Sacramento's Pacific Islanders are dying from covid-19 at twice the average.
Sacramento’s Pacific Islanders have been sounding the alarm about how COVID-19 has affected their small community, watching in horror as many of their loved ones became infected and died over the last year.
On Jan. 12, county public health officer Dr. Olivia Kasirye revealed some alarming numbers that confirmed the reality of their fears: Despite making up little more than 1% of Sacramento County, the COVID-19 fatality rate among Native Hawaiian and Pacific Islander residents in 2020 came to 4%.
That’s nearly twice as high as the county average of 2.1%, and higher than any other race. By comparison, the fatality rate for Asian residents was about 1.9%, 2.4% for Black residents, 1.5% for Hispanic residents, 2.8% for Native Americans and 2.6% for white residents, though more than half of the county is white.
And at about 142 positive cases per 100,000 residents, the infection rate is also much higher, Kasirye said during the Sacramento County Board of Supervisors meeting.
For such a small community, that’s astronomical. But for Sacramento’s Pacific Islander residents and community advocates, the news comes as little surprise.
“As far as how we’ve been coping … it’s not something that’s been easy,” said Franklin Henry, a Marshallese community advocate in Sacramento. “And then just this year alone … we’ve lost already three people, and most of these are elderly people who had preexisting conditions.”
“There was a funeral almost every other weekend,” said ‘Ofa Mann, president of the To’utupu’o e ‘Otu Felenite Association.
Pacific Islanders suffer from disproportionately high rates of conditions like cancer, respiratory disease, liver disease and diabetes, all of which make them more vulnerable to COVID-19 complications. They also tend to live in multigenerational households, meaning if one person gets infected, several families are immediately at risk.
And it’s not exclusively a Sacramento or even a California problem. The pandemic has hammered the nation’s Pacific Islander community at large, with the highest infection rate of any other race in April last year at 131 per 100,000 cases.
It’s a problem that’s been caused in many ways by the U.S. itself. After World War II, the U.S. tested dozens of nuclear bombs on Pacific Islanders, destroying their crops and giving residents long-term health problems and birth defects while also denying them adequate health care.
This long history of U.S. policies directly putting Pacific Islanders’ health at risk still has yet to be fully corrected, setting the scene for Sacramento’s NHPI community’s disproportionately high fatality rates long before COVID-19 even came into being. In other words, Sacramento’s Pacific Islanders knew their community would take an outsize hit as soon as the pandemic became news.
Most of the deaths have been elders, meaning every death is more than the loss of a loved one — it’s also the loss of a piece of culture, of generational knowledge and traditions that dissipate before elders can pass it on.
“Is our rate going to be going up? Probably,” said Mona Foster, founder of Hui o’ Hawaii of Sacramento Inc. “If our seniors do not get help right away, you’re going to see a higher rate.”
“Those are not just numbers,” Henry said. “They’re lives. … If it continues at that rate, I’m afraid we’re just going to be extinguished.”
According to a 2019 survey by the U.S. Department of Health and Human Services, Native Hawaiians and Pacific Islanders are 2.5 times more likely to be diagnosed with diabetes than white Americans.
A 2017 Centers for Disease Control and Prevention study also showed NHPIs were more likely to be diagnosed with cancer and die from it. American Samoan men are eight times more likely to develop liver cancer, while American Samoan women were twice as likely to be diagnosed with and die from cervical cancer than white people.
The root of Pacific Islanders’ disproportionate health problems began in the 1940s and 50s, when the U.S. began using the Marshall Islands as testing grounds for nuclear bombs. Soon after, Islanders started developing thyroid cancer, nausea, hair loss and lowered blood cell counts, which researchers determined were linked to nuclear testing.
When the U.S. ended nuclear tests on the islands in 1958, they left the Marshallese with radiation levels higher than Chernobyl. The Marshallese also continued to grapple with birth defects, additional cancers and destroyed crop harvests for decades afterwards.
In exchange for dropping 67 nuclear bombs on the Marshall Islands, the U.S. promised in 1986 that all Marshallese, Micronesians and Palauans would qualify for Medicaid, and could easily immigrate to the U.S. while remaining foreign citizens. But in 1996, President Bill Clinton killed the agreement in his welfare reform bill, an oversight with disastrous consequences.
It wasn’t until December 2020 that Congress restored Pacific Islanders’ eligibility for Medicaid coverage. But for the last 24 years, health problems directly caused by radiation poisoning and exposure have continued to spread throughout the island populations.
“The reluctance to actually correct the mistake of taking us out (was a major turning point),” Henry said. “Part of that promise was, ‘We’ll give you what you need to cope with what we’ve done.’ Everything went downhill from there.”
