As second-worst hit by COVID-19 in Hawaii, Filipino community continues to be resilient

By Jim Bea Sampaga

On Sept. 8, Honolulu Mayor Kirk Caldwell extended Oahu’s second lockdown order until Sept. 23. The “Stay-at-Home, Work-from-Home” order was supposed to be lifted on Sept. 10.

“The one thing we’re not going to do a second time is rush to reopen and then have a second spike. We’re going to be much more cautious, much more conservative,” Caldwell said at a news conference.

Non-essential businesses such as retailers, salons and gyms are closed while restaurants continue to operate for takeout orders only. Social gatherings are still banned.

On the same day Caldwell announced the extended lockdown, the state Department of Health also announced the total number of COVID-19 cases in Hawaii surpassed the 10,000 mark.

As of Sept. 16, the statewide total of COVID-19 cases is 10,946 with 103 fatalities.

Twenty percent of the total cases are Filipinos even though they only make up 16% of the state population. This also makes the Filipino community the second highest in COVID-19 infection rates in Hawaii, following Pacific Islanders (30%).

Frontliners, Essential Work
Dr. Marel Ver, president of the Philippine Medical Association of Hawaii (PMAH), says their organization acknowledges the alarming rise of COVID-19 cases in the Filipino community.

“As all members of PMAH take care of Filipino patients, we recognize this trend,” said Dr. Ver in an email interview. “Many physicians, through our own questioning and contact tracing efforts, have compiled similar reasons for this high rate [of COVID-19 cases in the Filipino community].”

Despite Caldwell’s lockdown order urging Oahu residents to work at home, most Filipinos can’t bring their work home as they make up a large number of Hawaii’s frontline and essential workforce in healthcare, food, hotel and service industry.

According to the Hawaii Center for Nursing, nearly one-third of registered nurses in Hawaii are Filipino. Many Filipinos also work in healthcare as doctors, nurse aides and caregivers.

In an interview with KITV, PMAH president-elect Dr. Lyla Prather said working in the healthcare and service industry “puts us at higher risk because we don’t have jobs where we can work from home.”

Dr. Ver also notes that some essential workers are also working multiple jobs and riding the bus for transportation. “Usually, these jobs don’t have sick leave, nor can they miss time off from work,” said Dr. Ver. “The exposure to the outside environment and other people puts these workers at risk for contracting and spreading COVID-19. Therefore, it is important to take safety precautions en route and at work.”

Cultural Norms
As Filipinos risk contracting the virus as an essential worker, they also risk spreading the virus to their family members in their multi-generational homes. Multi-generational homes are common among Filipino families in which multiple family members share the same spaces.

With the majority of its residents being Filipino and Pacific Islander, Kalihi is experiencing the worst COVID-19 outbreak in Hawaii. Councilman Joey Manahan thinks multi-generational households contributed to the outbreak in his district.

“Because they don’t have the space to quarantine properly, I’m hearing the numbers are going up every day,” Manahan said in an interview with Honolulu Civil Beat.
Additionally, some people also pointed out that Filipinos often host large gatherings at home or outdoors such as funerals, church services and parties but Dr. Prather disapproved of this idea during the KITV interview.

“I don’t necessarily think that statistically we are at higher risk or we don’t do any kind of a thing to prevent the spread. We do. We’re always really diligent about wearing our masks. It really starts with the knowledge in the home. Not just being able to distance, that’s very difficult for anybody in Hawaii because we are all about aloha,” she said.

According to Dr. Ver, it’s important to be mindful of each other’s exposure risk because there’s no way to tell if a person is an asymptomatic COVID-19 carrier even you all live in the same household.

“The unfortunate scenarios we have seen come from the essential worker spreading the virus in their place of work when the actual initial exposure was from the person’s home from a family member,” she explained.

COVID-19 in the Philippines
In the Philippines, the total number of COVID-19 cases is 257,863 as of Sept. 12. While the total number of fatalities is 4,292. Currently, the Philippines has the most COVID-19 cases in Southeast Asia.

The Philippines started with multiple setbacks with dealing COVID-19, according to public health expert Dr. Susan Pineda Mercado who is a former Director of the World Health Organization’s Western Pacific Regional Office and the incoming Director for Food Systems and Resilience of the Hawaii Public Health Institution.

“Unlike its neighboring countries, the Philippines has never experienced an outbreak of the magnitude of SARS or MERS-CoV. Hence, the experience and preparedness were not in place,” said Dr. Mercado.

“We started without the capacity to do the testing. COVID-19 hospitals were not immediately designated. And organizing the response for isolation facilities took time. By April, more than 20 doctors paid for this inexperience with their lives.”

Despite the lack of initial response, the Philippines was one of the first countries to ban all inbound and outbound China flights in late January and early February. It’s also the country with the longest lockdown in which they enforced an “enhanced community quarantine” lockdown since mid-March.

By April, they required everyone to wear masks when going out. In mid-July, a relaxed community quarantine was implemented which caused a spike in the country’s COVID-19 cases.

The lockdown was implemented without proper support in place for its citizens. As the economy crashes and businesses suffer, Dr. Mercado said, “hunger was the biggest threat as people lost daily income and it was difficult to distribute food.”

