San Francisco coronavirus tests show Hispanic & Latinx communities hit hardest : Short Wave In San Francisco, the coronavirus has disproportionately affected Hispanic and Latinx communities. This is especially true in the Mission District — a neighborhood known for its art and food culture. To understand more about how the virus has penetrated the neighborhood, a group of collaborators known as Unidos En Salud carried out a massive testing initiative focused on community and collaboration.

Follow Maddie on Twitter for more coronavirus coverage. Her Twitter handle is @maddie_sofia. Email the show at shortwave@npr.org.
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The Key To Coronavirus Testing Is Community

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The Key To Coronavirus Testing Is Community

The Key To Coronavirus Testing Is Community

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MADDIE SOFIA, HOST:

Hey there. If you're a SHORT WAVE newbie, welcome to the show. You're going to love it here. Go ahead and subscribe and follow us so you get all of our latest content as soon as it's out.

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SOFIA: You're listening to SHORT WAVE from NPR.

JON JACOBO: The Mission District is a longtime immigrant neighborhood for new arrivals. Formerly Irish, then Italian, and most notably now from the '60s and up, the Latinos have called this home in addition to many other folks.

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SUSANA ROJAS: Every time that you emigrate - right? - you don't know what you're going to find. Thankfully, my immigration story was surrounded by Latinos.

SOFIA: Jon Jacobo and Susana Rojas know San Francisco's Mission District well. Jon was born and raised in the neighborhood, so it's always been home to him. And they both work with nonprofits that support the Latino community in the area. Susana remembers when she first got there.

ROJAS: You walk down the streets, there's people talking Spanish. There's, like, (speaking Spanish) selling fruit and selling tamales. And it's just a very homey, very family-oriented environment. That's what makes, like, the Mission community so special is that you can have a piece of home every time you walk through The Mission.

SOFIA: Then came the coronavirus pandemic. Just like everywhere else in America, The Mission shut down. As the virus spread, it became clear that the Latinx community in The Mission and elsewhere was being hit particularly hard. So Jon helped organize a group called the Latino Task Force for COVID-19. Susana chairs the communication and outreach committee.

ROJAS: We had anecdotal information, right? Like, we knew that the majority of the cases that were seeing in general were Latinos. We knew that we were seeing people getting sick. We knew that there were very harsh economic repercussions for our community, but we didn't have the hard, tangible data.

SOFIA: Blocks away from the heart of the Mission District at Zuckerberg San Francisco General Hospital, Dr. Diane Havlir was seeing the same trends.

DIANE HAVLIR: Over 80% of all of the patients who have been admitted to Zuckerberg San Francisco General for COVID are Latinx. And that is over twice the proportion of patients that are admitted just in general for any conditions to the hospital.

SOFIA: Citywide, Hispanics and Latinos make up about 46% of coronavirus cases, but they're only an estimated 15% of the population. Dr. Havlir says in order to truly understand why specific communities were being affected and how much, there needed to be more testing.

HAVLIR: What we needed to do was move from the hospital to the community and to look and see who's still getting infected and how can we potentially impact that.

SOFIA: Dr. Havlir heads up the UCSF Division of HIV, Infectious Diseases and Global Medicine. So she, alongside other doctors and hospital partners, reached out to the Latino Task Force. And together with the Health Department and other government agencies, they created the partnership Unidos en Salud, United in Health. Their goal - to try and test everyone in one part of the Mission District and support those who tested positive. What they learned says a lot about why people of color are being hit disproportionately hard by COVID-19 and why community partnerships are so instrumental to bringing the virus under control. I'm Maddie Sofia. And this is SHORT WAVE, the daily science podcast from NPR.

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SOFIA: OK. So let's talk about how they set this all up. To start, they needed to pick one specific area to test, so they went with a part of The Mission, a census tract, that had a lot of people in a relatively small area.

HAVLIR: So one of the things that we know is that being in close proximity, of course, facilitates COVID transmission.

SOFIA: Next, Dr. Havlir said they had to figure out how to test everybody. And that's tricky because usually people only get tested for coronavirus because they're feeling sick.

