The coronavirus pandemic has disproportionately impacted the Asian, Latino and black communities. (Kevin N. Hume/S.F. Examiner)

San Francisco needs to change to reverse racial disparities in COVID-19 deaths

By Rev. Norman Fong, Antonio Diaz, and Kevine Boggess

Compared to many other parts of the country, the Bay Area’s strategy for shelter in place has been a major accomplishment. The collective sacrifices of communities across the region slowed the pandemic and saved lives. Yet even here there was sickness and death. And as the region reopens we need to prepare to work even harder to protect those most vulnerable.

That preparation requires a more honest conversation about the reality of racial disparities. Even in a high performing region, in too many cities the sick and dying were disproportionately people of color. One of those cities is San Francisco.

As of May 28, the data on deaths in San Francisco reveals the following:

SF Population*

COVID 19

Deaths (40)

Whites (Non Hispanic) 40.4% 25% (10)
People of Color 54.7% 70% (28)
o Asian 34.3% 45% (18)
o “Hispanic” 15.2% 15% (6)

o African American

5.2% 10% (4)
Unknown or Other 4.9% 5% (2)
(*Population estimate, Census 2018 ACS)

Since the start of the crisis there has been a clear racial disparity in deaths. This should have resulted in an equally clear response by the lead agency in the crisis. But our Department of Public Health’s response has been muddled and disappointing. At times our health officials appear to deflect rather than acknowledge the problem.

For example, several weeks ago, researchers at UCSF wrote an analysis highlighting the disproportionate number of Asian deaths and called on officials to share more information about the cases. At a Board of Supervisors hearing on May 12, Chief Health Officer Dr. Tomás Aragón was asked to explain the disparity. He responded as follows:

“If you just look at the demographics in San Francisco, the Asian population has more older persons than, let's say the Latinx population that has a lot younger and immigrant population. So the age distribution in both of those are just very different to start with, so you’re going to have a bigger group — you’re going to have a bigger group that’s at risk…”

This might seem like a plausible explanation. But it distorts the data and dodges the real issue of racial disparities. Even factoring in age, Asian, African American and Latinx seniors are dying at disproportionately higher rates than their populations reflect. Fifty-seven percent of seniors over 60 are people of color – yet 70% of deaths are persons of color. Age alone is not a sufficient explanation for disproportionate deaths.

Rather than deflecting questions on racial disparities those leading San Francisco’s COVID-19 response should acknowledge and work with impacted communities to address the problem. Instead we have seen bureaucratic resistance to community based solutions.

Thus when early citywide test results showed disproportionately high Latinx infections, the Latinx community sought increased neighborhood access to testing. Health officials again deflected questions and concerns. Facing such resistance, community organizers partnered with volunteers at UCSF to launch an ambitious testing program in the Mission District. After testing almost 3000 people the program found clear racial disparities in COVID-19 illness: while 45% of those tested were Latinx; 95% of those testing positive were Latinx and 0% were White.

This testing program also found that that essential workers in lower wage jobs face elevated risk of illness— jobs where workers of color predominate.

We do not raise these disparities to point fingers. We raise concerns because unless public agencies change course we will almost certainly experience more disparities as people return to unsafe workplaces and overcrowded transit, schools, and waiting room. We need change to save lives.

Change requires public agencies that welcome collaboration, data transparency, and solidarity across communities to address a common threat. Only collaboration and not top down directives will address the specific needs of diverse communities. Rather than rely upon Twitter and flawed Google Translations to provide essential health information for communities that don’t Tweet or are non-English readers, the health department should be partnering with community based organizations and media to reach everyday people.

Instead of providing only pre-packaged and incomplete information about the spread of the disease, San Francisco should become fully data transparent. Santa Clara County now shares detailed race, age, and other information about each specific COVID-19 death. San Francisco should do no less. Communities need better data to prevent future illnesses and deaths.

We recognize that these challenges are daunting. We also know that to achieve complete equitable treatment we must overcome deeper inequalities in our health systems, housing, and workplaces. But it has never been clearer that our lives depend on working together to make those changes a reality for everyone.

Rev. Norman Fong is a parish associate at the Presbyterian Church in Chinatown; Antonio Diaz is the director of PODER, an environmental justice organization rooted in the Latino immigrant community; Kevine Boggess is the Political Director at Coleman Advocates, serving and representing children, youth, and families.

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