Early statistics in San Francisco show that at least 20% of those with COVID-19 are LatinX though they only comprise 15% of the San Francisco population. Though their work is concentrated in agriculture, construction, and manufacturing, they also abound among San Francisco’s restaurant, grocery, domestic, and janitorial workers. (Shutterstock)

Who lies beneath the flattened curve: LatinX and COVID-19

By Marlene Martín, Alicia Fernández and Kirsten Bibbins-Domingo

We have reached a point of cautious self-congratulation in California. Headlines read “Bend it Like the Bay Area.” Indeed, prompt and intensive public health interventions and social distancing have “flattened the curve” on Coronavirus Disease 2019 (COVID-19) transmission in our region. However, at the public hospital in San Francisco where we are doctors, this isn’t the case for LatinX people, who are disproportionately affected by COVID-19.

Our LatinX patients with COVID-19 visit our outpatient clinics and emergency room, fill the medical floors, and comprise the bulk of the critically ill in our intensive care units. Many are under the age of 50. A paycheck away from eviction, our patients are roofers, cashiers, delivery people, cooks, taxi drivers, janitors, and house cleaners. Many share living spaces with families or multiple housemates because they cannot afford housing otherwise. Most have sick contacts who have not been tested. Barely able to feed their families in the best of times, they do not have the luxury of stocking up on a month of groceries. Some have lost their jobs but are not eligible for unemployment benefits nor assistance from the Coronavirus Aid, Relief, and Economic Security Act. For our LatinX patients with COVID-19 social distancing is a privilege they cannot afford and shelter in place an option they do not have.

There are 15 million LatinX individuals in California, of whom 12% are undocumented. LatinX individuals make up 20%-50% of the population in Alameda, San Mateo, Santa Clara, Riverside, San Diego, and Los Angeles––counties hardest hit by COVID-19. Most are longtime neighbors: nearly 66% have been in the US for more than 10 years, and almost half have US-born children. Though their work is concentrated in agriculture, construction, and manufacturing, they also abound among San Francisco’s restaurant, grocery, domestic, and janitorial workers. They are crucial to making shelter in place possible for the rest of us.

Despite this, there has been scant publicity about how COVID-19 is affecting LatinX people. Early statistics in San Francisco show that at least 20% of those with COVID-19 are LatinX though they only comprise 15% of the San Francisco population. This overrepresentation is likely an underestimate as race/ethnicity remains unknown for at least a third of those tested, and communities who lack access to care are undertested. Governor Newson reported on April 8 that 29% of people dying of COVID-19 in California are LatinX. In New York, it is also poor neighborhoods of color that are suffering the most, with LatinX people comprising 34% of the city’s COVID-19 deaths but only 29% of its population.

Detailed race/ethnicity, language, zip code, and severity of illness data are essential for an effective public health response to this pandemic. Though San Francisco statistics on LatinX people are incomplete, they already point to a need to direct testing resources, implement contact tracing, offer testing, and disperse Spanish language information to this community which has been disproportionately hit. And, when this crisis ends, the LatinX community will require support to cope with the aftermath, and as a region, we will need to design policies so such inequities don’t recur in any future public health emergency.

While no virus intrinsically discriminates based on borders, citizenship status, skin color, or socioeconomic status, the inequities in our society mean that COVID-19 is hitting the poor and socially marginalized hardest, both in our hospital and across the nation. This pandemic will continue ravaging our country, shelter in place will be prolonged, and more lives will be lost unless we mobilize resources to those who lie beneath the curve, including LatinX people in San Francisco. Supporting the most affected is what it means to be #inthistogether.

Dr. Marlene Martin is director of the Addiction Care Team and an assistant clinical professor at UCSF. Dr. Alicia Fernandez is director of the UCSF Latinx Center of Excellent and a professor of medicine at UCSF. Dr. Kirsten Bibbins-Domingo is a professor and chair in the Department of Epidemiology and Biostatistics and vice dean for population health and health equity in the UCSF School of Medicine.

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