HAVLIR: Nearly all testing right now is done as a convenient sample, and that can be people have the opportunity to go to a testing center in their car, at the - at a clinic or at a hospital.

SOFIA: But that convenient sample gives you an incomplete picture because you might miss people who have coronavirus but don't have symptoms.

HAVLIR: People can have active COVID disease and can transmit this disease without having any symptoms at all.

SOFIA: Plus, with a convenient sample, you might miss people who can't get to a testing center. So the team decided to test people where they are in their community.

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HAVLIR: Then, the community really has essentially all the say - understandably, the insight, the say on the how one does this. And then we defer to that because they're the experts. It's like, where should we do it? How should we do it? How should we mobilize for this?

JACOBO: I think this is where the Latino Task Force plays a huge role in that, as I alluded to earlier, many of us are born and raised here and know the intimacies of this neighborhood. We know our neighbors. We know the corner store owners, the clerks.

SOFIA: So Jon Jacobo and other community volunteers got to organizing big time.

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JACOBO: We did four days of outreach. We recruited 400 volunteers over an eight-day period to go out for the first four days and knock on 1,400 doors four times, phone bank those individual homes and leaflet to let people know that we were going to be doing COVID testing for everybody that lived within a particular census tract.

SOFIA: After all that outreach, it was time for testing. They set up pop-up testing sites in places like community centers or at public parks like this one, Garfield Square.

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UNIDENTIFIED PERSON #1: So let's - we all need to social distance.

SOFIA: Nurses, doctors and volunteers in protective gear worked to test as many people as they could.

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UNIDENTIFIED PERSON #2: Any symptoms of fever?

UNIDENTIFIED PERSON #3: No.

UNIDENTIFIED PERSON #2: Any dry coughing?

UNIDENTIFIED PERSON #3: No. But...

SOFIA: Volunteers even ended up going to the homes of people who couldn't come out to get tested. And aside from all the logistical difficulty of getting this many people organized, Jon says they also had to tackle other things like mistrust.

JACOBO: You know, who is doing this study, you know? Am I putting myself in jeopardy if maybe I'm undocumented? Am I putting myself at risk here?

SOFIA: But beyond that, there was fear of testing positive.

JACOBO: You know, we have people that literally said I'm symptom-free. I don't want to know if I have it because if I do, I have to miss work. And I think that is one of the realest points that hit us where we had to think through, OK, when these people inevitably do test positive, how are we going to support them?

SOFIA: Providing care for people after testing positive is a huge part of this story. They call it test to care. But first, let's talk about the data.

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SOFIA: All in all, they tested about 3,000 people who either lived or worked in that particular part of The Mission. According to the San Francisco Department of Health, at the time, this single effort increased San Francisco's total testing by almost 20%. Sixty-two people tested positive for coronavirus, about 2% of who they tested. But here's the thing; even though more than a third of the people tested were white, everybody who tested positive was a person of color.

JACOBO: Hundred percent of them were people of color - 95.1% being Latino and the remaining 4.9% being Asian/Pacific Islander.

SOFIA: Were you surprised by any of the results?

JACOBO: You know, the fact is yeah, I actually was. You know, I thought, you know, high percentage, but never 95%. I never thought that it would be 100% people of color.

SOFIA: Jon wasn't the only one thrown off by this. Here's Dr. Carina Marquez, another UCSF doctor on the study.

CARINA MARQUEZ: As someone who works in the hospital, the disparities were evident, I think, from the beginning. But I think we had not looked within the community, and this was more stark than I expected. And these are people who are living in the exact same census tract, although albeit their experiences and sort of the social determinants of health, I think, are also vastly different, which kind of, when you look at some of the other factors like income or whether you need to work or whether you're an essential worker, how many people you live with, those things all are very different.

SOFIA: One of those determinants, especially in San Francisco, was housing.

MARQUEZ: The cost of rent in the Mission District, in particular, has risen dramatically. And so a lot of people to be able to stay in the Mission District where they work, where they've grown up or where they have family and community, to stay here, have to live in very crowded living situations. And I think that's one component that also can increase your risk for exposure to COVID.

