Coronavirus disease 2019 (COVID-19) is a global pandemic. In the USA, the burden of mortality and morbidity has fallen on minority populations. The understanding of the impact of this pandemic has been limited in Asian-Americans and Pacific Islanders (AAPIs), though disaggregated data suggest disproportionately high mortality rates. AAPIs are at high risk for COVID-19 transmission, in part due to their over-representation in the essential workforce, but also due to cultural factors, such as intergenerational residency, and other social determinants of health, including poverty and lack of health insurance. Some AAPI subgroups also report a high comorbidity burden, which may increase their susceptibility to more severe COVID-19 infection. Furthermore, AAPIs have encountered rising xenophobia and racism across the country, and we fear such discrimination only serves to exacerbate these rapidly emerging disparities in this community. We recommend interventions including disaggregation of mortality and morbidity data, investment in community-based healthcare, advocacy against discrimination and the use of non-inflammatory language, and a continued emphasis on underlying comorbidities, to ensure the protection of vulnerable communities and the navigation of this current crisis.
To combat the disparities emerging during the COVID-19 pandemic, multi-level interventions are required. Policy makers and healthcare leaders must heed calls to release racial/ethnic demographic data on COVID-19 infection and mortality. For those states, counties, and cities that have already released them, the completeness and accuracy of the data must be ensured; in Texas, for instance, only a third of deaths have associated racial/ethnic data. We also recommend the identification of PIs as a distinct group within both national and local data, and to similarly do so for all other AAPI ethnic groups. Data should be stratified by socioeconomic status as well as by the primary languages of communities. Only after we identify at-risk populations can further steps be taken, such as outcome monitoring and differential assistance.
Further, government and healthcare leaders should invest in community-based care. By empowering community advocates in key positions, meaningful community and shared governance can be achieved and, thus, promote long-term health equity and self-determination among the hardest hit populations. Multilingual public service announcements are also important for immigrant communities, to ensure access to information on healthcare services and public health measures such as social distancing. Similarly, research must incorporate minority individuals for whom English is not their primary language. Research that excludes non-English speakers leads to a biased sample that over-represents AAPIs who have high levels of education and income. Such bias contributes erroneously to the “model minority” stereotype.
Finally, we must address the prevention and treatment of comorbidities, such as cardiovascular and metabolic conditions, that are rampant within minority communities and are major contributors to their morbidity and mortality during COVID-19. In the multi-ethnic USA, diversity is key to our strength. To focus on minority communities is thus essential, both to mitigate the damage of COVID-19 on these vulnerable populations and to ensure the weathering of this devastating pandemic.
Population: Asian American Pacific Islander
- Read the full article Asian-Americans and Pacific Islanders in COVID-19: Emerging Disparities Amid Discrimination published on the Journal of General Internal Medicine.
- Learn more about the Journal of General Internal Medicine.
- Access the full set of AAPI infographics and videos from the Division of the American Psychological Association.
- Read the article Asian Americans and Two Pandemics: COVID-19 and Daily Bigotry by Huff Post.
- Check out the recording NNED Virtual Roundtable Communities Respond to COVID-19: Implications for APIs.