As coronavirus continues to spread within Orange County, it is hitting residents of some cities far more than others, according to the city-by-city infection rates, which the County of Orange does not post on its data website widely used by the public.

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Researchers at the county Health Care Agency are finding that the most-affected communities tend to have lower incomes and higher rates of people working in essential jobs that require interfacing in person with the public. While residents of particular communities are disproportionately affected, researchers say infections can come from workplaces outside people’s city of residence.

The county currently posts raw numbers of confirmed infections on its public website, as well as population counts, but does not show the rate per population that allows for comparing the disproportionate way the virus is impacting different cities.

When looking at the rates, a much clearer picture of the virus’ impact on the county is visible.

Hit particularly hard are residents of Santa Ana and Anaheim, home to 20 percent of the county population but 40 percent of county residents who have tested positive for coronavirus.

“These two cities keep me up at night,” Dr. Clayton Chau said at the county’s weekly news conference on Thursday, in response to a question from Voice of OC about the cities’ higher rates.

For example, Santa Ana’s infection rate per resident is over 5 times higher than Irvine’s, 7 times higher than Laguna Niguel, and 11 times higher than the unincorporated gated community of Coto de Caza.

Anaheim’s infection rate is 4 times higher than Dana Point and about 6 times higher than Aliso Viejo and Laguna Niguel.

A county Health Care Agency analysis of infection rates by Zip code found that “the highest rates of cases are in lower socio-economic areas of the county including Zip codes in most of Santa Ana and western Anaheim,” said Curtis Condon, research manager with the county Health Care Agency, in a written statement Friday to Voice of OC.

Researchers at UCI also found that “lower income residents from lower [socioeconomic] ZIP codes in OC have had the fastest growth in Covid-19 cases,” he added.

“The case information that we receive does not have detailed demographic information like income or education, but we know from other reports like the Conditions of Children and Community Indicators reports that these areas hardest hit by COVID-19 tend to be lower income, higher density, and are often employed in essential jobs that involve interfacing with the public.”

Topping the infection rate list is Los Alamitos, OC’s second-smallest with about 11,000 residents versus 300,000 in Santa Ana and Anaheim. Los Alamitos city officials attribute their high rate largely to a single nursing home that has had about 77 percent of the city’s confirmed infections.

The total confirmed infection rates are widely considered an undercount of the number of people who actually have been infected with coronavirus, since many people with coronavirus have not gotten tested. And for many weeks in March and April, Orange County officials advised residents with mild and moderate coronavirus symptoms to not get tested, due to a shortage of test kits in the county.

Disease experts note Santa Ana and Anaheim residents tend to have jobs with a higher risk of getting coronavirus, and could have gotten infected at workplaces anywhere in the county.

“These are people with jobs that cannot socially distance. Because if your job is welding pieces of metal together or working as a cashier…you’re not spending your day in your pajamas in Zoom meetings,” said Andrew Noymer, an epidemiologist at the University of California, Irvine.

The case data is based on city of residence, so the actual place where people are infected is generally unknown because people can get infected up to two weeks before they have symptoms.

“You can get sick anywhere in the county,” and the case data shows where people reside, Noymer said.

It’s more difficult for people with lower-wage jobs to take time off if they’re sick, he added.

“Grocery stores have been open, and grocery store clerks have been going to work, and they’ve got jobs in a time when unemployment has gone way up. So people are [reluctant to stop working because it’s a] terrible job market, and so people are forced to take risks.”

Overcrowded housing, which has been linked to sharply rising housing costs as wages stagnate, is also cited as a risk factor for coronavirus spreading faster in a given community.

Among Orange County cities, Santa Ana has the second-highest rate of people living in each housing unit, which researchers have cited as a risk factor that increases the risk of an infection spreading once one person in a household has COVID. The novel coronavirus spreads even before people show symptoms, according to the U.S. Centers for Disease Control and Prevention.

A statewide analysis by the news agency CalMatters found that “Neighborhoods with large numbers of people per household have about 3.7 times the rate of confirmed COVID-19 cases per 1,000 residents as neighborhoods where few residents live in tight quarters.”

Anaheim has seen a concentration of cases at nursing homes, said city spokesman Mike Lyster, who was returning a message to Mayor Harry Sidhu.

“Where we see the biggest number of cases are where we have skilled nursing facilities. And that is not to say we don’t see cases throughout our community, because we do. But where we do see big concentrations of cases tends to be the nursing homes,” Lyster told Voice of OC on Friday.

“There is no doubt it continues to spread throughout our community.”

Los Alamitos Councilwoman Shelley Hasselbrink, who has been tracking her city’s numbers closely, said in such a small city as hers, a single nursing home has caused the numbers to be larger on a per-capita basis than it would otherwise be.

The nursing home’s impact on her city’s rate is “huge,” with 66 of the 86 cases, Hasselbrink said. “If you take that out, we have 20 cases.”

The county’s official data website for coronavirus displays the infection numbers in a way that epidemiologists say is not useful for comparing cities.

The county website shows each city’s number of confirmed infections and population, but doesn’t show the rate per capita. It’s the rate that takes into account each city’s population size, for comparison.

“Rates, and ratios are key cornerstones in understanding the health, morbidity, and mortality of populations,” according to an online public health textbook.

“Plain numbers of events, such as deaths, or births, or hospital admissions have very little meaning in themselves, lacking a context in which they can be interpreted. Calculating rates supplies such a context, by transforming the data in terms of the population at risk and the time period relevant.”

Orange County Health Care Agency officials didn’t have an answer Friday for why they don’t publish each city’s infection rate. They also rejected a request for the date of death and city of residence of people who have died from COVID-19 so far in Orange County, citing privacy laws.

OC’s recent death and hospitalization rates have gone from better than all four surrounding counties, to worse than three of them.

In recent days, OC consistently has had higher hospitalization and death rates than San Bernardino, San Diego and Riverside counties, as OC’s rates continue to climb faster than the surrounding counties.

And Orange County’s intensive care rates for COVID have now climbed higher than all four surrounding counties, including Los Angeles County.

“With hospitalizations, those are heartbreaking to see,” said Lyster, the Anaheim spokesman.

“I think what we’re all looking forward to is seeing a peak in hospitalizations and then seeing it continue to come down from there. That’s everyone’s goal and everyone’s wish.”

Nick Gerda covers county government and Santa Ana for Voice of OC. You can contact him at

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