Latinx, who represent 50% of the city’s Covid cases, only represent 9% of its testing
We will “continue to follow the data and science” in making decisions, Dr. Grant Colfax, the Director of Public Health, often says. It sounds good — until you take a hard look at the data and the science.
Then, if you belong to the city’s Latinx population or live in southeast San Francisco, where the coronavirus is most prevalent, you might wonder why you’re getting short shrift from the Department of Public Health. And if you live in another part of San Francisco, you still might ask why Colfax isn’t focusing on the most affected areas to bring the city’s total numbers down and allow life to return to normal.
At present, the city is in the “high alert” territory of California’s Covid watchlist, with about 53 new cases per day. Latinx residents – only 15 percent of the population – account for at least half of those cases. Cut their cases by half and we’re down to 40 cases a day; cut it by 75 percent and we’re at 33 cases a day – a rate that takes us off high alert and below where we were in mid-July before reopening ground to a halt.
The city’s positive test rate is now about 2.1 percent. Bring down infections in the most affected areas and populations, where positivity rates run from 6 to 12 percent, and that number could get closer to the 1 percent rates that New York is now seeing.
The situation recalls Sutton’s Law, named after Willie Sutton, who — apocryphally — explained that he robbed banks because “that’s where the money is.” Sutton’s Law, taught to medical students, instructed them to conduct tests first that would confirm the most obvious diagnosis rather than seek the most obscure.
Or, as Jon Jacobo, who is on the health committee for the Latino Task Force, which runs a once-a-week testing site at 701 Alabama St., put it, “Why wouldn’t you move to the neighborhoods” with the highest rates of infection?
But that’s not what’s happening.
Despite accounting for half of the city’s Covid-19 cases, Latinx residents represent only 9 percent of the nearly half-million tests the city has reported since January when the city started testing for Covid.
(Update: District Supervisor Hillary Ronen will call for hearings on the DPH response in the Latinx community.)
UCSF offers a model
The disparity in testing is increasingly a topic of conversation – and debate. On Wednesday, UCSF researcher Dr. Diane Havlir, who works at San Francisco General Hospital and has collaborated with the Latino Task Force on several testing studies in the Mission District, joined a discussion held by the Commonwealth Club of San Francisco.
She explained the virus’s trajectory. At the start, she said, “the infections had been spread across demographics, but over a very short time period, it really had settled into individuals who actually need to go out to work.”
Many of those, Havlir and her team found, were low-income Latinx workers who often returned home to crowded living conditions and inadvertently promulgated the virus’s creep.
The UCSF researchers figured this out back in April when a collaboration with the Latino Task Force tested more than 4,000 people in the Mission.
Those results were widely published, and after a few months, Colfax and DPH began offering some testing in the Mission and the southeastern part of the city.
The science and data suggest it is not nearly enough.
Havlir and her team returned to the Mission in July and, in a second collaboration with the Latino Task Force, set up a three-week testing study at the 24th Street BART station. (They will return Monday to test at the 16th Street BART Station from 9 a.m. to 2 p.m..)
The researchers found a positivity rate of 9 percent in the tests at the 24th Street BART station. “That’s just shocking,” Havlir said on Wednesday. “And that is completely unacceptable, because we knew back in April which populations were being affected.”
Havlir and others have long argued that the city needs more low-barrier testing in the Mission and Southeast. They define low-barrier as not only walk-up accessibility and quick results, but if someone tests positive, resources to help them quarantine – a hotel room if necessary – food, cleaning supplies and financial help.
Havlir said on Wednesday that the city does not have to test every person, but it must be “smart” and test “in the populations that are most affected and then provide the response. So we’re not just documenting the problem, we’re documenting and we are responding to the problem.”
In an email, Havlir wrote, “We need to accelerate strategic ‘test and respond,’ or adaptive testing to reach the most affected populations in the city.” She added that in the 16th Street BART station testing that starts Monday, the project “will be to see if we can reduce the time from symptom onset to isolation through education, and getting results back as fast as possible to clients.”
The UCSF researchers have sat down with the health department to talk about doing more testing in impacted communities. After publishing their results from the BART study, Dr. Kirsten Bibbins-Domingo, the vice dean of population health and health equity at UCSF, said, “San Francisco has higher testing overall, but several faculty have proposed to the city that they monitor the data more closely and commit to making even more testing available in the areas where transmission is high, including the Mission.”
For the most part, that has not happened.
