Authors: Joaquin Palomino and Tatiana Sanchez
Published: May 8, 2020
At San Francisco General Hospital, more than 80% of the first patients admitted for COVID-19 were Latino, nearly three times the rate the hospital usually sees.
As people came into San Francisco General Hospital with chest pain, dry coughs and fevers — telltale signs of the new coronavirus — Dr. Vivek Jain noticed an unsettling pattern: The vast majority of people so sick that they needed to be hospitalized were Latino.
Jain, an infectious disease specialist who is part of the team directing the hospital’s COVID-19 response, was prepared to see an influx of low-income Latino patients, many of whom continued to work essential jobs and had been pushed into crowded homes due to the city’s high cost of living.
But the numbers were even more stark than he had imagined.
Of the first 103 people admitted to S.F. General for the disease, more than 80% were Latino. Normally, about 30% of those at the hospital and its associated clinics are Latino. One third of the patients required intensive care treatment, a serious intervention that can lead to long recoveries.
“In times of infectious diseases, we’re always braced for the possibility that they’re going to have a disproportionate impact on our most marginalized and vulnerable communities,” Jain said. “That being said, we have been surprised at the degree of disproportionality.”
Photo: Photos By Santiago Mejia / The Chronicle IMAGE Gloria Buenrostro on her sewing machine makes a mask at her home on Saturday, May 2, 2020, in Half Moon Bay, Calif. Volunteers at Ayudando Latinos A So–ar (ALAS) are making and providing masks for free to farm workers, housecleaners and other essential workers amid the coronavirus pandemic.
While the Bay Area has received praise for its aggressive response to the coronavirus pandemic, instituting potentially lifesaving shelter-in-place policies early and avoiding a flood of people in hospitals, it has not escaped glaring racial disparities in who’s getting sick and dying from COVID-19 — a problem mirrored in cities across the country.
A Chronicle review of state and county data found that Latino and black people are disproportionately testing positive for, and dying of, the coronavirus in three of the region’s largest counties, magnifying inequities that predate the health crisis. Addressing the disparities will be crucial in slowing the spread of the virus, experts said, especially as social restrictions are loosened.
As of May 5, of the 1,375 coronavirus cases in San Francisco where a race had been determined, 45% were Latino, compared to 15% of the population, according to public health and census data.
In Alameda County, 43% of cases with a known race were Latino, compared with 22% of the population. And in Santa Clara County, Latino people made up 45% of cases with a listed race and 25% of the population.
In a recent study in a small slice of the Mission District, 95% of the people who tested positive for the coronavirus were Latino, even though the group made up just 44% of those screened. The overwhelming majority of people who tested positive were unable to work from home or made less than $50,000 a year.
Meanwhile, the death rate for black residents in the three Bay Area counties combined — 10.7 deaths per 100,000 people — was roughly twice as high as any other race. State public health figures show similar disparities in the proportion of black adults dying from the virus throughout California, as well as alarming rates for Native Hawaiians and Pacific Islanders.
Overall, Latinos are not dying from COVID-19 at disproportionately high rates in California, but the population is younger than other races and ethnicities, which has skewed the data.
When California health officials examined the impact of the coronavirus on just adults, they found a troubling trend. About 70% of people between 18 and 49 who have died of COVID-19 were Latino, compared to 43% of the population. More than half of the people between 50 and 64 who have died from the disease were Latino, compared to 32% of the population. There were similar, though not as drastic, differences in Latinos 65 and older who have died.
“When any group is marginalized to the point where their living conditions or work conditions make it difficult to get the medical attention they need or to protect themselves from this virus, that’s everyone’s problem,” said Norma Garcia, director of policy and advocacy at the Mission Economic Development Agency, which works to strengthen low- and moderate-income Latino families in San Francisco.
People are tested for COVID-19 at Garfield Park on Tuesday, April 28, 2020, in San Francisco, Calif. The UCSF testing was intended for those in the Mission District with or without symptoms who work or live in the area between Van Ness and Harrison and Cesar Chavez and 23rd. UCSF stated it hopes to ultimately test as many as 5,700 residents to see how many in a sample of the community are infected by or may have recovered from the coronavirus, and to learn how it spreads. UCSF chose the neighborhood for this project, called Unidos en Salud (United in Health), because of its high population density and large Latino population. (Photos By Santiago Mejia / The Chronicle | San Francisco Chronicle)
Health experts and epidemiologists believe the racial imbalance is driven by more than just a higher prevalence of preexisting health conditions among black and Latino people, or socioeconomic factors that can force people to work high-risk jobs that provide little protective gear.
