Of nearly 3,000 residents and workers in a Mission District census tract who were tested in late April for active infection with the novel coronavirus, 62 individuals (2.1 percent) have tested positive, according to initial results of the community-led screening project, called Unidos En Salud.
Overall, 1.4 percent of the participants who lived in the research area tested positive for COVID-19. More than half of those who tested positive (53 percent) reported experiencing no symptoms of COVID-19. Three quarters were men and an overwhelming number (95 percent) were Hispanic or Latinx. The majority of those who tested positive (82 percent) reported having been financially affected by economic fallout of the pandemic and only 10 percent reported being able to work from home.
The testing was conducted by Unidos En Salud, a unique partnership between Mission community organizers in the Latino Task Force for COVID-19, UC San Francisco researchers, the City and County of San Francisco, and the San Francisco Department of Public Health (DPH), which have come together to inform and mobilize a population that was not being reached by current testing and care systems.
The project aims to determine active and prior COVID-19 infections by providing voluntary testing for all persons in Mission District census tract 022901, regardless of symptoms. It also is evaluating a novel community-based “test to care” program that will provide extensive follow-up support to those who test positive for the virus.
The results suggest that as many as 1 in 50 people living and working in the Mission could be actively infected with the virus, and that many are likely to be asymptomatic. Due to the limited testing citywide, it remains unclear how representative this is of the city overall, although project leaders estimate that infection rates are considerably higher in this area, due to the long-standing legacy of socioeconomic inequities that contribute to the continued spread of the virus.
“The virus exploits pre-existing vulnerabilities in our society,” said Diane Havlir, MD, chief of the UCSF Division of HIV, Infectious Diseases and Global Medicine at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). “We have already seen that 84 percent of people coming into ZSFG for treatment for COVID-19 are Latinx, and our community-based screening study emphasizes how high infection risk continues to be for this population. Hopefully, with this data we can respond and start putting resources to work towards more equity in supporting this highly impacted community.”
The initial findings, which only include current infections, provide critical information for public health officials in gauging how widely the virus is spreading in the community and can help guide policies around testing resources and contact tracing, as well as timeframes for reopening San Francisco’s economy. Results of antibody tests to assess prior infections take longer to process and are expected later in May.
“Our vision is for all San Franciscans to have universal access to testing. As we continue to expand testing, this project is another big step in that direction,” said Grant Colfax, MD, San Francisco Director of Health, who oversees DPH. “By focusing on the Mission, this work enables a closer look at one of the communities that is most affected by health disparities, income inequality and discrimination – all of which put residents and workers more at risk for COVID-19. We are continuing and expanding our work to support those who test positive for COVID-19 and their families. We are going to continue to work with our partners, including UCSF and community-based organizations, to expand testing and testing research to other parts of the city.”
Detailed Demographic, Survey Findings
Unidos En Salud released survey data on 2,959 census tract residents or workers who formed the focus of the testing project, as well as 1,201 neighbors, school teachers and other volunteers. About 25 percent of those who tested positive had an underlying illness, such as heart and lung disease, high blood pressure, or diabetes. Notably, people with underlying medical conditions who tested positive were much more likely to report COVID-19 symptoms (76 percent) compared to those who tested positive without underlying medical conditions (38 percent).
The results so far suggest that those who are at highest risk for infection are those who cannot easily shelter in place due to job loss, furloughs, or because they are providing the essential services. 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).
Many Mission district residents and workers provide an assortment of essential services, including agriculture, construction, manufacturing, the restaurant and grocery industry, janitorial and domestic services. Recognizing the unique risks faced by essential workers, the City announced on May 4 that as part of its ongoing testing expansion, all essential workers are now eligible for free COVID-19 testing.
“This project represents an exponential leap into the next stage of the fight against COVID-19, which is to move from diagnostic testing of people who are ill to broad community-based screening. This is critical to our ability to identify where the virus is still actively spreading and to enable us to act swiftly to get control of this epidemic,” said Havlir, principal investigator of the UCSF study. “We hope this can be a model for future community screening efforts in San Francisco and beyond.”
Mission ‘Test to Care’ Screening a Model
Powered by an army of 450 medical and community volunteers, Unidos En Salud provided voluntary testing in open-air ‘pop-up’ testing sites, reaching an estimated 57 percent of all households in the census tract in just four days – increasing the city’s total testing by 29 percent.
“It required a lot of trust for the community to turn out in these incredible numbers, which reflects the thoughtful and passionate work put in by all our volunteers,” said Jon Jacobo, chair of the UCSF Study Committee for the Latino Task Force for Covid-19, noting that many of the volunteers were born and raised in the neighborhood and understood the community. “We came together through this pandemic, because we know it’s those with the least that are most disproportionately affected, both in terms of infection risk and economically. We built a true partnership and took action to promote the health of our community, with the understanding that it would provide valuable insights for the rest of our city.”
Tests were analyzed at the newly constructed UCSF Clinical Laboratory at China Basin – Biohub, where staff worked at break-neck speed to enable Unidos En Salud’s Clinical Response Team, based at ZSFG Ward 86, to reach out to everyone who tested positive as quickly as possible.
Unidos En Salud, in coordination with SFDPH, is continuing to provide in-home testing to homebound residents of the 16-square block census tract who were unable to be tested previously. The project is also offering ongoing medical screening and links to primary care, food assistance and other benefits to those who have tested positive, to enable them to self-isolate. SFDPH is conducting contact tracing to identify individuals in the community who may have been exposed and need to go into quarantine.
“The Mission District – and in particular the Latinx community – has suffered greatly and disproportionately from COVID-19,” said San Francisco Supervisor Hillary Ronen. “Having this study done in a community that has been so deeply affected by this pandemic sends a clear message that the health and well-being of our Latinx residents is an absolute priority. With the support of countless volunteers, UCSF, the Latino Task Force for COVID-19 and my office, we were able to organize a successful community testing effort for the Mission that will serve as an important model for future universal testing initiatives in San Francisco. This study was truly a labor of love by and for the Mission community.”
About Unidos En Salud: Through a partnership between UCSF, the Latino Task Force for COVID-19, and SF Department of Public Health, Unidos En Salud offered free COVID-19 testing as part of a study for all persons age 4 years and older in part of the Mission. This area includes approximately 5,700 people living between South Van Ness and Harrison and Cesar Chavez and 23rd Streets. For more details on Unidos En Salud, visit https://www.unidosensalud.org/
About LTF: The Latino Task Force on COVID-19 (LTF) is a group of Latino leaders and non-profit organizations that are working to meet the needs of our community members city wide.
About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area.