By Maria Abreu
NEW YORK — Despite the 14% surge in cases on Nov. 27, Alaska’s per capita Covid-19 death rate has remained one of the lowest, at 19 deaths per 100,000 people. The national rate is about seven times that, at 86.7 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 at increased risk of contracting or dying from the virus.
“Pacific Islanders are facing the highest Covid-19 case rates of any race and ethnicity throughout the country,” said Ninez Ponce during a webinar. Ponce directs the UCLA Center for Health Policy Research (UCLA CHPR), and is one of the founders of the NHPI Covid-19 Data Policy Lab, a platform that addresses the dearth of data and research regarding the disease’s impact on Pacific Islanders.
Even though they comprise only 1% of the state’s population, as shown in the graph below, the death rate of Native Hawaiian and Other Pacific Islanders (NHPIs) has been disproportionately high since the onset of the pandemic, at 97.6 per 100,000 people, according to data obtained from The Atlantic’s Covid Tracking Project. The next highest death rate was among American Indian/Alaska Natives (AIAN) at 46.9 per 100,000 people.
The highest number of NHPI deaths in the state has been 10, but Ponce says that for a group that is so small, “waiting until the eleventh death could be too late for these communities.”
An epidemiology report released by the state on Oct. 15 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 and the lack of transportation infrastructure 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,” said Krogh in a phone interview. “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.”
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.
Joseph Seia, executive director of the Pacific Islander Community Association of Washington, is of Samoan ancestry and lived in Alaska for eight years. His mother and other members of his family currently reside there. Seia says that Pacific Islanders have been more affected than Alaska Natives, despite having similar health issues and needs, because there are no medical services tailored to NHPIs.
On the other hand, Alaska Natives and American Indians do have health centers and organizations that specialize in treating them, such as the Alaska Native Medical Center, the Alaska Native Indian Health Service and the Alaska Tribal Health System.
“The health provisions in Alaska are for Alaska Natives and other Native Americans. I don’t think those places serve Pacific Islanders, even though there are lot of similarities as far as the health needs,” said Seia in a phone interview. “The state of Alaska already has existing relationships with Alaska Native Tribes, and have agreements to support [their] health. Similarly, Pacific Islanders need to nurture that relationship with the state to ensure there’s a safety net for our people.”
Seia says that the state’s long, harsh winters increase the chances of having many of the preexisting conditions that make people more vulnerable to the virus, such as obesity and diabetes.
“When I moved to Alaska, I gained 100 pounds in the first year. I feel like that is a very typical experience when Pacific Islanders move to Alaska or grow up there, because of the six to seven months of winter. That makes it really challenging for folks to prioritize their physical health.”
These endemic factors could partly explain 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, as shown in the graph below, the top three states with the highest population of Pacific Islanders, 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, Iowa, 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.
“[Pacific Islanders] are highly distinguishable, but there’s a frequent aggregation with other racial groups or otherwise complete omission from demographic data,” said Karla Thomas during a webinar, a scholar from the NHPI Covid-19 Data Policy Lab at UCLA’s CHPR.
“[We] 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,” Thomas said.
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.
Seia says churches are essential to inform these communities about the virus and health measures.
“In the islands you have your villages, but when you come to the United States, the churches become the villages. So when you think about engagements that are relevant for Pacific Islander people, you really have to think how the Department of Health partners effectively with the churches, and make sure [they] are being supported. It’s a huge need for Pacific Islanders in Alaska right now,” Seia said.
