A DEADLY TREND
Filipino American nurses in California are dying at alarming rates, making up more than two-thirds of deaths in the profession from COVID-19
Becoming a nurse was the obvious choice for Oliver Isleta.
The economy in the Philippines, his home country, was sluggish, and he wanted to make a better living abroad — without going through civil engineering school all over again. So after studying nursing in the city of Davao, he emigrated to the U.S. in 2006 to take his board exams.
He lived first in Bridgeport, Connecticut, in a dormitory with other Filipino nurses, before moving to Fresno, into the granny flat behind his sister’s house. Twelve-hour night shifts at Community Regional Medical Center left Isleta so tired he could barely walk on days off, but he felt much closer to his colleagues and his faith than he ever had as an engineer.
His salary flowed back overseas to relatives in Davao, where his wife and son Matthew counted down his once-a-year-visits — timed to coincide with Matthew’s April birthday — and hoped to one day to join him in California.
On Sept. 1, that future disappeared when
Isleta died from COVID-19 complications at Community Regional. He had been sick since mid-July and placed on a ventilator. When that didn’t work, he was put on a heart and lung support machine. But by the end of August, that had caused internal brain bleeding.
As his breathing slowed the morning of his death, dozens of coworkers filed down the hallway, waving goodbye through the glass partition of the intensive care unit. His sister hosted one last Zoom call so family around the world could tell Isleta they loved him. He was 58 years old.
“He will be missed so much,” his sister, Marilou Tomambo, said in an interview. “He had so much life to give, so much joy to share, so much that he deserved, in our minds.”
Isleta’s death illustrates a tragic nationwide trend, as Filipino and Filipino American nurses die from coronavirus at rates far higher than their counterparts in other groups. Nationally, over 30% of the 205 nurses who have died are Filipino American, though the group makes up just 4% of the nursing workforce. In California, where about 20% of nurses identify as
Filipino, they account for 11 of the 16 COVID-19 deaths in the profession, or nearly 70%, according to the California Nurses Association.
Among health care workers as a whole, the outsized impact of the virus on Filipino Americans is likely much greater. In California — where more than 39,000 health care workers have contracted COVID-19 and 191 have died — Filipino Americans comprise about 12% of all health care workers and 11% of health care support jobs, like assistants in nursing homes — putting them in v ulnerable essential jobs where coronavirus has run rampant and personal pro - t ec t ive equipment has been chronically scarce.
While the state does not track coronavirus infections among health care workers by race, Filipino Americans’ overrepresentation on the lower-paid end of the industry suggests that they account for a disproportionate share of cases as well as deaths, said Jeanne Batalova, a senior policy analyst at Migration Policy Institute, who researches immigrant workers.
“Death is a good and unfortunately morbid, representation of the trends that we’d see if we had the data for infections,” Batalova said. “So it is likely that we’re underestimating the extent of morbidity and exposure to COVID that this population faces.”
Even within hospital systems, Filipino American nurses are more likely to work in hig her r i sk roles such as the intensive care unit, emergency med icine or t elemetr y, which puts them directly in the path of COVID-19, said Catherine Ceniza Choy, a professor of ethnic studies at UC Berkeley, whose work has focused on the
history of Filipino American nurses.
“Filipino nurses, here specifically in the U.S., are concentrated specifically in in-patient critical care services,” Ceniza Choy said. “Many of them are also caregivers at home, not only of children, but also their parents and other elders. And so part of the problem with the pandemic is these multiple layers of vulnerability and exposure.”
Mark Brown, chief nursing officer at Good Samaritan Hospital in San Jose, has watched those realities collide firsthand. Earlier this year, four Filipino American nursing assistants at Good Samaritan were working second jobs at a long- term care facility in the area when they all came down with COVID-19.
“They’re full time with me, full time somewhere else and maybe even part
time somewhere else,” Brown said. Combined with the lesser protections at nursing homes as compared to hospitals, plus the higher likelihood that these workers live in larger households, “it’s a bad recipe” for COVID-19, he said.
Liza Aquino, 48, who emigrated to the U.S. from outside Manila, fell ill in March, soon after a patient on the telemetr y f loor at Kaiser Permanente in Fresno, where she works, tested positive for COVID-19. A high fever, chest pain and shortness of breath made it difficult for her to even stand up in the shower.
“Before, I told myself, ‘I’m ready when God takes me.’ But when I had COVID, I was bargaining to God: ‘I’m not ready, yet, to die,’ ” Aquino said.
For virtually her entire career, Aquino feels she and her Filipino coworkers have
been handed the toughest patients. Hard- earned money needs to stretch — she estimates about 80% of her Filipino friends support people outside their nuclear family with hospital wages or live with extended family.
“It’s a way of life for us,” she said. “And I wish it could change.”
Both caring for COVID-19 victims and becoming them has been a onetwo punch, several Filipino and Filipino American nurses told this news organization. Yet the extent of the disease’s reach within the community remains difficult to track as the California Department of Public Health does not collect data on specific Asian American subgroups.
Statewide, Asian Americans make up about 5% of coronavirus cases and 11.7% of deaths, compared to their 15% of the population. But
experts say the number likely masks higher rates for some groups of Asian Americans, including Filipino Americans.
“It’s horrifying,” Choy said. “There’s an incredible amount of grief that I have been dealing with, but also, Filipino Americans in general — this tremendous sense of loss.”
Celia Marcos spent 16 years caring for some of the toughest patients in the telemetry unit of Hollywood Presbyterian in Los Angeles. After emigrating from the Philippines in 2001, she started as a nursing assistant and worked her way up to charge nurse at Presbyterian, overseeing high-risk heart attack and stroke patients.
She was infected with COVID-19 in April while intubating a patient who had stopped breathing, equipped with only a surgical mask herself. Her death two weeks later at age 61 triggered an outcry from fellow nurses, along with a complaint from her union, SEIU Local 121 RN.
But before all that, she was simply really good at her job, said her youngest son, John Paul Marcos, 25, who lives in Daly City. His first and second cousins were also nurses, but he never thought of it as a specifically Filipino profession. His mom just loved taking care of people.
“I try not to think about her death too much. It’s more just — how she lived, and who she was,” Marcos said. “It was just natural for her.”
Filipino nurses have been a fixture in the U.S. health care system since the 1960s when short- staffed hospitals, particularly in California and New York, began heavily recruiting from the Philippines.
For years, many of these nurses were cut out of lucrative jobs and exploited for wage theft in the U. S., said Choy, a legacy that persists today. Yet for many Filipino A mericans, the nu r s i n g t r a d i t i on remains a cultural linchpin across generations.
In Fresno, where Isleta’s granny f lat now sits empty, the family oscillates between prayer and tears. They still don’t know how Isleta got infected, but they suspect it was at work.
Tomambo misses her brother’s hugs before heading to the night shift, the silly faces he made at his nephews while doing housework, his carefully perfected lumpia and adobo. His coworkers called him Kuya Oliver — big brother — just like she did. After he died, some were so grief-stricken they asked to switch units.
Ever y day, Tomambo FaceTimes her brother’s wife and son, Matthew, to take turns crying. Matthew still calls his father’s number sometimes just to hear it ring and ring.