Los Angeles Times - 03.04.2020

L ATIMES.COM S FRIDAY, APRIL 3, 2020A

areas threatens to give resi-
dents there the false and po-
tentially deadly impression
that they have less to fear
from the pathogen, and
hence little reason to heed
physical distancing orders.
“There’s a lot of misinfor-
mation and indifference in
the black community,” said
Sadio Woods, an Inglewood
resident who sought unsuc-
cessfully to be tested for
COVID-19, only to be told lat-
er by a doctor that she prob-
ably had the disease but re-
covered. “There’s this narra-
tive it’s a rich white man’s
disease. They travel. They
are the ones who are spread-
ing this disease all around to
each other.”
Nationally, cities with
large black and Latino
populations such as Chi-
cago, New Orleans and
New York have become hot
spots in the spread of the
coronavirus.
Worried that race and in-
come are playing a role in
these outbreaks, California
Sen. Kamala Harris and a
group of fellow Democratic
lawmakers have urged
health officials to record
comprehensive demo-
graphic data on those tested
and treated for the disease
—information that is now al-
most nonexistent.
“This lack of information
will exacerbate existing
health disparities and result
in the loss of lives in vulnera-
ble communities,” the law-
makers wrote in a letterto
Health and Human Services
Secretary Alex Azar.
In Los Angeles County,
more than 21,000 people
have been tested for the co-
ronavirus, and roughly 12%
have tested positive. Howev-
er, the county does not track
the location of all negative
tests, so it is impossible to
determine whether tests are
being given equally across
the county.
On Wednesday, county
health officials said they
were “aware of geographic
disparities” in testing and
are now asking labs to report
negative results along with
positive results, “so we
have a full picture of what
is happening.”
“Our hope is that we’re
paying attention to some of
the areas where in fact we
know there has been less
testing,” said Barbara Fer-
rer, director of the L.A.
County Department of Pub-
lic Health.
Alack of accurate and
readily available test kits
has hampered the response
to COVID-19 since the first
cases appeared in the
United States, making it all
but impossible for local offi-
cials to track and slow the
outbreak. Ferrer said it re-
mains difficult for most
symptomatic residents to
get tested for COVID-19.
“You still need a provider
to write an order for the
most part, and I think some
people in some communities
may have easier access to a
provider that is willing to
just write that lab order than
others,” Ferrer said. “So I do
think there is an issue still

about who is getting tested

and who is not getting

tested.”

Wealth, she said, could

play a role in both the spread

and detection of disease, al-

though it was unclear to

what extent.

A vacationing virus

In the weeks before the

novel coronavirus hit the

county, some residents of

Brentwood and West Holly-

wood were infected while

traveling in Europe and

brought the virus home, cre-

ating a “cluster effect,” Fer-

rer said. “I do know with cer-

tainty that in the beginning

we had a lot of travel-related

positives, and that those

tended to be more people

who were traveling for vaca-

tion, which would imply that

they’re wealthier.”

The Times also reported

last month that “concierge”

doctors who cater to rich

people and celebrities have

been selling testing kits to

patients and their families.

The doctors are based in

Santa Monica and Beverly

Hills, wealthy areas that

rank high in the county for

infection rates.

Ferrer said it’s too early

to know if these types of ex-

clusive medical services

have had an effect on the

confirmed case totals, and

she stressed that people are

transmitting the virus in ev-

ery community.

When comparing com-

munities, county health offi-

cials emphasized the impor-

tance of looking at the rate of

cases per capita, rather than

the total number of cases.

They began publicly report-

ing those rates this week.

“The place that had fewer

cases might actually have a

higher burden of disease

relative to the number of

people in that community,”

Ferrer said.

For example, the county

health department has re-

ported that the wealthy en-

clave of Beverly Crest has re-

corded 22 total infections for

a rate of 177 per 100,000 peo-

ple, compared with the

larger working-class neigh-

borhood of Pacoima that

has a rate of fewer than 10 per

100,000.

Nickie Miner, a longtime

resident of Beverly Crest,

bristles at the idea that resi-

dents of wealthier areas

have easier access to testing

and said hillside communi-

ties might actually be safer

because of their tucked-

away locations. Her neigh-

bors, she said, are following

city guidelines that urge

residents to stay home and

avoid nonessential travel.

