Maria Abreu’s Article Draft

Alaska’s Covid-19 death rate is among the lowest in the country, yet the state has one of the highest death rates of Native Hawaiian Pacific Islanders (NHPIs).

Despite the 14% surge in cases on Nov. 27, the state’s per capita Covid-19 death rate has remained one of the lowest, at 16 deaths per 100,000 people. The national rate is about seven times that, at 81 deaths per 100,000 people. However, the state has not escaped one nation-wide trend: the enduring systemic, health and social inequalities that have put people of color, especially NHPIs, at increased risk of contracting or dying from the virus.

“(NHPIs) are facing the highest Covid-19 case rates of any race and ethnicity throughout the country,” said Ninez Ponce, director of the UCLA Center for Health Policy Research in a phone interview (UCLA CHPR), and one of the founders of the NHPI Covid-19 Data Policy Lab.

Making up just 1% of the Alaska’s population, the mortality rate of NHPIs is at 83.6 per 100,000 people, according to an epidemiology report released by the state. The next highest mortality rate was among American Indian/Alaska Natives (AIAN) at 26.7 per 100,000 people.

The highest number of NHPI deaths in the state has been nine, but Ponce says that for a group that is so small, “waiting until the 10th death could be too late for these communities.”

The state’s epidemiology report cites that underlying health conditions, along with “long-standing health and social inequities” can partly explain the state’s race-based disparities. However, there are other factors endemic to Alaska that contribute to the challenges faced by this group.

Arne Krogh, a dentist who has a private pilot license in Alaska, says that geography, weather, the lack of transportation infrastructure and the concentration of this population in rural areas makes it more difficult for NHPI and AIAN communities to be served and get access to healthcare.

“A lot of them can’t drive because they’re not on the road system. If they need to be ambulanced it’s by air to Anchorage mostly. On a day like today, I’m looking outside my window and it’s snowing sideways. The visibility is probably two miles, so it’s hard to get in and out of some of these places when the weather’s like this. When you add the fact that they’re not on the road system, and you’re always fighting the weather elements up here, it just exacerbates the health care and the lack of services. Even though we want to, it’s just hard to get out there,” Krogh said in a phone interview.

These communities are typically shut off from outside visitors and accessible only by boat or plane, with their only lifeline being through carrier delivery. “These places don’t have level three trauma hospitals,” Krogh said. “Typically, the nurse is also the mailman or the teacher. You have a lot of different people wear different hats.”

Lacking the healthcare infrastructure needed to treat Covid-19 complications, many patients have to be flown to Anchorage in a turboprop or small jet, and if the case is severe, they have to go as far as Seattle or Portland.

These endemic factors could be part of the reason why the death rate of NHPIs in Alaska is one of the highest in the nation, without having the largest population of NHPIs. In fact, the top three states with the highest population of NHPIs, California, Hawaii and Washington, are not among the states with the highest death rates of NHPIs. The Pacific Islander Covid-19 Response Team, a group of NHPIs researchers, health experts and community leaders, reports that the states with the highest case and death rates are Arkansas, Louisiana, Illinois and Alaska.

However, it is difficult to observe any nation-wide virus trend with certainty because only 30% of states are reporting NHPI disaggregated data, according to the UCLA CHPR. Many other states lump together NHPI and Asian American as a single race category.

“(NHPIs) are highly distinguishable, but there’s a frequent aggregation with other racial groups or otherwise complete omission from demographic data. NHPIs are historically and presently overlooked, even in a time when racial disparities in Covid-19 are a significant topic of national public health discussion. With a high-stakes pandemic, there’s an urgent need for widely available disaggregated NHPI data,” said Karla Thomas, a scholar from the NHPI Covid-19 Data Policy Lab at UCLA’s CHPR.

Nationwide, there are other contributing factors to the high death rate. According to Thomas, who is part of the community herself, one in four of them work in essential roles, many are undocumented and are a very communal population. They frequently gather for traditional events like chiefly bestowments and religious ceremonies, which have continued even with rising cases of Covid-19.

UCLA’s CHPR has partnered with the Pacific Islander Covid-19 Response Team to generate reports that are sent to community constituents in the hopes of allocating more resources to help NHPIs. They’ve also planned and implemented infrastructure for informing and supporting families about the virus. Many of their presentations are in Samoan to ensure faith-based leaders, who are primary NHPI-language speakers and trusted messengers of the community, spread the information as widely as possible.

“Pacific people are a minority with a majority mindset. Moving forward, there is a need we have all uncovered. This work is spiritual in its nature. Everyone from (the NHPI Response Team and UCLA) sees this work as a spiritual venture into something greater, because we all hold ourselves – as people who collectively think, eat, live and breathe together in the Pacific Islands – as responsible to each other,” said Thomas.