Hawaii among nation's worst for COVID racial disparity

HONOLULU (KHON2) — Even with the recent COVID-19 spikes, Hawaii officials tout the state’s low numbers compared to the mainland. But Hawaii is among the nation’s worst places for racial disparities among COVID victims.

KHON2 looked at COVID rates by race nationwide and found the virus is attacking the Pacific Islander community in Hawaii to an extent unseen just about anywhere else in America by other minority groups.

Most states track incidents of COVID by a number of demographics including age, area of residence and race. In Hawaii, the positive percentage for most racial groups is about the same as their percent of population. But Pacific Islanders show a stark disparity, among America’s most extreme. At only 4 percent of Hawaii’s population, Pacific Islanders account for 25 percent of the state’s COVID cases.

“From what we’re seeing it’s very similar to what other jurisdictions are seeing on the mainland in their Hispanic population or their African American population,” explained Dr. Sarah Park, the state’s lead epidemiologist with the Department of Health. “It’s just that for us in Hawaii, the Pacific Island population is that population that experiences a lot more social disparities.”

It’s similar to the mainland in terms of a minority population bearing the brunt, but far worse in Hawaii than just about anywhere in the country.

A KHON2 look at state-by-state racial data found Hawaii’s gap for Pacific Islanders is behind only Native Americans in New Mexico — where that group makes up 9 percent of state residents but 54 percent of the COVID cases — and African Americans in Maine and Missouri.

University of Hawaii researchers found the disparity earlier in the pandemic, too, as they tracked Native Hawaiian and Pacific Islander populations here and in other states.

“When you look at places where we’re well-represented in population size like California, Oregon, Washington state and even here in Hawaii with Pacific Islanders, we have the highest rates,” explained Keawe‘aimoku Kaholokula, PhD, professor and chair of the Department of Native Hawaiian Health at UH’s John A. Burns School of Medicine. “Even in places where there are American Indians and Alaska natives, we’re having higher rates and even in some places deaths.”

Hawaii does not report racial data for the COVID death cases, nor for the COVID hospitalizations. The hospital numbers are only cumulative. The state is not giving counts of those currently hospitalized nor a daily tally of ventilators in use.

“Our Native Hawaiians and Pacific Islanders have higher rates of asthma, diabetes, heart disease and have multiple chronic medical conditions,” Kaholokula said. “So should they get this, they’re more likely to get severe symptoms, hospitalized and even death. We need to understand the hospitalization rates by ethnicity, and the death rates, to really understand the impact it’s having in our community. We need to get a better handle on the testing. We need to be collecting ethnic and racial data, very specific data, so we actually know what communities are most at risk.”

“It really underscores that in order to combat the pandemic here, we need to not just put the Band-Aid on things, if you will, in terms of identifying cases, quarantining and isolating,” Park said. “But we also need to understand root causes of why disease spreads.”

Why has COVID spread in the Native Hawaiian and Pacific Islander population so much, both here and elsewhere? In part, many have been on the front lines from day 1 of the pandemic, while much of the other workforce went home or worked from home.

“A lot of the Micronesians are out there, (working at) 7-11, they’re out there at the fast food restaurants, they’re out there at the nursing homes,” said Jocelyn Howard, program director at We Are Oceania, a nonprofit that addresses Micronesian community needs in Hawaii. “We’ve just got to recognize we’re part of this community.”

Kaholokula estimates about 30 percent to 35 percent of the essential workforce, including military, are Native Hawaiian or Pacific Islanders.

“So that means they’re being exposed to others,” he said, “but they’re also going home to larger households perhaps where there are multiple people in the household who are essential workers.”

Congested home settings are contributing to the spread, according to the health department.

“They tend to live in more crowded settings, they tend to be in front-line professions and such,” Park said. “What we’re seeing is what disease does, pretty much, once it gets in the community setting, it starts to basically uncover our social disparities.”

Simply having alternatives for where to isolate and quarantine when COVID strikes a family member is among the top things advocates say needs to be done right away.

“They have multigenerational households, they live in crowded neighborhoods, so that ability to self-quarantine is very limited,” Kaholokula said. “We need resources around that and how to make that happen.”

Howard agrees, saying: “I think this is where we turn to the government and we rely on the government to create alternatives or emergency living options. Maybe how they have the hotels for family members that cannot be quarantined at home, maybe have this more available. Really think of this, that we may need that in the next 6 months out.”

She says they’re working on adaptive measures culturally, too.

“My concern was always once it reached our community it was going to be hard because of our lifestyle, our culture, hugging and coming together and sharing, and seeing each other often, even daily,” Howard said. “I knew that this was going to be a problem. When the number was spiking in our community, we had to identify the immediate priorities and the immediate goals.”

We Are Oceania has been working directly with the Micronesian and other Pacific Islander communities to reinforce mask wearing, hand washing, social distancing and putting off gatherings whenever possible.

“We learned that some of the ways the virus was spreading was through funeral services and through church gathering at homes,” Howard said. “So we tried to create messaging that would be culturally sensitive and also that it’s not offending a family member. Especially when it comes to funerals, those are a very important part of who we are.”

Who they are is something Howard says she hopes the community comes to understand better, and with more compassion.

“You can see that on any coverage about COVID,” Howard explains. “You’ll go to the article, the story, you’ll read the comments and you can see those kind of backlashes from the community and unfortunate comments.”

“It makes us work harder,” she adds. “I feel like it’s always working against the strong current, but it really doesn’t stop us. For people who misunderstand or discriminate against us Micronesians, for our community, it’s just always hoping that they learn more about who we are. Once they learn our story, there’s no difference actually from any other Pacific Islander’s stories including Native Hawaiian.”

Kaholokula puts the bias problem bluntly: “I think structural racism is at the core, there’s a big attention nationally with everything that is going on, and I think we need to highlight that.”

“Structural racism is the root cause of all of this,” he adds, “inequities in the social determinants of health that place our people at a disadvantage economically, educationally, socially, is really the culprit here.”

Kaholokula warns of both explicit and implicit biases, even in health care.

“Implicit bias is unconscious preferences for certain groups or people over others that may influence how we care for others, the recommendations we make, how much time we may dedicate or even how much time someone has to wait for care,” he said. “But then there are other terrible ones that are explicit biases. That is really terrible. These things are working against us and we need to address them at the highest levels.”

UH advocates and others have formed the Native Hawaiian Pacific Islander COVID-19 Response Recovery and Resilience Team, aiming to turn the tide on the disease and build community at the same time.

“This is giving me hope that this pandemic may shine light to our disparities,” Howard said, “however, it also shines lights to our strengths and our assets in our community and the helping hands and the beautiful culture that we the Pacific Islanders and any other islanders share. That community, and family value, that’s what brings us together.”

Kaholokula says access to testing and health care regardless of insurance could help to combat the COVID disparity, plus more housing alternatives and food security. We’ll follow up to watch for progress.