Other conditions that complicate COVID for Islanders include diabetes and hypertension. One 2016 CDC study of Marshallese in Arkansas found that about 62 percent of the community were obese, 38 percent had diabetes and about 41 percent had hypertension.
Part of this is due to the lack of affordable fresh food on the islands, a side effect of the nuclear testing that destroyed their farms and crops. As a result, many Pacific Islanders were raised with unhealthy diets and poor nutritional education.
Multiple generations of Pacific Islanders often live under one roof, which makes the virus much easier to spread. Rena Burch, a Marshallese community health worker, said scared residents have told her they had nowhere to go when their family members got the virus.
“Even if they’re careful, the frontline essential workers, they still go out. They have to work,” Henry said. “If they bring it back … guess what? All 20 people in the household are infected. And that’s pretty much what’s been happening.”
“When I had COVID, my husband had COVID,” said Mann, who added her and her husband tested positive last summer and have recovered. “We tried to isolate, but then eventually everybody (in my house) got infected.”
Cultural and language barriers can also be an issue when it comes to explaining the minutia of medical records. For instance, women won’t always feel comfortable sharing their full health history with male doctors, advocates said, and men won’t always feel comfortable if their doctor is standing over them instead of sitting beside or across from them.
“Even amongst Pacific Islanders, there’s a lot of slightly different aspects to their medical care,” said Deborah Yoder, founder of Nito’s Wings, a Sacramento nonprofit focusing on Marshallese health issues. “There are slightly different cultural considerations from island to island. That makes it really difficult to … meet those needs.”
Because of the long history of betrayal, many Pacific Islanders also tend to be skeptical of the U.S. healthcare system. That makes it difficult not only to get islanders to go for regular checkups, advocates said, but it also presents an extra layer of complication when trying to convince people to get the COVID-19 vaccine.
“Yes, we do have the vaccine, but how many will take the vaccine because of the fear?” Mann said. “I would like to see more translations, I would like to see more outreach to encourage them, to show them that it’s not scary.”
WHAT SACRAMENTO IS DOING, WHAT ISLANDERS WANT
In a statement, Sacramento County public health spokeswoman Brenda Bongiorno said the county has been working with leaders from the Tongan, Marshallese and Samoan communities to distribute masks and hand sanitizer, as well as translate COVID-19 information and combat misinformation about the vaccine. Last fall, the city of Sacramento launched a joint effort with Asian Resources Inc. to train more than 50 bilingual community members as contact tracers, community health workers and COVID case investigators.
Advocates said they appreciate the communication they’ve had with public health officials, but they need more help. For one thing, they’d like to see more financial assistance, whether that’s to hire more translators and community health workers, to pay the volunteers already in these roles or covering the cost of funerals.
“A Marshallese friend that lives in a multigenerational household had to have a family member isolate,” Yoder recalled. “What her family had to pay for the resources to isolate the family member would be cost prohibitive to most.”
Regardless of COVID-19, Yoder said, she wants the county to hire an advocate that specializes solely in Pacific Islander outreach such as the one hired by Alameda County, who offers direct services such as accompanying people to doctors’ appointments and explaining their insurance options. She also wants more healthcare workers to have education about Pacific Islanders and their complicated immigration and health history included in their diversity and culture training.
Work like this is already happening, Mann said, but the weight of responsibility often falls to nonprofit organizations in Sacramento run entirely by volunteers. She wants to see her staff’s time compensated and she wants to see some more county or city-level investment to make this possible.
“I don’t even have time to do translations,” Mann said. “All volunteers working … we need to compensate for their time.”
But the most urgent need, advocates agreed, is to simply provide clear instruction on where and how to get the vaccine as soon as it’s available. Vaccine rollout has been painfully slow in Sacramento County, and all agreed that as soon as vaccines can be made available to their elders, they want plain instructions on where to go and how to sign up their elders.
They’d also like more resources to help them isolate if needed. Many have nowhere else to go if they get infected, advocates said, or don’t have the means to find a place to isolate.
“The majority of them who are getting sick with (COVID-19) is our seniors,” Burch said. “That was the main thing that we wanted to explore, to see where can we get them to register and get … the vaccine.”
Watching loved ones in such a tight-knit community die over the past year has been unspeakably painful, advocates said, with the added sting of being unable to gather and grieve as one. It’s now more crucial than ever to meet the needs of a community whose grave concerns have long been overlooked by the U.S. healthcare system.
“We don’t want to relive 1996,” Henry said. “We need a clear path on how we can enroll these folks so they … can avoid something like this from ever happening in the future.”