The Honorable London Breed
Mayor, City of San Francisco
City Hall, Room 200
1 Dr. Carlton B. Goodlett Place
San Francisco, CA 94102
Via Electronic Mail
Re: COVID-19 Request for Action to Address Socioeconomic Vulnerabilities for Low-Income Latinos in San Francisco
Dear Mayor Breed:
The undersigned community organizations respectfully request your support to ensure that the requests set forth in this statement are addressed as a matter of urgency. We would appreciate your response by Friday, June 12, 2020 and are committed to working with you to address these matters with the urgency they deserve.
For all the reasons discussed below, we respectfully call for an investigation into the civil rights implications of the alarming rates of COVID-19 infections in the Latino community in San Francisco and the social circumstances driving these tragic results. The public health data now available, and our experience as Latino-serving organizations, confirm that the stunning overrepresentation of infection vulnerability among San Francisco’s low-income Latino community is undeniably tied to social inequities and the conditions they create. As these risk factors have proven determinative, we also request that the descriptions of who is considered vulnerable to COVID-19, as articulated in public health directives issued by the City of San Francisco, be broadened to include a category identifying low-income Latinos who experience social inequities that lead to greater vulnerability. To address the severe public health impact COVID-19 has had on our community and the related economic hardships, we also request the special resources needed to help mitigate that impact by increasing access to food, healthcare, affordable housing, job-related services and economic support, now and through our community’s recovery.
In early March 2020, in anticipation of the Coronavirus pandemic descending upon the City of San Francisco, the City published definitions of those who are considered especially vulnerable to severe illness should they contract the virus. These include individuals 60 years of age or older, and those with certain pre-existing health conditions.1 We recognize that this determination was done before the City had more experience with how the infection would be impacting communities.
However, since then, over the last several weeks, experience and data have revealed that San Francisco’s low-income Latinos have been disproportionately infected and sickened by COVID-19 in our city at alarming rates due to the social inequities they experience, significantly increasing their vulnerability to the disease and its resulting impacts.
Documentation of the disproportionate impact on San Francisco’s low-income Latinos includes:
● In April 2020, a study conducted by UCSF of Mission District residents,2 primarily living within one census tract revealed:
- Latinos accounted for 44% of all people tested, but 95% of those who tested positive.
- Among those who tested positive, 90 percent reported being unable to work from home. In contrast, among those who tested negative, 53 percent reported no impact on their work or financial stability.
- Nearly 89 percent of those who tested positive earn less than $50,000 a year and most live in households of 3 to 5 people (59.6 percent) or larger (28.8 percent).
- Notably, people who lived outside the census tract but who go there for work were much more likely to test positive (6.1 percent) than residents (1.4 percent).
- “The COVID-19 prevalence among Latinos was about 5%. By contrast, the prevalence among their white neighbors was 0%.”3
- “Project leaders estimate that infection rates are considerably higher in the area [of the study], due to the long-standing legacy of socioeconomic inequities that contribute to the continued spread of the virus.”4
● On May 8, 2020, The San Francisco Chronicle reported that “the vast majority of people so sick that they needed to be hospitalized at San Francisco General Hospital were Latino.” As the hospital “was prepared to see an influx of low-income Latino patients, many of whom continued to work essential jobs and had been pushed into crowded homes due to the city’s high cost of living” the stunning numbers defied expectations. “Of the first 103 people admitted to S.F. General for the disease, more than 80% were Latino.”5
● Most recently, preliminary data from a May 26, 2020 testing of 567 Mission Neighborhood Health Center (MNHC) patients (mostly low-income Latino individuals and their families) revealed that of those tested, 25% tested positive for COVID-19.6
Such significantly higher infection and hospitalization rates among San Francisco’s low-income Latinos, occurring as a result of longstanding social inequities, heightens vulnerability. When those conditions are not addressed and persist, they continue to place individuals at significant risk for COVID-19. The data confirming vulnerability among San Francisco’s low-income Latinos is stark and demands a focused effort by the City of San Francisco to fully address its socioeconomic origins and impact.
Regarding the high infection rates among San Francisco low-income Latinos, on May 27, 2020 before the U. S. House of Representatives, Ways and Means Committee, Dr. Alicia Fernandez, physician and Professor of Medicine at University of California San Francisco testified, “Early on, the physicians at ZSFG realized that there was a significant outbreak among Latinos in our city. When my colleagues analyzed data from the first 70 COVID-19 patients hospitalized at ZSFG, they found that 83% were Latinx. By comparison, only 35% of hospitalizations at ZSFG are typically Latinx.”7
Dr. Fernandez additionally testified that “the majority of patients were men, their median agewas 47y; and nearly all were working despite the shelter in place order. The prototypical COVID-19 patient in our hospital is a Latino middle age man with diabetes, a low-wage worker who is continuing to work.”8
As characterized by Dr. Fernandez, “This stunning over-representation of Latinos prompted UCSF researchers to partner with a coalition of community groups to conduct an important study”, 9 the Unidos en Salud study (noted as the UCSF study above) in which the “most common occupations among the COVID-19 positive participants was restaurant and janitorial jobs.”10 In recounting the study findings, Dr. Fernandez confirmed what we all feared to be true: socioeconomic factors were driving exposure and “The need to leave home to work, because of both the demands on essential workforce and low-wage worker’s intense financial need, is the clearest driver of COVID-19 disparities among Latinos and among many immigrants. [and indeed] Emerging data indicate that the need to leave home to work drives infection throughout the country”11 Dr. Fernandez also confirmed that congregate living is the “second important driver of Latinx disparities.” Affordable housing remains an area of great need and this pandemic has underscored the importance of prioritizing its availability to eliminate the kinds of increased risk its absence creates. “Dense housing occupancy, often because of low-wages and high rents, i s most likely the second driver of Latino [health] disparities nationally.”12
As we know, any of these factors taken alone exposes one to greater risk of infection; taken together, they form the perfect storm of exposure. Compounding this, low-income Latinos who are also within the existing defined high vulnerability categories (over 60 years of age or with certain medical conditions) are at even higher risk of infection, especially because the disease can be spread by asymptomatic individuals.