“It’s somehow targeting

the ‘elite,’ as people like to

say, for having better health-

care whether they do or not,”

said Miner, vice president of

the Bel-Air/Beverly Crest

Neighborhood Council. “I

think the whole situation is

universal and we’re all in this

together. It really doesn’t

matter if you isolate a

wealthy segment or a work-

ing-class segment.”

About 17 miles southeast

in Bell Gardens, a 95% Lat-

ino city with one of the low-

est rates of reported co-

ronavirus cases in the

county, Mayor Alejandra

Cortez said she suspects the

disparity is a result of a lack

of access to healthcare and

“the fact that not a lot of peo-

ple have been tested.”

“People have been turned

away from testing until they

develop further symptoms,”

Cortez said. “I think that

contributes to the low num-

ber of cases.”

In a letter last week,

Cortez and leaders from 15

neighboring communities in

southeast L.A. County

urged the county to set up

drive-through testing sites

in the area, citing its large

percentage of low-income

Latino families and high

population densities “which

in some cities exceed that of

New York City.”

Cortez said reducing bar-

riers to testing is especially

important in communities

like hers with large numbers

of people whose lack of legal

immigration status and

health insurance can be a

deterrent to seeking care.

“Making testing more ac-

cessible and less intimidat-

ing for our community, I

think that’s one way to have

people come out,” she said.

Area hospitals have already

reported a lot of cases, she

added, “so I know people are

scared to even go to these

hospitals to be tested, be-

cause they think they’re go-

ing to get it just from enter-

ing the facility.”

Awoman who answered

the phone at a local clinic,

the Bell Gardens Family

Medical Center, said the fa-

cility isn’t offering COVID-

testing, though people are

calling to request it. She

said workers there have

been told to send those peo-

ple to county hospitals,

and though they are trying

to get test kits, they’re not

sure how or when that will

happen.

There is variation in the

data, as some middle-class

communities also have

higher infection rates. West

Hollywood currently has the

second-highest rate in the

county at 179 cases per

100,000 residents, but its me-

dian income is about aver-

age for the county.

Given the city’s long-run-

ning initiatives regarding

testing for sexually trans-

mitted diseases, residents in

West Hollywood are quicker

to seek testing for COVID-19,

city spokeswoman Lisa Bel-

santi said.

“We certainly have a

population that was dispro-

portionately affected by

HIV back in the early days,

and still HIV has not been

eradicated,” she said. “You

could make that correlation

that people with preexisting

conditions, people who are

HIV-positive, might seek out

early testing if they had

symptoms.”

Social inequality

Though testing capacity

has improved since the co-

ronavirus outbreak began, it

remains spotty and incom-

plete, with California lag-

ging far behind New York in

the number of people tested

despite having about double

the population.

Some point to the geo-

graphic divide in confirmed

cases as evidence that our

understanding of the virus’

spread is twisted by social

inequality.

Victor Cuevas, an urban

planner from Mount Wash-

ington who has created his

own county coronavirus

maps, said he is concerned

that insufficient testing in

lower-income Latino com-

munities is already having a

dangerous effect. “I’m telling

my parents who live in the

northeast Valley to stay

home, but they have neigh-

bors not taking it seriously,

saying, ‘We’re OK, there’s no

cases here in Pacoima,’ ”

Cuevas said.

Ferrer said that, because

of the lack of testing, it would

be a “really, really erroneous

assumption” to think that

the number of cases re-

ported in any given commu-

nity is reflective of how many

it actually has.

“There are thousands of

people who are positive for

COVID-19 that have not

been tested, don’t necessari-

ly know that they’re positive.

They may have mild illness,

they may be fairly asymp-

tomatic,” Ferrer said.

“There are people in every

community that have the

potential to infect others.

And you could be one of

them that’s infecting others.

Or you could be one of them

that’s getting infected.”

Paucity of testing

One of the lowest rates of

confirmed cases is in Po-

mona on L.A. County’s east-

ern edge. Resident Dwight

Pennington said that could

be because the city experi-

enced the county’s first

COVID-19 fatality — that of a

patient who died after being

brought in by ambulance in

full cardiac arrest, Pomona

Valley Hospital Medical

Center announced March 9.

“I think people got the

message because it was in

our own backyard,” said

Pennington, 27. But he

thinks, based on personal

experience, that Pomona’s

low numbers could also be

due to lack of testing.

