The coronavirus is tearing through Native Hawaiian and other Pacific Islander communities in California, fanning longstanding health disparities and killing community members at a higher rate than any other racial group in the state.
Data from California’s department of public health reveals that Pacific Islanders have contracted coronavirus at nearly twice the state’s overall rate. As of 17 May, they have died from the virus at a rate 2.6 times higher than the state population – the highest death rate of any racial or ethnic group.
Public health experts have often said the group’s relatively small size can skew the numbers, making percentages appear outsized. But to community members and advocates, that argument obfuscates a long history of overlooked needs and health disparities.
“Time and again we’ve been told, ‘Your numbers are so small, they’re statistically insignificant,’” said Natalie Ah Soon, co-chair of the Regional Pacific Islander Task Force. “We’ve heard that before. We didn’t know infant mortality rates were a concern in our community until they published the data.
“When I hear someone say we’re ‘statistically insignificant’ I hear, ‘I’m not going to devote my time and mental energy to comb through this data.’ This disease is just ripping through our communities and we continue to be overlooked.”
About 317,000 Pacific Islanders with origins in Hawaii, Guam, Tonga, Samoa, Fiji or the Marshall Islands live in California, making up less than 1% of the state’s population. The communities account for 537 of the state’s 80,400 confirmed coronavirus cases and 28 of the 3,300 deaths attributed to the virus.
The impact of Covid-19 among Pacific Islanders is exacerbated by the high prevalence of a range of pre-existing health conditions in the community, including diabetes, hypertension and high cholesterol.
Roughly one in five Pacific Islanders have been diagnosed with heart disease and they are 46% more likely than the general population to be diagnosed with cancer – a rate higher than any other racial group, according to an April report from the Pacific Islander Center of Primary Care Excellence.
High poverty rates, lack of access to healthcare, and higher than average rates of “essential workers” can compound risk and accelerate the spread of the virus among Pacific Islander communities, said the organization.
Life in multigenerational households, common among communities of Pacific Islanders, complicates the challenge to maintain distance – especially if a member of the household works in the community and returns home to elders.
“There’s always a lot of stigma around disease in our community. Tongans are faithful people, and there’s been negativity attached to the narrative around coronavirus – a sense that, if you have it, God must be punishing you for something,” she said.
Ah Soon said the stigma and shame were consistent with commonly held beliefs in Samoan and other Pacific Islander communities and often created barriers to preventive healthcare and testing.
“When we’re sick, there’s a belief that it’s probably because of something that we did to offend our ancestors. It’s something that’s hard to explain through a western lens, but it’s very common,” Ah Soon said.
While it’s clear the Pacific Islander community is heavily affected, incomplete data statewide prevents a comprehensive view.
In some regions where data is available, the local discrepancies of Covid’s impact are stark. In Los Angeles county, for example, officials say the infection rate for Pacific Islanders is four times that of the population; the death rate is more than six times greater.
But in the San Francisco Bay Area, home to 87,000 Pacific Islanders, only five of nine counties – Alameda, San Mateo, Marin, Santa Clara and San Francisco – disaggregate data for Pacific Islanders, according to Melissa Jones, executive director of the Bay Area Regional Health Inequities Initiative. ( Some California counties don’t report racial or ethnic data at all.)
A spokeswoman for the public health department in Sacramento county, which reports deaths among Pacific Islanders as “other”, told CalMatters in early May: “We are not currently tailoring any outreach to this community because of the very small percentage it makes up of the population and impact.”
The Alameda county public health director, Kimi Watkins-Tartt, said her county’s decision to disaggregate data was part of a longstanding push toward health equity.
“If you don’t know where the disparity is, you can’t address it,” Watkins-Tartt said.
One reason for the incomplete data in California and elsewhere is that while labs and hospitals are required by law to report positive cases, healthcare entities may not be required to collect and report racial and ethnic data, explained Ninez Ponce, director of the Center for Health Policy Research at UCLA.
Data collection is prone to errors. Patients sometimes don’t self-identify on hospital intake forms, and healthcare staff can report inaccurate information or leave sections blank, rendering racial and ethnic data imperfect, she said.
That doesn’t mean counties can’t choose to prioritize data collection and reporting, said Tulua.
“We had a conversation with the chief science officer in LA county on a Wednesday and explained the need for more data. By Friday, it was published. It’s absolutely possible for counties to do this,” she said.
Four hundred miles north, in Alameda county, the rate of coronavirus cases among Pacific Islanders is the third-highest among racial groups – behind Latinos and African Americans. Watkins-Tartt said she was concerned about the picture data revealed for Pacific Islanders, but she was not shocked.
“Seeing the data [for rates of coronavirus infection] was not completely surprising to us because we’ve already seen it in chronic disease; we’ve seen it in infant mortality rates.”
Cultural traditions hang in the balance
Meanwhile, some Pacific Islanders are worried that coronavirus is not only threatening the health of their members, but also their customs.
The night before the funeral for her 15-year-old nephew, Ah Soon couldn’t sleep.
Funerals are sacred events, their importance deeply ingrained in Samoan culture. Family members will drive hours to attend, often hauling trailers filled with cultural items for the si’i, a traditional way of showing support for loved ones.
But coronavirus has interrupted tradition. When an elder recently passed away in San Francisco, a death that wasn’t attributed to coronavirus, Ah Soon said the funeral director warned the family that no more than 10 people would be allowed to attend the funeral and graveside service – and if they violated the rule, police would come to disperse the crowd.
The death of Ah Soon’s nephew, William Valelei I’aulualo, wasn’t attributed to coronavirus. He had type 1 diabetes and suffered health complications, she said. But with lockdowns in effect, congregating with family posed risks Ah Soon felt a need to protect her family against.
“We were all in sadness and disbelief. My son and my nephew were the same age, and very close. But I kept tossing and turning. Finally, I texted my sister that we just couldn’t come. It was very painful.”
To pull Pacific Islanders through the pandemic, advocates and healthcare professionals have organized a national response team and regional taskforces, sharing best practices and tips for consistent messaging. Central to the efforts across groups is a demand for better data.
Taunu’u Ve’e, co-chair of the regional Pacific Islander taskforce, said it was crucial that trusted members of the community remain involved in the fight against coronavirus by leveraging relationships and ensuring that communication and contact tracing is done in a culturally and linguistically appropriate way.
At stake, said Ah Soon, were their elders and their very culture.
“We’re worried about our elders and what will be lost. So much of our tradition is oral and relies on engaging with elders,” she said. “Those are things that are on the precipice of being lost if we don’t do something.”