Bay Area Phlebotomy Laboratory Services, a company that grew from a just a handful to 80 employees during the pandemic, collected samples during the 24th Street UCSF/Latino Task Force pop-up around Thanksgiving. Photo by Mike Kai Chen

San Francisco loves to compare itself to other cities, especially when it is doing spectacularly better. We expect city officials to do this and they rarely disappoint.

Two favorite Covid-19 statistics that elicit frequent backslapping among SF officials include San Francisco’s testing rates — we do more than anywhere else in the country — and the city’s lower covid mortality rate. The latter is a marvel. The former, not so much, as testing is only now moving to the high-risk communities. 

The San Francisco Chronicle jumped on the cheerleading bandwagon earlier this week, looking at how the city’s recent case rate compares to other large metro areas.

“California is now the epicenter of the nation’s latest coronavirus surge,” the piece began, but quickly moved from the bleak to the upbeat. Lo and behold, San Francisco has a lower new case rate than other major cities; only Seattle fared better. “Others are two, sometimes even three times higher, including big cities in Texas and several Southern California counties.”

Another reason to cheer? Probably not. Generalized case rates, as epidemiologists have pointed out throughout the crisis, minimize the importance of who is getting sick. In this pandemic, the most impacted, depending on the city, are either low-income Black residents or low-income Latinx residents.

Looking at overall case rates, said Peter Khoury, a data scientist who lives in the Mission District, “builds a sense of complacency, and you don’t see your weak spots — and the virus exploits the weak spots. In San Francisco, that [weak spot] is the Latino population.”

But, the Chronicle piece made us wonder – maybe San Francisco is doing much better in the Latinx community compared to the other major cities. 

Alas, no. San Francisco may be richer and hillier, but some of its Texas counterparts with a lot more poverty and Trump voters have lower case rates in their most-impacted Latinx communities.

The Chronicle’s look at case rates in 20 counties that include Houston, Dallas, Seattle, Indianapolis and Denver showed San Francisco’s with the second-lowest recent case rate after Kings County, which includes Seattle. 

But, looking at the most impacted communities in those cities tells a wholly different story.  

San Francisco has among the highest case rates in its Latinx population. At an adjusted rate of 8,664 per 100,000 residents, San Francisco ran well ahead of Houston at 4,827, Indianapolis at 6,278 and Seattle at 7,962. Only Denver’s rate was worse — 10,943 per 100,000 residents. 

San Francisco did top out in two categories: it is the worst place for a Latinx resident to live, in terms of their chances of getting Covid-19. Much worse. A Latinx resident in San Francisco is five times more likely to get covid than other San Francisco residents. 

And, it’s a swell place to be white: San Francisco has the lowest overall case rate for whites — 1,463 per 100,000 compared to those living in Marion County, which includes Indianapolis, Indiana, with 4,544 cases per 100,000 in the white population. Whites are also more than two times less likely to get infected with covid in San Francisco, according to Mission Local’s analysis. 

This appears to speak more to disparities than to the size of the Latinx population. The Latinx community makes up 15 percent of San Francisco’s population. On the contrary, Latinx residents make up the biggest population in Dallas County, but the probability that a Latinx resident will get sick in Dallas is only slightly higher than that of a white resident.  

Khoury said the ratios point to greater income disparities. San Francisco’s Latinx residents are predominantly low-income and more likely to live in crowded housing.  

Here and elsewhere, poverty can lead to overcrowded housing, low-paying frontline jobs and an inability to access medical affordable medical care. For example, in two Indianapolis areas where covid has spread the fastest, between 15 and 20 percent of residents live below the poverty line, and most residents are white. 

The Centers for Disease Control and Prevention acknowledged these effects, and created a formula that uses factors like income, living situation, and ethnicity to determine “social vulnerability. ”  

The center defines that as the “the potential negative effects on communities caused by external stresses on human health.” It’s unsurprising to find that many of the areas where covid is rampant across the country also score as “highly vulnerable” on this metric — for example, neighborhoods in Tarrant County, Texas and Indianapolis — meaning that lack of resources and extra stresses could potentially exacerbate effects of the pandemic. 

Though the city is moving to address inequities now with more testing and better outreach, it’s also been no secret that the hardest-hit neighborhoods have long been underserved and “highly vulnerable.” 

“We have communities where there has been systemic underinvestment hit hardest by the pandemic,” Dr. Kirsten Bibbins-Domingo, the vice dean of population health and health equity at UC San Francisco said earlier this month. “We need to make sure that people have the resources to be able to take the steps to protect themselves and their family. And collectively, we as a city have to be able to do that to protect the city.”

In other words, the metric that will matter at the end of all of this is how San Francisco measured up in treating its most vulnerable and impacted populations. 