Pennington, who works

as a wellness advocate for

the Tri-City Mental Health

Center, recently tried to get

tested for COVID-19 because

he had developed a cough,

but he was told by his pri-

mary doctor and three ur-

gent care facilities that they

didn’t have test kits. He said

he would’ve kept calling

more hospitals if there was a

guarantee they’d have the

kits. Though Pennington

said he’s confident he

doesn’t have the virus, he re-

members the experience as

“really nerve-racking.”

Chandra Ford, professor

at the UCLA Fielding School

of Public Health, said there

is probably “testing bias” in

the data because tests

haven’t been equally avail-

able across the county.

As more people get

tested in the coming

months, areas with greater

shares of homeless people

and uninsured workers will

see infection rates rise dis-

proportionately, she said.

“Over the long run, the

population of people who

were missed are likely to be

the most vulnerable mem-

bers of our society,” said

Ford, founding director of

the Center for the Study of

Racism, Social Justice and

Health at UCLA. “I expect

what we will see is the nature

of the epidemic in Southern

California will actually shift,

where these vulnerable

populations will account for

a greater share of the new

cases.”

University of Minnesota

epidemiologist Ryan Dem-

mer said the available data

on current infections at the

neighborhood level here re-

flect a broader nationwide

trend of healthcare access.

“More affluence is usually

linked to a higher likelihood

of being diagnosed with a

chronic disease if the disease

is actually present,” Dem-

mer said.

Still, focusing on con-

firmed cases can be mislead-

ing in the first place because

so many people have been

unable to get tested, accord-

ing to health experts. A

much better indicator of the

outbreak’s spread, they say,

is the number of deaths and

hospitalizations, including

how many people end up in

intensive care units.

L.A. County Department

of Public Health data show

the number of people who

have died or been hospital-

ized with the virus has risen

in recent days, but those fig-

ures are not broken down

beyond the county level.

Back in Inglewood,

where the rate of infection

has been reported as 32

cases per 100,000 people,

Woods said she has little

faith in the accuracy of re-

cent statistics, “because I

know that people are not be-

ing tested widespread.”

She worries a that long-

standing mistrust of the

healthcare system and other

barriers play a role in the

nonchalance she has seen in

the black community.

Men in her neighborhood

still cluster on the corners.

Teens ride their bikes in

groups. Her neighbors are

still gathering and partying.

Very few people are wearing

gloves or masks. There’s

hardly any social distancing

happening.

“I know what happens in

low-income, underserved

communities and communi-

ties of color,” she said. “It

could be like New Orleans.

I’m afraid for South L.A.”

She worries that people’s

behavior will not change un-

til they know somebody who

has tested positive. By then,

it might be too late and dis-

ease could be rampant in the

community.

The coronavirus has al-

ready touched Woods in

more ways than one. On

Tuesday, she spoke of a fam-

ily friend — a black man from

South L.A. — who was fight-

ing for his life after contract-

ing the virus along with doz-

ens of other black people af-

ter going on a ski trip to

Idaho.

Later that day, Woods

learned that the coronavirus

had claimed his life.

Times staff writers Soumya

Karlamangla, Ryan

Menezes, Ben Welsh and

Priscella Vega contributed

to this report.

HEALTH OFFICIALSsaid they were “aware of geographic disparities” in COVID-19 testing across L.A. and would seek a fuller picture of where tests are being given.

Robert GauthierLos Angeles Times

Cases as of Wednesday. Areas shaded gray had 1 to 4 cases.

Los Angeles County Department of Public Health

B e n P o s t o n Los Angeles Times

Disparities in infection rates

Higher rates of reported coronavirus infections in wealthy

areas of L.A. County are probably due to easier access to

testing and international travel before the outbreak,

officials say.

Cases per 100,000 residents

0 50 100 150 200

Lancaster

Santa

Clarita

Glendale

West

Brentwood Hollywood

Century

City

Manhattan

Beach

Pacific

Palisades

Santa

Monica

Torrance

Calabasas Tarzana

Beverly

Hills

Palos

Verdes

Estates

Melrose

Beverly

Crest

Bel-Air

Hancock

Park

Crestview

Westchester

Marina

Peninsula

LAX

Detailed

A class divide in contagion data

[Disparity,from A1]