JoAnn Fields watched the funerals of two dear friends and leaders in the Filipino community in the last week of January. She has another memorial on the first day of February.
Since Jan. 1, at least four men in her community have died of COVID-19.
On the first day of the year, was Dr. Chester Banaag, a dentist and active member of the San Diego Filipino American Seventh Adventist church. Then, was Benjamin Clanor, who worked on audio during the Island Vibe Music Festival and other major events. Then there was Obie Sibug, a popular contractor in the community, and Rey Monzon, a researcher and faculty member at San Diego State, who was an active supporter of Filipino and other Asian and Pacific Islander students.
“I’m talking to my friends and there are whole families who are COVID-19 positive,” Field said. “Even in just my immediate family, I have cousins who are scared to be around their moms because they are nurses. This has not happened in our community before.”
Filipino community leaders and health care workers in San Diego believe that their community has been hit especially hard by COVID-19, but data about the virus’ impact specifically on Filipinos has proven hard to come by.
“I’m trying to direct my anger and sadness into advocacy,” Fields said. “These people can’t have died in vain.”
Most public health data regarding the pandemic groups dozens of nationalities, who speak hundreds of different languages, under one category when it comes to race and ethnicity: “Asian.” But not all Asian communities have been equally affected by the virus, and many in the Filipino community believe that being grouped with other communities may be hiding the true impact on Filipinos.
“What’s critical, particularly in pandemics and epidemics, is you need to be able to communicate with at-risk communities,” said Dr. Maria Rosario Araneta, a professor of family medicine and public health at UC San Diego School of Medicine.
There are several reasons why those in the Filipino community in San Diego believe they’ve been contracting and dying from COVID-19 at higher rates.
One is that some of the most affected ZIP codes in the county are also where Filipinos live.
“When I review the areas that have the highest number of cases, they are places with Filipinos,” said Fields. “At one point it was 92154, where I was raised. Then there is 91910 in Chula Vista, where I live now, and 91950, which is National City, where we shop, where many Filipino businesses are.”
Mira Mesa, which also has many Filipino residents, has also seen higher COVID infection rates than the communities surrounding it.
Many Filipinos work in the health care sector or in other essential, high-risk employment, like in assisted living facilities.
Filipinos make up nearly a fifth of registers nurses in California, according to a 2018 Board of Registered Nursing survey. Soon after the Philippines became a U.S. colony in 1898, the United States implemented American nursing programs in the country. Then in the 1960s, a change in U.S. immigration laws and a shortage of nurses resulted in many Filipino nurses coming to the United States to work.
“If we know the numbers a little bit better, then it’s easier to start looking at the issue and try to figure out what is happening and why,” said Crisamar Anunciado, a senior medical liaison for AstraZeneca.
What the Existing Data Shows
There is some limited data, both nationwide and from other localities, that show Filipinos have been hit harder than other groups.
A September 2020 report from National Nurses United, the country’s largest nursing union, found that even though Filipino nurses make up only 4 percent of the nursing population nationwide, nearly a third of nurses who have died from the coronavirus in the country are Filipino.
Santa Clara County disaggregated its Asian coronavirus cases into subgroups and found that Filipinos and Vietnamese people were being disproportionately impacted by the virus. Though Filipino Americans make up 13 percent of the Asian American population in the county, they accounted for 21 percent of coronavirus cases between June 1 and Dec. 3 last year.
Data collected by the Los Angeles Times in July 2020 found that Filipino Americans accounted for at least 35 percent of coronavirus deaths among Asians in California. The Times also reported at the time that of 48 Filipino Americans known by the Philippine Consulate General of Los Angeles to have been infected with the coronavirus, 19 had died. Though that data is very limited, it suggests a 40 percent mortality rate – far higher than the overall mortality rate from the virus.
There are 43 contact tracers working for San Diego County or county contractors who speak Tagalog, according to county spokeswoman Sarah Sweeney. Four of those also speak Ilocano, another language spoken by some in the Philippines. Sweeney said that since May 5, 2020, 0.7 percent of individuals interviewed by contact tracers requested to be interviewed in Tagalog. This is also likely an underestimate of Filipino cases, since many speak English.
Data locally wasn’t disaggregated from the state largely because at the federal level, all Asian subgroups are categorized as one, said Araneta. But that doesn’t mean states and counties can’t choose to report their data in more detail. Hawaii, for example, has been disaggregating its data and it revealed that the state’s Filipino community had the second worst disparity in the state, making up 16 percent of the population, but more than a fifth of confirmed coronavirus cases.