Arnold Perkins, the former director of the Alameda County Public Health Department, told Mission Local back in fall that “If [Covid-19] was a war, you have poor people on the front line, and you have rich people in back.”

It’s no secret that’s what’s happening in San Francisco, too. The Bayview, the Mission, and the Tenderloin have been leading the way for covid spread and positivity. 

Singing San Francisco’s praises requires one to overlook that. 

This article was supported in part by University of Southern California Annenberg and the USC Center of Health Data Fellowship.

Lydia Chávez

I’ve been a Mission resident since 1998 and a professor emeritus at Berkeley’s J-school since 2019 when I retired. I got my start in newspapers at the Albuquerque Tribune in the city where I was born...

Annika Hom

Annika Hom is our inequality reporter through our partnership with Report for America. Annika was born and raised in the Bay Area. She previously interned at SF Weekly and the Boston Globe where she focused...

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15 Comments

  1. The disparity between latinx and white populations has widened since this second lockdown — not surprising as The former makes up a disproportionate fraction of the essential workforce that is still going to work as most businesses closed. But given that, sfdph should take this opportunity to majorly ramp up testing in that community right now, knowing that whites and Asians are actually seeing new cases plateau.

  2. Just want to thank you, Mission Local, for this piece and for all of your pieces throughout the year. I am one of those singing the City’s praises — not because of our numbers, but because of news sources like you.

  3. Income, dense housing, and frontline work status likely correlate to higher Latino infection rates, but other factors I observe daily in the Mission include lax mask use, ongoing/nightly gambling gatherings (shared dice, drinking) at Garfield Park (usually 3 groups of 12-20 men each group nightly) and team soccer games (not a few folks kicking the ball around, but full on teams). DPH, Calle 24, the police, park rangers et al have all been enlisted to help stop this behavior to no avail. Chasing the teams off the field and handing out masks to the gamblers is the best the authorities can do.

    1. Booradley, I’ve seen similar kinds of anti-social behavior among my white friends, especially lax or no use of masks, and little regard for physical distancing. I don’t know how many times I have heard “I only hang out with my close friends and family.”

    2. This isn’t just in the mission. The same could be said about the Marina where people are always out and about, gathering at parks in large groups, shopping in Chestnut in crowds, and not wearing masks or socially distancing. They’re also predominantly white and presumably more affluent than what you describe as what you see in the Mission/Bernal Heights. I see this in the Marina all day, everyday and no one every points a finger at this neighborhood.

  4. Great piece of reporting on a story that badly needs to be told! Health disparities in the US are appalling but particularly disturbing in SF and CA some of the wealthiest places in the world! Not sure what is wrong with our government on all levels that we can’t and haven’t addressed this real local problem!

  5. Thank you for continuing to point out this real time systemic racism right here in San Francisco.

    One question about deaths and hospitalizations — could it be that our numbers are lower because our population does not have a typical percentage of elders compared to other cities?

    We are the lowest in the nation for people under 18 (and even lower for those between ages 5-18). I assume we are also quite low for people over 65. That would explain a lot about our “great job” with deaths and hospitalizations.

  6. The question is, what is any persons chance of not getting exposed before they get vaccinated?

    With today’s spread numbers and today’s state of vaccination anyone who isn’t on an at-risk priority list is more and more likely to get covid at least once before they get a vaccine.

    This is not intended to minimize the importance of highlighting socioeconomic inequality factors, but to point out that this isn’t done, and by the time it is, we are all in the same boat. Most of us are getting it, and minimizing age adjusted mortality loss should be our goal.

  7. What a lack of respect to call us Latinx changing a formal language to who knows what! A todos los que usan la palabra Latinx…STOP! Eso no es Español!

  8. In Latinx should I say Mxmitx Mxmxsotx Now, that’s not Spanish but chingxdex This is crazy loco loca locx locx! HELLO! Que payasada!

  9. I’ve been helping the Covid Tracking Project analyze their race and ethnicity data. It’s important to be careful about what numbers mean.

    So many studies have shown large disparities in San Francisco in many ways; however, it’s hard to interpret case counts in isolation.

    Cases are not the same as infections. There are more infections than we’re detecting.

    What is causing the higher case rates above? How much comes from more infections? How much comes from San Francisco doing a better job testing vulnerable communities than other cities?

    Both of these would increase case rates.

    1. Yes Bryan, You are correct. If we were testing more in vulnerable communities, we would have even higher case rates because we would be detecting more cases, but the point of testing and contract tracing is to respond, isolate those with the virus and prevent spread, which will bring case rates down. But, up until very recently, SF has mostly been testing in low-risk areas. https://missionlocal.org/2020/12/city-collaborates-on-bart-testing-pop-up-but-new-data-shows-hardest-hit-neighborhoods-remain-least-tested/

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