San Diego Union-Tribune (Sunday)
• Without data, COVID-19’S impact on some San Diego minority communities is overlooked, advocates say.
Filipino, Middle Eastern, other communities can be ‘invisible’ in case, vaccination data
There were signs early in the pandemic that led Maria Araneta, a professor of family medicine at UC San Diego, to believe COVID-19 was overwhelming San Diego’s Filipino community.
She wasn’t looking at statistics — something an epidemiologist usually relies on for surveilling health issues — because those weren’t available about Filipinos.
Instead Araneta, a Filipina, paid attention to anecdotal stories of Filipino families buying dozens of obituaries and an uptick in requests for COVID contact tracers who speak Tagalog.
“What kind of public health care system do we have when we have to rely on obituaries, rather than a surveillance system to track who’s getting ill?” she asked.
Meanwhile, Dr. Raed Alnaser, a physician at Sharp Grossmont Hospital, was noticing that Arab Americans were checking into the hospital’s intensive care unit at rates he’d never before, usually for complications related to COVID-19.
And around San Diego, refugee advocates saw their organizations overwhelmed with requests for rental, meal and other assistance from refugees from North Africa, East Africa and Southeast Asia who lost their jobs.
Advocates and health professionals are saying that some of San Diego’s minority communities affected by the pandemic are “invisible” because of how they are categorized in local public health data. The county’s COVID-19 case and vaccination data groups Filipinos in the “Asian” category, Arab Americans as “White” and international refugees as part of a variety of demographic groups.
The county says data is being tracked using categories set by the California Department of Public Health and the U.S. Centers for Disease Control and Prevention.
In addition to that standard, hospital systems statewide do not include more specific demographic categories in the information reported to the county, said Sarah Sweeney, a county spokeswoman.
“In essence the varied entities tracking and gathering this information all need to use the same standards and categories,” she wrote in an email Thursday.
Still, many advocates and health experts question how equitable the response to COVID-19 has been if data for some groups is not available.
“Our reporting systems of race and ethnicity should reflect our own local demographics, otherwise they continue to be invisible,” Araneta said. “And for as long as they’re invisible, these poor health outcomes will continue.”
Joann Fields, an advocate with the Asian Pacific Islander Initiative, said the county should provide disaggregated data to help inform decisions about where to send resources and vaccines.
Fields has watched the pandemic claim the lives of friends in the Filipino community. She organizes educational webinars on COVID-19 to keep people informed.
“We hear ‘equity’ over and over again, but how can we say that?” Fields said. “We can’t monitor if we are making an impact if there is no data.”
San Diego has one of the largest Filipino populations in the United States. There are about 196,000 Filipino residents in San Diego, according to the Pew Research Center.
Filipinos often have underlying health conditions that make them more susceptible to developing complications from COVID-19. Araneta said some of the highest diabetic rates are among Pacific Islanders, Filipinos and Asian Indians.
While local data is not available, November data at the state level shows Filipinos have been hit hard by the virus. Araneta said that among California’s Asian COVID-19 cases where subgroups are known, 40 percent of the cases are Filipinos, and fatality rates among Filipino cases were 21.3 percent, compared to 1.2 percent among all California residents.
Filipinos often work front-line jobs that put them at higher risk. According to a survey published in September by National Nurses United, Filipinos comprise 4 percent of U.S. nurses but 32 percent of nurse COVID deaths; and in California, 20 percent of nurses are Filipino, but 70 percent of nurse deaths from COVID are Filipino.
Those numbers tell Araneta that data needs to be disaggregated in San Diego to know the rate that Filipinos are contracting the virus and how many are dying.
Other counties such as Santa Clara have found that Filipinos and Vietnamese residents are being disproportionally impacted by the virus when compared to their populations.
“Otherwise we’re just guessing, and that is not a way good science should be conducted,” Araneta said.
“It is not an effective way to conduct public health, where the goal is to interrupt transmission.”
Not counting them sends the Filipino community a misleading message that the virus is not hitting their population as hard, so some people ignore public health guidelines, she said.
Marc Pescadera and four family members living under one roof in Mira Mesa contracted COVID-19 in January. Pescadera’s parents and sister were admitted into the hospital for shortness of breath a couple of days after testing positive.
Then he followed. He remembers talking on the phone with his parents about the possibility that the family would not make it.
“There were a lot of tough conversations,” said Pescadera, who has diabetes.
On Feb. 1, Pescadera’s mother died.
“My mom was 64, I was thinking that she was going to be alive until her 80s and see more grandchildren, but that was taken away from her,” Pescadera said.
The county looks at race and ethnicity data, Sweeney said, as well as healthy equity and other metrics. The county also partners with more than a dozen organizations to develop outreach messaging for hard-to-reach populations, she said.
The county’s contact tracing team can conduct interviews in more than 40 languages, she said, but 75 percent of those interviewed todate have requested to be interviewed in English.
Arab Americans and people of Middle Eastern descent have been categorized as “White” since the 19th century, said Yen Espiritu, a professor of ethnic studies at UCSD.
At the time, she said, that designation offered the community some protection from discrimination. Recently there have been efforts to add a category for people from the Middle East and North Africa — MENA — to the census.
Dr. Al-naser said his curiosity was triggered early in the pandemic, because many patients in the ICU were Arab American or Middle Eastern immigrants. Whole families coming into the clinic had COVID-19, he said, but there was little discussion about it in the news or among elected officials.
Al-naser, president of the San Diego chapter of the National Arab American Medical Association, reached out to colleagues in other states; they echoed his observations.
There are economic, social and health issues that put the Arab and Middle Eastern community at higher risk of contracting the disease, Al-naser said. That includes working essential jobs, living in multigenerational households and medical conditions like hypertension, smoking, chronic lung disease and diabetes.
“There are no ways to tell how this disease, COVID-19 in particular, or any other health problems impact this particular community,” Alnaser said.
The same issues arise as vaccines are distributed, he said. It’s hard to know where to place resources to provide correct information when there’s an abundance of misinformation and conspiracy theories about the vaccine churning in the Arab American community in San Diego, he said.
And without knowing vaccination rates — “if we don’t know, we won’t deliver,” Al-naser said.
Doris Bittar, who was born in Iraq and works with Syrian refugees, said the implications of being lumped into the “White” category are immense because it makes a whole group invisible.
“Being invisible means that you’re not protected,” she said.
Bittar, president of the American Arab Anti-discrimination Committee, said refugee families often rely on information from family members back in their home countries, so there is a lot of misinformation. Without data, its hard to counteract that, she said.
Some organizations are taking data gathering into their own hands.
The civic engagement arm of the Muslim American Society, MAS-PACE, is working to finalize data from more than 156 families that have turned to the organization for assistance during COVID-19. Ismahan Abdullahi, executive director of MAS-PACE, said it is clear the pandemic has taken a big toll on the community based on anecdotal stories.
“I’ve had elders call me and say, ‘I don’t know how to feed my family next month,’” Abdullahi said.
Abdullahi said the organization has focused on helping refugee families navigate unemployment, rental and food assistance applications.
Other local organizations and UC San Diego’s Community Health Center’s Refugee Health Unit have created a coalition to assess the impact of COVID-19 on refugees. The coalition interviewed more than 300 families from 18 countries in August.
Data helps providers identify gaps, impacts and resources needed, said Amina Sheik Mohamed, director of the refugee unit. Since the public data is not available, it’s important for community organizations to do on-the-ground work to identify needs, she said.