Impact of COVID-19 on Communities in Riverside County

March 2020 marked a shift in our daily lives. Routine broadcasts on the radio and television were interrupted by news reports detailing the casualties caused by a spreading novel virus. There was a shared sense of uncertainty as updates flooded in. A global health emergency was declared, compelling families gathered in living rooms, staring at screens, or lost in thought, grappling with overwhelming information.

Over 7,000 lives were lost to COVID-19 in Riverside County [ 1 ]. We all experienced fear and uncertainty at the beginning of March 2020. The aftermath brought increased isolation, surges in depression & anxiety, and economic upheaval from widespread layoffs [ 2 ]. These experiences were universal yet hold distinctive accounts of the impact of the COVID-19 pandemic on human lives.  

With the advent of physical distancing and the rise of virtual communications, the stories presented here may sound familiar [ 3 ].  They highlight individuals in communities and emphasize the importance of stories, as they bring about a common feeling: that we are not alone. That our emotions and experiences matter. 

Reflecting on the past can bring clarity and comfort to others and bring about change in individuals and the communities around us.  Despite the widespread impact of COVID-19, which varied from community to community, the shared experience brought to our keen awareness the extent of our interconnectedness. These stories fortify, enlighten, and unite us—they are part of our healing as we stride towards a post-pandemic world.

The Health Equity Program at Riverside University Health System – Public Health conducted 17 in-person, virtual, and hybrid listening sessions from January- September 2023 with community-based organizations, faith-based organizations, community members, and individuals in Riverside County to learn how COVID-19 impacted them.

Our approach aimed to amplify voices of historically underrepresented and under-resourced groups, and those who were most at-risk for the impacts of COVID-19.

Sentiments from listening session participants are italicized throughout.             

With their grace and consideration our team entered their spaces, listened to their experiences, and identified multiple themes and narratives. The stories presented here were guided by the four questions below:

1. In ONE word, describe what community means to you?
2. What challenges have you/your community faced as a result of the COVID-19 pandemic?
3. What are the things that helped people in your community do well despite challenges?
4. What types of resources do you think would be most beneficial for you or members of your community to help address some of these challenges?

With each listening session, the first question posed was “In ONE word, describe what community means to you.” Participants were asked to speak or send in their responses in writing. As responses cascaded in and were recorded, three words stood out above all: support, connection, and unity.

Support was reflected in the heightened awareness of the importance of mental health, with community members looking out for and leaning on each other when the mental toll was too heavy.

Support was also given from promotores (also known as “community health workers” or “trusted messengers”), connecting others with resources of all types, but especially with mental health services [ 4 ]. As local governments rolled out COVID-19 resources and guidelines, promotores disseminated information and resources out to the community, arming them with the knowledge and physical tools to face COVID-19. Their constant presence in communities encouraged and supported community members in utilizing available resources. Promotores were the connection between local governments and community. The COVID-19 pandemic emphasized the importance of their roles as trusted messengers with proximity to communities. The assistance provided by promotores is substantial, particularly during moments of duress.

The best thing that came out of the pandemic and even the racial justice uprising was the understanding on the part of the government that the community and ‘trusted messengers’ are the best way to spread factual information.

Connection came hand in hand with the support that was felt. Connection meant occasionally reaching out to family, friends, colleagues, and neighbors, ensuring their well-being, offering assistance, or simply extending a comforting presence through gestures like sharing meals or offering prayers. It was making your presence known to people within and outside of your community or social circles, acknowledging that the quarantine need not be endured in isolation. Relationships, formed before, during, and after the quarantine, remained vibrant and enduring.  These relationships were further uplifted through socially distanced gatherings, technological aids like virtual meetings and phone calls, effectively bridging the gap that isolation imposed upon us. These connections and moments shared between neighbors were a sign that communities were healthy and thriving despite the physical barriers of quarantine.

Communication increased and strengthened, calling relatives that lived far, checking up and following up with each other.

Through support and connection, the isolated feelings that rose from quarantine came with the sense of unity. The connections that were made, the support that was given and received, manifested under the umbrella of this shared understanding of unity. Though we were isolated, there were shared experiences and tools (such as virtual communication) that connected us, and actions (for instance masking up) that showed kindness and consideration. These were incredibly important to the feeling of unity as it strengthened the fellowship that was present between us all and, from that fortified bond, provided strength to those within the bond when the harder experiences became too much to bear.

