Three years into the pandemic, doctor Carina Marquez can’t shake the story of a Latino man in his seventies.
After he tested positive for Covid-19, he feared passing the disease to his immunocompromised daughter. He couldn’t isolate in their overcrowded home.
“He disappeared” for a while, recalled the professor at the University of California, San Francisco, who worked throughout the pandemic testing and vaccinating local residents. To protect his daughter, she later learned, he temporarily moved into an abandoned building with no heat.
“I will never forget,” she said Tuesday during a Mission Economic Development Agency held a press conference about how housing directly exacerbated Latinx Covid-19 health inequities in San Francisco.
The conference expanded on a new report and pilot health study which was the result of a $254,000 California Department of Public Health grant to MEDA.
City officials, community groups and medical experts who spoke on Tuesday agreed: To prevent the inequitable consequences of Covid-19, new housing and economic policies need to be implemented. Partnerships between government and community groups, like Unidos en Salud and Supervisor Hillary Ronen’s Right to Recover, are successful examples of how the government can distribute resources more equitably and bolster the support system for workers without insurance or the luxury to work from home. But in the end, better housing can make a big difference in protecting vulnerable communities.
Community workers and promotoras surveyed 261 Latinx people from the Mission, Bayview, Excelsior, Tenderloin, and Visitacion Valley, and found 79 percent of respondents tested positive or lived with someone who tested positive for Covid-19. About 91 percent of those surveyed reported sharing a room with at least one other person, which the report defines as overcrowded housing.
“COVID-19 amplified many of the negative health consequences of a pre-existing and systemic underinvestment in the community,” MEDA’s report said. “In retrospect, the gears for the disproportionate impact of COVID-19 on this community were set into motion long before the pandemic arrived. COVID merely lifted the veil.”
Increasing economic opportunities was one key recommendation to prevent poor health outcomes. Before the pandemic, Latinx residents in San Francisco reported slower growth for median household income compared to white residents, which the report chalks to “a widespread lack of access to jobs with living wages.”
Leaders need to do more to ensure the proper recovery of San Francisco’s Latinx community, advocates said, so they can afford better housing. As the pandemic forced shut-downs, it setback veteran restaurant workers who were let go, according to the report. The economic institute McKinsey Global Institute published a separate report signaling job growth will center on high-wage jobs post-pandemic through 2030, and that low-wage workers need to be retrained.
MEDA leaned on McKinsey’s findings, and similarly encouraged city-funded job retraining programs for Latinx workers. The report asks businesses to accept skilled applicants without degrees, and wants strengthened protections for mid-career and/or gig workers.
The report also urged the adoption of a Guaranteed Basic Income, especially for low-income Latinx workers. A potential model is the $3.3 million GBI program for foster youth, which launched in San Francisco in November, 2022. This could combat high rental prices that contribute to the displacement of 10,000 Latinx residents from the Mission from 1990 to present, along with racial income disparities.
Going hand in hand with job opportunity, policymakers at all levels should push for more affordable housing, advocates said Tuesday. “Affordable housing is the top need of my patients,” Marquez said.
Multiple health experts, buttressing MEDA’s report, recognize housing as a major factor in people’s health, or a social determinant of health. Overcrowding is a direct consequence of housing unaffordability, the report said.
“There’s no space in San Francisco. Everyone lives overcrowded. Moms have to be in the same room as their children,” one respondent of MEDA’s report said.
As Covid-19 hit San Francisco before vaccines were available, some essential service workers who worried about making rent continued to go to work. That facilitated spread at work, and in society. A UCSF/Latino Task Force testing and research study in April, 2020, found that 90 percent of those who tested positive could not work from home.
“I have no savings, no money. At my job, I was the only one to return,” another report respondent said.
Chronic stress and anxiety skyrocketed as workers fell behind on rent, and feared eviction. The report showed 56 percent of respondents — mostly domestic, hospitality or restaurant workers — borrowed money for pandemic rent. Though rent relief and eviction moratoriums reduced the impact, Supervisor Dean Preston noted on Tuesday, individuals still suffered. In 2022, Latinx homelessness increased by 55 percent, despite the citywide count decreasing by 3.5 percent.
“We are falling short, as a city, in creating deeply affordable housing,” Preston said. “We all must center the needs of low income and working class people … and stop obsessing with creating more and more luxury housing.”
Marquez recalled a story of an unhoused man who was “renting a hallway” and lacked a place to properly store his diabetes and HIV medications. Moving into stable housing allowed him to follow his prescription, and his viral load was suppressed, and his diabetes was controlled.
“Housing is medicine,” Marquez said. “Let’s not repeat the mistakes of the past. Let’s move towards action.”
Tight money forces some difficult decisions, such as squeezing several tenants in a room, living in substandard or aged housing that could harm people’s overall health, or forcing them to leave their community. The report called for stronger city habitability enforcement.
The issue of density has long been known. Stefan Baral, an epidemiologist at Johns Hopkins University who spoke with Mission Local in September, 2020, said then that square footage per household was the best predictor of whether someone would get Covid. Testing sites, he said, could have been placed early on in high-density areas.
Affordable, higher-quality housing would reduce residents’ stress and exposure to disease, the report showed. Out of 46 respondents who were interviewed about overcrowded living conditions, some said they cried from the stress of quarantining with multiple people. Another interviewee added: “My diagnosed mental health issues were exasperated because six people live in the room.”
The effects were clear. Though Latinx people make up 15 percent of San Francisco’s population, they account for almost 33 percent of the unhoused population. At one point in early 2020, Latinx residents accounted for 84 percent of San Francisco General Hospital’s Covid-19 patients. And, for much of the pandemic, 50 percent or more of all Covid cases were in the Latinx community.
The city was slow to respond to some of the inequities documented in early studies done by UCSF and the Latino Task Force and as late as September, 2020, Mission Local found that only 9 percent of the city-controlled tests were going to Latinx residents who, at the time, comprised 50 percent of the city’s covid cases.
Norma Paz García, the policy counsel and director of advocacy for MEDA, who presented Tuesday’s report, hoped state and local officials would use the data to change policies. “This,” she said, “is just the beginning.”