Wealthy L.A. areas have higher rates of coronavirus cases. Why those numbers are deceiving
As a potent new coronavirus continues its lethal spread across California, many of Los Angeles County’s whitest and wealthiest enclaves are reporting far higher rates of infection than are poorer neighborhoods of color.
Predominantly white, affluent areas such as Hancock Park, Bel-Air, Beverly Crest and Brentwood reported some of the highest per capita rates of confirmed cases, while many working-class and majority nonwhite communities such as Bell Gardens, Watts and El Monte reported much lower rates, a Times analysis of county health data through Wednesday shows.
But those disparities do not mean the virus that causes COVID-19 is spreading more widely through rich neighborhoods than in poorer ones, public health officials and experts say. Rather, they are probably skewed by uneven access to testing and, in some instances, by wealthy residents who traveled internationally and had some of the earliest confirmed infections.
The trend, some experts say, bodes poorly for local efforts to control the spread of COVID-19, as it suggests a troubling disparity of testing along the lines of race, income and immigration status. They say a lack of adequate testing in lower-income areas threatens to give residents there the false and potentially 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 misinformation and indifference in the black community,” said Sadio Woods, an Inglewood resident who sought unsuccessfully to be tested for COVID-19, only to be told later by a doctor that she probably had the disease but recovered. “There’s this narrative it’s a rich, white man’s disease. They travel. They are the ones who are spreading this disease all around to each other.”
Nationally, cities with large black and Latino populations such as Chicago, New Orleans and New York have become hot spots in the spread of the coronavirus. Worried that race and income 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 demographic data on those tested and treated for the disease — information that is now almost nonexistent.
“This lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities,” the lawmakers wrote in a letter to Health and Human Services Secretary Alex Azar.
In Los Angeles County, more than 21,000 people have been tested for the coronavirus, and roughly 12% have tested positive. However, 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 Ferrer, director of the L.A. County Department of Public Health.
A lack 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 officials to track and slow the outbreak. Ferrer said it remains 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, although it was unclear to what extent.
In the weeks before the novel coronavirus hit the county, some residents of Brentwood and West Hollywood were infected while traveling in Europe and brought the virus home, creating a “cluster effect,” Ferrer said. “I do know with certainty that in the beginning we had a lot of travel-related positives, and that those tended to be more people who were traveling for vacation, 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 exclusive medical services have had an effect on the confirmed case totals, and she stressed that people are transmitting the virus in every community.
When comparing communities, county health officials emphasized the importance of looking at the rate of cases per capita, rather than the total number of cases. They began publicly reporting 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 reported that the wealthy enclave of Beverly Crest has recorded 22 total infections for a rate of 177 per 100,000 people, compared with the larger working-class neighborhood of Pacoima that has a rate of less than 10 per 100,000.
Nickie Miner, a longtime resident of Beverly Crest, bristles at the idea that residents of wealthier areas have easier access to testing and said hillside communities might actually be safer because of their tucked-away locations. Her neighbors, 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 healthcare 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 working-class segment.”
About 17 miles southeast in Bell Gardens, a 95% Latino city with one of the lowest rates of reported coronavirus 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 people have been tested.”
“People have been turned away from testing until they develop further symptoms,” Cortez said. “I think that contributes to the low number 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 barriers 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 accessible and less intimidating 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, because they think they’re going to get it just from entering the facility.”
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A woman who answered the phone at a local clinic, the Bell Gardens Family Medical Center, said the facility isn’t offering COVID-19 testing, though people are calling to request it. She said workers there have been told to send those people 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 median income is about average for the county.
Given the city’s long-running initiatives regarding testing for sexually transmitted diseases, residents in West Hollywood are quicker to seek testing for COVID-19, city spokeswoman Lisa Belsanti said.
“We certainly have a population that was disproportionately 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.”
Though testing capacity has improved since the coronavirus outbreak began, it remains spotty and incomplete, with California lagging far behind New York in the number of people tested despite having about double the population.
Some point to the geographic 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 Washington who has created his own county coronavirus maps, said he is concerned that insufficient testing in lower-income Latino communities is already having a dangerous effect.
“I’m telling my parents who live in the northeast Valley to stay home, but they have neighbors 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 reported in any given community 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 necessarily know that they’re positive. They may have mild illness, they may be fairly asymptomatic,” 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.”
One of the lowest rates of confirmed cases is in Pomona on L.A. County’s eastern edge. Resident Dwight Pennington said that could be because the city experienced 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 primary doctor and three urgent 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 remembers the experience as “really nerve-racking.”
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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 available 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 disproportionately, she said.
“Over the long run, the population of people who were missed are likely to be the most vulnerable members 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 Demmer said the available data on current infections at the neighborhood level here reflect 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,” Demmer said.
Still, focusing on confirmed cases can be misleading in the first place because so many people have been unable to get tested, according 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 hospitalized with the virus has risen in recent days, but those figures 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 recent statistics, “because I know that people are not being 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 communities 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 until they know somebody who has tested positive. By then, it might be too late and disease could be rampant in the community.
The coronavirus has already touched Woods in more ways than one. On Tuesday, she spoke of a family friend — a black man from South L.A. — who was fighting for his life after contracting the virus along with dozens of other black people after 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.
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