People started wearing masks because ‘I wear this for you because I want to protect you.’ And that felt kinda good!

What challenges have you/your community faced as a result of the COVID-19 pandemic?

A broad question, but so deeply effective in its vagueness that the responses recorded were, with each listening session, sweeping and diverse. The theme that arose the most pertained to the mental and behavioral health systems.

Lingering effects of social isolation impact [the] mental health of most of the community. Social services systems are overwhelmed and unable to fully meet the needs of the community. Many individuals for example clergy members were burned out/experienced covid fatigue and retired because of all the loss they had in their congregations plus all the efforts they made on the frontlines i.e., feeding the community, hosting vaccine clinics etc.

Each individual community experienced nuanced challenges. The disruption of rituals and practices within faith-based communities, especially when it came to mourning those who passed from COVID-19 was particularly challenging [ 5 ]. The social dynamics in families changed, as many were now in close and intimate quarters without the usual barriers of leaving the house for work, school, and social activities.

These are some of the challenges highlighted by communities and for Riverside County as a whole. However, it is important to note that these challenges run much deeper than what is highlighted here. Narratives about the challenges faced by the community, particularly as they relate to mental health, housing, poverty, and education will be elevated with additional Story Maps.

The systems that supported the emotional well-being of communities in Riverside County were unsustainable due to:

• the digital divide from a lack of access to technology
• technical difficulties that arose through virtual platforms
• adjusting to the new climate of telehealth [ 6 ]

All resulting in burnout from community health workers and leaders. Meanwhile, this burnout was rippling through the other health systems as well, with these same workers and their public health counterparts struggling with health communications and health education.

Getting word out on services (testing, behavioral health classes, therapy), telehealth, etc. using traditional media, not just social media was a challenge.

Trust is incredibly important for our society to run smoothly, especially during times of crisis and adversity. Many started to lose trust in the health information being shared, especially during the COVID-19 crisis. Different people reacted differently to the pandemic, and their views were often shaped by their political beliefs. This split had real-life effects, especially for those who are more at risk, like people with disabilities, old folks, and those with weaker immune systems. In places where not everyone followed safety guidelines like wearing masks, these vulnerable groups faced more dangers [ 7 ].

Immunocompromised folks are at risk in newly maskless environments.

The pandemic also brought to light the impact of systemic racism on communities of color. The tragic death of George Floyd in May 2020 prompted the Riverside National Association for the Advancement of Colored People (NAACP) to urge the Board of Supervisors to declare racism as a public health crisis [ 8 ]. In August 2020, the Board of Supervisors responded by officially declaring racism a public health crisis .

These events underscored the necessity of trust in navigating public health challenges and addressing systemic issues. Trust, or the lack thereof, played a pivotal role in shaping health decisions, highlighting its significance as a fundamental factor in fostering resilience and unity within communities. The call to action from the Riverside NAACP and the subsequent declaration by the Board of Supervisors reflected a collective understanding that trust is not merely a sentiment but a pragmatic force capable of effecting positive change in the pursuit of justice and equity.

Children and the effects of quarantine [ 9 ] on their social development was also discussed across communities. As exposure to screen time increased and social interaction with their peers decreased, adjusting to the new normal was difficult for children of all ages [ 10 ]. Several studies across the country have shown that short-term school closures as part of social lock-down measures resulted in adverse mental health symptoms and health behaviors among children and adolescents. When schools transitioned back to in-person, the new protocols around health and safety added to a new set of challenges and adjustments.

Children before covid…they can focus and move forward with a problem but after the pandemic it is hard to help them persevere socially and academically.

The global impact of the pandemic was also felt among immigrant communities. The precarious position of many foreign-born workers, who made up 29% of the U.S. physician workforce and 39% of food processing workers, was exacerbated by the fact that many of them did not benefit from things like sick leave, health insurance, or public benefits that buffer many Americans during challenging times [ 11 ]. Immigrants experienced higher unemployment during the height of the lockdown with many of them suffering economic hardship because of job loss and no safety net to fall back on.

Additionally, some immigrant communities, deeply rooted in their homelands, grappled with profound concern for family members residing there. A feeling of helplessness due to the inability to travel and personally attend to their loved ones.

