Though it’s a popular time to reflect on where or what you were doing when you found out about Covid-19 a year ago, doctors have decided to ask a more specific question: when did it become apparent that the virus would have a disproportionate impact on certain groups of people?
At the second part of The Path Forward: The COVID-19 Mandate for Equity panel, doctors and community organizers on the front lines of the Bay Area pandemic response took a break from their continued efforts to share their thoughts on the virus’s anniversary on Tuesday.
“The pandemic exposed the many vulnerabilities in our society, our inequities along age lines, along economic lines, along racial and ethnic lines,” said Dr. Kirsten Bibbins-Domingo, the moderator of Tuesday’s discussion, the chair of UCSF Department of Epidemiology and Biostatistics, and co-founder of the UCSF Center for Vulnerable Populations.
“These were all factors that fueled the spread of the virus, and then [these] led to disproportionate harms to these same communities that also were experiencing the effects of the economic crisis that coexisted,” Bibbins-Domingo said.
So when did the intuition about inequality first kick in for the panelists, Bibbins-Domingo wondered?
For Dr. Carina Marquez, an assistant professor of medicine at UCSF and associate director of education in the Division of HIV and Infectious Diseases at Zuckerberg San Francisco General Hospital, it was painstakingly obvious. ZSFGH, where she worked, was filling up with Latinx and essential workers diagnosed with Covid-19.
“We at the General are used to seeing a lot of health disparity, [but] this was more than we had been used to seeing.” Marquez recalled. “It was striking.”
Marquez and Dr. Diane Havlir, UCSF professor of medicine, quickly organized the first major mass testing study in San Francisco with community organizers in April. The results in the now well-known Mission study confirmed their observations, and what needed to be done: Latinos and frontline workers needed low-barrier testing — fast.
That inequity was also front and center for Jon Jacobo, the health chair for the pandemic-borne Latino Task Force. Anecdotes from Latinx residents circulated quickly about friends and relatives who felt really sick. In no time, the Latino Task Force partnered with Marquez and Havlir for the April study.
That attention to effects on Mission and Latino residents heightened even more once the April study revealed that more than half of the participants lacked any type of primary care doctor or healthcare provider, Marquez said.
But Latinx and frontline workers, who have accounted for the majority of Covid-19 cases in the Bay Area, were not the only ones who were at risk or who warranted immediate attention, doctors said.
Dr. Naveena Bobba, the deputy director of public health for the city and county of San Francisco, said that the Health Department initially focused on residents in long-term care facilities, nursing homes, jails, and congregate care settings like homeless shelters, all of which were places where outbreaks were occurring early on.
Dr. Kim Rhoads, associate professor of epidemiology and biostatistics at UCSF and director of community engagement at UCSF’s cancer center, and Dr. Nicholas Moss, the Alameda County Health Officer, both recalled thinking that other ethnic groups might face extra hurdles during the pandemic as well.
Rhoads said she shifted to Covid-19 when she realized there were few resources and groups specifically looking to do outreach and testing in the Bay Area’s Black community.
Moss remembered being concerned for the Asian American community, the Trump Administration’s primary virus scapegoat. Those impacts have resurfaced recently as violent attacks on Asian Americans in the Bay Area and in the United States increase.
As the pandemic continued, it became clear to Bobba that “no one individual or institution would get us through the pandemic.” A key to addressing all of this inequity was the partnerships between health institutions, city officials, and on-the-ground community members.
“Some of the blind spots that we have is really what’s happening on the ground,” Bobba said. “Folks that work with the community day in and day out are able to bring that lived experience and then really provide all of the gaps that they are seeing in the response.”
Those on-the-ground relationships between UCSF and the Latino Task Force, and between UCSF and Umoja Health, have been integral to getting vulnerable populations what they needed. But the question remains: what happens after the pandemic is over?
“The idea of getting to shelter in place and have your income be preserved is actually privilege,” said Rhoads, adding that this acknowledgement should be at the forefront for other health issues, like diabetes and cancer. “We haven’t owned and addressed that. That’s real.”
That doesn’t have to be the case, all the panelists said. Centering more community engagement and trust in future public health work can continue.
One viable way to do this is by having medical institutions stay constantly accessible, and to have them appear at a variety of community events year-round, which Rhoads called “non-transactional community engagement.” That tact has been beneficial to the cancer center, especially in regard to informing Bayview Hunters Point residents about their programs, she said. It also allowed locals to trust medical experts who ran Covid-19 testing in the neighborhood.
“So: we’re here, whether that’s a pandemic, we’re here, whether there’s a study we want you to sign up for or just to provide information,” Rhoads said. “And so we maintain that kind of relationship where folks can turn to us and say, ‘I have this problem.’”
Moss agreed. He said he feared that if those in healthcare decided to pull out of communities once the pandemic dies down, then all the established relationships and built up trust would be “squandered.”
He added, “I think it’s incumbent for people like me to to really fight, to not let that happen, to make sure that we’re going to finish this work.”
A big piece of following through on that is keeping the spotlight on the community leaders who know how to serve people in culturally appropriate ways. Marquez pointed out that several policies and programs, like Right to Recover and rapid resource response, would be less efficient in reaching the vulnerable or every day populations without the assistance of respected community members and their networks.
Jacobo agreed. “it’s those with the deepest ties and deepest relationships that had been able to move the quickest, and respond, and be nimble, because the trust is baked in,” he said.
For this reason, Jacobo hopes that the voices and knowledge of community members continue to be valued by government and institutional leaders.
“I hope that as we move into the future, it flips that dynamic that exists and empowers community to have a voice and actually take it seriously.”