Blanca Aleman, an asylum-seeker from El Salvador, first came to the U.S. in the summer of 2016 to reunite with relatives living in the San Francisco Bay Area.

Today, Aleman’s family — her two daughters, mom, aunts, brothers and nephews — live together: a total of 13 people in a three-bedroom, one-bathroom house in Richmond.

“It’s very difficult,” said Aleman, 35, in Spanish. “Sometimes we have to wait in line to use the bathroom, or to cook in the kitchen.”

During the pandemic, those inconveniences also mean Aleman’s entire household is at higher risk of getting sick and transmitting the coronavirus. In April, Aleman’s aunt tested positive for COVID-19. Shortly after, her 13-year-old daughter, Lindsay, also had it.

“How am I going to distance her?” asked Aleman, who shares a bed with Lindsay and her youngest, Megan, who is 3 years old. “You can’t do it. There’s not enough space at home.”

[pullquote size="medium" align="right" citation="Dr. Kirsten Bibbins-Domingo, UCSF"]'This is a twin epidemic ... An epidemic of the virus and an epidemic of the economic crisis. And it's the latter that I think will really make it much more difficult to keep the former under control.'[/pullquote]

Aleman, who is five months pregnant, also fears for her unborn baby. Her doctor at Lifelong Brookside Richmond Health Center said there are not enough data to know if or how the coronavirus could hurt Aleman’s pregnancy or baby.

“It can affect me. But they don’t know to what degree,” Aleman said.

Medical professionals advise patients recovering at home from COVID-19 to stay in a room by themselves if they live with others, and avoid sharing a bathroom and kitchen utensils. But those guidelines are practically impossible to follow for many low-income immigrants doubling or tripling up to afford rent in the San Francisco Bay Area.

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Because of high housing costs, California’s overcrowding rate is more than double the national average, according to the Public Policy Institute of California. Latinos are also much more likely to live in overcrowded, multigenerational homes than other racial or ethnic groups.

“They often don't have the luxury to be in settings where they can really maintain the type of distance that's required to keep themselves safe and the people around them safe,” said Dr. Kirsten Bibbins-Domingo, a professor of medicine and epidemiology at UCSF.

As state officials loosen stay-at-home orders and slowly reopen the economy, Bibbins-Domingo expects more outbreaks of the virus at a time when millions of Californians have lost their jobs and may struggle to afford the basics.

“This is a twin epidemic,” she said. “This is an epidemic of the virus and an epidemic of the economic crisis. And it's the latter that I think will really make it much more difficult to keep the former under control, particularly in the communities that are hardest hit.”

Statewide, Latinos represent more than half of 71,000 confirmed cases where race or ethnicity was identified. In Contra Costa County, where Aleman lives, Latinos comprise about a quarter of the population, but nearly 40% of confirmed COVID-19 cases, according to Contra Costa Health Services.

Living in close quarters, such as in congregate settings or overcrowded homes, increases the risk of exposure to the virus after someone brings it in, said Dr. Ori Tzvieli, Contra Costa County deputy health officer and a family practitioner.

“The more densely people are living, the higher their risks that they would transmit coronavirus to one another,” said Tzvieli. “Most of the cases that we have seen in China and many in the United States have been through household contact.”

[aside label='Latest News on Coronavirus' tag='coronavirus']Contra Costa, like other counties in the Bay Area, offers free hotel stays for people who don’t have a safe place to quarantine and are confirmed positive for coronavirus or considered “under investigation” by public health officials while they await test results.

So far, the county has placed more than 300 high-risk people experiencing homelessness in hotels under the state’s "Project Roomkey" initiative, according to health officials. But Tzvieli said only a few patients with homes of their own have taken up that option.

“For most people, we have found a way to help them effectively isolate in their home,” he said. “But it’s good to have that option ... the benefit is to the patient, their housemates and the entire community knowing that the people have a safe place to stay.”

Aleman said she tried to find another place to live before the pandemic. But she said smaller apartments, even in less desirable neighborhoods, were too expensive.

Under normal circumstances, she and her family pitch in to cover the $2,600 in monthly rent for their house. Aleman’s portion for the room she shares with her daughters is $850.

But after Aleman’s work as an office cleaner dried up in March and other adults in her household also lost income, the family worries about how they’ll pay June’s rent.

Aleman considered applying for unemployment benefits, for which she is eligible, but believed her request would be denied because the state requires a valid work authorization, and her work permit was set to expire soon.

It wasn’t until this month that she learned U.S. Citizenship and Immigration Services automatically extends work permits for asylum-seekers and other immigrants who properly file renewal requests, as the agency takes several months to process those applications. Aleman submitted her renewal request in April, about a month before her permit expired.

For now, without having secured wage replacement benefits, Aleman relies on nearby food banks to contribute to the staples her family prepares: beans, fried rice, cheese, eggs and Aleman’s favorite — fresh, hand-made tortillas.

Living together helps Aleman’s family save on rent and other expenses, and they are able to support one another by taking turns to cook meals, clean the home and care for each other’s children.

“We live as family and that’s a great help,” Aleman said. “We have each other.”

Aleman is also relying on her relatives in a new way. Recently, she started feeling sick and experiencing shortness of breath and bad headaches, she said.

Like her daughter and aunt before her, Aleman tested positive for COVID-19 this month and became one of the nearly 37,000 Latinos so far confirmed with the coronavirus in California.

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