Flawed response: Case rates for Latino residents nearly four times higher than for White residents, analysis shows. Why?
When COVID-19 came to the Perez family’s apartment, the Bay Area’s shutdown was powerless to stop it. ¶ “Work from home” and “shelter in place” had little relevance in the small home in San Rafael’s Canal neighborhood where 10 people jostled for space, with Yanira Perez, her husband and two children consigned to a bunk bed and adjacent hammock. After a roommate who worked in construction brought the virus home in April, it was just a matter of time before they all were infected. ¶ “Here in Canal, we said it’s the nest of the virus because almost everyone got it,” Perez recalled.
It is a reality mirrored across the Bay Area. Efforts to control the deadly disease have fallen tragically short in Latino communities, leaving the people most at risk with the least protection from the coronavirus’s spread. A four-month Bay Area News Group investigation — including more than 50 interviews and a first-ofits-kind analysis of case and testing data — helps explain why.
Public health leaders’ centerpiece strategy, the nation’s first
and strictest stay-at-home orders, instituted one year ago, proved ill-suited for a population whose members often live in crowded housing and have no alternative to working outside the home. Local and state governments were slow to muster the focus and resources that might have made a real difference, even as community advocates pleaded for more action.
“I’m just exhausted. I’m not tired of the work, I’m tired of fighting to get our community needs,” said Maritza Maldonado, the head of a nonprofit serving San Jose’s Mayfair neighborhood, where she grew up. “You get tired of jumping up and down and saying, ‘Look at us over here. Hello, we’re dying.’”
The investigation found:
TWO PANDEMICS >> While Latino communities have fared worse against the virus across California, the disparity has been particularly acute in the Bay Area. In the six counties under the original stay-at-home order, Latinos have case rates more than four times those of White residents. Infections among Latinos in the Bay Area are nearly as high as the rates of Latinos in hard-hit Los Angeles County, while White people here have endured a case rate just half as severe as their counterparts to the south.
UNEQUAL TESTING >> The Bay Area failed to marshal its coronavirus testing resources in the places and ways needed to contain the virus, consistently testing its majority Latino communities at low rates relative to risk, according to this news organization’s analysis. In Alameda County, residents in the 94705 ZIP code that includes Berkeley’s largely White Elmwood neighborhood were almost twice as likely to be tested as people in Oakland’s majority Latino Fruitvale district. But Fruitvale residents were almost seven times more likely to have COVID-19.
A STRUGGLE TO CONNECT >>
Other time-tested public health strategies also lagged. Contact tracing programs were undermined for months by a lack of bilingual workers. Hotel rooms where essential workers or people in crowded homes could quarantine were underused. Workplace outbreaks were not publicly reported, leaving employees dependent on their supervisors — or the neighborhood grapevine — for information. And community groups that could have fostered connections and compliance with health orders said they were ignored.
ILL-FATED REOPENING
>> When the region’s health officials began lifting lockdown orders in late May, citing statistics showing the Bay Area was containing the surge, they missed a critical fact: Their strategy was mainly working for White residents, many of whom had easy options to isolate. Over the course of the first lockdown, the virus continued to ravage the Latino community, driving its share to a staggering 78% of new Bay Area cases by late May. Latinos account for less than a quarter of the population in the sixcounty region.
These racial and ethnic disparities also have affected Black residents and some Asian communities, notably Pacific Islanders and Filipinos, whose members also live and work in ways that leave them vulnerable. But locally and statewide, the impact has been most devastating to the Latino community: Nearly 1.5 million California Latinos have gotten COVID-19 — more than the entire populations of San Jose and Oakland combined — and more than 23,000 Latino residents have died.
“Many of the public health directors truly never prioritized communities of color, in particular Latinos,” said former state senate president Kevin de
Leon, one of the most highprofile critics of California’s failure to protect Latinos from COVID-19. “These are very smart, well-intentioned people with the biggest blind spot that had devastating life-and-death consequences for our most vulnerable communities.”
