Michael, 44, sat outside the T-Mobile store on Third Street in the Bayview, smoking a cigarette. He will “never get” the Covid-19 vaccine, he said emphatically.
“Big Pharma just wants to maintain. They want to keep you coming back for the medicine. I think they get paid for every vaccination. They get promoted, or a benefit, or a bonus.”
In general, most people Michael knows in the neighborhood are “more ‘nay’ than ‘yea’” regarding inoculations, he said, in part due to past mistreatment of Black communities by media and medical institutions.
In fact, some 81 percent of Bayview’s residents are vaccinated, putting it among the most vaccinated neighborhoods in the city. But in the midst of a surge of the highly transmissible Delta variant that “comes on faster and has a higher viral load, which certainly increases infectiousness,” anyone unvaccinated is vulnerable, said UCSF Dr. Carina Marquez.
“That’s true whether White, Black or any ethnicity,” added Dr. Naveena Bobba, the deputy director of health at San Francisco Department of Public Health.
Just as Michael’s low-income neighborhood in the Bayview has been in the midst of a Covid-19 outbreak, two wealthy census tracts are right behind it, in Mission Bay and nearby Embarcadero.
Marquez said studies show that researchers “saw increased risk of hospitalization” with the Delta variant, but that vaccinations are effective.
So far, San Francisco’s population of hospitalized patients are unvaccinated.
Low vaccination rates hit Black and White residents, and the young are showing up in hospitals
Black and white residents have the lowest vaccination rates across the city, with 60 percent of eligible Black residents and 65 percent of White residents vaccinated. That compares to 78 percent for Asians and 72 percent for Latinx residents.
Vaccination rates are higher in the elderly population: 90 percent in the White population and 84 percent in the Black population. With lower vaccination rates among the young, it is no surprise that the number of hospitalized covid patients has plummeted.
At the start of the pandemic, the vast majority of covid patients in the hospital were in their 60s. Nowadays, the average age is 48, according to Bobba. Moreover, 25 percent of those hospitalized are 35 and younger, and almost 18 percent are 25 and younger, she said.
For Black residents, UCSF researcher Dr. Kim Rhoads called it a “perfect storm.” Relaxed mask mandates and low vaccination rates among certain populations give rise to more spread.
“This means that Black people are certain to be over-represented in the ongoing round of deaths we will see from COVID as a result of recently and rapidly rising cases,” Rhoads said.
Indeed, health officials said they are seeing a disproportionate number of Black residents in the hospital. Black residents, Mayor London Breed said last week, comprise 28 percent of those hospitalized with covid while only making up 5 percent of the city’s population.
While white residents in San Francisco are vaccinated at the second lowest rate, privileges such as higher paying work from home jobs and less likelihood of overcrowded housing is probably why they are not showing up in the hospital in disproportionate numbers, Bobba said.
These disparities are why health officials are working on how to increase the vaccination rates among Black residents. However, those in the community understand how difficult that can be when past treatment of Black residents remains in recent memory.
“Certainly the African American community has a really healthy distrust of the medical institution … and in big media,” said Dr. Monique LeSarre, executive director of Rafiki Coalition Leadership, a Black wellness organization in San Francisco.
Michael’s comments on the virus underscored that distrust. The coronavirus, he said, was no more deadly than the “common flu” and “it’s the media that’s pushing it. It’s an agenda.”
Still, this didn’t prevent others from getting inoculated, even while harboring similar concerns. “I am out here working on the front lines, so I have to think long-term. I don’t want anything to happen to my family,” said Chika Mezie, who works at the A. Philip Randolph Institute, a local community organization.
And it’s spreading fast where Mezie lives, in Census Tract 231.03 near India Basin Shoreline Park, a tract not too far where Michael lives in the Bayview. Census Tract 231.03 now has the city’s highest new case rate of 107.27 per 10,000 residents, based on data from June 16 to July 15. It is also one of the city’s poorest, with a median household income of less than $25,000.
Just west of there, in Stony Hill, Census Tract 231.02 has the second highest case rate — 50.5 cases per 100,000 residents, and an average household income of less than $40,000 a year.
More than 50 percent of the residents in each census tract are Black. To reach them, Bobba said DPH and its community partners are changing their strategy. “People have their own journey,” she said. “Some of the interventions that we did early on with having events or social media or ad campaigns or incentives, those helped initially. But I think this next phase is really about the one-on-one communications with family members, with trusted community members, medical professionals. It is much more focused.”
Community members and doctors like LeSarre and Rhoads have also been implementing “roving pop-ups” where vans or home-visits can offer the vaccine to residents who haven’t gotten it yet in these high-need areas. These too, rely on one-on-one conversations.
“[Black and Latinx residents are] not in the conversation. Then, you have no chance of moving them or changing their opinion. And they call it hesitancy,” Rhoads said. “It’s racialized, because like I’ve said so many times, you’ve got whole pockets of people in Marin who are ‘anti-vaxxers.’ They’re never called ‘vaccine hesitant.’”
White neighborhoods are also impacted
After the two Bayview census districts, the two hardest hit districts in the latest wave are contiguous Census Tract 607, in Mission Bay, with a new case rate of 25 per 10,000 and nearby Embarcadero Census Tract 615, which has a case rate of 23 per 10,000, based on data from June 16 to July 15.
White and Asian residents comprise more than 80 percent of the residents in both census tracts, and the median household income in Mission Bay is $161,000. It’s $208,000 in the SoMa census tract.
One post-doctorate student at University of California, San Francisco on the Mission Bay campus, Tianyi, said she’s received several emails from the school, warning that cases are popping up again. Her lab recently reversed its decision to forgo masks inside, even among vaccinated students.
Public health officials attribute the increase to unvaccinated residents going out more.
Contact tracing appears to work even less among the young
Contact-tracing efforts, which might help contain the surge, appear to be failing. According to city data, in the last two weeks, only 75 percent of contacts who may have been exposed were reached. This shows “moderate alert,” which is the second worst rating in this category.
“I don’t know if it’s a failing of that system, as much as a redesign that we have to do,” LeSarre said.
Bobba said contact tracing in the younger population that is getting sick has proved more difficult. They don’t get back, they’re less likely to pick up the phone.
“It’s just maybe the nature of how they view the disease and how they view contact tracing,” said Bobba. “So that is also a bit of a change that worries me.”
Here is a link to a map of where and when there’s accessible vaccinations in Mission Bay and Bayview Hunter’s point. And here is a list of all the city’s vaccination sites.