About two weeks ago, an Arkansas resident who worked at a Tyson Foods factory died of COVID-19. The death was one of tens of thousands across the nation due to the coronavirus pandemic.

But to Melisa Laelan, the loss was especially worrisome. That’s because the person who died was the first reported Marshallese person to die of COVID-19 in the state. Laelan, the director of the Arkansas Coalition of Marshallese, estimates the state is home to about 13,500 Marshallese residents, one of the largest concentrations in the U.S.

She has since watched the confirmed coronavirus cases climb for her community.

“All of a sudden we went from zero to 40,” she says. This week, Arkansas reported 46 total COVID-19 cases among those who identify as Native Hawaiian or another Pacific Islander ethnicity. Laelan suspects most, if not all, of those cases involve Marshallese residents, although that breakdown isn’t available.

Forty-six is a tiny fraction of the the 1.34 million coronavirus cases reported in numerous communities throughout the country.

But for Arkansas’ Pacific Islanders, that’s four times more than their share of the state’s population. The community makes up only about 0.3% of Arkansas’ population, according to the 2018 American Community Survey. But so far they comprise about 1.2% of coronavirus cases in the state, and 1.4% of deaths.

Multiple states are reporting high rates of COVID-19 in Native Hawaiian and other Pacific Islander communities. A Civil Beat review of state-level health department data found that indigenous Pacific peoples face disproportionate rates of COVID-19 in California, Alaska, Colorado, Oregon, Utah, Hawaii, Arkansas and Washington.

It’s not clear how many of the cases are actually affecting Native Hawaiians compared with other Pacific Islander communities, because no state has yet separated the data to that extent.

The absolute numbers of people with the virus are relatively small, but as a proportion of the population they’re high. In Los Angeles, Pacific Islanders have a COVID-19 death rate that’s 12 times higher than Californians who are white.

In Alaska, Native Hawaiians and other Pacific Islanders represent 3.4% of coronavirus cases, even though they only make up 1.1% of the population. In Colorado, the community makes up just 0.12% of the population, but comprises 1.61% of COVID-19 deaths. Pacific Islanders in Oregon have the highest rate of COVID-19 in relation to their population compared with any state — 16 per 10,000, more than three times the rate of white Oregonians.

In Hawaii, these glaring disparities don’t currently exist, according to available data. The state Department of Health says that 13% of coronavirus cases involve Native Hawaiians or other Pacific Islander communities, who represent 10% of the population when you exclude people who have more than one race.

But Native Hawaiian advocates are concerned that the data’s multiracial category could be obscuring cases involving their community. Still, Hawaii has generally been hit less hard than states like Washington by coronavirus in part due to early enforcement of social distancing guidelines.

Joseph Keawe‘aimoku Kaholokula, a professor and chairman of the Native Hawaiian Health program at the University of Hawaii medical school, recently co-wrote a paper on the disparities, highlighting the high rates in Utah, California, Oregon, Hawaii and King County, Washington.

Kaholokula says indigenous Pacific people are at higher risk of contracting COVID-19 because of socioeconomic factors that have long gone unaddressed.

“The vulnerability has nothing to do with race and ethnicity. It has everything to do with conditions we are more likely to be in because of racism,” he says.

A lot of race and ethnicity data about coronavirus is still missing, including in three states and every U.S. Pacific territory. In Nevada, for instance, there’s no racial breakdown yet of COVID-19 data but Clark County data shows Pacific Islanders are disproportionately affected in coronavirus cases, hospitalizations and deaths.

The numbers are small, and changing every day. And they’re being compared to population surveys that have a margin of error. But leaders in indigenous Pacific communities are worried that without targeted action, the virus could rip through their communities, where families often live in multi-generational homes and rates of diseases like diabetes and obesity are already high.

“If you wait for those numbers to increase, you’re asking for our population to be decimated,” says Raynald Samoa, a Samoan physician in Los Angeles who co-wrote the paper with Kaholokula and recently recovered from COVID-19.

A High-Risk Community

Part of the urgency is that Pacific Islanders already suffer from multiple health disparities.

They have high rates of diabetes and hypertension, two illnesses that recent studies suggest are correlated with higher COVID-19 death rates, Kaholokula says. At the same time, Kaholokula says, Native Hawaiian and other Pacific Islander youth have high rates of smoking and vaping.

The disparities are prompting Pacific Islanders, including Hawaiians, across the nation to organize and call for better public policies for their communities.

The Office of Hawaiian Affairs has been pushing for disaggregated data in Hawaii that would separate Hawaiians from other Pacific Islanders. Nationally, the Pacific Islander Center of Primary Care Excellence formed a Pacific Islander COVID-19 Response team, led by Samoa and Nia Aitaoto, an associate professor at the University of Utah’s College of Health. The group is pushing for more targeted testing, language translations and better health care access for Pacific communities.

Dr. Wilfred Alik, a Marshallese physician in Hilo, says the Marshallese community created a local COVID-19 response team after the virus infected a Marshallese Kona resident.

“It’s very devastating,” he says of the pandemic. “It’s exposed and highlighted the major health disparity suffered by this population to which the federal government can no longer turn a blind eye.”

