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 a 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’ spread. A four-month Bay Area News Group investigation — including more than 50 interviews and a first-of-its-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. And 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-county region, 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 COVID-19 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 percent of new Bay Area cases by late May. Latinos account for less than a quarter of the population in the six-county region.
These racial and ethnic disparities have also 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 high-profile 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 ⅕ 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 socio-economic 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. And 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.”
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 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 percent of Latinos work in those front-line essential jobs, according to an analysis from the University of California, 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 UCSF 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, says 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 Permanente 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 recalls, 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-year-old 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 percent of Latino households are crowded — containing more than one resident per room — compared to 2 percent 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 says 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.
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. BANG’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 BANG 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 percent 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 just 543 COVID 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. 31, 2020. 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 BANG found. Initially, free-testing sites were located far from Latino neighborhoods. They were usually open only during business hours, the same hours essential workers had to work. Drive-through sites weren’t accessible to anyone without a car. And for months, the free-testing 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 so-called “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 similarly-sized San Carlos, where the majority of residents are White. Yet East Palo Alto residents were seven times more likely to contract COVID-19.
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 Spanish-speaking 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 to contact tracing, Santa Clara County had just 60 bilingual Spanish speaking tracers — 6 percent of its total. Last month, it was 15 percent, 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 percent now 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 the University of California, San Francisco, 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, 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 percent. Contra Costa County’s analysis shows the isolation hotel rooms in hard-hit Richmond had an average vacancy rate of 90 percent.
“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.”
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 community had exploded — and in the last weeks of May, Latinos made up a staggering 78 percent of all new coronavirus cases in the six-county Bay Area.
Yet some health leaders were still missing the signal. At a May 26 San Mateo County Board of Supervisors meeting, Supervisor Warren Slocum, whose district includes East Palo Alto and heavily Latino North Fair Oaks, asked Public Health Officer Dr. Scott Morrow if there was “cause for concern” in the rising number of Latino cases.
Morrow declared the data “not representative,” adding that, “at this point in time, it doesn’t mean anything.”
Meanwhile, county policies kept employees in the dark about risks at work. For one, no Bay Area county — nor the state of California — was willing to publicize specific information on workplace outbreaks, citing privacy concerns. It was a sharp contrast to the strategy in Los Angeles and the state of Oregon, which believed workers had a right to know.
That left Dr. Noha Aboelata, chief executive officer of the Roots Community Health Center in East Oakland, to do the job herself.
Roots was conducting free testing in poor communities and using the data to piece together workplace clusters, discovering at one point that 68 percent of construction workers it was testing had COVID-19. Aboelata recalls becoming so frustrated with the lack of communication she considered using a bullhorn to warn workers and employees about an ongoing outbreak at a local grocery store.
“You have entire industries where people are not protected, and that probably accounts for the disparity we are seeing,” she said. “The Latino population didn’t have protections.”
The first reopenings were quickly followed by a summer spike in cases — the majority among Latinos. By mid-July, the governor had rolled back the state’s reopening plan, and businesses once again shut down, only to reopen and close again during a huge winter surge.
The sequence of events showed the costs of overlooking persistently high case rates in Latino communities, said UCSF’s Bibbins-Domingo.
“It is not enough to say in my neighborhood, I don’t know anyone who has COVID, nobody around me has COVID, therefore we should open up,” she said. “Wherever there’s a pocket of high transmission, it’ll be impossible to get a city or county under control.”
As 2020 progressed, leaders at the local and state level began to address the Latino disparities publicly and offered some targeted programs. But they came in fits and starts, and Latinos in overwhelmed communities said the neglect continued.
The California Department of Public Health declined repeated requests from the Bay Area News Group to provide a top official to discuss its efforts in the Latino community. But in a detailed email, a spokesperson said department officials “began to notice” the Latino case and death numbers in summer 2020 — a surprisingly late time frame.
In July, the email continues, the department convened an internal work group to address the problems of COVID-19 in the Latino community, focusing on testing, contract tracing, isolation and quarantine, and health care access. It launched a Spanish language media campaign two months later. And in late September, Gov. Newsom unveiled a new series of equity measures to ensure that counties wouldn’t reopen if case or testing positivity rates in the most vulnerable communities were significantly higher than the county average.
