su mente durante los últimos meses. Dávila ha estado especialmente preocupada por la posibilidad de llevar el virus a su hijo pequeño y a su madre diabética que viven con ella.

Y aquí estaba ella, parada afuera del Centro de Convenciones de Long Beach con cientos de otros residentes y trabajadores de la ciudad, a punto de recibir una codiciada vacuna contra covid, a pesar de que solo tiene 31 años.

“Es como un alivio, diría yo. Estoy emocionada”, comentó.

La ocasión: un gran centro de vacunación sólo para trabajadores del sector de alimentación. El 5 de marzo se ofrecieron 3,000 vacunas para empleados de restaurantes, despensas y mercados, cocineros, o cualquier otro residente de la ciudad que trabajara en ese sector.

La clínica de vacunación de ese día fue un intento por ayudar a reabrir, de manera segura, los restaurantes de Long Beach y, al mismo tiempo, agradecer a las personas que han estado en riesgo de enfermarse para mantener a la ciudad alimentada, dijo el alcalde de Long Beach, Robert García.

En un momento en que millones de californianos buscaban sitios web durante horas para encontrar citas de vacunación, Long Beach, que tiene su propio departamento de salud separado del resto del condado de Los Ángeles, tenía como objetivo simplificar el proceso, al menos para algunos grupos vulnerables.

“Los empleados del sector de la alimentación han estado trabajando sin parar desde el comienzo de esta pandemia y merecen sentirse seguros cuando van a trabajar para servir a su comunidad”, dijo García, cuya madre y padrastro murieron a causa de covid en julio.

Jennifer Rice Epstein, vocera del departamento de salud de la ciudad, alentó a los residentes y trabajadores de Long Beach a registrarse en para una de las 3,000 citas de vacunación que la ciudad ofrece diariamente a los empleados en estos sectores: alimentación, atención médica, agricultura, trabajadores de emergencias, educación, servicios de limpieza, y toda persona mayor de 65 años.

Además de las 3,000 citas, la ciudad tiene 500 vacunaciones adicionales disponibles cada día para los residentes de la ciudad y los trabajadores sin citas, siempre que muestren un certificado u otra prueba de que están en un nivel de prioridad.

El centenario departamento de salud de Long Beach ha establecido relaciones con escuelas, asociaciones sin fines de lucro y empresas, que han ayudado a construir un nivel de confianza que facilita el desarrollo de estas campañas, señaló Rice Epstein.

La ciudad de 466,000 habitantes también fue una de las primeras en el estado en enviar clínicas móviles para vacunar a los residentes con discapacidades físicas y mentales, añadió.

La ciudad también se ofreció para enviar un equipo de vacunación a cualquier persona calificada que no pueda llegar físicamente al centro de convenciones. Al 15 de marzo, aproximadamente el 20% de los residentes de la ciudad ya habían recibido al menos una dosis, similar a la tasa general del estado.

El registro en línea de citas para los empleados del sector de alimentación en el centro de convenciones se llenó rápidamente. Para cuando el evento se inauguró, a las 11 am, una fila de cientos serpenteaba alrededor del Teatro Terrace del centro de convenciones, donde se administraron las vacunas.

“Me siento afortunado”, dijo Eric Bohay, de 28 años, quien tiene asma y trabaja en una tienda de Target. “Todos los días estoy en estrecho contacto con los clientes. Tomo todas las precauciones que puedo, pero uno nunca sabe lo que hay ahí fuera”.

Los trabajadores del servicio de alimentación han estado plagados de covid durante la pandemia. Un encontró que las muertes de trabajadores del sector en restaurantes, producción de alimentos y agricultura, aumentaron un 39% de marzo a octubre de 2020.

Los adultos con covid tienen el doble de probabilidades de haber cenado en un restaurante en las dos semanas antes de mostrar signos de enfermedad, , lo que sugiere que el virus permanece en el aire donde los meseros, cocineros y trabajadores, pasan muchas horas al día.

