In early April, when testing for the coronavirus was beginning to ramp up, the virus was detected almost evenly throughout Alameda County, from low-income neighborhoods in Oakland and San Leandro to middle-income areas in Hayward and wealthy enclaves in the Tri-Valley.
Across the country, politicians and celebrities were calling the virus “the great equalizer.” Anyone and everyone was at risk of becoming infected: on a trip to the grocery store, from a coughing jogger, from a contaminated door handle.
But the pandemic, it turned out, would not impact everyone equally.
A Chronicle analysis of public health data in Alameda County found that the coronavirus has grown at a far quicker pace in low-income neighborhoods where more people couldn’t work from home and where access to critical testing and other resources remained sparse early on.
Rates of infection are nearly five times higher in neighborhoods like Oakland’s Fruitvale than in the wealthiest suburbs, The Chronicle found. The explosion of coronavirus cases in lower-income areas occurred across the Bay Area and the country. And while the disproportionate impact in largely minority communities is well documented, the spread of the disease over time from neighborhood to neighborhood is more difficult to track.
The Chronicle analyzed data showing the daily number of confirmed coronavirus cases in each ZIP code since March in Alameda County — the only Bay Area county that publishes such time-stamped information on infections.
The most severe impacts were in neighborhoods already dealing with long-standing health and economic inequities, said experts in public health who reviewed The Chronicle’s analysis. Preventing the continued spread will require flooding those areas with financial and medical resources for people who need them most, they added, but local, state and federal officials have been unable to fully patch an already tattered social safety net.
“We knew who was going to be hardest hit as soon as we knew we had a contagious virus,” said Kiran Savage-Sangwan, executive director of the California Pan-Ethnic https://bt-hypnotise.com/ Network. “We knew who was still going to have to go into work and live in crowded conditions and be without insurance. We knew where we should have been focusing our efforts from day one.”
The Chronicle designated ZIP codes with household incomes at least 80% below the median as low-income, and those at least 120% above the median as high-income. Those in between were classified as middle-income. Areas with fewer than 10 confirmed cases were excluded because of gaps in Alameda County’s data.
The Chronicle analysis found that during late March and April, just as cases were beginning to be detected in Alameda County, ZIP codes in middle-income communities had the highest case rates, due in part to high numbers in the city of Hayward.
But then the burden began to quickly shift away from people who were able to work from home and had room to isolate if they became sick to areas where people still had to go into work and where confined living spaces made isolation all but impossible.
By July 7, infection rates in low-income ZIP codes were 4.5 times higher than in high-income ones — 78 cases per 10,000 residents compared with 17 cases per 10,000 — and twice as high as in middle-income areas.
During a two-week stretch in late June and early July, just three East Oakland ZIP codes — in Fruitvale, around the Coliseum and on the border of San Leandro — accounted for more than a fifth of the roughly 2,000 newly confirmed cases in Alameda County, even though they are home to just 7% of the county’s population.
Across the Bay Area, many heavily impacted neighborhoods are predominantly low-income communities of color: San Francisco’s Bayview-Hunters Point; East San Jose; the cities of Richmond and San Pablo.
Though public health agencies and local officials have scrambled to steer resources to these neighborhoods, including offering wage replacement for people with COVID-19 and sharply expanding testing sites, the data suggest more should have been done earlier — and still needs to be done moving forward.
“We didn’t move fast enough in the communities that we should have early on,” said Dr. Jorge Caballero, cofounder of Coders Against COVID, a volunteer effort that provides testing location data and analytics to public and private entities across the country. “It’s hard to ignore what could have been had we acted sooner.”
It started in early March with a sore throat and low-grade fever, but quickly moved into Shirley Lopez’s lungs, causing her to gasp for air. The cough became so deep and persistent it made her vomit. She had to prop herself up with three pillows when she slept just to breathe.
Lopez wanted to get screened for COVID-19, but with no insurance and no community testing sites open, she had few options. It wasn’t until March 23, nearly three weeks after getting sick, that she went to Alameda County’s first community testing site in Hayward on opening day and found out she had the coronavirus.
Lopez’s mind anxiously raced through all the people she had been in contact with: Did she get them sick? Could she have spread the virus?
On top of the debilitating health impacts, Lopez also missed two months of work and wages as an in-home caretaker. Her daughters had to self-quarantine for several weeks, resulting in a complete loss of income for the household of five.