Although the city increased testing pop-ups in the southeast this summer, and today Mayor London Breed is slated to open a new one in the outer Mission, the city’s testing in impacted communities remains dramatically lower than elsewhere.
Testing pop-ups operate one to three days a week, compared to the daily service at the Embarcadero or the five-day-a-week service at SoMa. Even the established neighborhood clinics offer fewer hours, or as the city’s website warns when clicking on the neighborhood option, “capacity limited.”
Moreover, once a pop-up testing site gets approved, community advocates must fight for resources and in some cases contribute their personal money to make sites work.
The city finally relented in July and offered the Latino Task Force 100 tests for a once-a-week testing hub at 701 Alabama St. Valerie Tulier-Laiwa and Jon Jacobo from the Latino Task Force fought back and demanded more tests. The Hub now tests about 250 people every Thursday.
Other neighborhoods have had the same battles. After an outbreak in June in Sunnydale’s Black community, local advocates had to tap into the medical and political power of Dr. Kim Rhoads, a UC San Francisco professor of epidemiology and biostatistics, and Dr. Monique LeSarre, the executive director of the Rafiki Coalition, a center for health and wellness in Bayview. Only then could they get the attention of the Department of Public Health. Now there is testing in Sunnydale two days a week for four hours a day.
In total, 1,996 tests have been done at seven pop-ups in the impacted communities and 47 percent of those tested there have been Latinx, according to the health department. At five neighborhood clinics in the Southeast and Mission, 23,270 people have been tested; 45 percent have been Latino.
The positivity rate for Latinos at the clinics has been 21.5 percent, according to DPH. The rate for others is 5.4 percent.
Compared to the approximately 25,000 residents tested in affected communities, 176,031 tests have been conducted at the city’s Embarcadero and SoMa sites, according to the Department of Public Health. The health department did not give us positivity rates, but one source said it was between 1 and 2 percent. The health department said that 17 percent of those tested at the Embarcadero and SoMa were Latinx.
Peter Khoury, a data scientist who lives in the Mission District, compared the Latino Task Force Hub’s testing numbers for several recent days with testing elsewhere in San Francisco. Testing at the Alabama Street site routinely revealed disproportionately higher rates of infection.
“You’re not putting the resources of our community to the best use,” Khoury surmised.
The Department of Public Health declined repeated requests for an interview and provided only partial data. Most of the data used here came from community-based organizations, doctors and others who attend a weekly meeting with DPH. (We have updated this post below with some answers from Dr. Colfax.)
One of the slides DPH regularly shows at these meetings shows a list of the most impacted census tracts. Mission Local took these lists and added population figures to analyze the correlation between representation in the population compared to positivity rates.
In nearly every instance — no matter how few Latinxs live in a neighborhood — Latinx residents represent the vast majority of positive cases. As researchers and advocates have long pointed out: Latinx residents are disproportionately represented because they must leave home to work, putting themselves and their families at greater risk.
So why doesn’t DPH follow the science and data to test more in the impacted neighborhoods?
The large concentration of cases in the southeast and Mission suggests that a large testing site might be called for and the health department said in a fact sheet prepared for Mission Local that it is indeed considering moving the SoMa site to the Mission. But that has yet to happen.
Moreover, no one I spoke to in the Mission has been told that this is under consideration – although they did have suggestions for where it might be housed: Parque de Los Niños and Garfield Park, the two sites used successfully in April by UCSF and the Latino Task Force.
It’s unclear why the health department has not taken full advantage of the game plan set out by the UCSF/Latino Task Force collaborations.
Those studies not only armed them with science and data, but also offered a way to approach aftercare with wellness teams who come from the community.
“I’ve looked at Grant Colfax 10 times and I trust that he is a man who wants to do good, but I just see bureaucracy and politics,” said Santiago Lerma, an aide to District 9 Supervisor Hillary Ronen.
Lerma said he feels like the health department wants to retain control when it might make more sense to delegate to community-based organizations that have already demonstrated their skills around Covid. He uses the example of $5 million in DPH’s budget for culturally competent Covid responses. “Where is the money? It is not on the street.”
There are more cynical rationales for the city’s sluggish response. The population most impacted – undocumented Latinx workers – do not vote. And, San Francisco’s overall low death rate – a wonderful outcome in an otherwise bleak year – has diminished some of the urgency.
