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Tanzina Vega: Across the United States, members of the Asian American and Pacific Islander community have become the targets of racist violence from those who wrongly accused them of being the source of COVID-19. The attacks have gotten national attention, including from celebrities like tennis player Naomi Osaka to actors like John Cho. Yet the impact of the COVID-19 virus itself on Asian-American communities has gotten far less attention, especially when compared to other racial and ethnic groups.

That's in part because the data on COVID-19 infections in Asian American populations tell many different stories. Some AAPI subgroups have infection rates comparable to whites, while others like Filipino Americans are among the hardest hit. I'm Tanzina Vega and COVID-19's toll on the physical and mental health of Asian American and Pacific Islander communities is where we start on The Takeaway today.

I'm joined by Karthick Ramakrishnan, founder and director of AAPI Data and a professor at the University of California, Riverside. Karthick, welcome to The Takeaway.

Karthick Ramakrishnan: Thank you for having me.

Tanzina: Also is Leezel Tanglao, multimedia journalist and project director of the Tayo Help Desk, a project of the Filipino Young Leaders Program. Leezel, thanks for being with us.

Leezel Tanglao: Happy to be here.

Tanzina: Leezel, let's start with you. Why has the actual health impact of COVID-19 on Asian American and Pacific Islander communities gotten so little attention?

Leezel: I think it stems from the fact that in many ways, a lot of the conversations that's been happening have taken place in a very binary form, whether it's Black and white, but everything in between often never gets any attention. I think that has had devastating impacts on a community like the Filipino American community, where we are literally on the front lines of COVID-19, but yet very little has been done on the impacts of that for our community. If you just even look at any studies or even news coverage, very little is out there. Part of it I think is just this kind of overall binary perspective where we know that that's not true. There's just so many other threads to that

Tanzina: Karthick, let's talk about what is out there. What does the data tell us right now? We know that data about Asian American communities is often lumped together. It's not often dis-aggregated so that we can see how different communities that fall under that broader umbrella are being affected, but what do we know right now?

Karthick: What we know is, first of all when we look at the impacts of COVID-19, it's not only the health impacts but also the economic impacts. First looking at the health impacts, what the data tells us depends on the kind of data that you're looking at. If you're looking at COVID-19 as the attributable cause of death, from the data that we see in different states that reliably collect this data, doesn't seem like they have a higher risk.

Although those same states, they do not dis-aggregate the data, meaning that they do not separate the Asian population into different nationalities, so groups like Filipinos, for example, or other groups that we don't even know that might have a higher risk. Chances are Southeast Asian groups that traditionally are over-represented in the essential worker population are probably more likely to be at risk. We can surmise that from other kinds of data like occupational data, but we don't actually have the cause of death data that is dis-aggregated.

There's another set of data, which is the disproportionate death data. This is something that the CDC puts out that the Marshall project and Associated Press did an analysis a few months ago and using that data, so that compares the death rate at any given point in time with the prior five-year average in that state, for that racial group.

You see a dramatic increase in the Asian death rate in most states across the country where they have sizable numbers. That's something that's important to note, because that disproportionate death data could reflect the direct effects of COVID-19 as well as indirect effects, either as complicating factors or people delaying their care because they're not going to visit hospitals and clinics.

Tanzina: That not going to visit hospital and clinics is because of what, Karthick?

Karthick: One, in general, Americans are reluctant to go visit hospitals and clinics, but there's a couple of other factors specific to the Asian American population. First is the stigmatization of the kind of rhetoric that we heard during the Trump era, from the president on down. We've seen before, for example, with the onset of AIDS and the gay community, that when you stigmatize a population, they are less likely to seek care.

Chances are very high that that was also going on in the Asian American community. Another factor is the Trump administration's public charge rule. This was a rule that was passed a couple of years ago, which would have made it more difficult for legal permanent residents, green card holders, to become US citizens if they got state assistance, including assistance on healthcare.

That also likely had a chilling effect. We know even before COVID, that people were trying to remove their names out of health clinic records so that they would not risk their chances at naturalization. Both of those factors likely played a significant role even more so than the baseline general population.

Tanzina: Leezel, you were talking earlier about the impact that COVID-19 is having on Filipino Americans and Pacific Islanders specifically. Tell us more about that.