Structural barriers, including policies that may lessen immigrants’ odds of gaining legal residency if they access public services, have also fueled the unequal spread of the virus, as well as a mistrust of health care providers due to past and current mistreatment, public health officials said.
“The COVID-19 pandemic has ripped a Band-Aid off of the structural inequities that exist within our society,” said Dr. Stephen Lockhart, chief medical officer at Sutter Health. “We must address these disparities right away, because the cost of not addressing them is measured in human life.”
Some Bay Area cities have begun funneling tests, housing assistance and other aid to hard-hit communities, and grassroots efforts have sprung up to provide masks and protective gear to at-risk families and workers.
Health care workers test Mission District residents for COVID-19 at Garfield Park on Tuesday, April 28, 2020, in San Francisco, Calif. The UCSF testing was intended for those in the Mission District with or without symptoms who work or live in the area between Van Ness and Harrison and Cesar Chavez and 23rd. UCSF stated it hopes to ultimately test as many as 5,700 residents to see how many in a sample of the community are infected by or may have recovered from the coronavirus, and to learn how it spreads. UCSF chose the neighborhood for this project, called Unidos en Salud (United in Health), because of its high population density and large Latino population. (Santiago Mejia / The Chronicle | San Francisco Chronicle)
Directing resources to places where the virus is most prevalent — whether it’s nursing homes, neighborhoods or jails — offers protection to everyone, said Dr. Mahasin Mujahid, an associate professor of epidemiology at UC Berkeley’s School of Public Health.
“For infectious disease, that’s the only way you can think about it,” Mujahid said. “We’re going to have to change our priorities and say that these high-risk populations deserve more. It’s really a difficult conversation, and I don’t envy the people who have to make those kinds of decisions, but that’s the reality.”
After developing a fever and losing his appetite last month, Carmen Gonzalez Puga was diagnosed with COVID-19 — grim news for the 88-year-old diabetic and his family.
They don’t know where he was infected with the virus but suspect it may have happened in the San Jose home he shared with nine other people, the family said. After he was diagnosed, Gonzalez Puga moved in with one of his daughters — while quarantining himself from the rest of the family.
He has since recovered, but being apart from her father as he battled the deadly illness was the most trying aspect of his diagnosis, said Francisca Gonzalez, who did not see her father for weeks while he was ill.
“I almost fell into a depression in having to close the doors on my family,” said Gonzalez, 55. “It hurt a lot. He needed the help of his kids.
“God was always with us — my dad is OK now,” Gonzalez added. “But it’s sad to know that there’s people in other places who are no longer here.”
Even relatively minor cases of COVID-19 can ripple through families and households, leading to painful separations and fears of infecting loved ones — along with financial impacts such as lost wages.
From left: Francisca Gonzalez, her sister Juana Gonzalez, father Carmelo Gonzalez Puga and family friend Paola Pea prepare for dinner on Thursday, May 7, 2020, in San Jose, Calif. Carmelo Gonzalez Peña said he tested positive for the coronavirus in mid April and has since recovered from COVID-19. (Santiago Mejia / The Chronicle | San Francisco Chronicle)
In Santa Clara County and other parts of the Bay Area where Latino people have particularly high rates of infection, advocates and health care leaders are trying to tamp down the spread of the virus among high-risk populations.
Joaquin Jimenez spends up to seven days a week canvassing communities along the coast of San Mateo County, offering Latino residents everything from food assistance to masks, which he always has on hand.
The longtime organizer and outreach worker with Ayudando Latinos a Soñar, or ALAS, goes to malls, grocery stores and farmworker housing complexes in an effort to reach even the most marginalized people. He gives out his personal cell phone number — and his phone rings often.
“We’re exposed to it a lot more,” Jimenez said. “Latinos are still out there working. We’re talking about auto shops, grocery stores, some restaurants, landscaping, farmworkers.”
As the economic strains of the shutdown mount, people across the Bay Area have started to ask ALAS not just about protective gear but also financial assistance, said Dr. Belinda Hernandez-Arriaga, the group’s founder and an assistant professor at the University of San Francisco.
“Our families were already at a stress-breaking point before, with the high cost of living in the Bay Area,” said Arriaga, a licensed clinical social worker. “Now you have COVID-19, which has broken what was already stressful. This goes way back.”
In San Francisco, the median income for black households in 2018 was about $31,000, for Latino households it was $76,000, and for white households it was $153,000. Meanwhile, the city has some of the highest rents in the country, forcing some people to live in packed homes where the virus can spread more easily.
A recent Pew Research Center study found that about half of the Latinos surveyed in the country either have taken a pay cut or lost their job due to the pandemic, or they live with someone who has. That compares to about a third of all adults in the country.