Overall, Dr. Mercado said that “the government has been very responsive to the needs of people, but given the severe economic backlash, urban congestion, crowding, poor living conditions and limited capacity of health facilities—it has been difficult; but in general people are cooperative and there is a sense of stability despite the uncertainty.”

COVID-19 Pandemic for Asian-Americans
Hawaii’s lockdown orders pushed businesses on the brink of closure and left thousands unemployed. According to the Economic Policy Institute, the Asian unemployment rate in Hawaii is 21.9%.

The COVID-19 pandemic has also exposed the mental health crisis in the Asian American community. The economy’s downturn, high unemployment rates and alarming rise of COVID-19 cases cause one-third of Americans to show signs of clinical anxiety and depression, according to the Bureau of Census.

For many Asian Americans, physical and mental health visits, hospitalization and medicines are unaffordable, especially for those without health insurance. In an American Association of Retired Persons study, 20% of Asian American adults aged 50 to 64 do not have health insurance.

Sending A Message
PMAH strongly believes that COVID-19 educational campaigns should be more accessible in different languages especially for the at-risk community including Filipinos and Pacific Islanders. It’s also important to hire contact tracers who can speak different languages.

“As people should be staying home, TV, online media and radio are very powerful. We should strongly encourage masking, hygiene, and distancing in a manner that sounds important,” said Dr. Ver.

“There is a crucial immediate need for contact tracers who speak the native language and can convey proper isolation measures and explain important risk reduction measures. To communicate in a culturally sensitive way will get more compliance from the population, given that there is more understanding, connection, and mutual respect.”

Through social media platforms such as Facebook, Instagram and YouTube, PMAH has been providing COVID-19 education and safety protocols to the general public in English, Tagalog and Ilokano. They are also starting an online series on Facebook Live where PMAH members share their experiences as frontline doctors fighting COVID-19. They have also partnered with various Filipino organizations to reach more audiences in the community.

“Special communication campaigns are needed for the Filipino community, using individuals who are highly credible to deliver key messages,” Dr. Mercado added.

Quarantine, Health Services
Dr. Rainier Dennis Bautista of Primary Care Clinic of Hawaii also pointed out that there should be easy access for COVID-19 quarantine facilities especially that there are concerning household-level risks in the Filipino community.

“Since multiple families can live in a single home, one positive exposure can potentially infect every member of that household. Not every member of the household has their own room. Instructing them to quarantine inside their own home puts a lot of hardship on families,” Dr. Bautista explained.

Dr. Mercardo also supports this idea noting that “we need to rethink how our cities and communities are designed.”

Losing your job also means losing your benefits including health insurance. Even though many Filipinos are essential workers, most of them still lost their jobs due to the tourism industry being greatly affected by the pandemic.

Bayanihan Clinic Without Walls, a PMAH-affiliate organization, launched the Job Loss Program to provide free doctor visits to anyone who has lost their jobs or health insurance.

Essential businesses should also provide a better workplace environment for their employees.

“Workplaces will need to come up with protocols for safety, including zoning—or classifying areas into red, yellow and green in offices to protect vulnerable individuals who need to report to work, workplaces should do their own contact-tracing and not wait for the government to do this, or test results to come out,” Dr. Mercado explained.

COVID-19 Vaccine, Safety Protocols
Six months into the COVID-19 pandemic, the world desperately needs a vaccine. The fastest vaccine ever developed was for Ebola, and it took 5 years to be created.

“Currently there are 25 candidate vaccines, the two leading vaccines from the UK and China have just started Phase 3 of Clinical Trials, where the vaccine is given in double-blinded studies to patients who are at risk,” said Dr. Mercado. “Our human experience with this vaccine is 7 months, so unless we wait for a year, we would not know if there could be adverse effects of the vaccine on individuals a year after getting it.”

As we wait for the vaccine, strictly following health safety protocols is the most effective defense we have against COVID-19.

Always wear a mask, frequently wash and sanitize your hands and surfaces, and maintain a social distance of six feet from others. As much as possible, refrain from going out and meeting other people.

Hawaii had a shortage of personal protective equipment (PPE) and PMAH provided $25,000 worth of imported face masks in which they distributed to doctors in the community.

Filipino Resiliency
Filipinos are known for their resiliency especially during tough times. In a healthcare crisis comparable to the great influenza pandemic in 1917, the COVID-19 pandemic has truly changed our lives today and in the future.

As COVID-19 cases continue rising, hospitals, healthcare providers and personnel are doing their best to take care of patients, ensuring that the community is safe. Burnout is becoming common in the healthcare industry.

“Besides supporting the general community, PMAH supports our physicians with resources, education, and continued camaraderie,” Dr. Ver shared.

To help relieve the burnout we are experiencing, Dr. Bautista said, “cooperating with our healthcare providers and our policymakers is of utmost importance.”

Dr. Mercado hopes governments will realize and invest on the importance of public health. She stresses that surviving the pandemic “requires sacrifice and faith” but we need to do everything we can to prevent the spread of COVID-19.

“Deep inside, I feel that God is rearranging our world, and it is important to stop and listen,” she said. “We are the solution to stopping the spread of COVID-19.”