Araneta said she received some data from the California Department of Health that showed case fatality rates – meaning how many people who have confirmed cases are dying – were high among Asians both statewide and in San Diego County. (Araneta said she wasn’t able to share specific numbers with the media.)
“The message I want to convey is the urgency of disaggregation, especially in the state with the largest Asian American population,” Araneta said. “It hinders our ability to provide information and resources to people. If we don’t have information on subgroups, how do we know what languages to use to reach out to people in need and what venues to target? Do we go to Vietnamese temples or Filipino churches?”
The lack of data about Filipino deaths can also feed into misinformation about the pandemic and the vaccine, said Dr. Gilanthony Ungab, a cardiologist at Sharp Chula Vista and the founder of the Sharp Chula Vista Center for Inclusion and Diversity in Clinical Research.
“As doctors, it would be easier to get the community on board if we had data that showed that Filipino people were dying in San Diego,” Ungab said.
A March report from the UC Davis Bulosan Center for Filipinx Studies found that Filipinos were an at-risk group during the pandemic because of not only their exposure as health care workers, but also because of economic insecurity, pre-existing health conditions, a lack of health insurance and the fact that there are tens of thousands of undocumented Filipinos in California.
Araneta and Anunciado also pointed out that there are also other risk factors, like that Filipinos are more likely to live in multigenerational households.
San Diego County’s Challenge
San Diego has one of the largest Filipino populations in the country.
Between 2014 and 2018, the San Diego-Carlsbad metropolitan region had the fourth largest immigrant population from the Philippines in the country, totaling about 98,000 people, according to the Migration Policy Institute. That makes up 3 percent of the region’s population. The total Filipino population in the region, which also includes those born in the United States, is around 200,000. After Spanish, Tagalog is the second-most spoken non-English language in the county.
So it would stand to reason, the Filipino advocates and health care workers Voice of San Diego spoke to agreed, that the data from elsewhere in the country showing COVID-19 hitting Filipinos especially hard would be relevant here.
“We are such a large ethnic group,” Fields said. “But when we fall under this umbrella of [Asian American and Pacific Islander] that is so huge and diverse, it’s really hard to voice concerns. It feels like our entire community is an afterthought.”
Disaggregating data could potentially identify other groups within the Asian American and Pacific Islander community who may be infected or dying at higher rates, but whose plight remains hidden because they are grouped with so many other nationalities that may have far different experiences during the pandemic.
For example, disaggregated data in New York City showed that South Asians and Chinese New Yorkers were among the racial and ethnic groups hardest hit by the pandemic.
But such data in San Diego County hasn’t yet been made available, at least not publicly, though many in the community have been asking for it – and have even volunteered to do the work if the county would be willing to partner with them or provide some funds to do so.
“This is something we have been asking for a while now,” said San Diego City Councilman Chris Cate, who is Filipino and represents Mira Mesa, which has a large number of Filipino residents. “I don’t know what the issue is. We have a large Filipino community here in San Diego. Elected leaders and policy leaders need to recognize the community and its needs.”
Cate said he worked to get a testing site in Mira Mesa to ensure people in the community have access to testing.
San Diego Mayor Todd Gloria also sent a letter to Gov. Gavin Newsom in August, requesting that the California Department of Public Health report ethnicity by Asian subgroups “instead of using ‘Asian American’ as an overarching label.”
The county did not respond to questions about why the data hasn’t been broken down, but county spokeswoman Sweeney said people self-identify their race or ethnicity for the county’s data collection.
“If you don’t have the data that shows your community is in need, then when funds come that could help, they don’t come to you,” Fields said. “That is a form of racism.”
That’s why Fields, Ungab and others started their own Filipino COVID-19 Task Force, to try and provide information and a voice for Filipinos throughout the pandemic. But even with community members and those in health care willing to take on the additional work, it’s hard to get more specific data without the county’s cooperation.
Other studies have used things like algorithms that analyze last names to divide past data into subgroups, and Ungab and Araneta think such analyses are possible to do in San Diego.
Ungab said he is hoping for a grant so that the Sharp Chula Vista Center for Inclusion and Diversity in Clinical Research could analyze and disaggregate the data. He said he did not receive a grant when they were previously given out by the county.
Araneta also said she has offered to do the disaggregation work for San Diego, but hasn’t received any response. On a brighter note, she did say she had several Tagalog-speaking medical students who were volunteering to work at the vaccine superstations in South Bay to help encourage more Filipinos in the community to get vaccinated.
Anunciado said she thinks the county is doing the best it can, but “what you don’t see is what you don’t see.”
“Until we collect the data and have hard numbers, it’s hard to start fixing what is wrong,” she said.