He hopes broader awareness of Pacific Islander health disparities prompts policymakers to reinstate Medicaid coverage for migrants like him who legally moved to the U.S. from Palau, the Marshall Islands or the Federated States of Micronesia.

“If there’s ever an optimal time to make this right, now’s the time to do this,” he says.

Missing Data

There are more than 1.5 million people in the U.S. who are part-Pacific Islander, according to data from the 2018 American Community Survey. Even though the community is relatively small, it is extremely diverse. Pacific Islanders include people indigenous to U.S. states and territories, including Hawaiians, Chamorros and Samoans from American Samoa.

Many are also native peoples from Polynesia, Micronesia and Melanesia who migrated to the U.S., or their descendants.

Getting data about them is challenging, however.

Federal data collection guidance has for more than two decades recommended separating Native Hawaiians and other Pacific Islanders from other categories like Asian. But most states aren’t doing it. The majority of states tracking COVID-19 race and ethnicity data either combine Pacific Islanders with Asians or Native Americans, or exclude them altogether.

There are a lot of reasons that could be the case, says Aitaoto from the University of Utah. In many states, there aren’t a lot of Pacific Islanders, and some hospitals won’t report racial data unless the numbers exceed a threshold, she says. Lack of awareness is also a factor.

“States where they disaggregate Pacific Islanders are where there’s a good number of Pacific Islanders and also where people know who Pacific Islanders are,” Aitaoto explains.

Communities that do try to separate those groups could still be undercounting them because more than half of the population is multiracial, says ‘Alisi Tulua, the program manager for the Orange County Asian and Pacific Islander Community Alliance.

“Even though we have some of this data, it is not the complete picture,” she says.

Regardless of the reason, the lack of data can have real consequences for what money and attention is allocated for government services.

“We want good data because we know that’s how resources are given out,” says Kaholokula from the University of Hawaii.

More Exposure

The coronavirus itself doesn’t discriminate, Kaholokula says, but because of their socio-economic circumstances, people from Native Hawaiian or other Pacific Islander communities are more likely to catch it. The community works in service occupations at a higher rate than the U.S. average, according to 2018 data from the American Community Survey.

Once the virus is caught, advocates fear the contagious respiratory illness could easily spread through their families. On average, Native Hawaiians and other Pacific Islanders have bigger households and are more likely to live in families where grandparents take care of grandchildren.

That’s a concern for Tulua from the Orange County Asian and Pacific Islander Community Alliance, who is of Tongan descent and lives with her parents, her brother, his partner and children. She says the pandemic comes as many young Pacific Islander people are trying to reconnect with their culture and learn from their elders.

“If we are not careful as a community we run the risk of losing an entire generation that holds the connection between the diaspora and our culture back home,” she says. “That is a very scary thought. The same way that we spread love easily as a culture we can easily spread this disease within our families.”

Apart from the health concerns, the unemployment spike associated with pandemic shutdowns could exacerbate existing economic inequalities. Already, people who are part Native Hawaiian or another Pacific Islander community are less likely than the average American to own homes and more likely to be renters. They are more likely to be veterans, and more likely to be unemployed.

There are also disparities within the broader Pacific Islander community. The national poverty rate for American families was 9.3%, according to the 2018 American Community Survey. For Native Hawaiians, it was 10.1%. For Samoans, it was 12.4%. For Micronesians it was 14.6%.

Nationally 6.2% of people who identify as part Native Hawaiian lack health insurance, compared with the national average of 8.9%. But that number rises to 9.5% for people who are part Samoan, and 11.2% for people who are part Micronesian, according to the 2018 American Community Survey.

Concerns about the health and economic costs of the pandemic are spurring action and calls for further data disaggregation to help better target responses. Some Pacific communities could benefit from more language interpretation and translation, and others could use more culturally specific interventions, advocates say.

In Hawaii, Native Hawaiian-serving organizations are delivering meals to kupuna and working to help Hawaiian-owned businesses affected by COVID-19. Laelan in Arkansas is helping Marshallese residents with housing and food deliveries. Service providers helping Hawaii’s Micronesian community are fielding an onslaught of requests to help apply for unemployment.

In Oregon, advocates used data on COVID-19 rates to persuade the state to add Pacific Islanders to the list of communities that are priorities for COVID-19 testing, says Manumalo “Malo” Ala’ilima, who chairs Utopia PDX.

She and several other advocates formed the Oregon Pacific Islander COVID-19 Emergency Response team on April 24, made up of people who are a range of Pacific ethnicities including Palauan, Chuukese, Pingelapese, Marshallese, Chamorro, Samoan, Tongan and Native Hawaiian.

Josie Howard, who runs the nonprofit We Are Oceania in Honolulu that serves citizens of the Federated States of Micronesia, Palau and the Marshall Islands, says that there’s a silver lining to the virus: it’s brought different Pacific Islander communities together.

“You forget that I’m Chuukese, he’s Samoan, he’s Hawaiian, she’s Chamorro,” she says. “You forget that because you are all united on one thing, and that is to care for the community.”