“The data show us that when the case rates grow, so too do the disparities,” the email said. “Eliminating these is a priority equivalent to eliminating COVID-19 itself.”
In fact, the data on Bay Area infections contradict the state’s assertion: Although Latino case rates were persistently the highest of any group, disparities actually declined during the massive winter surge, as the virus raced from neighborhood to neighborhood, and case numbers for Latino and non-Latino residents rose in tandem.
Despite its efforts, the state’s approach to vulnerable populations often neglected urban areas. Its temporary isolation housing program, for example, was aimed at farmworker communities in the Central Valley and Imperial County. California didn’t offer an equity playbook that included specific strategies for Latino community outreach and support, as it did for high school sports or auto dealerships or cardrooms, until December.
Some Bay Area leaders are harsh in their assessment of the state’s efforts. Asked if his county had received useful resources — in terms of testing, data or communicating with the Latino population — from the state, Santa Clara County Executive Jeff Smith said no.
“Everything that they’ve actually done since last year has impacted the equity populations in a negative way,” Smith said.
Lacking better guidance, county programs have continued to vary widely.
In the Bay Area, local advocates single out Contra Costa County as an area that should have done more sooner.
While the county had a robust Spanish-language website, they said, there was little on-the-ground outreach to Latinos in many neighborhoods until late fall. For example, Bay Point — an unincorporated area with the county’s second-highest case rate — didn’t get its own testing site until October.
In late fall, there were still no signs or billboards and no on-the-ground outreach workers telling residents of the largely Latino Monument Corridor neighborhood in Concord how to avoid the virus or where to get tested, said Alejandro Hernandez, a Monument resident, well-connected PTA volunteer and assistant manager at a Moraga Taco Bell.
In that vacuum, rumors spread, so Hernandez became a self-appointed coronavirus resource, sharing information he got online or from his children’s school — doing at a small scale what he said the county should’ve been doing for months.
“They don’t have any sort of campaign. For instance, we all go to FoodMaxx. We all go to the Meadow Homes Park,” he said. “It would be great to have promotions there or people there telling you, ‘Here’s how to get a test.’ ’’
Contra Costa County Health Officer Dr. Chris Farnitano disagrees that the county was slow to act, noting that, among other things, the county set up a bilingual telephone line in March to provide information to people without internet access, had five testing centers in high-risk communities by April, and in June began meeting regularly with a working group focused on the Latino community.
“The information was there and the testing was there, and we’ve been promoting it since day one,” he said.
But when Edgar Quiroz, a retired Kaiser executive and member of United Latino Voices of Contra Costa County, volunteered at a two-day mass testing event in September in Oakland’s Fruitvale neighborhood, it became obvious to him what his own county wasn’t doing: a culturally competent event such as that one.
Two months later, working with United Latino Voices, Contra Costa County held its first testing event aimed specifically at the Latino community at San Pablo City Hall. More than half the people tested that day were Latino, more than one-third were Spanish speakers, and more than three-quarters were being tested for the first time.
“Had we reached out earlier to the community, there would have been more testing earlier, and what would that have meant for the case rate?” asked county Supervisor John Gioia. “I don’t know. … But clearly, I feel that piece could have happened earlier.”
By the end of 2020, Latinos made up nearly half of Californians who had died of COVID-19, and 63 percent of the fatalities among working-age Californians — a statistic that shows the perils of essential work.
“We actually created this differential harm for the Latinx community. Not all of it, but a lot of it,” said Solano County Health Officer Bela Matyas, who argues that a smart containment strategy would have focused from the very start on routes of transmission — specifically safeguarding essential business workplaces and providing advice on living more safely in a crowded home.
Bay Area health officers note that they’ve adapted their approach as the months have worn on, delivering walk-up community testing, implementing fines and stricter workplace protections, and working more closely with trusted local groups.
But as vaccines roll out, Latinos are again suffering disproportionately. Among Bay Area residents who had received at least one shot by early March, Latinos accounted for 12 percent while White residents made up 40 percent of the total.
“We haven’t been able to close the disparities,” said Alameda County’s Moss. “We have done quite a bit. We have focused our efforts on (East Oakland) and various Latinx communities. But I acknowledge that we are still seeing the same patterns.”
Data reporter Harriet Blair Rowan and staff photographer Randy Vazquez contributed to this report.