Carmelo Gonzalez Puga at his home on Thursday, May 7, 2020, in San Jose, Calif. Carmelo Gonzalez Puga was diagnosed with the coronavirus mid April and has since recovered from COVID-19. (Santiago Mejia / The Chronicle | San Francisco Chronicle)
Dr. Jain, at San Francisco General Hospital, said what most accelerates the spread of the coronavirus among the city’s Latino community are high-density living arrangements and economic pressures that force people to keep working.
Jain has seen some families in which both parents have developed symptoms of the coronavirus, but only the sickest person received medical care so the other could continue to run the household.
“These are very difficult situations that are playing out for people,” he said.
Esperanza Macias, director of policy and communication at Instituto Familiar de la Raza, a community organization in San Francisco’s Mission District, said there has been a flood of requests from clients for food, diapers, baby formula and other essential items. Many have come from undocumented residents who do not qualify for federal aid or stimulus funds, which has given them a much thinner safety net.
Some have told Instituto staff they’re worried to go to the hospital since it might draw the attention of Immigration and Customs Enforcement officers — a trend that predates the health crisis.
Immigrants’ chances of gaining a green card or visa can also be hurt if they receive public benefits — or if the government believes they are likely to do so in the future — which could deter some from seeking medical care, Macias said. The government has said immigrants who seek treatment or preventive services for COVID-19 will not be negatively impacted under the policy, known as public charge.
“There’s a lot of panic and fear and anxiety right now, both because of the pandemic and because people are wondering, ‘How am I going to pay rent, how am I going to put food on the table,’” Macias said.
Many public health experts and politicians say that pinpointing the people and places most impacted by the coronavirus will be particularly important as the state gradually reopens society, so health officials can target medical and financial resources to the places that need it most.
In Oakland, high-risk individuals — including those who are homeless, were recently incarcerated, work in the community or have pre-existing health conditions — can be tested for free. On Wednesday, a walk-up testing site opened at the Roots Community Health Center, which has a clinic that mostly serves uninsured and low-income residents in East Oakland — a community with especially high rates of confirmed coronavirus cases.
From front left: Volunteers Juana Ruano and Julio Lopez take in food donations to be organized and distributed to people in need in a makeshift drive-thru site on Saturday, May 2, 2020, in Half Moon Bay, Calif. Amid the coronavirus pandemic, people in need received a box of food and gift cards without leaving their vehicles. Ayudando Latinos A So–ar (ALAS) hosted the event. ALAS is a Latino cultural arts and social services program in Half Moon Bay. (Santiago Mejia / The Chronicle | San Francisco Chronicle)
“We’re utilizing a trusted messenger, an organization that has been doing great health access work in our most vulnerable populations,” said Oakland Mayor Libby Schaaf. “We need to not just stop overt discrimination, we need to proactively correct for it.”
In East San Jose, a largely Latino and Vietnamese neighborhood hit hard by the pandemic, local officials are expanding outreach efforts and culturally relevant messaging to help stop the spread of the virus. Camille Llanes-Fontanilla, executive director of the nonprofit SOMOS Mayfair, said that could be as simple as advising Latinos — who are generally very family-oriented — to stop visiting relatives outside of their household.
“Culturally, our connection to family runs deep — deeper than the potential risk of acquiring an illness for some,” she said. “There was one message that captured this essence and conveyed that, ‘I’m separating myself from you because I care about you so deeply. Because I love you, I have to stay away for a while.”
And in San Francisco, Supervisor Hillary Ronen said the city plans to tap into its Give2SF fund to provide people who have tested positive for the coronavirus guaranteed pay and somewhere to self-isolate if they’re unable to at home, along with other resources. The free testing study that took place in the Mission may soon expand to Bayview-Hunters Point, she added.
“What we hope is that by highlighting how big the disparity is with the Latino community, that we will be able to shift policy and resources and prioritize neighborhoods that are hardest hit,” said Jon Jacobo, a member of San Francisco’s Latino Task Force for COVID-19. “Some people may not prioritize those with the least, but if they’re taken care of, you can rest assured that you’re taken care of.”
Dr. Amani Allen, an associate professor at UC Berkeley’s School of Public Health, said the state still needs more data to understand what’s driving the racial inequities with the coronavirus, including information on education, employment status, occupation and income level.
“What we tend to see is the most socially vulnerable groups being the most heavily impacted,” Allen said. “As horrible as the coronavirus is, when it ends, if we don’t fix the societal issues we’re going to see this exact same pattern with every passing epidemic.”