How is it that the vulnerability of our community was not articulated by policymakers that could have put the community on alert and plan for their safety during this pandemic? When this pandemic started, there was a lot that was not known. As the pandemic progresses and we learn more about its impact, what has become clearer is that social determinants of health and its disparities are inextricably intertwined with the socioeconomic factors of race and income. The nationwide structural inequities that put sound housing, a living wage, healthy food, access to healthcare and freedom from injustice, and more, out of reach of San Francisco’s low-income Latinos, are those that also perpetuate extreme vulnerabilities in this pandemic.
To address this glaring reality, we are proposing a broader framework to identify and articulate public health vulnerability that is based on the data and experience of our community. And we need your help to ensure that the civic response prioritizes resources for prevention and recovery, commensurate with the need, that replaces injustice with enduring opportunity and prosperity.
Therefore, we ask you to investigate the civil rights implications of the alarming rates of COVID-19 infections in the Latino community in San Francisco, broaden the description of vulnerabilities to include the socio-economic conditions that have created heightened vulnerability for low-income Latinos, and provide special assistance to increase access to food, healthcare, affordable housing, job-related services, and other economic support, now and through our community’s recovery.
We recognize that there are other communities in San Francisco that have been disproportionately impacted by the socioeconomic factors that exacerbate COVID-19 infection rates and their consequences. We are committed to standing with those communities as they seek assistance from the City of San Francisco, now and through our collective recovery.
We look forward to working with you to ensure that these urgent issues are addressed. We would appreciate a response by June 12, 2020.
Luis Granados, CEO
Mission Economic Development Agency (MEDA)
Mario Paz, Executive Director
Good Samaritan Family Resource Center, Inc.
Santiago Ruiz, CEO
Mission Neighborhood Centers, Inc.
Estela Garcia, Executive Director
Instituto Familiar de la Raza, Inc.
Francisco Javier Herrera, Co-director
Ysabel Duron, Founder/President
The Latino Cancer Institute
Celina Lucero, Executive Director
Horizons Unlimited of San Francisco, Inc.
Susana Rojas, Executive Director
Calle 24 Latino Cultural District
Juno Duenas, Executive Director
Support for Families of Children with Disabilities
Edward Kaufman, CEO
Nelly Sapinski, Executive Director
The Jamestown Community Center
Teresa Mejia, Executive Director
The Women’s Building
Ani Rivera, Executive Director
Galería de la Raza
Teresa L. Arriaga, Executive Director
Parents for Public Schools — San Francisco
Marcia E. Contreras, Deputy Executive Director
Mission Housing Development Corporation
Amanda Alvarado Ford, Esq., Executive Director
La Raza Centro Legal, Inc.
Yohana Quiroz, Chief Operations Officer
Antonio Díaz, Organizational Director
People Organizing to Demand Environmental & Economic Rights
Brenda Storey, MSW, LCSW, Executive Director & CEO
Mission Neighborhood Health Center
Lariza Dugan-Cuadra, Executive Director
Central American Resource Center (CARECEN)
Malea Chavez, JD, Deputy Director
Homeless Prenatal Program
Roberto Y. Hernandez, Artistic Director & Executive Producer
Rodrgo Duran, Director
Cultura y Arte Nativa de las Americas (CANA)
Marco Montenegro, Director
Josué Rojas, Executive Director
Acción Latina/El Tecolote
Jose Ramirez, Executive Director
St. Anthony’s Foundation
Melba Maldonado, Executive Director
La Raza Community Resource Center
Anthony Mickens, Executive Director
Seven Tepees Youth Program
Savitha Moorthy, Ph.D., Executive Director
Tandem, Partners in Early Learning
Jennie Rodriguez, Executive Director
Mission Cultural Center for Latino Arts (MCCLA)
Lorena Melgarejo Executive Director
Faith in Action Bay Area
cc: Members, San Francisco Board of Supervisors
California Assemblymember Phil Ting
California Assemblymember David Chiu
California State Senator Scott Wiener
U.S. House of Representatives Speaker Nancy Pelosi
U.S. Senator Kamala Harris
U.S. Senator Diane Feinstien
Director, San Francisco OCEIA
Director, San Francisco Human Rights Commission
Director, San Francisco Department of Public Health
1 San Francisco Department of Public Health Announces Aggressive Recommendations to Reduce the Spread of Coronavirus (COVID-19), March 6, 2020.
2 Fernandez, E., Weiler, M. (UCSF), Initial Results of Mission District COVID-19 Testing Announced; Latinx Community, Men and Economically Vulnerable Are at Highest Risk . Accessed June 4, 2020.
3 Testimony of Alicia Hernandez, MD. before the United States House of Representatives, Ways and Means Committee, May 27, 2020 The Disproportionate Impact of COVID-19 on Communities of Color, p.2, Accessed June 4, 2020.
5 Palomino, J., Sanchez, T., Troubling upward trend in Latino COVID-19 cases, May 08, 2020, San Francisco Chronicle . Accessed June 4, 2020
6 Unpublished data from Mission Neighborhood Health Center.
7 Testimony of Alicia Hernandez, MD. before the United States House of Representatives, Ways and Means Committee, May 27, 2020 The Disproportionate Impact of COVID-19 on Communities of Color , 1. Accessed June 4, 2020.
8 Ibid., 1-2.
9 Ibid., 2.
12 Ibid., 3.