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Why Testing for Coronavirus in Low-Income Neighborhoods Lagged

Even as access to testing grew in wealthier, whiter parts of several California Bay Area counties, community testing sites lagged or offered only limited hours in communities of color where the virus was spreading fastest.

by Cynthia Dizikes and Joaquin Palomino, San Francisco Chronicle / July 27, 2020
AP

(TNS) — As the coronavirus dug into the Bay Area’s low-income Latino and Black neighborhoods this spring, doctors and community leaders pleaded for more testing sites.

But even as access to testing grew in wealthier, whiter parts of several Bay Area counties, community testing sites lagged or offered only limited hours in communities of color where the virus was spreading fastest, according to a Chronicle analysis of test-site data from March through mid-July.

Richmond and San Pablo — predominantly Latino, Asian American and Black working-class cities — have some of the highest infection rates in Contra Costa County. Yet they still have about the same number of community testing sites as Walnut Creek, an affluent, mostly white city with half the population. Walnut Creek had 4 cases per 1,000 people compared with 13 in Richmond and 19 in San Pablo, as of Friday.

East Oakland, the epicenter of Alameda County cases, had no community testing site until early May, nearly two months after the pandemic hit. In Solano County, the first testing sites were in higher income areas that were less impacted by the virus.

And in San Mateo County, about half of the community testing sites remain in wealthier ZIP codes. Meanwhile, there are still no permanent sites in working-class East Palo Alto — which has the county’s highest case rate — or in coastal towns with large farmworker communities. Only roving clinics that set up a few days a week service those areas.

Three cities with some of the highest case rates in San Mateo County lack a permanent testing site accessible to anyone: East Palo Alto, Half Moon Bay and South San Francisco.

“It should have been a priority for the county to come to areas where low-income families live, to the farms where there’s crowding in the barracks,” said Joaquin Jimenez of the nonprofit Ayudando Latinos a Soñar (Helping Latinos to Dream), which provides protective equipment and other help to farmworkers along the San Mateo County coast. “That should have been the main concern from day one, not places with big homes and two people living in them.”

About a dozen other community groups, local leaders and medical professionals in Alameda, Contra Costa and San Mateo counties told The Chronicle that their requests to county officials for more testing sites have not yielded enough options for low-income people — who often work in essential jobs where it’s hard to socially distance. Such communities are bearing the brunt of the pandemic.

Officials in these counties said they were hamstrung by a shortage of money, testing supplies and staff, particularly early on. When the state offered to fund more testing locations through a multi-million dollar effort to fill so-called “testing deserts,” county officials were able to cover more communities. But the state limited the number of sites, and counties’ repeated requests for more were denied.

People who live in Bay Area testing deserts have long shared anecdotal evidence of the problem. To quantify the disparities for the first time, The Chronicle analyzed data collected by Coders Against COVID and GISCorps, volunteer groups that have amassed the most comprehensive database of community testing sites in the country.

The groups define a community testing site as a location — such as a hospital, clinic, pharmacy or pop-up site — that gives diagnostic or antibody tests to people beyond its own patients. These sites provide a critical access point for those who lack a primary health care provider or health insurance.

The Chronicle’s analysis found that several counties waited until at least late April to begin opening community testing sites in some lower-income areas — after case rates had already taken off there. By contrast, several privately run sites opened in wealthier areas as early as mid-March.

Though local and state officials have since expanded testing options in some low-income communities, public health experts say there should still be far more in neighborhoods where people have limited access to health care and transportation — and greater exposure to the virus.

“To see it play out in real time has been the most heart-wrenching,” said Dr. Jorge Caballero, a co-founder of Coders Against COVID and an anesthesiologist at Stanford Health Care. “It comes down to trust, and there was a betrayal of trust. They didn’t move fast enough in the communities where they should have been involved early on.”

The reasons for the disparities are multifold, public health experts said, but in short, money yielded tests. Underfunded public health departments often had little means to open testing sites, or to add tests at the ones they had opened. At the same time, better-resourced medical providers in higher-income areas were able to expand testing to more people. California also lagged behind most other states in clearing the way for pharmacies to test customers.

And once sites opened, cities and counties often failed to tell low-income communities where they were. Other barriers also emerged: such as requiring clients to set up an account in advance, and show an ID — often a problem for undocumented immigrants.

The result, experts said, has been a public health disaster: The virus has spread further and faster in some of the Bay Area’s most vulnerable communities. And now that cases are surging, demand for testing is again outpacing supplies, often in those very communities.

“This mirrors what we know about health access in general for people of color — it’s bad,” said Denise Herd, a professor at UC Berkeley’s School of Public Health. “If someone can’t get tested, then they can’t self-quarantine, and other people are going to be infected. You can’t protect the population if you don’t know who has it.”

County public health officials told The Chronicle that it was nearly impossible to expand testing anywhere in March and early April because of shortages in testing supplies across the country. And even though the state offered additional sites through partnerships with two testing companies, counties said there weren’t enough sites provided.

For example, Contra Costa County got three sites this spring. But when the county of nearly 1.2 million people requested three more, the state said no.

