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Deep in rural Nebraska sits a meatpacking plant, where workers stand shoulder to shoulder for hours at a time. In the midst of the Covid-19 pandemic, plant workers pack into windowless rooms for their lunch breaks, where they cannot wear masks while eating.

A recent federal lawsuit filed by the American Civil Liberties Union documented how, in the absence of proper oversight, unsafe working conditions throughout the Nebraskan meatpacking industry created a breeding ground for Covid-19 infection. The lawsuit alleges that plants failed to take basic measures to protect their workers, such as adequate masks provision and Covid-19 testing. “It’s a terrible cycle,” says Albert Maribaga, a South Sudanese community leader, and employment specialist at the Catholic Social Services of Nebraska, “young men go to work at these plants, get sick and don’t know it, and come home and infect their families.”

Throughout the Covid-19 pandemic, the South Sudanese immigrant community of Nebraska has been hit hard, trapped in poor working conditions due to an uncertain economy. Nebraska is home to one of the largest enclaves of South Sudanese immigrants in the United States, with an estimated 10,000 residents in Omaha alone. According to researchers University of Nebraska Omaha, the population of South Sudanese residents in Nebraska is small enough that its value is not publicly available, by the United States Census Bureau. This redaction indicates that the Nebraskan South Sudanese population falls between 10,000 and 65,000 residents. The population of Black or African American residents in Nebraska is 100590 as of 2019, South Sudanese Nebraskans may account for anywhere between 10%-64.5% of that sub-population.

Data from The Atlantic’s Covid Tracking Project reveals that Black or African American Nebraskans account for 5% of the state’s Covid-19 cases, and 6% of their Covid-19 deaths. The accuracy of Nebraska’s Covid-19 race data reporting is suspect, as state officials have only disclosed race data for 50% of cases, and 62% of deaths. In the graph below, we see that of Nebraska’s minority communities Black or African Americans (represented in turquoise) had the highest Covid-19 case rates, as of December 9^th, 2020. It should be noted that Nebraska does not report Covid-19 rates for the LatinX community.

Organizations like the Catholic Social Services of Nebraska, and the Lutheran Family Services of Nebraska help place South Sudanese immigrants in jobs throughout the state. This is not an easy task, as 79.3% of South Sudanese immigrants come to America with a high school level education or less. The Nebraska Office of Health Disparities and Health Equities reports 52.7% of homes that speak African languages speak English less than “very well”. “Because of the pandemic, all job interviews are over the phone,” says Maribaga “translators are not allowed in phone interviews”. With these limitations, South Sudanese community members often are limited to work in meatpacking warehouses, nursing homes, and as housekeepers – all high-risk jobs in the Covid-19 pandemic.

Prior to, and throughout the pandemic, the Trump administration has pursued an aggressive deregulatory agenda, reducing safety standards for industrial and service workers. In 2017, the Trump administration halted electronic reporting of workplace injury and illness reports by the Occupational Safety and Health Administration. In June 2018, Trump’s Center for Medicare and Medicaid Services halved fines for nursing homes violating safe working condition practices. Although the federal government was pressured to require greater transparency from nursing homes regarding Covid-19 outbreaks in May 2020, these facilities are not required to inform staff members about case rates in their facilities.

But it is the conditions in the Nebraskan meatpacking facilities, such as the Smithfield Foods warehouse in Crete, and Noah’s Ark processing plant in Hastings, that have been the source of countless Covid-19 cases, and deaths. In February 2018, the Trump administration revised inspection standards for the Federal Food Safety and Inspection Service, reducing government oversight of safety measures in meatpacking warehouses with the intent to increase food production speeds.

South Sudanese meatpacking workers have relied on their employers’ healthcare plans to protect them and their families during the pandemic, all too often these healthcare plans are insufficient. Albert Maribaga reports new meatpacking workers find themselves without coverage, if their healthcare deductibles go unmet. Maribaga also notes that long term hospital care is not covered in meatpacking healthcare plans. Workers infected with Covid-19 are forced to stay home without pay, with no room in their budget to seek the extended treatment necessary to deal with severe symptoms. Christa Yoakum, Senior Welcoming Coordinator for Nebraska Appleseed’s Immigrants & Communities Program, alluded to another issue with meatpacking healthcare: “many plans are not accepted by local hospitals, and in-network hospitals are too far away to access”. Undocumented South Sudanese Nebraskans are unlikely to seek treatment altogether, as they are without social security numbers.

The Nebraskan South Sudanese community faces socioeconomic factors, outside of poor working conditions, that contribute to the spread and fatalities of Covid-19. Approximately 1 in 3 Black, non-Hispanic Nebraskans live in poverty. According to Christa Yoakum: “if workers don’t get Covid in the factory, they get it while carpooling to and from the factory because they cannot afford individual transportation”. Yoakum also points out, that often times both parents in immigrant households get infected with Covid-19, because both work in the same facility.

Cezar Garcia, a Community Organizer for Nebraska Appleseed’s Immigrants & Communities Program, highlights how community dynamics, brought on by economic stress, contributes to the spread of Covid-19 in the South Sudanese community: “often times meatpacking workers aren’t just providing for their immediate family, they support their extended family too”. Sole providers for households or extended networks face pressure to show up for work regardless of health risks, even if they test positive for Covid-19. It is common in these communities for older members to live with their families, because they cannot afford housing in assisted living centers. While younger family members with more robust immune systems can fight off the symptoms of Covid-19, elders perish. At the time of our interview, Albert Maribaga knew of five community elders who had passed away that week.

Some Nebraskan institutions are developing programs to help their immigrant communities, centered around inclusion, employment, and awareness. In South Sioux City, newscasters have been broadcasting public service announcements about Covid-19 in the different languages of Nebraska’s immigrant communities. “These awareness initiatives are so important,” says Cezar Garcia, “I have heard stories about people who don’t know when or how to wear their masks, and they’ve been relying on the news to get that information”. Food banks across Nebraska have adjusted their models for food delivery, opting to subsidize restaurants and grocery stores that serve foods from immigrant’s home countries. Christa Yoakum has confirmed that an anonymous donor has financed an angel fund to help pay for the treatment of Covid-19 infected undocumented workers. The Worldwide Education Services have doubled down on its existing proposals to Nebraska’s state senate lobbying for the certification of immigrant practitioners who hold medical licenses in their home countries to be certified as registered nurses and vaccine administrants.

The road to commensurate support for South Sudanese immigrants in Nebraska is long, but the Covid-19 pandemic has brought them unprecedented connection to non-for-profits. “Nebraska is a big state, we have relied on volunteers and word of mouth to build connections to immigrant communities,” says Yoakum “now, we have direct communication with community members, and we will strengthen and deepen our ties with them to provide long term support.”

 

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.

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