LOS ANGELES — Betty Rivera was the first in her household to fall sick, early last month. To protect her family, she locked herself in the bedroom she shares with her grandson. Her daughter left chicken soup and herbal remedies of ginger and garlic and rosemary outside her door.
But it was impossible to stop the spread, not with three generations crammed into a one-bedroom apartment in one of Los Angeles’s most overcrowded communities.
Her three-story brick building is wedged between Koreatown and Pico-Union, neighborhoods filled with immigrants who stock groceries and drive buses and where the streets are dotted with businesses that serve the underprivileged — 99-cent stores, check cashing outfits that dole out payday loans, pawnshops. These days, the wail of ambulance sirens never seems to fall silent.
“It’s all day long,” Ms. Rivera, 69, said in a recent interview in her living room, where her family sleeps and where the fireplace is jammed with toys.
Ms. Rivera’s daughter was the next to fall ill, and then her son-in-law and two of her grandchildren. Even Chloe, the black-and-white dachshund and Chihuahua mix scurrying around the apartment, became sick, she said.
Los Angeles may not have the population density of New York, may not have as many skyscrapers or high-rise apartment buildings or jam-packed subways, but the county does have a higher percentage of overcrowded homes — 11 percent, according to the U.S. Census Bureau — than any other major metropolitan area in America.
Overcrowded housing is defined as more than one person per room, excluding bathrooms. If you drive across the vastness of Los Angeles County, starting at the ocean and going east, the shifting landscape tells the story of the housing inequality that has fueled the virus surge. Mansions give way to smaller, single-family homes, and finally to the immigrant areas like where Ms. Rivera, who moved here from El Salvador almost 40 years ago, lives, six people in a tiny one-bedroom. In some areas, like Westlake, where street vendors line the sidewalks near MacArthur Park, close to 40 percent of homes are considered overcrowded.
It is this Los Angeles, of tight-knit families, of streets packed with food vendors from Central America and Mexico, of encampments of homeless residents, where the virus has spread ferociously, bringing so much sickness and death.
Early in the pandemic, many hoped that Los Angeles — at least the Los Angeles of the popular imagination, with nice houses and backyard pools and everyone in their cars — would somehow be protected from catastrophe.
Now, the hospitals are overrun, and Southern California has become one of the centers of the nation’s outbreak, with alarming daily death tolls. In communities across Los Angeles County, the nation’s largest with a population of more than 10 million people, it is clear those early hopes were misguided.
Perhaps nowhere else in America can the unequal toll of the virus be felt more dramatically than in Los Angeles, where suburban sprawl and freeways demarcate the neighborhoods of the haves and the have-nots.
And now that the virus is coursing through the city’s densest neighborhoods, it has underscored the crisis in economic inequality and housing affordability that, even before the pandemic, was one of the region’s most pressing issues.
The problem has been most visible in the growing number of homeless encampments across the state, but also in some ways hidden, with so many people living in crowded homes.
“I think that L.A. was extremely vulnerable and has been vulnerable all along,” said Anne Rimoin, an epidemiologist and professor at the University of California, Los Angeles’s Fielding School of Public Health. “L.A. is extremely large and it’s extremely complex. There is a lot of overcrowding and I think that is very critical to thinking about how the virus spreads.”
Wearing Masks, Even at Home
Amid soaring cases and deaths, Los Angeles leaders in recent weeks have issued urgent pleas to citizens to wear masks and keep their distance from one another. Officials like Mayor Eric Garcetti are also increasingly warning people that the virus is now spreading rapidly in the one place they thought they were safe: their own homes.
To combat that spread, people should keep their masks on indoors if they live in overcrowded homes, especially those who interact with the public at work, said Barbara Ferrer, Los Angeles County’s public health director. Ms. Rivera has already been taking that advice.
“This is particularly important,” Dr. Ferrer said, “for those people that live in their households with people who are very vulnerable, people who are older, people who have serious underlying health conditions that put them at great risk for serious illness from Covid-19.”
The county has no way to enforce such a recommendation, but she added that wearing masks indoors would “add a layer of protection while we get through this surge.”
Because the virus has spread so rapidly in Los Angeles, efforts at contact tracing have not been enough. The county and state has moved some homeless people into motels, and offered rooms in R.V.s and motels to those infected who cannot isolate safely at home, but many people have chosen to stay with their families, or on the street.
