When scientists from UCSF and the city’s Department of Public Health approached San Francisco’s Latino leaders in April 2020 about testing Mission District residents for COVID during the earliest weeks of the pandemic, Valerie Tulier-Laiwa was intrigued but skeptical.
The proposal was to
test every resident
in a four-by-four block area of the neighborhood, to better understand how widespread the virus was at the time. Tulier-Laiwa, who had grown up in the Mission, was already convinced that the city’s Latinos were being hit hardest by COVID, but she and her peers lacked the data to prove it.
A formal study could provide that evidence, and help get the resources badly needed to keep the community safe. But the traditional approach to academic research — with scientists in control and their subjects gaining little beyond whatever care they receive during the study — wasn’t going to give her community the benefits it needed, Tulier-Laiwa said.
Instead, the scientists, the public health experts and the Latino community formed an unusual continuing partnership called Unidos en Salud (United in Health) that made the Mission both a research subject and a locus for services.
More than two years later, that partnership’s flagship clinic, at 24th and Capp streets in the Mission, has provided more than 90,000 COVID tests and delivered more than 60,000 vaccines, mostly to Latino clients. And the research conducted there has produced more than a dozen academic papers, several of which have reached audiences far beyond the Mission and contributed vital knowledge about COVID to the global pandemic response.
But the future of the Mission clinic — which has expanded services and now also does HIV and diabetes testing, along with monkeypox and other non-COVID vaccinations — is uncertain. It has funding to remain open through the end of this year, and possibly into the spring, but not beyond that.
“They’ve said the pandemic was over before,” said Tulier-Laiwa, referring to summer 2021, when vaccines had become readily available and many health officials anticipated the worst of COVID was past. “And then all of a sudden there are the surges. We’ve always been here, we’ve never closed down. We still need to be here for the community at any time.”
The main Mission clinic, located under a clutch of white tents behind the 24th Street BART entrance, is a “living laboratory” — a uniquely San Francisco pandemic response that’s produced data fundamental to understanding the coronavirus: everything from the role of asymptomatic spread in fueling the pandemic to the increasing contagiousness of new variants and how
the course of disease has changed over time.
The most recent work, published over the summer, found that people infected with omicron or its subvariants
remained contagious far longer
than the U.S. Centers for Disease Control and Prevention had assumed — closer to 10 days than five.
Scientists “only have all this data because we’ve given them permission to be in our community,” Tulier-Laiwa said. “You have it because we have given it to you, and because we’ve partnered with you and because the community has been involved all along the way.”
Valerie Tulier-Laiwa, co-founder of the Latino Task Force, stands outside the Mission Hub on Alabama Street in San Francisco as the COVID clinic and resource center opens to guests on Thursday, Oct. 13, 2022.
Lea Suzuki / The ChronicleGetting buy-in from the community matters because it’s fair and ethical, said Dr. Diane Havlir, a long-time HIV clinician at UCSF and one of the founding scientists of Unidos en Salud — but it also makes the research itself stronger.
Having community support makes it easier to ask people sensitive questions and participate in studies that might require multiple visits to a clinic or other inconveniences. Also, Latino leaders were involved in crafting the type of studies that were done, so they would be applicable to the community needs — for example, one study analyzed whether giving families financial and other support when someone tested positive would improve their ability to isolate safely at home.
“It takes a community to end a pandemic,” Havlir said. “It was essential, from the very start, to merge service and science.”
Meena Bubakar, lead vaccine coordinator, restocks COVID-19 vaccines at the Unidos en Salud/United in Health community testing and vaccination clinic in San Francisco’s Mission District on Sept. 23, 2022.
Amy Osborne, Freelance / Special to The ChronicleWhen the first shelter-in-place order was announced in San Francisco in March 2020, Tulier-Laiwa and other Latino leaders knew their community was going to be particularly vulnerable, due to a confluence of factors including jobs and housing: Latino residents were more likely than others in the city to be essential workers who couldn’t stay safely locked down, and many lived in more crowded, multi-generational homes where social distancing was impossible.
In response to that anticipated burden, a cluster of community advocates, including Tulier-Laiwa and friends she’d grown up with in the Mission, founded the Latino Task Force to develop strategies for keeping their community safe.
Meanwhile, by April 2020 health care workers at San Francisco General Hospital were seeing that a strikingly high proportion of their
seriously ill patients were Latino, suggesting the virus was spreading more readily in that community. Doctors there contacted Havlir and other colleagues at UCSF, as well as officials at the Department of Public Health, about the need to study San Francisco’s Latinos to understand how COVID was hurting them, and to get them resources.
Quickly, the Latino Task Force became involved. Its leaders recognized that such studies could benefit their community, but only if they were equal partners with the doctors and scientists. Havlir, who had experience with similar partnerships treating HIV in East Africa, was immediately on board, and her colleagues at UCSF and in the public health department were supportive.
A mother brings her child to get a vaccination at the United in Health/Unidos en Salud COVID-19 testing and vaccination clinic in San Francisco on Sept. 23, 2022.
Amy Osborne, Freelance / Special to The Chronicle“There’s always this stigma: Researchers go into a community and study a community and leave a community, and the results sometimes aren’t even shared with them,” said Dr. Naveena Bobba, deputy director of health with the San Francisco Department of Public Health. “That was the radical difference this time. The community was part of the decisions of how this research would unfold.”
The first surveillance study — testing everyone in a targeted section of the Mission — was done in May 2020. Several key results came out of that work, including proof that Latinos were far more likely than white residents to be infected — a finding that prompted the city to open a testing site in the neighborhood, at 701 Alabama Street. The 24th Street site would open a few months later.
Among the other findings was, for many scientists, more shocking: About half of everyone who tested positive had no symptoms. Experts at the time had become increasingly concerned about the role of asymptomatic spread of COVID, but in the spring of 2020 most U.S. clinics still only tested people who had a cough, fever or other symptoms. The Mission findings, along with other international studies, soon prompted public health officials to expand testing.
Later studies analyzed the relative infectiousness of new variants as they arrived; how barriers to testing and isolation affected community transmission; strategies for increasing vaccine uptake; and the varied immune responses to different variants and vaccinations.
The studies ranged from science-heavy research that required extensive laboratory work at UCSF and at the Chan Zuckerberg Biohub — also a partner in Unidos that provided genomic sequencing — to reviews of community responses like San Francisco’s
“right to recover” program, which offered cash and other support to low-income families dealing with COVID infections.
Jackie Sharif waits to be tested for COVID-19 at the community clinic in San Francisco’s Mission District on Sept. 23, 2022.
Amy Osborne, Freelance / Special to The ChronicleOne of the more recent studies, published in January, provided among the earliest and strongest evidence that rapid home tests were accurate enough to replace the expensive and cumbersome laboratory tests that had caused significant logjams in the pandemic response.
“The reason you can buy the Binax home test at Walgreens now is because we tested it in the Mission,” said Joe DeRisi, president of the Biohub.
Unidos has remained open for the past two years through a combination of funding sources, including the federal government, the San Francisco public health department and UCSF, plus private donations. Much, if not all, of the federal funding is expected to disappear at the end of the year, and the group is currently trying to raise more private money. But community leaders and scientists alike said they’re hoping for a more sustainable solution.
“I really hope people see how valuable this partnership is,” DeRisi said, “and they deem it appropriate to provide additional funding to keep it going.”
Erin Allday is a San Francisco Chronicle staff writer. Email: [email protected] Twitter: @erinallday
