By May of 2020, Katya Nuques and her colleagues at Enlace Chicago in Chicago’s Little Village neighborhood had been “panicking for weeks,” she said. Members of the community, where 84% of residents are Latinx, were testing positive for COVID-19 at a rate almost three times the state average, and the Little Village ZIP code had the highest number of virus cases in Illinois.
That same month, the University of Chicago Poverty Lab, one of five UChicago Urban Labs housed at Harris Public Policy, began a project to understand why the rate of test positivity was so high in some communities.
“Test positivity was beginning to emerge as an important factor in understanding where COVID-19 infections were going undetected,” said Carmelo Barbaro, executive director of the Poverty Lab, which conducts research studies aimed at increasing economic opportunity in communities harmed by disinvestment, discrimination and segregation. High positivity rates suggest high rates of disease transmission and a strong likelihood that many more people in the community have COVID-19 but haven’t been tested yet.
Researchers from the lab began with Illinois Department of Public Health data on the number of COVID-19 tests and confirmed cases in the region, and linked it to American Community Survey data from the US Census Bureau. The team examined test positivity rates’ correlation with a variety of neighborhood characteristics, such as race, ethnicity, income, and population density.
“We learned that the two factors most strongly associated with test positivity and undertesting in a given ZIP code at that time were the percentage of people without health insurance and the percentage of people who are undocumented,” Barbaro said, adding that those factors were “more predictive than race, income, and even the number of essential workers in the community.”
Observations from community experts inform recommendations
The Poverty Lab collaborates with communities in order to understand from them their most urgent challenges so that Poverty Lab’s research can translate into meaningful, measurable policy changes that improve lives. When the correlations became clear, the Poverty Lab research team reached out to Enlace and The Resurrection Project (TRP) in Pilsen for input. Both organizations serve many people who are uninsured and undocumented.
“When the Poverty Lab contacted us they said, ‘This is what we’ve found. Based on your conversations with your clients and community navigators, what’s your understanding of the reasons this is happening?’”, said Eréndira Rendón, vice president, immigrant advocacy and defense at TRP.
“We were hearing about multiple issues. People were being told to get a doctor’s note to be tested, but most uninsured adults don’t have a primary care doctor, and they didn’t know whether they’d have to pay for testing and treatment. They often had to go to multiple sites before getting tested. There were language barriers at testing sites, and technology barriers around having to make testing appointments online.”
Nuques said that Enlace’s clients and community navigators were reporting the same issues, along with reasons why those who test positive were often unable to self-isolate. “Every person who works in the cash economy — doing construction, being a domestic worker, taking care of children — goes to a different place every day and doesn’t have the luxury of taking sick days,” she said. “And when you’re sick, you can’t work, and you don’t get paid. Economically, our community has been the most impacted by COVID-19.”
By providing their observations to augment the Poverty Lab team’s research findings, TRP and Enlace “helped us create a more holistic and complete set of recommendations to policymakers about how to control the spread of COVID-19 more effectively,” said Barbaro.
The team’s final recommendations included eliminating the doctor’s note requirement, assuring people that their test results are confidential, making sure people know that state programs will cover their testing and treatment costs, addressing loss of income for undocumented residents who need to self-quarantine, and hiring contact tracers from the community.
The lab shared its final report with community partners and policymakers, including the Chicago, Cook County, and Illinois departments of health. TRP and Enlace shared the findings with residents as well as community-based organizations, funders, aldermen, and others who helped set up more testing and implement many of the recommendations, such as communicating in Spanish and making sure people know that COVID-19 testing and treatment are free for everyone, regardless of immigration status.
By August, the test positivity rate in Little Village had come down to about 9% from a May high of nearly 70%, said Nuques. “What makes the difference is a comprehensive approach,” she said. “Increased testing helped. We also took a hyperlocal and culturally sensitive approach to directing people to resources: We’ve had an army of immigrant women who speak Spanish talk to people about what it means to wear a mask and how you have to take care of yourself.
“At every community event, we make COVID-19 a topic and distribute masks and hand sanitizer. We make sure people know that if you don’t have insurance, your treatment is covered — and if they get a bill, one of our community health promoters will contact the provider and make sure they’re not charged. It’s all important.”
Nuques and Rendón both said that they welcomed the chance to collaborate with the Poverty Lab team. “They did a great job of sharing the data and asking us what specific solutions we’d recommend,” Rendón said. “It helped us make a good road map for how to start removing some of the barriers to testing and treatment.”