Imbalance
open only during business hours, the same hours essential workers had to work. Drive-thru sites weren’t accessible to anyone without a car. For months, the freetesting program the state provided in partnership with Google offshoot Verily required online registration with a Gmail account, a barrier for many older or Spanish-speaking residents.
Meanwhile, Jon Jacobo of the San Francisco Latino Task Force said testing numbers in areas with few cases are boosted by the socalled “worried wealthy” who can go to multiple testing sites or use private providers. In East Palo Alto, which has one of the highest coronavirus case rates in the Bay Area, testing was so hard to come by in the spring that city officials spent more than $130,000 through the fall on supplies for their own testing site.
Councilman Ruben Abrica called San Mateo County’s early testing efforts “lackadaisical” and said the virus’s outsized impact in his community was predictable. Two-thirds of the city’s residents are Latino. Overcrowded housing is common and many residents work in essential jobs.
“They should be testing every single worker,” he said in late fall. “I feel this whole pandemic has shown how inadequate the system still is.”
Even with expanded testing in Latino communities, the disparities persisted throughout 2020. By the end of the year, East Palo Alto’s test-per-case rate was just about one-seventh the number in similarlysized San Carlos, where the majority of residents are White. Yet East Palo Alto residents were seven times more likely to contract COVID-19.
Struggle to connect
If testing was the first critical step in controlling
the virus, contact tracing — identifying and contacting the associates an infected person may have exposed — was next. But Bay Area counties failed for months to deploy enough Spanishspeaking tracers.
Starting in May, with their own hiring efforts lagging, more than two dozen California counties asked the state for help. But only a “small percentage” of the state’s available staff spoke a language other than English, according to the California Department of Public Health. Santa Clara County requested 150 Spanish-speaking workers. It received none.
By August, when Gov. Gavin Newsom announced he would commit millions of dollars donated by Kaiser Permanante to contact tracing, Santa Clara County had just 60 bilingual Spanish-speaking tracers — 6% of its total. Last month, it was 15%, still far short in a county where for months at least half the infections came in the Latino community. In Alameda County, which has many fewer contract tracers overall, about 45% speak Spanish.
“We should have maybe prioritized that a lot more in the beginning and recruited way more bilingual English and Spanish folks,” Rikita Merai, a contact tracing program manager with UCSF, said last summer. “Initially it was like, ‘Who can we even man to do this?’ Not, ‘Who can we get are the right people?’ ”
Contact tracers are important for more than just tracking viral spread; they also were the primary source of information for most infected people about how to isolate. But the language gap, along with other communication deficiencies, hampered the delivery of the information to those who really needed it.
As early as March 2020, San Francisco, San Mateo and Santa Clara counties began efforts to help residents isolate safely, adding to a state hotel program meant to house the homeless during the pandemic so that rooms were available
to essential workers or people in crowded homes. By May, Alameda, Contra Costa and Marin counties did the same.
But some infected residents who heard from contact tracers — many never did — said the accommodations were never offered to them. Others said isolating alone in a hotel room simply didn’t sound realistic.
One East San Jose resident, who didn’t want to be identified because of
her COVID-19 status, said a contact tracer called after she tested positive in December and offered an isolation hotel room. But who would take care of her if she was alone in a hotel? She was sick for six weeks, she said, sometimes unable to walk 50 feet or get her own food.
“I couldn’t do anything for myself,” she said.
Today, health officials acknowledge they erred in thinking that people
would willingly leave home to quarantine, though some have come to believe smarter outreach could encourage them. For whatever reason, the hotel rooms were persistently underused. In Santa Clara County, the average occupancy from August through mid-February was 59%. Contra Costa County’s analysis shows the isolation hotel rooms in hardhit Richmond had an average vacancy rate of 90%.
“We were making an assumption that people would, once diagnosed, seek isolation from family members that might otherwise be exposed. A lesson was that people don’t want to leave their families,” said Dr. Matt Willis, Marin County’s public health officer. “It’s obvious.”
Ill-fated reopening
With public pressure mounting to reopen and case rates seemingly plateaued, Bay Area health officials in late May began to ease their shutdown. But in some counties, their moves drew a swift rebuke from Latino leaders and others — a public manifestation of the deep disconnect surrounding the question of how to control coronavirus. In Alameda County, more than a dozen community health leaders in June issued a public letter blasting then-Health Officer Erica Pan for allowing retail activity and outdoor dining. Pan, now the California state epidemiologist, declined requests for an interview.
By late spring, most counties in the region were posting limited case rate data suggesting the virus was spreading disproportionately in Latino communities. On May 10, the Bay Area News Group published a review of death records in Santa Clara County that found fatalities concentrated in four low-income, heavily Latino ZIP codes.
In their letter, the community leaders warned Pan and the Alameda County Board of Supervisors that if reopenings continued, “Black and brown residents and workers will disproportionately bear the brunt of new infections, and increased morbidity and mortality.”
The disparities were even worse than they knew. White Bay Area residents had seen a decline in their infection rates over the spring months, according to an analysis of the region’s weekly case data by this news organization. But infections in the Latino