Some of those health directors now acknowledge the missteps, even as emerging data on vaccination rates among racial and ethnic groups show that the imbalance endures.
“Our very strategy itself caused COVID to spread in communities where people didn’t have the privilege, like me, to work from their living room,” Alameda County Health Officer Dr. Nicholas Moss said. “It introduced and exacerbated the disparities we have seen.”
To be sure, the Bay Area’s coronavirus efforts have notched some impressive successes. Most important, overall death rates remain relatively low. Consider San Francisco, where the population is roughly the same size as the state of South Dakota but the death rate is one-fifth as severe. And in the Canal neighborhood in San Rafael, concerted public health efforts clearly helped contain infection rates in the Latino community after early surges.
But the success stories are few among the region’s most vulnerable population. And while it’s important to note that a pandemic of this scope is unprecedented in most of our lifetimes, requiring policy leaders to engage in extraordinary improvisation in the face of socioeconomic forces they cannot control, experts say the problem should have been expected.
COVID-19 followed a pattern documented in decades of public health research showing Latinos tend to be disproportionately affected by infectious diseases that spread through indirect contact, such as measles and flu.
Sandra Crouse Quinn found that Latinos were at significantly higher risk of exposure when she studied the 2009 H1N1 pandemic for the University of Maryland’s Center for Health Equity. The reasons were not surprising: Latinos were more likely to work in crowded conditions and less likely to have paid sick leave, the study determined. Those who got sick at work brought the illness back to larger households crammed into smaller homes.
“We’re seeing it play out today,” she said. “And the tragedy of all of this, among other things, is that some of this could’ve been prevented.”
Two pandemics
In the chaotic early weeks of the pandemic, with only a few hundred local cases detected, health officers from six Bay Area counties took a bold step to slow the spread of the virus. They directed millions of residents to stay home in what amounted to the nation’s first — and at the time the strictest — shelter-in-place order. The aggressive response spearheaded by Santa Clara, San Francisco, Alameda, San Mateo, Contra Costa and Marin counties quickly became a national model.
But those first orders held a critical flaw: They didn’t include clear strategies to protect essential workers whose jobs made it impossible for them to stay home. In California, 55% of Latinos work in those front line essential jobs, according to an analysis from the UC Berkeley Labor Center.
Local leaders were blinded in part by the way the virus arrived with travelers from China and Europe and spread initially among those who came in contact with them.
A review of Slack channel messages from the Association of Bay Area Health Officers between Feb. 2 and June 2, 2020, obtained through public records act requests — which includes the health officers of Santa Clara, San Francisco, Marin, Alameda, Contra Costa and San Mateo counties — shows no mention of its impact on communities of color and no discussion of the risks posed to essential workers unable to stay home.
“For us not to really recognize that the very strategy we have to combat the pandemic does not combat the pandemic for the people who need to continue to work just makes it a real failure,” said Dr. Kirsten Bibbins-Domingo, a UC San Francisco epidemiologist. “It’s devastating to the Latino community, and it also means (the strategy) doesn’t work as well as we ultimately think it does.”
Santa Clara County Health Officer Dr. Sara Cody, one of the principal architects of the shutdown order, said she still believes shutting down was the right strategy for the entire Bay Area.
“The only way that I know to protect people who are most vulnerable — either because of their health condition or their living conditions or what have you — is to simply keep the overall community prevalence as low as possible,” said Cody, an epidemiologist.
But Cody acknowledged that she was surprised to learn from a Kaiser Perma
“I’m just exhausted. I’m not tired of the work, I’m tired of fighting to get our community needs.” — Maritza Maldonado, above, the head of a nonprofit serving San Jose’s Mayfair neighborhood, where she grew up. Maldonado’s sister died of the coronavirus in May.
nente physician at the very end of March that a large number of local coronavirus patients were Latino. Focused at the time on the risks of international travel, she remembers thinking, “Wow, that’s not the pattern I was anticipating.”
