There's Unequal Risk And More Than One Curve Suggested In COVID-19 Data

A healthcare worker directs a patient at a testing site at the Forum in Inglewood. (Courtesy of the County of Los Angeles)

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Last month, we got the first glimpse of where COVID-19 cases were concentrated in L.A. County. When UCLA Professor of Public Health David Hayes-Bautista saw those maps, he immediately had some concerns.

"There were almost all in wealthy areas — West L.A., Brentwood, Bel Air, Beverly Hills, et cetera. If you look at East L.A., there were almost no cases," Hayes-Bautista told KPCC's Take Two.

At the time, he made a prediction: "I am thinking we are going to see a secondary — almost a [primarily] Latino — surge. Right now, we're on the edge of the perimeter."

The logistics of the prediction he and other experts made went like this: As the pandemic progressed, it would shift from the wealthy - people who before the pandemic could afford to travel, and who now can now afford to shelter at home - to the poor, who in many cases can't. He explained,

"We need to think about the gardeners, the nannies, the cooks, the construction workers, the farm workers, who do not have access to these tests, who do not have access to doctors, who do not have access to health insurance...but who will be exposed."

That prediction appears to have been right: The curve is not flattening for everyone. And it's not just Latinos who are hurting. A series of reports in recent days makes it increasingly clear that low-income communities of color are taking the biggest hit — and that things could get worse.

A study released by the L.A. County Department of Public Health looked at COVID-19 infections and deaths adjusted by age, and found that communities of color — and poorer county residents in general — are experiencing a disproportionate share of both.

Those suffering the highest rates of infections and deaths are people of color: African Americans continue to die at a pace that exceeds their share of the population, in L.A. and elsewhere. An even higher death rate exists for the county's Native Hawaiians and Pacific Islanders.

Latinos now make up almost half the COVID-19 cases in L.A. County, according to the new county data. And while their death rate still appears lower than their population share, adjusted by age, Latinos' death rate is the third-highest.

In the month since LAist first reported on early mapping projects, the brunt of the disease has shifted to less affluent areas. The recent L.A. County analysis found that people in the highest-poverty census tracts, with more than 30 percent of the population below the poverty line, are dying from COVID-19 at three times the rate of people in the wealthiest ones.

New maps illustrate this shift.

A recent report from Advancement Project California, a local racial justice organization, features an animated timeline map that follows the movement of coronavirus cases across the county in recent months. At first, cases were concentrated in places like the more affluent Westside communities, wealthier parts of the San Fernando Valley and the South Bay. By early May, cases were spreading into and taking root in communities such as South and Southeast L.A., poorer areas of the San Fernando Valley, and north into Lancaster and Palmdale.

CREDIT: Advancement Project California

A similar movement, generally from west to east, is seen in new maps put together by Crosstown, a non-profit news organization that mapped the spread of COVID-19 in L.A. County early on.

Janel Bailey, co-executive director of the Los Angeles Black Worker Center, joined a recent call that the Advancement Project California held with community groups. She said the trajectory of the virus doesn't surprise her:

"When I heard people initially talking about the curve, it was pretty obvious to me that there wasn't one curve. I knew immediately that there was definitely a Black curve."

For starters, Bailey said, stay-at-home orders aren't equitable, because not everyone can work from home.

"It tends to protect wealthy white folks who can stay home, and it puts black and brown workers — who are most often clustered in low-wage work — in harm's way," Bailey said.

Bailey said they began offering COVID-19 testing at the Black Worker Center's Crenshaw Boulevard office after noticing people in the community weren't taking full advantage of the public testing sites, something she attributed to a historical mistrust of medical institutions.

John Kim, the Advancement Project California's executive director, said he believes it ultimately boils down to systemic racism.

"There is a directionality and velocity to this virus," Kim said. He continued,

"The path of confirmed cases is showing that there are underlying compounding factors, like generations-long disinvestment in public health infrastructure, racial segregation, and high housing density."

SEPARATE, UNEQUAL CURVES

County data also shows that census tracts with the highest poverty rates are the ones with the lowest rates of testing for COVID-19, while testing remains higher in wealthier areas.

Testing is also strikingly low among some groups: For example Latinos, who make up 49 percent of the county's population, account for less than 17 percent of those tested. By contrast whites, who make up just over a quarter of the county's population, account for nearly a third of those tested.

All this is happening as California slowly begins to reopen after weeks of stay-at-home orders.

"As the curve is flattening for middle- and upper-class whites, the incline is actually sharpening for Latinos and African Americans in L.A. County," L.A. City Councilmember Marqueece Harris-Dawson told KPCC's Take Two last week. He continued,

"So while we are opening back up, that's great, but there are still communities that are getting as sick as they were in the beginning."

In the past few days, additional COVID-19 studies have raised questions about how the poor and communities of color will fare in the coming weeks and months.

A nationwide study released last week from the Kaiser Family Foundation suggests that, based on existing health risks — such as diabetes and asthma — certain groups, including Native Americans and African Americans, are especially vulnerable to complications if infected with COVID-19. It also suggests that for working-class Americans in general, the lower the household income, the higher the risk of serious illness from the virus.

And last Friday, UC Irvine announced that a study of the university health system's patients revealed a "disproportionate rise in COVID-19 cases among Hispanic/Latinx in disadvantaged communities" within the county. The study points to risk factors such as high-density housing and the inability to socially distance, and employment in "essential/frontline" jobs.

UCLA's Hayes-Bautista expects the class and racial divide in COVID-19 risk to keep growing once more people in hard-hit communities seek treatment in hospitals.

"They will not start entering the data systems until after the wave has plateaued in the rest of the population," Hayes-Bautista told LAist, adding,

"It's delayed access to tracking and to care."

The challenge now is getting the right information to vulnerable communities before the virus takes a bigger toll.

Trust remains an issue, said Angelica Salas with the Coalition for Humane Immigrant Rights of Los Angeles. Speaking on the Advancement Project California's phone call recently, Salas said she worries that even though most of the local economy and government is scaled down, immigration enforcement isn't.

Many immigrants her organization works with fear being deported, she said, and are concerned about what's known as the public charge rule, a Trump administration edict that aims to bar people from obtaining legal residency if they use, or may use, public benefits. As a result, she worries some people may not seek care, and then put relatives at risk:

"In our communities, especially in L.A. County, mixed (immigration) status families are the norm. So, lack of access for one individual in that family actually has implications for the entire family when it comes to healthcare."

Immigration officials have said immigrants won't be penalized for seeking treatment for COVID-19, but Salas said there's a chilling effect nonetheless.

Health and community advocates are calling for a bigger information push, better access to testing, and better funding for services in hard-hit communities.

In their report, L.A. County health officials recommend an expansion of testing, along with options that don't require online registration; working with community partners to find alternate housing for people who test positive and live in crowded conditions; and working with trusted community leaders and in-language media to ensure public health messages are heard.

The Advancement Project California report makes similar recommendations and some additional ones, including getting the message to low-income Angelenos that they can be tested at no cost — testing is free at L.A. city and county sites — and that treatment costs can be subsidized by the state as well. California has said Medi-Cal patients can receive treatment for COVID-19 under the state insurance plan, which covers hospitalization. Immigrants age 26 and older who lack legal status don't qualify for full-scope Medi-Cal, but they can obtain coverage for emergencies.

That report also recommends that phone banks and trusted community-based organizations be used to disseminate information about COVID-19; better access to testing appointments for those with limited internet access; and more funding, protective equipment, and testing capacity for community clinics that treat low-income patients.