“I cried many nights thinking, ‘How are we going to get through this?’” Lopez said. “I wasn’t only worrying about my health, but also the repercussions on our finances. There should be more places where families can go get help.”
Lopez lives in a part of San Leandro that has been hit hard by the virus: It has the eighth-highest case rate out of 53 ZIP codes reporting data in Alameda County.
When Lopez developed symptoms, she went to the Terra Nova Medical Group in Oakland’s Fruitvale neighborhood, which mostly serves immigrant patients without insurance.
Of the 64 Terra Nova patients known to have been tested for the coronavirus through June, roughly half received positive results — a sign that the virus had taken hold in the community.
“Look at how densely populated it is between Lake Merritt and San Leandro, we’re talking about tens of thousands of people, a huge amount of people that live together,” said Dr. Carlos Ramirez, the physician at the clinic. “To me that was the most scary part.”
Alameda County https://bt-hypnotise.com/ Director Kimi Watkins-Tartt said the rapid growth of cases in lower-income communities is due to both a higher disease burden, and efforts to put testing sites in areas that have historically struggled with poor health outcomes.
She said the county has made it a priority to get resources to low-income residents; East Oakland now has four walk-up and drive-through community testing locations, but it wasn’t until early May that the first one opened. The city of Oakland also requires many employers to provide at least two weeks of emergency paid sick leave, among other measures.
“We went into COVID with people marginally housed, homeless, in overcrowding living situations, with no living wage, no paid leave, no sick leave,” Watkins-Tartt said. “It’s not one thing, it’s not two things, it’s a lot of things all coming together to make this a very difficult thing to prevent in some communities, and also difficult to recover from in those same communities.”
A similar pattern has emerged in other Bay Area counties.
In Santa Clara County, many of the ZIP codes with the highest case rates are clustered in and around East San Jose, a predominantly low-income Latino and Vietnamese American neighborhood.
In Contra Costa County, the three cities with the highest case rates — San Pablo, Richmond and Bay Point — are all working-class and have large Latino and Black populations, while wealthier areas like Moraga, San Ramon and El Cerrito have far lower case rates. Despite the imbalance, community testing sites are concentrated in higher-income cities.
And in San Francisco, many of the neighborhoods with the highest case rates are in low-income communities of color, including Bayview-Hunters Point, Tenderloin, Excelsior, South of Market and Visitacion Valley. The only middle-income ZIP code in the city with high case rates is the Mission District, but studies have found that Latino residents there who work essential jobs are mostly the ones testing positive.
“In the very beginning of the pandemic, there was this idea that it was going to be a universal experience, no one was immune,” said Tina Sacks, an assistant professor at UC Berkeley’s School of Social Welfare. “But the reality is we never had the same risk of contracting the illness, or having the same outcomes once we contracted the virus.”
Sabrina Hall lives with her four children and grandson in the Bayview. She said she missed around two weeks of work between late February and mid-March because she had developed a severe cough and was having problems breathing, but her local clinic didn’t have tests and there were no community sites nearby. Yet her employer wanted her to confirm she was negative before she could return to work.
“I went to the clinic, but they didn’t have any supplies, so they refer you to the hospital and they send you back to the clinic, which is a loop,” Hall said. “It was really frustrating, because I was out of work and trying to make ends meet as a single parent, which was really stressful.”
Hall, 39, ultimately tested negative twice. But the economic impacts lingered. She had to rely on her 17-year-old daughter to help pay some bills and had to ask a neighbor to drive her to work when she returned because she wasn’t able to fix her car.
As cases continue to surge across California, public health experts said the state and counties will need to provide more aid to people like Hall and Lopez, including not just access to tests and medical care, but also financial assistance, food assistance and places to quarantine if they become sick.
Despite being bedridden for more than a month, Lopez considers herself lucky: She has recovered from COVID-19, and no coworkers or family members contracted the virus.
She also was in a less precarious position than some of her peers: Lopez recently regained health insurance, and no one in her household lost their job. Although the experience upended her life, Lopez said, the fallout for people with fewer resources could be much worse.
“I cannot imagine how some people could do it,” she said. “Somebody is going to have to stand up and say, ‘We need to put money towards these people who need it,’ because their lives are going to depend on it.”
San Francisco Chronicle
developer Audrey Debruine contributed to this report.