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SOFIA: The large majority of positive cases were folks who lived in households of three or more people. And lastly, because these tests were done well into shelter-in-place, the team wanted to look at if working from home made a difference. When they asked everyone they tested if they could work from home...

MARQUEZ: Forty-three percent of those people said yeah, I can work from home.

SOFIA: But 90% percent of those who tested positive said they couldn't.

MARQUEZ: They're either still working outside of the home. They're our essential workers. They're the people keeping our city running. And then a component of those people were also recently unemployed or furloughed, as well, so were maybe recently working outside of the home as an essential worker but then lost their job and then now may be at home.

SOFIA: Now, the researchers haven't analyzed the exact breakdown of who is still leaving the house for work versus couldn't work at all, but they're pretty comfortable saying if you can work from home, that's huge.

MARQUEZ: I think the take-home message from that work-at-home question was being able to shelter in place and work from home is really a privilege. And it's the people that have to go out and work and who are essential workers that are at high risk.

SOFIA: So the study showed that the Latinx community in the mission was being hit hard, and it gave some sense as to why. The doctors we spoke to made it clear that social and economic inequities in place way before COVID were to blame - how the households were set up with groups of people sharing small spaces, the fact that most of the people who tested positive couldn't work from home, plus income. Those making less than $50,000 were more likely to have coronavirus. But this isn't the end of the story.

MARQUEZ: Our study was not just about testing. It's really responding to a positive test and really thinking about how to provide these wraparound services for people who test positive because people aren't going to test if they are just going to have negative consequences for testing.

SOFIA: This is where the care part of the test-to-care model comes in. Susana, who's in charge of community outreach for the Latino Task Force, says that once the results come in, everyone's given access to a website to see their results.

ROJAS: But if you were positive, you got a personal phone call.

SOFIA: ...As soon as the results came back. And that's important because more than half of the people who tested positive didn't have symptoms at the time, which means they probably didn't know. So somebody on the hospital team calls to notify you and then does an assessment. After that, they pass the names of those testing positive onto the community wellness team, so they could figure out the best way to support you.

ROJAS: Like, we can give you some food. We can give you some masks. We can give you some gloves.

SOFIA: They delivered groceries or even offered a place for people to properly isolate themselves, like hotel rooms. That way, they didn't have to be worried about getting other people sick, and they could focus on healing.

ROJAS: We wanted to bring dignity back into their care and be able to afford them to just focus on being healthy and caring about themselves and their family and not worry about, like, whoa, what am I going to eat today? Or I don't have a mask.

SOFIA: Susana says a good portion of the patients didn't want help at the start, but the community wellness team was able to cultivate a meaningful rapport.

ROJAS: And that was very important for us that the people that were coming from the community wellness team were culturally relevant and that they spoke Spanish and that they understood that kind of respect that you have to have in order to communicate with our families.

SOFIA: Both doctors and community organizers we spoke to said that this understanding is what enabled them to reach as many community members as they did.

ROJAS: You know, you got to the point, like, when the ladies would call them. Like, (speaking Spanish). I'm feeling better.

SOFIA: The team says community-led initiatives like this are essential, especially in communities of color, because the evidence they give about disparities within the community allow the community to turn and advocate for more resources. Susana says, for her, it's proven just how strong the community is.

ROJAS: One of my favorite sayings ever is they try to bury us, but they didn't know we were seeds. And I think that this whole time right now during COVID, the testing, the way in which the community has responded is just a testament to that saying. And it completely fills me with pride and joy and hope because we Latinos - we are the force that keeps this city moving.

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SOFIA: Last weekend, Unidos en Salud began expanding their testing efforts to three more neighborhoods in San Francisco.

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SOFIA: This episode was reported by me and Rebecca Ramirez. Rebecca also produced it because she is twice as talented. That's math. It was edited by Viet Le and Geoff Brumfiel, fact-checked by Emily Vaughn. Special thanks to Eric Westervelt for his help with the episode. I'm Maddie Sofia. And this is SHORT WAVE from NPR. See you next time.

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