The virus has underscored inequalities around the country, bringing far more death to poor people and communities of color.
Consider the number of coronavirus deaths Los Angeles County has registered through Thursday in wealthy, predominantly white neighborhoods on the Westside: Brentwood, nine; Bel-Air, two; Venice, 13; the city of Beverly Hills, 21. There, where life feels almost normal, ambulance sirens are not a constant intrusion and many people are able to work from home.
Now consider the death tolls in overcrowded, more populated neighborhoods to the east, like the one where Ms. Rivera lives: Westlake, 202; Pico-Union, 146; Boyle Heights, 187; the city of Compton, 147.
On one quiet street in Pico-Union, Bob Armstrong runs a business that has been in his family since 1903, first in Canada and then, starting in the 1920s, in Los Angeles — the Armstrong Family Malloy-Mitten Mortuary. He has never been busier. There are new refrigerated units out back to store the growing number of bodies received from hospitals. He has pulled all his advertising off the internet.
“Everyone in our industry is swamped right now,” he said. “We’re turning away business. I’ve been in the business for 45 years and this is the most challenging situation we have ever seen.”
As immigrant households in Los Angeles become consumed by the virus, many people are also worrying about relatives back home. In El Sereno, a largely Latino working-class neighborhood in East Los Angeles, Domingo Miguel Aguilar, the family patriarch who lives with three generations in a small, two-bedroom bungalow, lost his mother in Guatemala to Covid-19.
In his home, almost everyone became sick. His wife, who had been living in Bakersfield while working at a fruit packaging plant, died.
Mr. Aguilar, 69, an evangelist and missionary, reflects on his losses with the equanimity of a deeply spiritual man. “We have prayed and God has fortified our lives,” he said. “He has blessed us and lifted us. We have not fallen.”
Pawning Jewelry to Afford Food
The virus often leaves economic devastation in its wake because so many people who fall ill are working in jobs that provide no health benefits or sick pay.
Ms. Rivera, who works in child care, lost income when she got sick; so did her son-in-law, who missed shifts at a textile factory. To pay their $1,500 monthly rent, Ms. Rivera had to pawn off the gold necklace her daughter received for her quinceañera. She got $500.
She hopes to get it back, but after just a month, she already owes $200 in interest. They have relied on charity to leave food boxes outside their door.
“Even if we don’t have enough to eat we have a roof over our head for the kids,” Ms. Rivera said.
In South Los Angeles, Hilda Rodriguez-Guzman was lucky enough to buy a house about 20 years ago in the neighborhood where she grew up. But as housing prices have skyrocketed in the region, homeownership is out of reach for her children.
So now, there are four generations living in her small three-bedroom house, which has one bathroom. Her adult son sleeps on the couch. There are grandchildren running around. Her father recently came to live with her after being hospitalized for Covid-19. For a time so did her godson, a veteran who was homeless and suffering from PTSD.
“We are forced to live in these conditions where we’re basically all on top of each other,” Ms. Guzman said. “There’s no privacy.”
Nearly everyone in the house has come down with Covid-19. Ms. Guzman believes that the infections started when her daughter attended a small dinner party in June, after the initial coronavirus restrictions were lifted. Ms. Guzman had the worst of it, and was hospitalized for nine days last summer. She needed supplemental oxygen for months afterward.
In richer and whiter neighborhoods, she said, people who get sick can easily isolate and they often have jobs that provide benefits and allow them to work from home. “We can’t do that,” she said. “We don’t have that luxury. And it says a lot about the inequity that does exist and the racism. This pandemic has made the disparities all the more clear.”
With so many people in the house, and so many falling sick and missing work, money became tight. Utility bills skyrocketed and so did food costs, as quarantined family members relied on delivery apps like Postmates.
“Luckily we had a little bit saved up but all of it is gone now,” she said.
And still, as Los Angeles officials parse the daily drumbeat of cases and deaths, looking for any sign that the surge is slowing, Ms. Rivera keeps hearing the sirens.
With each passing ambulance, Ms. Rivera pauses, wondering who is sick this time. Her lingering effects from the virus include loss of smell, and she is scared about getting reinfected.
Before she gets on the bus for work each morning, she says a short prayer, asking God to keep her safe.
But she does not leave it all in God’s hands. For protection, she always has extra face masks, passing them around on the bus to those who need one.
Ana Facio-Krajcer contributed reporting.