Jessica Dormus and Methinee Mullen process swab samples with Abbott Antigen rapid tests at an Unidos En Salud (United in Health) low barrier COVID-19 test site located at 24th Mission Bart Station targeting San Francisco's hardest hit Latino community on March 2, 2021.

As public health officials nationwide raise concern over a “triple-demic” of respiratory disease, Mission health workers are putting themselves to the test. Starting last week, the local 24th and Capp street site offers an all-in-one test to determine Covid-19, the flu, and the surging Respiratory Syncytial Virus (RSV) infection.

“Our community is now weathering multiple respiratory viruses,” said Diane Havlir, professor of medicine at the University of California, San Francisco, in an email. 

But the test goes a step further. When 24th and Capp patients turn up negative for all three diseases but exhibit respiratory symptoms, a local lab will determine the biological source through a catch-all test called “metagenomic sequencing.”

The ambitious pilot is the latest medical foray of Unidos en Salud, an alliance in which UCSF, the Latino Task Force, and the ChanZuckerberg BioHub. Together, these agencies have combined service and science at the 24th and Capp Street site since the beginning of the covid pandemic. Unidos began with testing for covid, expanded into vaccinations and boosters, and now offers diabetes testing and monkeypox vaccines as well.  

The Misson’s response to the latest respiratory disease follows heightened national attention on the multiple viruses, specifically regarding the emergence of RSV. Though it’s generally a mild respiratory disease, at the end of last year, public health experts worried that RSV patients would combine with covid and flu cases to overwhelm hospitals

Those who caught RSV described it as a “cold on steroids,” and health experts warn that it can be severe for children or elderly adults. 

“Nationwide, we have a surge, so we want to see if we have a surge in the Mission,” said Salu Ribeiro, the founder of the BayPLS, the group that conducts the tests at 24th and Capp.

Last November, people showed up at the site feverish, coughing, and desperate for a covid test. Despite the suggestive symptoms, time and time again, the results returned negative. By then it was clear, said Susana Rojas, a Unidos leader and executive director of Calle 24 Latino Cultural District: “They are infected with something else.”

Joe DeRisi, a professor of biophysics at UCSF and president of the Chan Zuckerberg BioHub laboratory, said UCSF hospital admissions confirmed that suspicion. 

Havlir, a Unidos leader, suggested in an email that “RSV has peaked in our area, but is still circulating.” The doctor stressed that it is not yet time for concern until it is clear hospitalizations “are rising.” 

DeRisi and his team have learned through negative test samples that some San Franciscans with respiratory symptoms may have contracted something besides the “Big Three.” He said, “It’s not explaining a lot of the illness we’re seeing.”

His team will take all the samples that test negative for covid, RSV, or the flu, and subject them to metagenomic sequencing — an “all-but-the-kitchen-sink” type of analysis. This way, researchers can better learn what is affecting the community, whether it be a bacterial infection, a virus, or a fungi. Identifying the culprit is important in suggesting treatments or prevention steps, he said. 

“When we publish things, it influences what vaccines might be made in the future, or a search for antiviral therapeutics,” DeRisi said of his team’s research. “These are all things that lead to making better diagnostics and intervention — but you don’t get that by not asking the question.” 

Yet few clinics or hospitals are testing for disease beyond covid, RSV, and the flu, due to cost and intensiveness. ChanZuckerberg and Unidos don’t have that problem, DeRisi said. 

Last Friday, tests for each disease and the metagenomic sequencing started with the familiar, albeit slightly uncomfortable, swab up the nose. 

All research conducted by the BioHub, as in the past, is shared first with community members and published on the Unidos site. “It is important to give community answers, so they can make a real plan to take care of themselves,” Rojas said. 

For example, a patient may decide to obtain antiviral flu medication like Tamiflu, or Paxlovid if they have covid. Also, knowledge that three respiratory diseases are spreading may motivate community members to get their flu or covid boosters, or to start wearing masks more frequently, Rojas said. 

And as Unidos en Salud learned in early 2020 — the group formed as a result of increased covid infections in the Mission during the pandemic — essential workers are especially vulnerable to respiratory illnesses. Since many Latinx residents work essential jobs, paying attention to how other respiratory illnesses like RSV affect the population is important, Rojas said. 

“All these illnesses are transmitted in the same way, through the respiratory system,” Rojas said. “The more contact you have with people, the more you work outside [the home], the more chances you have to contract these.”

With only a week of data to go off of, it’s not yet clear exactly how prevalent RSV is at 24th and Capp, DeRisi said. He said that by February, the BioHub will know much more regarding the Big Three respiratory viruses, and whatever else the metagenomic sequencing turns up. 

The San Francisco Department of Public Health confirmed to Mission Local that it does not monitor local RSV cases, and instead defers to UCSF and state health department data. The health department continued, “we encourage people who are feeling sick, or people caring for a child who feels sick, to contact their health care provider to discuss their symptoms, and possible testing or treatment options.” 

San Francisco is reporting a 7-day rolling average of 118 covid cases per day, and has 86 current hospitalizations, according to city data. Approximately 86 percent of the city population is vaccinated. 

Meanwhile, Rojas encouraged folks to get their bivalent covid booster and their flu booster, which are also available for free at Capp and 24th streets. Rojas used herself as a prime example — she waited too long to get her flu shot, and days later became infected with a flu that knocked her out for two months. “It’s very, very strong this year.” 

Unidos en Salud is open Fridays, Saturdays, and Mondays from 9 a.m. to 3:45 p.m. Visit at 24th Street and Capp Street. For questions, please call 844-965-0987.

Joe DeRisi serves on the nonprofit board of Mission Local. 

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REPORTER. 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 on local news and immigration. She is a proud Chinese and Filipina American. She has a twin brother that (contrary to soap opera tropes) is not evil.

Follow her on Twitter at @AnnikaHom.

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