Los que estaban en la fila expresaron cierto nerviosismo por la vacuna. “La gente dice distintas cosas sobre cómo se sienten después de recibirla”, dijo Sydney Tripoli.

La joven de 21 años fotografiaba bandas de rock en el condado de Orange y Los Ángeles antes de que la pandemia cerrara los eventos en vivo. Luego tomó un trabajo en Ahimsa Vegan Cafe, en Fourth Street, en Long Beach. Tiene esperanzas de que una vacuna la acerque un paso más a regresar a fotografiar conciertos.

Los funcionarios de la ciudad habían telefoneado y enviado correos electrónicos a los gerentes y propietarios de empresas de alimentación, desde supermercados hasta bares y restaurantes, alentándolos a invitar a sus empleados a inscribirse para una vacuna.

Así fue como se enteró Andrew Anderson, de 37 años, dueño de Spicy Kitchen, que hace salsas picantes, aderezos y encurtidos para restaurantes y mercados.

“Estaba muy emocionado porque trabajo con muchos negocios de comestibles y vendedores, así que estoy expuesto a mucha gente”, dijo. Terminó charlando con un amigo de la industria que también estaba en la línea de vacunación.

“Siento que me gané la lotería”, comentó su amigo Lance Todd, un bartender de 52 años en The Brit, un bar LGBTQ en Long Beach. “Mi esposo aún no puede recibir una vacuna, así que al menos uno de los dos la tendrá”.

La editora de datos Elizabeth Lucas colaboró con este informe.

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As a server at the Navy Proof Restaurant and Bar, the specter of covid has weighed heavily on her mind for the past several months. Davila has been especially worried about the possibility of bringing the virus home to her young son and diabetic mother.

And here she was, standing outside the Long Beach Convention Center with hundreds of other Long Beach residents and workers, about to receive a coveted covid vaccine — even though she’s only 31.

“It’s like a relief, I would say,” she said. “I’m excited.”

The occasion: a super-sized vaccine clinic just for food workers. The March 5 date offered 3,000 slots to restaurant workers, bodega and market employees, cooks or anyone else in the city’s food business.

The vaccine clinic that day, which the city has followed by dedicating more shots to food and other essential workers, was an attempt to help safely reopen Long Beach restaurants while providing a giant thank-you to people who’ve been risking illness to keep the city fed, said Long Beach Mayor Robert Garcia.

At a time when millions of Californians were trolling websites for hours to find vaccination slots, Long Beach, which has its own health department separate from the rest of Los Angeles County, aimed to simplify the process, at least for a few vulnerable groups.

“Food workers have been working nonstop since the start of this pandemic and they deserve to feel safe when they go to work to serve their community,” said Garcia, whose mother and stepfather died of covid in July.

Jennifer Rice Epstein, a spokesperson for the city health department, encouraged Long Beach residents and workers to register at for one of 3,000 vaccine appointments the city is offering daily to employees in these sectors: food service, health care, agriculture, emergency response, education, janitorial services — and anyone 65 or older.

In addition to the 3,000 appointments, the city holds an additional 500 spots open each day for city residents and workers without appointments — as long as they show a pay stub or other proof they are in a priority tier.

Long Beach’s century-old health department has established relationships with schools, nonprofit partners and businesses that have built up a level of trust that makes it easier to organize such campaigns, Rice Epstein said.

The city of 466,000 was also one of the first in the state to send mobile clinics to vaccinate residents with physical and mental disabilities, she said. The city also offered to send a vaccinating team out to any qualified person who can’t physically reach the convention center. As of March 15, the roughly 20% of city residents who’d gotten at least one shot was similar to the overall rate in the state.

Online registration for vaccination for the food service clinic at the convention center filled quickly. By the time the event opened at 11 a.m., a line of hundreds snaked around one side of the convention center’s Terrace Theater, where the shots were administered.