Soon after, Cody’s public health department met with the East San Jose PEACE Partnership, an advisory group it had formed years earlier, to discuss concerns about the virus’s impact on those who were at greatest risk: Communities of color, service workers and people living in crowded housing. But “stay home” remained the centerpiece strategy.
By then, Maritza Maldonado was already watching the virus ravage the low-income, largely Latino neighborhood of Mayfair.
Less than a week after the Bay Area’s March 16 shelter-in-place order, Maldonado recalled, the people around her started to die: The grandmother of six who worked at the nearby FoodMaxx and the beloved owner of Nacos Tacos, a popular restaurant next to her office. Women started coming to her nonprofit, Amigos de Guadalupe, asking for help paying for burials.
On May 4, the virus hit even closer to home: Maldonado lost her sister, Miriam Maldonado-Magaña, an Amigos volunteer who had been delivering groceries to sick families.
“This community, we knew it was coming,” Maldonado said.
And when it came, her community was virtually defenseless.
That’s what happened in Yanira Perez’s home in San Rafael. The 27-yearold mother and her family couldn’t possibly isolate in a shared home where the
family who rises first in the morning gets first dibs on the kitchen for breakfast.
The situation isn’t uncommon in the Bay Area, where 19% of Latino households are crowded — containing more than one resident per room — compared to 2% of White households, according to census data. In the Canal neighborhood, Perez said, you could knock on any door in their large apartment complex and whoever answered had either gotten
COVID-19 or knew someone who did.
Tearing up, Perez recalled her family spending a week and a half sick with symptoms in their single bedroom. Roommates left jugs of water at the door. A neighbor down the hall brought cookies for the kids. They feel lucky that no one in the home died. But Perez has lingering discomfort.
“I can still feel it in my bones,” she said of the virus.
As cases grew in Latino communities, fear, heartbreak and an oppressive resignation spread alongside. Perez’s sister-in-law, Veronica Duarte, said their neighborhood had a motto: “Sálvese si puede:” Save yourself if you can.
Unequal testing
From the start, regional and statewide lockdown orders were accompanied by official pledges to ramp up testing — in the pandemic’s early days, tests were in as short supply as vaccines are now. But inequities plagued the Bay Area’s testing plans, meaning that once again vulnerable Latinos had fewer protections.
To quantify those inequities, the Bay Area News Group compiled testing data for 210 ZIP codes, neighborhoods and cities, comparing the numbers of tests administered to the total cases found. The conclusion: Predominantly Latino communities in the Bay Area were tested much less often than majority White areas, relative to their risk of infection. This news organization’s analysis focused on the residences of test takers because not enough data has been collected on race and ethnicity.
The tests-per-case metric this news organization used is not common, but epidemiologists who reviewed the analysis said it is an effective way to examine disparities. A low number suggests there’s insufficient testing to detect cases, while a high number indicates testing is plentiful enough to help control the virus’s spread.
Throughout the Bay Area, communities in which Latino residents make up at least half the population had a rate of 11 tests for every case detected. In neighborhoods where less than 10% of residents are Latino, the rate was more than five times higher: 61 tests for every case.
In Santa Clara County, for example, Cupertino’s 95014 ZIP code had 543 COVID-19 cases through 2020. But its test per case rate of 66 was nearly seven times higher than East San Jose’s 95127 ZIP code, where 4,733 cases were reported by Dec. 3. Asked about the findings, Bay Area health officials did not dispute the conclusion that hard-hit communities haven’t been adequately tested. But local and state officials said they’ve made strides in expanding testing overall and in at-risk communities.
Still, it’s clear that the region’s testing practices posed challenges for Latinos, particularly essential workers and Spanish speakers, contributing to the disparities this news organization found. Initially, freetesting sites were located far from Latino neighborhoods. They were usually