He was back in the COVID ICU. The gentleman we transferred to the ICU three weeks ago got better. He went from the ICU to the sixth floor. After a turn for the worse, he is back on a ventilator. Standing outside his room, I see a large photograph of him taped to his door. He is in casual clothes, smiling. His head tilted towards his son perched on his right shoulder. His son’s smile is bigger. A joyous moment in both lives. The nurse told me all the families are sending photos of their loved ones. Looking around, I see them now. Photos are on every door. Anyone entering had to look right at them - a person in dress clothes at a celebration; another laughing over a meal with family; one sitting on a stoop with friends in the Mission. Anyone looking at the photos would also see they are mostly LatinX men. The nurse confirmed what my hospitalist colleagues observe - about 80% of the patients with COVID in the ICU and on the sixth floor have been LatinX. The man I transferred to the ICU is LatinX. To begin to appreciate the enormous significance of this 80% prevalence, realize before the pandemic, LatinX patients made up 25-30% of the General’s hospitalized patients. From last census, they represent about 15% of San Francisco’s population. That means we are hospitalizing three times as many LatinX people with COVID than our typical admission pattern and five times more than you would predict based on their population. What is going on? We need to understand more of this story. Financial strain likely is playing a role. Many in the Mission are compelled to work in essential jobs at grocery stores, in cleaning services and preparing take-out food carried to our doors. Their work supports us to shelter safely, and relatively comfortably. The community urgently needs and deserves prevention interventions.
The roots of effective initiatives lie in the legacy of San Francisco’s response to the HIV epidemic. Through the 1980s, as gay men died, healthcare professionals in the clinics, at the General, in the SFDPH in partnership with UCSF, recognized the need for new approaches to care. Out of this realization grew the San Francisco Model of AIDS Care based on the intent to meet the people you serve on their terms, informed by their stated wishes and needs. It involved listening and often letting the community lead. As misinformation, fear and denial persisted, Project Inform organized in 1984 to advocate by and for people infected with HIV. As communities suffered from hunger and isolation, volunteers organized Project Open Hand to bring the healing of lovingly cooked food. Once HIV testing was available, clinicians worked with community groups to expand screening, refining outreach messages to resonate with audiences distrustful of institutional approaches. City hall mobilized resources, financed new programs. Throughout, scientists carefully studied what worked to focus resources on activities of greatest impact. All this, to save lives through prevention, while work advanced in parallel for effective therapeutics and vaccines. This legacy in the care of people with HIV inspires many of us. Initial examples of community outreach, expanded screening of vulnerable populations, advocacy for equity and rigorous scientific analysis are taking place now. Far more is required. Yet, collectively these are hallmarks of our work with HIV. With history as a guide, we will rise to the challenge of COVID-19, together, with the community.
“Know from whence you came. If you know whence you came, there are absolutely no limitations to where you can go.”
With great respect for your caring work. With gratitude for your caring self.