“I feel lucky,” said Eric Bohay, 28, who has asthma and works at the grocery pickup counter at a Target store. “I’m in close contact with customers on a daily basis. I take as many precautions as I can, but you never really know what’s out there.”

Food service workers have been plagued by covid during the pandemic. One found that deaths of food workers in restaurants, food production and agriculture jumped 39% from March to October 2020. Adults with covid were twice as likely to have dined out in a restaurant in the two weeks before they showed signs of illness, , suggesting that the virus lingers in the air where servers, cooks and bussers spend many hours a day.

Those in line expressed some nervousness about the vaccine. “People are saying different things about how they feel after” getting the shot, said Sydney Tripoli.

The 21-year-old photographed rock bands in Orange County and Los Angeles before the pandemic shut down live events. Then she took a job at Ahimsa Vegan Cafe on Fourth Street in Long Beach. She was hoping a vaccination would bring her a step closer to returning to photo gigs.

City officials had phoned and emailed managers and owners of food enterprises — from grocery stores to bars and restaurants — encouraging them to invite their employees to sign up.

That’s how Andrew Anderson found out. Anderson, 37, owns the Spicy Kitchen, which makes hot sauces, rubs and pickles for restaurants and markets.

“I was super excited because I do work with a lot of grocery stores and vendors, so I am exposed to a lot of people,” he said. He ended up chatting with an industry friend who was also in the vaccination line.

“I feel like I won the lottery,” said his friend Lance Todd, a 52-year-old bartender at The Brit, an LGBTQ bar in Long Beach. “My husband can’t get a shot yet, so at least this is better than neither one of us having it.”

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Her county, a rural outpost in the Sierra Nevada foothills with a population of about 54,000, has only five psychiatrists — “a huge shortage,” she said.

But Gunter, 56, wasn’t about to quit her job at the Me-Wuk Indian Health Center in Tuolumne and relocate to some distant campus for two years to get certified as a psychiatric nurse practitioner.

Then, in February, she learned that the University of California was launching a new program to provide that certification online in just one year. She fired off her application, and last month she received an acceptance letter.

“Sometimes I think, ‘What are you doing?’” Gunter said, referring to the online classes that will take over her nights and weekends once the program starts. “But I care about the community.”

The online certification program, conducted jointly by the nursing schools at the University of California-San Francisco, UCLA and UC-Davis, was scheduled to start in the fall, but it has been postponed until January because the on-site clinical hours required as part of the training are not possible during the COVID-19 shutdown.

Despite the delay, the potential expansion of psychiatric care is opportune given the expected increase in due to the social isolation and financial stress stemming from the pandemic.

The need for more mental health nurses is about to be bigger than ever, said E. Alison Holman, a health psychologist at UC-Irvine who studies emotional responses to collective trauma.

“We now have who have lost their jobs, who have no income — and how are they going to pay rent? How are they going to buy food?” Holman said. “And then you have to stay home. This event is rolling out like a long, chronic stressor.”

Even before the current crisis, California faced a serious shortage of mental health professionals, especially in rural areas. California’s psychiatrists and psychologists are age in large numbers, and a recent uptick in medical students choosing to specialize in psychiatry isn’t enough to offset the drain.

A projected that the state would have 41% fewer psychiatrists than needed by 2028. of Californians with mental illness receive no treatment, according to a February 2019 by the California Future Health Workforce Commission.

UC’s online mental health nurse practitioner program is one of the solutions recommended by the commission that created a master plan to address the Golden State’s shortage of health care workers.

The program is expected to put 300 more mental health NPs into California communities, particularly rural ones, over the next five years. Applicants such as Gunter, who live in underserved rural areas, will be given priority in the hope that they will stay in their communities upon completion of the training, said Deborah Johnson, a UCSF nursing professor who is co-director of the program.

