The Hawaii Department of Health is struggling to fill major holes in race and ethnicity data for coronavirus cases after a sharp increase in cases in August overwhelmed investigators.

More than half of the race data is currently missing, but the information that is available shows that Pacific Islanders — excluding Native Hawaiians — and Filipinos are still experiencing disproportionately high infection rates.

Between Aug. 23 and Sept. 24, Pacific Islanders made up 610 of known cases, with a rate of 108 cases per 10,000 population. Filipinos reported even more cases during that time period, 636, but because they have a higher population in Hawaii their rate of infection was nearly four times lower at 29 cases per 10,000 population.

Medical personnel assist by giving directions on how to self swab during COVID-19 surge testing held at Ala Wai Park on the baseball field. September 5, 2020
The health department fell behind on tracking the racial demographics of people with COVID-19 in August when the state saw a surge in cases and the federal government facilitated wide-scale testing. Cory Lum/Civil Beat

Although race is a risk factor for coronavirus deaths across the nation, that’s not currently the case in Hawaii, according to Joshua Quint, an epidemiologist at the Hawaii Department of Health. But he noted the non-Hawaiian Pacific Islander community has a high mortality ratio by nature of its high infection rate, with 38 deaths.

Quint cautioned against reading too much into weekly trends in race data for coronavirus deaths, noting there’s a lag in when the data is reported.

“In looking at the overall COVID-19 case demographics for Hawaii it is clear that age and the presence of underlying medical conditions are the most important risk factors for COVID-19 deaths,” he said.

 

This graph shows coronavirus race data in Hawaii over time. Screen shot of DOH data interactive

As of Oct. 11, non-Hawaiian Pacific Islanders make up 27% of the state’s coronavirus cases compared to just 4% of the population. That’s still the worst disparity in the state by far, but in previous weeks the community made up as much as 31% of statewide cases. The rate of rising infections has slowed compared with August, according to the state’s new interactive data visualization.

But Quint cautions against drawing major conclusions. He noted more than half of the cases reported to the health department between August 23 and September 24 are missing race data. That’s 2,581 missing out of 4,859 during that time period.

“The same trends that we were seeing when we had complete data are what we are seeing from the data we are collecting now,” Quint said. “I would not infer any drastic change from the trends that we saw in the beginning of July.”

He said there are 443 additional cases that are categorized as either Native Hawaiian or another Pacific Islander community but the state hasn’t yet determined which group they belong to.

As of Friday, data on race and ethnicity exists for nearly 7,800 coronavirus cases in Hawaii. Nearly 4,200 cases still lack such data and state Department of Health staffers are still plugging in missing data as they continue case investigations.

Missing race data ballooned in August as the virus proliferated in Hawaii and COVID-19 investigators became overwhelmed. The Department of Health has been trying to close the gap in missing data with more staff, better technology and new strategies such as using short-form interviews to access race and ethnicity data.

“That said, there was a marked shift in the shape of the curve with a decrease in the number of new cases per day beginning in September due to the combined efforts and sacrifices of everyone in the state, including our Pacific Islander communities,” Quint said.

Still, even a slight improvement is encouraging to Pacific Islanders who are working to help their communities. Josie Howard, who leads the social service organization We Are Oceania, said more widespread mask-wearing has helped slow the coronavirus spread along with faster state Department of Health response to families who test positive.

“I really want to give credit to the community,” she said. “We wouldn’t know how to support the families if they didn’t tell us.”

The city has also been improving its outreach to the Pacific Islander community. Honolulu Mayor Kirk Caldwell’s administration recently hired Shanty Asher to serve as a liaison to the Pacific Islander community, the first Pacific Islander on Caldwell’s staff.

The city is funding a new help line at We Are Oceania. The organization is hiring bilingual specialists to help answer calls in seven Pacific Islander languages: Chuukese, Marshallese, Kosraean, Yapese, Pohnpeian, Palauan and Samoan.

Quint said he’s also closely watching the curve in the Filipino community, noting that in mid-August it surpassed the white community to be the second largest number of cases.

Community Outreach

Leaders from Hawaii’s Marshallese community are particularly happy to hear of a flattening curve and say that reflects months-long efforts to educate their community. Although the state doesn’t post a breakdown of cases among Pacific Islanders, Marshallese community leaders say there have been relatively few COVID-19 deaths in their community compared with other cities on the mainland.

Isabela Silk, the consul general, said a Hawaii COVID-19 Marshall Islands task force, made up of Marshallese community leaders from each county, has been meeting weekly since March. The group has been busy answering questions from pastors and other community leaders and translating state, county and federal coronavirus guidance into Marshallese.

“Since March we’ve been observing what’s happening around the mainland,” she said. “We knew that we needed to be prepared and shouldn’t wait until it started hitting our community.”

Here’s an example of a video in Marshallese encouraging people to contact the new helpline:

In lieu of their annual in-person Marshallese Education Day event celebrating school achievement, Marshallese children participated in a TikTok challenge to encourage people to wear masks and social distance. The task force recently even held a concert on Facebook to entertain Marshallese residents stuck at home.

She compared the COVID-19 preparations to the Marshallese word for preparing before a storm comes, manjabobo.

“It’s always good to manjabobo,” she said.

Dr. Wilfred Alik, a Marshallese physician who is another member of the Hawaii task force with Silk, said he was disappointed with the state’s response to COVID-19 but has been encouraged recently, particularly by comments from Honolulu Mayor Kirk Caldwell about the importance of not forgetting Pacific Islanders.

“They’re starting to realize that you know what, we’re in this thing together,” Alik said. “We’re all a part of this pandemic.”

He noted that the Marshallese community in Hawaii and Pacific Islander community more broadly have been working to conduct food drives, deliver masks and hand sanitizer and educate other members of their community about how the virus works so that they can make informed choices.

“We are not just bystanders. We took the initiative to really try to help our people. That’s something we’re really proud of,” he said. “We took matters into our own hands.”

This story was produced with support from the USC Annenberg Center for Health Journalism National Fellowship and its Dennis A. Hunt Fund for Health Journalism.

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