Similarly, San Mateo County was denied a second site, despite multiple requests, said Deputy County Manager Justin Mates.

“Our low-income populations and communities of color are bearing a greater exposure to COVID-19,” Mates said. “But responsibility for testing is a shared responsibility: It’s the county, it’s the state, it’s health care providers, it’s other entrants to the market like CVS and Walgreens.”

California Department of Public Health spokeswoman Ali Bay did not explain when asked why the state turned down the counties’ requests. She noted that more than 100 community testing sites operate across the state through its coronavirus testing program.

“Although we have made considerable progress,” she said, “we still have much more work to ... ensure adequate access to testing, particularly among low-income and minority communities.”

Curtis Louis, 72, of North Richmond said he wanted to get tested in mid-June before parishioners returned to BibleWay Missionary Baptist Church, where he serves as a deacon. Louis called a county number to schedule a test but said he was told to go to Berkeley, in another county. That meant Louis, who does not own a car, would have to take BART or a bus, then walk multiple blocks.

At the time, there was just one clinic in Richmond offering testing to the wider community. But Louis and several community leaders said they didn’t know about it. Louis said he was trying to figure out how to get to the Berkeley location when his pastor, Nathan Whittom, offered to drive him to a site in nearby San Pablo.

“People aren’t getting tested who want to get tested because they don’t know where to go, and they don’t have any way to get to the test sites,” Louis said.

Whittom said that he and a group of pastors and medical professionals have been talking with local officials since early April, pressing to get more test sites in Richmond.

“What bothers me is that we are four or five months into this thing, and we know where the pockets of people are who are being affected,” Whittom said. “Why wouldn’t you bring the testing to these people?”

Contra Costa County opened 10 state or county-funded testing sites between late April and mid-June. Just three went into the working-class cities of Antioch, Pittsburg and San Pablo. The other seven were set up in middle-income Pinole, Brentwood, Martinez and Concord — which got two — and in wealthier and whiter cities with far fewer coronavirus cases per capita: Walnut Creek and San Ramon.

Contra Costa County officials recently opened a second community testing site in Richmond, and are considering another in unincorporated North Richmond. They also said they are trying to do a better job of letting people know where to find testing.

“We want testing to be available to everyone,” said Erika Jenssen, the county’s deputy health services director. “I think subsequently we really understood that this pandemic is greatly affecting Latinx, African American low-income communities, and so we’ve opened up additional sites in those communities.”

In San Mateo County, public health officials rotate their lone state-provided site among six underserved communities, including East Palo Alto and Half Moon Bay, a small agricultural town that gets the testing once a week.

Deputy County Manager Mates said the vast majority of county residents are insured and can be tested through their health care providers. Many farmworkers in rural parts of the county, however, lack health insurance, making the roving clinic their primary option for being tested, said Jimenez of Ayudando Latinos a Soñar.

If they need to be tested at any other time, it could mean an hour-long bus ride east over the coastal range. That makes it difficult for people to be screened, especially if they’re showing symptoms.

In Solano County, public health officer Dr. Bela Matyas said the state gave county officials days to choose the locations for two state-sponsored sites.

He said the county asked cities to propose two rent-free locations. They offered one in a low-income area of Vallejo and another in a higher-income area of Vacaville.

In late June, however, after considering where the sites might be more effective, the county moved the Vacaville testing site to an area of Fairfield where the median household income was $20,000 lower and case rates were significantly higher. The county also shifted the Vallejo site to a lower-income area closer to several apartment complexes.

“We had so little time at the outset that we had to go with convenience,” said Matyas. “After they were put in place, we were able to be much more strategic in targeting where the need was.”

Getting a site up and running is just the first step, experts said.

In Marin County, health officials have placed one permanent testing site and two pop-up sites in San Rafael’s Canal area, a dense and mostly Latino neighborhood where the coronavirus has spread rapidly. Lucia Martel-Dow, director of immigration and social services at the Canal Alliance, which runs one of the pop-up sites, said that 20% to 30% of tests in the community are coming back positive — far higher than the 7% rate countywide.

Despite efforts to expand testing in the area, growing demand means it can take a week to get an appointment at some clinics, and even longer for results to come back, Martel-Dow said — though wait times are improving, according to county officials. The delays mirror those across the state as coronavirus cases have spiked in recent weeks.

Public health experts said county efforts to connect residents with community sites have sometimes been weak, particularly in historically underserved communities where English is not the primary language.

In other cases, people have been wary or unable to use even nearby sites because of certain requirements like releasing personal information, or having to get tested during standard working hours.

For some, even having to show ID is a too-high hurdle, said Dr. Noha Aboelata, founder and CEO of Roots Community Health Center in East Oakland, a health care provider that operates free walk-up testing sites.

“We need to make sure that when we set up testing sites we are actually serving the community and not just checking a box,” she said.

Cynthia Dizikes and Joaquin Palomino are San Francisco Chronicle staff writers. Email: jpalomino@sfchronicle.com, cdizikes@sfchronicle.com Twitter: @JoaquinPalomino, @cdizikes

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