Whatever the reasons, the consequence of not focusing on impacted populations are clear, said the Latino Task Force’s Jacobo. The city will not be safe until impacted communities are safe.
Yesterday morning, Tulier-Laiwa and Jacobo were preparing for another day of testing. Every week, they show up early to make sure the volunteers, testers and residents are ready for the day. They must also contend with weekly distractions. On this morning, a couple of windows of the building where they house the Hub have been broken.
Tulier-Laiwa was already on top of it with a call for funds to help fix the windows.
She has long wanted to use the wellness model devised during the UCSF collaboration in April. It involved immediate calls to anyone who tested Covid-positive, delivery of appropriate food and cleaning supplies, follow up and financial assistance.
After the April study by UCSF and the Latino Task Force, however, DPH carried on with its own model. A health worker contacts the Covid-positive person, offers services and a box of food, and that’s pretty much it, said Tulier-Laiwa.
That’s not enough, she says.
She knows that because her group is seeing people in its food lines who have tested positive. They’re hungry. This has made her skeptical of more testing without first providing adequate after care. “I’m not in agreement with more testing unless we have the capacity to take care of those who test positive and right now we don’t,” said Tulier-Laiwa.
Ever since the April study showing the high need for food, income and services, the Latino Task Force has been asking the city to fund locally based wellness teams. There are meetings with city officials, they said, where spreadsheets appear to show how much the city is already doing; an oft-made point is that the money is being spent on Latinos who use San Francisco General Hospital. No funds follow.
In an email, Dr. Havlir wrote that the wellness teams are critical to delivering food, cleaning equipment and masks. She is hopeful about the city coming around to the benefits of the wellness teams. “Our Latino Task Force collaborators have pioneered this model, and public health officials City and State have shown much interest in its expansion for vulnerable populations,” she wrote.
While Supervisor Ronen’s office also supports the idea of wellness teams, they have not yet materialized. The city’s help has so far been minimal. The Hub on Alabama Street cannot run on volunteers forever, said Tulier-Laiwa. She said the city recently released $30,000 for the Hub, but that money has already been spent. A site coordinator has been working without pay.
The Department of Public Health does send two or three workers to the Hub every week – Oscar Marcias and Isela Ford are two. Jacobo and Tulier-Laiwa are grateful, and they say that Marcias and Ford could be crucial actors in any new wellness team system.
And, it’s not as if the city isn’t spending anything on the Latino community. Because it is so impacted, 46 percent of the people who are using hotel rooms to quarantine are Latino, according to the health department. Moreover, because Latinos are heavily represented in positive cases, the city has had to hire more bilingual contact tracers. Of the $9.6 million in new expenditures for contact tracing, $4.9 million has been allocated to the Latinx population.
The money ran out — quickly
After the April study in the Mission showed the dire need to offer financial support for Covid-positive workers unable to replace their wages from other state and federal programs, Mayor London Breed approved $2 million for Ronen’s Right to Recover initiative.
It gave some 1,500 Covid-positive workers two weeks of wages or $1,285.
The money ran out fast, said Christopher Gil at the Mission Economic Development Agency, which helped to distribute the funds. Talks are under way with some philanthropic groups, but the mayor has yet to set aside any new funds.
What this means is that the fliers encouraging workers to get tested – even if they are asymptomatic or have mild symptoms – can no longer promise financial assistance. Get tested, get positive results — and you will not be able to work or replace your wages. That’s a disincentive to get tested, but that’s the reality — one that impacts all of San Francisco.
As Breed said at a recent press conference, “Just imagine if we all did our part, if we all did our part, where we would be today. That’s what this is about.”
Dr. Colfax visited the outer Mission today, and Mission Local’s Juan Carlos Lara caught up with him to ask about the disparity in testing. (Previous repeated interview requests were ignored, but my request for an extended interview remains open.)
Mission Local: Why does the city’s testing in the southeast remain dramatically lower than the rest of the city?
Colfax: “We are continuing to expand testing,” and will be focusing on the southeastern part of the city “so that we reach the people most at risk. … And this is going to be our focus today, and this will be our focus going forward.”
Mission Local: What barriers prevent testing in the southeast from being proportional to the rest of the city?
Colfax: “We have to do things differently now in the age of Covid-19. Innovation like this where we have the pop-up sites can do 250 tests per day. And scaling that up is going to be really key. … And so we’re going to continue to expand testing options, low-barrier testing options for people who live in the southeast part of the city and that expansion will be happening over the next two months.”
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