With that feeling comes the feeling of guilt---vaccines offered here were not offered back home. Parents felt guilty for getting vaccine where grandparents could not. In Jordan, the vaccine was weaponized against certain communities, where they weren’t allowed to wear masks, or get vaccine, or go to the hospital.

Community members reflected on the economic struggle brought forth by the pandemic. Rising costs in health care, housing, and transportation due to inflation was frequently discussed among community members during listening sessions. Local studies show the economic harm on communities because of the pandemic, with significant challenges in housing affordability [ 12 ].

Single parents who didn’t have much income lost their jobs. People incurred lots of debt during the pandemic. Recovery from COVID-19 has not been happening a lot for families. The financial makeup has changed in families.

What are the things that helped people in your community do well despite challenges?

Despite the many challenges community members faced, many reflected on the positive aspects that helped them overcome some of those challenges. Increased access to government programs and subsidies were a lifeline for many.

The expansion of telehealth and remote work created a new normal for more people to access more services. However, not everyone has equal access to digital services. Digital literacy varied among community members, with elderly people reporting feeling isolated and disconnected due to difficulty in using virtual meeting platforms like Zoom or Microsoft Teams.    

Resources were vamped up to allow folks who had been needing these resources for years, especially disabled people to access telehealth on a large scale. The impact to many immunocompromised and people with disabilities in that aspect was good, as well as remote work.

Our tribal community had to embrace technology; we had a meeting via Zoom. This was harder for older folks. Monthly tribal check-in meetings, community forums via Zoom. This was major! Our tribe gave out devices to kids who needed it for school, YouTube was used to watch videos about the vaccine. We can still attend meetings without all of us being in one sitting area.

Additionally, while some pandemic induced innovations such as telework became part of our current culture, government sponsored subsidies, such as stimulus relief payments, student loan repayment deferment, and CalFresh Benefit increases, all which helped a large proportion of the population escape poverty, have been discontinued [ 13 ]. Multiple studies have demonstrated that the temporary Child Tax Credit (CTC) helped drive child poverty to low record levels in 2021, and the failure to extend the expanded CTC caused an increase in child poverty in 2022 [ 14 ]. The aftermath of discontinuation of such programs remains to be seen.

We saw more use of safety nets like EBT, subsidies, etc. Everyone is on the spectrum- some people have been using the support while others were using it for the first time.

Perhaps one of the most talked about aspects in terms of resiliency during the pandemic were things like community and social support. For the Asian American and Pacific Islander community, this was particularly important.

Having a supportive community with shared experiences to check in with one another and honestly just vent at times to feel seen, heard, and understood. AAPI folks came together, we used to think we were a monolith, because of that it brought community support and love.

Times of crises bring both hardship and resiliency, as was noted by several community members:

We all got through it and that’s resiliency. It supported this idea of resiliency like if we got through that then we can get through anything. You learn certain skills that speak to resiliency.

Meditation, prayer, and other healing practices were also mentioned as tools that community members leaned on during the pandemic. Spiritual leaders in the County reflected on the emotional toll the pandemic took, some even saying they were close to losing their faith. Maintaining community through ceremonies and spiritual practices helped them get through the most difficult times.

Despite mistrust, we held ceremonies and prayer circles. The Sundance Ceremony was skipped the first year but was practiced safely with precautions the second year (there were vaccine requirements for in-person gatherings). Coming together as a community to pray was incredible. We started monthly talking circles online via Zoom. This rejuvenated our faith and allowed us to support one another.

What types of resources do you think would be most beneficial for you or members of your community to help address some of these challenges?

Amidst the challenges and triumphs of the COVID-19 pandemic, community members echoed a resounding message: having access to resources is not just about availability; it's about breaking down barriers and fostering genuine connections.

It doesn’t matter how you market resources. If you can’t get to those resources, then it doesn’t do any good.

This sentiment captured the shared frustration of many, highlighting the importance of not just resource availability, but accessibility.

During the pandemic, community health workers and leaders stepped up, delivering care packages that contained essential items—working thermometers, groceries, oximeters—items that were not just necessary but often impossible to obtain due to mobility restrictions.