Leezel: The Filipino American community is getting disproportionately impacted by COVID-19 and that's just by nature of the roles we play in society. If you look at the data from the National Nurses United, only 4% of US nurses are Filipino, but about 30%, almost 200 registered nurses, have died from COVID-19 since it started the pandemic. Besides being represented in the medical healthcare field, Filipinos are also on the front lines in different essential roles such as postal workers, grocery workers and things like that. When we work those day jobs, we come home to inter-generational households.

That also has devastated our family structure there, when you're living with multi-generations from your grandparents to other family members, and you're out there working your day job, and you're at higher risk in getting exposed to COVID-19. That has had a devastating impact in our community, along with other cultural barriers that have prevented a lot of folks in our community to seek help because they feel ashamed to do that, or you don't want to let people know that you're sick because you don't want to burden people for that. That's been many of the challenges that the Filipino American community has faced during COVID-19.

Tanzina: Leezel, is that also part of the mental health effect that COVID-19 is having? We've been talking a lot about the physical health effects, but what about the mental health effects that this virus is having on AAPI communities?

Leezel: Most definitely. I think even pre-COVID, mental health is not necessarily a conversation that comes up. It's often just tightly kept within the community, because again, you don't want to let people know there might be something wrong with you. I think COVID has definitely kicked open the door to these conversations that, to be honest, needed to happen a long time ago.

I think it's only now that we've been able to talk more openly about what is happening in our community, how do we deal with it, and how do we talk more openly and address these issues that COVID has surfaced.

Tanzina: Karthick, I'm wondering, we talked a little bit about why people might be hesitant to seek care. They may be afraid because of some of the racist rhetoric and violence that has been targeted at Asian Americans more recently, but I'm also wondering if there are language barriers that could emerge for folks. I live near Flushing, Queens, which is a very dense Asian American community.

There are people who are here for generations. There are people who are recent arrivals. We know that this is one of the fastest growing communities in the United States. Is language and immigration status also, could that be a barrier for folks?

Karthick: Absolutely. When it comes to the Asian American population, it's important to recognize that they are the only racial group that is majority immigrant. Many people when they think about immigrants, they think about Latinos, but Latinos are majority native-born. When it comes to language barriers, actually the proportion of Asian Americans that are limited English proficient is just slightly higher than the Latino population. We can go later into the dynamics of how the different proportionalities work out. Now, there are various clinics, including federally qualified health clinics, that not only provide language assistance but also culturally competent care. In places like New York that you mentioned, this is less of a concern because those resources are there.

That said, the public charge rule did send a massive chilling effect in all of our communities, because immigrants, even if ultimately they hold some kind of a dream of going back to their home country, they are very concerned about naturalization, and the vast majority of Asian immigrants do naturalize. Saying that seeking care will penalize your ability to become a US citizen, that's a very tremendous burden that people have to face, and so they are very reluctant to seek health care.

During COVID, the Trump administration did say that COVID treatment would not count against immigrant populations. It's unlikely that people would have found that credible given the rest of the actions of the Trump administration did. When it comes to language assistance, in larger denser cities it's less of an issue. In more rural and suburban areas where you don't have as much of population concentration, language barriers absolutely are a problem.

Finally, when it comes, beyond just actual medical care, if you look at the PPP program for small businesses and non-profits, if you look at other kinds of programs that try to ease the economic burden of COVID, language barriers emerge significant there as well.

Tanzina: Vaccine equity. Is the population that you're working with, are they getting access to vaccines? We've got one minute to go.

Karthick: Vaccine equity. The data is so far seems to indicate that the Asian average looks on par with the white population. Again, we know that if we dug down with many of the essential worker populations, including not only Filipinos but Vietnamese-Americans, Hmong, Pacific Islanders that are disproportionately represented in the gig economy, those populations need a lot more outreach than is currently happening.

Tanzina: Karthick Ramakrishnan is the founder and director of AAPI Data and a professor at the University of California, Riverside. Leezel Tanglao is a multimedia journalist and project director of the Tayo Help Desk, a project of the Filipino Young Leaders Program. Thanks to you both for joining me.

Karthick: Thank you.

Leezel: Thank you.

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