Forty spots are available for the class that begins in January, and not all have been filled yet, Johnson said. Applications are being accepted until June 1, and 65 additional spots will open in fall 2021 and each fall thereafter for three more years, she said.

The UC system received a $1.5 million grant from the California Health Care Foundation to develop, design and launch it. But tuition is expected to make it self-sustaining. (Kaiser Health News, which produces California Healthline, is an editorially independent publication of the foundation.)

Applicants for the new program must already be advanced practice nurses, which means they hold either a master’s degree or doctorate in nursing. now practice in California, but only 1,200 are certified to treat psychiatric patients.

Three hundred more psychiatric NPs won’t completely fill the growing mental health care need, but they are expected to treat patients over a five-year period.

Though the online program means working nurses won’t have to leave their jobs and their lives to relocate, they will still face challenges.

For one thing, their certification will require 500 hours of supervised clinical training with patients in hospitals, jails or schools. And some applicants live in communities where such opportunities may not be available, which could require them to commute long distances to meet the requirement.

Another challenge is that, even after nurse practitioners are certified, state law requires they find a medical doctor to supervise them. Havilyn Kern, a school nurse in Nevada City, California, quit her job two years ago so she could spend three days a week at UCSF — 155 miles away — to train as a psychiatric nurse practitioner.

She graduates in June, so the new online program is too late for her. Kern, who plans to work in her own community, hopes she will find a psychiatrist in the Bay Area willing to tele-supervise her.

“It shouldn’t have to be this way,” said program co-director Johnson. “California is so archaic. It’s the most restrictive state in the western portion of the country.”

Twenty-eight states plus Washington, D.C., to work autonomously. Santa Rosa Assembly member Jim Wood, a Democrat, has introduced a bill, , that would allow California NPs to practice without doctor supervision. It passed the Assembly in January and is pending in the Senate.

“If AB 890 passes, it will certainly help fill the loss of specialty physicians such as psychiatrists everywhere, including in underserved areas,” Wood said.

But that’s a big “if.”

California’s powerful doctors’ lobby, which has repeatedly scuttled similar legislation, is aggressively fighting it again. They argue that letting NPs order tests and prescribe medications independently would “dilute care.”

Doctors also have a financial incentive to keep things the way they are. It restricts competition, and they to review their charts and prescriptions every few months, according to a report by the California Health Care Foundation and UCSF.

Johnson suggested it is time for a change.

“We are the workhorses,” she said. “Oh, my God, there is so much need. This new program could not come at a more important time.”

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If he wants, he can shower, get his hair cut or have his teeth cleaned. Those twice-weekly visits are the highlights of the week for Perez, a 65-year-old retired mechanic who has diabetes and is legally blind.

“The people here are very human, very nice,” he said. “I’m gonna’ ask for three days a week.”

The nonprofit Gary and Mary West PACE center, which opened in September, is California’s newest addition to a system of care for frail and infirm seniors known as the .

The services provided by PACE, a national program primarily funded by Medicaid and Medicare, are intended to keep people 55 and older who need nursing home levels of care at home as long as possible and out of the hospital.

The program is more important than ever as baby boomers age, its proponents say.

“The rapidly growing senior population in California and across the country will put enormous strain on our current fragmented, and often inefficient, health care delivery system,” said Tim Lash, president of Gary and Mary West PACE. California officials consider PACE an integral part of the state’s strategy to upgrade care for aging residents.

The said shows seniors enrolled in PACE cost states 13% less on average than the cost of caring for them through other Medicaid-funded services, including nursing homes.

Perez, like 90% of PACE enrollees nationwide, is a recipient of both Medicaid and Medicare. He’s part of a population that typically has low income and multiple chronic conditions.

PACE participants who do not receive government medical benefits can pay out of their own pockets. At Gary and Mary West, the tab ranges from $7,000 to $10,000 a month, depending on the level of care.

Nationally, 50,000 enrollees participate in PACE programs at over 260 centers in 31 states. In California, PACE serves vulnerable seniors at 47 locations.