Yet, amidst the challenges, there were bright spots of collaboration and innovation. The rollout of initiatives like TakemyHand™, a live peer support chat born from the Help@Hand Riverside Program, showcased the power of unity, as participants described how their involvement fostered a sense of purpose and belonging. TakemyHand uses an online Peer-to-Peer live chat interface, where Live Peer Operators engage with community members in real-time conversations about emotional wellness and help chat visitors build resiliency when life is difficult. [ 15 ]

Peer support emerged as a vital force, breaking down previously insurmountable barriers, leading to improved service provision and integration of behavioral health services. The importance of culturally congruent health providers, especially in mental healthcare, was emphasized, underlining the need for a deep understanding of the community's diverse needs.

Community members also emphasized the need for education and awareness. Digital literacy training has become a necessity, especially for older adults and non-English speakers, ensuring that they are not left behind in an increasingly digital world. Similarly, social-emotional learning (SEL) programs, both for children and parents, were highlighted as crucial tools needed to promote empathy, understanding, and mental health in the community.

However, the path forward is not without its challenges. Participants stressed the necessity of data to support their cause, urging for comprehensive needs assessments, for example, specific to the deaf and hard-of-hearing community. They called for increased sensitivity, imploring institutions to ask for community preferences and to accommodate accordingly because doing so would hold the key to breaking barriers. Obtaining demographic data that is inclusive and accurately represents individuals that make up the community continues to be a problem.  Tools like Healthy Places Index can help bridge the gap by providing open and accessible data on neighborhood health conditions and social conditions that impact health. However, they are no substitute for more inclusive data systems and practices. 

Conversations steered toward economic stability, recognizing the financial strain on small businesses, particularly those owned by immigrants. While technology posed challenges, it also presented opportunities. Local restaurants harnessed the power of food delivery platforms and utilized their personal websites for takeout services, to which the community could support them and preserve the vibrant tapestry of their neighborhoods.

Additionally, there was a call for educational support, emphasizing the need for free tutoring services, creating a bridge between college students and younger learners.

The community recognized a deeper issue: housing.

 We need policies in place to ensure we can afford housing.

The housing crisis, alongside a growing unhoused population, underscores the need for urgent policy changes and community support systems. Homeowner assistance programs [ 16 ], such as the Home Affordable Modification Program (HAMP) [ 17 ] and down payment assistance initiatives, play a crucial role in aiding middle and lower-income families. HAMP, established in 2009, helps struggling homeowners modify mortgage payments, while down payment assistance programs offer grants or low-interest loans to overcome financial barriers to homeownership. Emergency shelter programs [ 18 ] and transitional housing initiatives address immediate housing challenges, while advocacy efforts focus on increased funding for affordable housing developments, rent control, and zoning reforms to alleviate the systemic issues contributing to the crisis. Comprehensive solutions are essential to address the housing crisis and provide stable housing options for under-resourced under populations.

What would help is for RUHS-Public Health, other public health organizations, and health providers to develop strong, lasting relationships with community-based organizations and other trusted messengers to rebuild that trust and keep information flowing.

As Riverside County moves forward, it does so with the knowledge that empathy is not just a sentiment—it's a catalyst for transformative change. By fostering understanding, breaking down barriers, and advocating for accessible resources, the community stands united, ready to face whatever challenges come their way. Through empathy in action, Riverside paves the way for a future where everyone, regardless of their circumstances, can thrive.

Moving forward, the Health Equity Program commits to turning empathy into action, recognizing that our shared experiences demand a collective response. Together, we will actively contribute to the creation of healthier communities by breaking down barriers to resources and ensuring accessibility for all.

The Community COVID-19 Impact Hub, as an evolving project, will incorporate additional health topics identified during listening sessions, such as mental health, housing, poverty, education, health communications, and resources. The Health Equity Program will continue to incorporate these narratives to the Story Maps on its website, inviting the community to read and share them through various platforms.

In addition, in our commitment to community action, we pledge to address economic stability, educational support, and the housing crisis through comprehensive needs assessments and community-driven plans and implementation. This collaborative effort aims to foster genuine connections and build a resilient community where everyone can thrive. Recognizing the interconnectedness of well-being, we will continue to focus on initiatives that support mental health and social connections. The Health Equity Program firmly believes that:

EVERYONE'S VOICE MATTERS.

We will persist in elevating real experiences until every historically underrepresented and under-resourced voice is heard. Through these combined efforts, we strive to lay the foundation for enduring health and prosperity for all in Riverside County.

