A community service? Or a research center? Unidos en Salud’s testing tents at the 24th Street BART Station, and its vaccination site across the street, are both, lead researcher Dr. Diane Havlir explained on a Monday phone call with community leaders.
The undertaking, a collaboration between UCSF and the Latino Task Force, she said, does “service and science and, really, learning as we go.”
Now in its 11th month, Unidos en Salud continues to produce research as relentless as the virus; research that, among other things, chases down the new variants to help shape city policy and stop the spread.
While community-based and community-initiated research has become increasingly popular, it’s hard to get it right, said Charles Branas, Chair of the Department of Epidemiology at Columbia University’s Mailman School of Public Health. San Francisco, he said, appears to have done that.
Ysabel Duron, the president of the Latino Cancer Institute in San Jose, called such collaborations “the best way in which you’re going to get the necessary data to move policy and change, as well as serving the people who need that service.”
Sequencing is one of many research results from a community model
The sequencing Unidos en Salud reported on Monday is just one of the many results that have come from the collaboration since it began in April with a testing and research campaign in the Mission’s most heavily Latinx census tract. That project, and everything that followed, was inspired by Havlir and Latino community leaders like Jon Jacobo and Valerie Tulier-Laiwa watching as ZSFGH filled with Latinx Covid patients.
Latinx residents account for only 15 percent of the population but a disproportionate share of the caseload. Month to month, the imbalance was dramatic, starting at 30 percent of all cases in March 2020, peaking at 63 percent in May and registering near or over 50 percent for June, July and August before cases started falling in September.
All told, they currently account for 42 percent of all cases since the pandemic began.
The Unidos campaign set out last April to figure out how to arrest those numbers, and to learn more about how the virus was transmitting so efficiently. As we have previously published, its April findings were a wake-up call: about half of all carriers were asymptomatic, most were low-income and most couldn’t work from home.
We have already written how that pushed Mayor Breed to fund Hilary Ronen’s Right to Recover, a safety-net paycheck equal to two weeks of minimum-wage pay or $1,285. Subsequent studies piled on more research that appears to have stabilized the funding, which had been dependent on philanthropy.
Finding the high number of asymptomatic carriers in April, said Joe DeRisi, co-president of the Chan Zuckerberg BioHub, completely changed how the city would have to act to control the spread. Most importantly, it showed the need to test as many people as possible.
As academics, said DeRisi, he and Havlir feel that it’s their role to “dig deep,” “write the playbook” on how to tackle the virus and “hope for adoption,” particularly at a time when the city’s overwhelmed health department was uncertain how to respond.
Although San Francisco’s health officials were slow to adopt the playbook, they are increasingly following it. And even back in April, the finding on asymptomatic spread made an impression on public health officials, said Dr. Naveena Bobba, deputy director of Public Health at the Department of Public Health.
The Unidos campaign in April “really helped kind of motivate the city to think about how we get testing for essential workers in general,” Bobba said.
It was thanks to Unidos’ findings, she said, that the city relaxed its testing requirements at two big fixed sites — the Embarcadero and SoMa — and opened them to all essential and frontline workers. We’ve written extensively about the time it took — from April to mid-November — to open up a larger site in the communities. In an interview, Bobba addressed that lag.
“There was a little bit of tension, like, will a big site work in a community setting?” she said. And then there was the question of finding the right location.
They chose right. By late January, so many people were using the walk-up option at Alemany that staff stopped taking reservations.
“So, yes, I wish now … ” Bobba said. “We definitely worked on that for a long period of time. And actually, it has gotten to a population that is much, much more highly impacted.”
Bobba also credits UCSF and the Latino Task Force with the “proof of concept” on rapid testing, which grew out of Havlir’s goal to get faster results so that infected residents could quarantine quickly, giving them more time in isolation.
To accomplish that, Havlir, focused on breaking the transmission cycle as quickly as possible, began experimenting with rapid tests in September — carefully testing their efficacy against the PCR test, which is the gold standard but takes at least 24 hours to get a result.
By Thanksgiving, she had enough data to open 24th Street BART testing as a rapid-testing-only site. The time between test and isolation was reduced to less than a day, and isolation time went from three or four days to nine days out of the 10 recommended. In a rare expression of satisfaction, Havlir said on Monday’s call that “ is really, really exciting and an accomplishment.”
It’s one, she said, that could not have happened without the community collaboration.
And in that, Havlir is correct. The Latino Task Force’s reach into the community has been constant. On the weekend before a new testing and research campaign starts, it is hard to take a walk in the neighborhood without running into canvassers handing out fliers. From the first study in April, Susana and Susy Rojas have been working to fine-tune the response to those who test positive. Tulier-Laiwa is helping other neighborhoods develop a similar wellness model. On Monday’s call, Susana Rojas announced another social-media education campaign on vaccinations and testing.
The community is also part of the fundraising team. On a Thursday in January, Jacobo had to excuse himself from an interview to hop on a fundraising call with Havlir and a donor. Although community leaders respectfully refer to Havlir as Dr. Havlir, she has increasingly become Dr. H.
Dr. Elsie Taveras, the executive director of the Kraft Center for Community Health and a professor at Harvard Medical School, said “we need more programs like this, where there is authentic and genuine co-design and co-implementation of interventions that benefit vulnerable populations.” Others, she said, are happening across Boston with mobile testing units.
“So what UCSF is doing, I would say, is what we would love to see all academic medical centers do, which is to not just superficially engage stakeholders, but to really have those stakeholders and partners co-design, implement, and evaluate,” Taveras added. “The more we can promote that work, the better it will become and the more kind of mainstream that approach will be.”
The National Institute of Health, she said, has taken note in its recent RADx-Up funding round for projects that focus on testing disparities in underserved communities. UCSF’s project with the Latino Task Force was one of the projects awarded funds to test the model across other counties.
And at home in San Francisco, Havlir’s work on rapid testing has already been noted by the health department, which started offering rapid testing at its South East clinic last week. Bobba expects to expand rapid testing to other clinics as well.
Havlir and DeRisi also see its possibilities for schools. At least one, Synergy, is now using rapid testing.
The research never stops
While the bread-and-butter work of testing, vaccinating and educating continue, the researchers are exploring new areas including household studies by Dr. Carina Marquez and others looking at how the project in San Francisco can be adopted in places like Marin and Merced.
And, back at Capp Street, Havlir is already enrolling residents in a study testing both those who have been vaccinated and those who have not.
“We are now going to be studying viral strains circulating from persons who have and have not received the vaccine,” Havlir wrote in an email. “Importantly, vaccines prevent serious disease, but [people] can still get infected. To stay ahead of this virus, we need to continue to study circulating strains.”
As yet, none of those vaccinated and subsequently tested have been positive.
DeRisi will keep sequencing the positive samples from 24th Street and hopes that what they are doing in the Mission will inspire other like-minded collaborations.
”We have fantastic molecular biology labs all around the country and throughout California,” he said. “There should be mechanisms by which they can engage with their own communities in their own backyards to execute these kinds of studies so that we have a more holistic view of the spread of covid and can help stop these transmission chains and bring them up short.”
Testing runs Sunday through Wednesday from 9 a.m. to 2 p.m. at the 24th Street BART Station, and vaccinations are open the same hours across the street at 24th and Capp Streets.