PACE programs nationally offer all services covered by Medicare and Medicaid, and nurses, primary care doctors, social workers, dietitians, drivers and personal care attendants, as well as physical, occupational and recreational therapists. PACE enrollees commonly have conditions such as vascular disease, diabetes, congestive heart failure, depression and bipolar disorder.

About two-thirds of PACE participants have some degree of cognitive impairment. The Gary and Mary West center is no exception, which is why it has alarms on all the doors. If participants become agitated, they are led to the “tranquility room,” a softly lit space with an ocean soundtrack and a recliner.

On weekdays, participants can arrive at the center as early as 8 a.m. and stay until 4:30 p.m. A PACE driver provides transportation to and from the center, as well as to appointments with outside specialists.

The center goes a step further than most other PACE programs: It offers dental care. Staff dentist Karen Becerra said some of her patients have cried for joy when they learned they were going to have their teeth fixed or replaced.

“These are folks who have terrible teeth,” Becerra said. “And if they have painful mouths, they have poor nutrition.”

Perez is missing teeth, but he was all smiles when he talked about his upcoming dental appointment. “They’re going to put new ones in,” he said.

The center opened with money donated by San Diego billionaires Gary and Mary West, telemarketing and telecommunications entrepreneurs. They’ve donated about $11 million to establish PACE centers around the country.

The center in San Marcos is spacious and cheery, with sofas and chairs scattered about and plenty of natural light. It’s meant to feel “like a friendly inviting living room,” said Dr. Ross Colt, a retired Army colonel who joined Gary and Mary West PACE a year ago as the primary care physician on staff.

Enrollees can repair to a patio to get fresh air or tend herbs in planter boxes. And they can participate in activities such as bingo, coloring and Trivial Pursuit, led by a recreational therapist.

Just down the hall from the main lounge are patient exam rooms decorated with photographic murals of sunsets and seascapes.

Center participants can get physical and occupational therapy in a rehabilitation gym, and the facility has a spa where they can shower or get their hair done.

The executive director, Renata Smith, recalled a woman whose husband had been bathing her with a garden hose before she joined PACE. “We’re talking about basic human dignity here,” Smith said. “The spa makes participants feel good about themselves.”

PACE programs also send personal health care aides to the homes of participants.

Twice a week, an aide named Sylvia Muro picks up Perez at his home and takes him out to shop for groceries. Sometimes they stop at McDonald’s for pancakes and sausage.

Colt said participants come to him for checkups about once a month, but he can see anyone with a medical problem on a moment’s notice.

Unlike doctors in private practices, “I have the luxury of seeing them for an hour if I need to. And I can bring them back tomorrow if I need to,” he said.

Such access can save a diabetes patient from missing an insulin injection and avoid a costly hospital admission.

“That’s what the benefit of this model is,” Colt said. “The patient doesn’t want to go stay in the hospital, the family doesn’t want them to, and society doesn’t want them to.”

Smith, the center’s executive director, noted another important benefit: “the comfort of social interaction and something to wake up to every day.”

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But since being diagnosed with metastatic breast cancer in 2013, an event that forced her into retirement, Shanahan has discovered that not all of her doctors are as attentive to such requests.

Getting copies of her records has been, as she puts it, “a colossal pain.”

With few exceptions, federal law requires that health care providers make copies of medical records available within 30 days after patients request them and, when possible, in the format they desire. Under California law, providers have to hand over the records if they are being sent directly to the patient.

But many patients, who may have records scattered across doctors’ offices, labs, hospitals and clinics, say responses from health care providers can range from sluggish to churlish. Assembling the records can be onerous.

Earlier this year, Shanahan turned to a Silicon Valley startup called , which requests medical records on behalf of cancer patients and redacts them for clarity and legibility.