[1] California Department of Public Health. (n.d.). Respiratory Dashboard. California Department of Public Health.  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Respiratory-Viruses/RespiratoryDashboard.aspx#location-riverside 

[2] World Health Organization. (2022, March 2). COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide. World Health Organization.  https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide 

[3] DeFilippis, E., Impink, S. M., Singell, M., et al. (2022). The impact of COVID-19 on digital communication patterns. Humanities and Social Sciences Communications, 9, 180.  https://doi.org/10.1057/s41599-022-01190-9 

[4] Moon, K. J., Montiel, G. I., Cantero, P. J., & Nawaz, S. (2021). Addressing Emotional Wellness During the COVID-19 Pandemic: the Role of Promotores in Delivering Integrated Mental Health Care and Social Services. Preventing Chronic Disease, 18, 200656.  https://doi.org/10.5888/pcd18.200656 

[5] Gabay, G., & Tarabeih, M. (2022). Death From COVID-19, Muslim Death Rituals and Disenfranchised Grief - A Patient-Centered Care Perspective. Omega, 302228221095717. Advance online publication. https://doi.org/10.1177/00302228221095717

[6] Siegel, A., Zuo, Y., Moghaddamcharkari, N., McIntyre, R. S., & Rosenblat, J. D. (2021). Barriers, benefits and interventions for improving the delivery of telemental health services during the coronavirus disease 2019 pandemic: A systematic review. Current Opinion in Psychiatry, 34(4), 434-443. https://doi.org/10.1097/YCO.0000000000000714

[7] Cheng, V. C., Wong, S. C., Chuang, V. W., So, S. Y., Chen, J. H., Sridhar, S., To, K. K., Chan, J. F., Hung, I. F., Ho, P. L., & Yuen, K. Y. (2020). The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. The Journal of infection, 81(1), 107–114. https://doi.org/10.1016/j.jinf.2020.04.024

[8] Riverside County. (2020). Resolution declaring racism public health crisis.  https://rivco.org/sites/g/files/aldnop116/files/News%20Articles/Documents/Resolution%20declaring%20racism%20public%20health%20crisis.pdf 

[9] Nature. (2022). Editorial: Endless frontier: A new vision for science.  https://www.nature.com/articles/d41586-022-00027-4 

[10] Viner, R., Russell, S., Saulle, R., et al. (2022). School Closures During Social Lockdown and Mental Health, Health Behaviors, and Well-being Among Children and Adolescents During the First COVID-19 Wave: A Systematic Review. JAMA Pediatrics, 176(4), 400–409. https://doi.org/10.1001/jamapediatrics.2021.5840

[11] Migration Policy Institute. (2022). Pandemic's impact on immigrants in the US immigration system two years on.  https://www.migrationpolicy.org/news/pandemic-impact-immigrants-us-immigration-two-years-on 

[12] Angst, C. M., White, M., Dunn, L. F., & Masucci, M. M. (2022). The Impact of the COVID-19 Pandemic on Housing Affordability in the Southern California Region. Berkeley Institute of Governmental Studies.  https://belonging.berkeley.edu/sites/default/files/Angst%20et%20al%20Housing%20Affordability%20COVID%20SoCal%20Region.pdf 

[13] Center on Budget and Policy Priorities. (2023). Government's pandemic response turned a would-be poverty surge into... [Webpage]. Retrieved from  https://www.cbpp.org/research/poverty-and-inequality/governments-pandemic-response-turned-a-would-be-poverty-surge-into 

[14] Economic Policy Institute. (n.d.). Child tax credit expansions were instrumental in reducing poverty to historic lows in 2021. [Webpage]. Retrieved from  https://www.epi.org/blog/child-tax-credit-expansions-were-instrumental-in-reducing-poverty-to-historic-lows-in-2021/ 

[15] Take My Hand. (n.d.). Retrieved from  https://takemyhand.co/ 

[16] National Council of State Housing Agencies. (n.d.). Retrieved from  https://www.ncsha.org/ 

[17] U.S. Department of the Treasury. (n.d.). Troubled Asset Relief Program (TARP) – Housing – Making Home Affordable (MHA) – Home Affordable Modification Program (HAMP). Retrieved from  https://home.treasury.gov/data/troubled-assets-relief-program/housing/mha/hamp 

[18] National Alliance to End Homelessness. (n.d.). Racial equity and emergency shelter access and outcomes. Retrieved from  https://endhomelessness.org/resource/racial-equity-and-emergency-shelter-access-and-outcomes/