Shanahan logged on to the company’s website and signed an electronic consent form, handing over to Ciitizen the task of requesting her records from multiple providers. The company emails her when a record is ready for her to view.

Ciitizen does not charge patients for gathering their medical information. Rather, it hopes to make money “in the near future” by taking a transaction fee for “matching third-party researchers with patients who wish to share their records,” said Deven McGraw, Ciitizen’s chief regulatory officer and former head of health care privacy policy at the U.S. Department of Health and Human Services. She said the company plans to offer its services to people with other serious illnesses in the future.

On Tuesday, Ciitizen, based in Palo Alto, Calif., released an update to a report card it first published in August that uses a five-star system to rate how health care providers comply with federal rules governing record requests. The scorecard, which Ciitizen plans to refresh every few months, can be viewed online at .

It shows that of the 210 providers from whom Ciitizen has requested patient records so far — including hospitals, doctors and specialty clinics nationwide — 51% have only one or two stars, meaning they were noncompliant or required significant intervention by the company to comply.

Ciitizen also published a , based on the scores of those 210 providers plus telephone surveys of nearly 3,000 health care institutions, that found that more than half of providers were out of compliance with federal patient data access rules.

That is in line with a by Yale University researchers last year showing that many top U.S. hospitals were not in compliance with patient records rules.

“Cancer patients do not have the time or energy to make two to three phone calls and argue with their providers,” McGraw said. “We did a lot of arguing. We encountered so many roadblocks.”

In a , Seema Verma, administrator of the Centers for Medicare & Medicaid Services, called the Ciitizen scorecard “a powerful tool for patients” that “will hopefully spur competition amongst providers to make patient data more readily accessible.”

Lois Richardson, vice president and legal counsel of the California Hospital Association, said the scorecard is too new to assess whether its findings are significant or just a collection of anecdotes based on a small number of records requests. “It could be either; I just cannot tell,” she said.

Some consumer advocates say enforcement of laws governing medical records accessibility is ineffectual.

“There have never been any cops who will go around and bust a hospital for failing to produce the data,” said Dave deBronkart, a pioneer of the patient access movement.

DeBronkart, 69, beat the odds after doctors gave him 24 weeks to live following a diagnosis of metastatic kidney cancer 12 years ago. Along the way, he has butted heads with the medical establishment over his health records.

When he was invited to speak at a medical conference in Toronto in 2009, the organizers asked him the title of his speech. He replied: “Just call it ‘Give Me My Damn Data.’”

That phrase quickly became a rallying cry, a , a meme, a coffee cup, a , and even a rap: “Give me my damn data/’cause it’s my life to save/give me my damn data /just like e-patient Dave.”

DeBronkart and others in the medical data access movement applaud Ciitizen’s report card but believe the real game changer will be a new federal rule that could eventually allow patients to see their medical data on their cellphones as easily as they can see their bank accounts.

“What we have been striving for is starting to happen,” deBronkart said. “For the first time in 10 years of advocating for patient access to our medical information, I am excited and optimistic.”

The new rule is expected to begin rolling out in 2020, a CMS spokeswoman said. It will require health care providers doing business with Medicare and Medicaid, and in the federally run Affordable Care Act marketplaces, to share their patients’ data through apps that are compatible with an international standard for sharing health care information known as FHIR (Fast Healthcare Interoperability Resources).

Unlike current federal law governing records access, the new rule will have some teeth, federal officials say. Just how it will be enforced is still being hammered out, but it will likely entail financial penalties.

Some patient advocates worry about consumers’ privacy when their medical data is shared so widely online. “Of course we want consumers to be more empowered, but it does seem like we’re rushing into this idea,” said Dena Mendelsohn, a senior attorney in the San Francisco office of Consumer Reports, adding that there are not yet laws in place to protect patient privacy.

But Shanahan, the breast cancer patient and former OB-GYN, said it should be her decision.

“I’m the patient,” she said. “I’m saying, share my freakin’ information.”

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