Katherina Faustino didn't think much of the sore throat she developed in late July. As an intensive care nurse at a hospital in Henderson, Nevada, she always wore a mask at work and was used to her throat's constantly feeling dry as a result.
But then she started coughing. And then came a fever that lasted for seven days. Five days after she began exhibiting symptoms, she tested positive for COVID-19, the disease caused by the coronavirus. Then all the adults in her household — her husband, her brother and her in-laws — also contracted the virus. And as a mom of a 10-month-old, she was left with no choice but to care for her daughter while infected.
"I felt like I brought this home to my entire family," said Faustino, 46.
Faustino and her family are among many Filipino Americans across the country who have been heavily affected by the pandemic for a variety of reasons, including their large presence in the U.S. health care system — particularly in nursing — and their high rates of pre-existing conditions.
According to the nonprofit Migration Policy Institute, Philippine immigrants represent the largest share of America's 512,000 immigrant registered nurses, at 28 percent, although that figure is likely an undercount.
Catherine Ceniza Choy, author of "Empire of Care: Nursing and Migration in Filipino American History," told NBC Asian America in April that studies often don't account for second- and third-generation U.S.-born Filipino Americans who also enter the profession.
The large number of Filipino nurses is rooted in the country's colonization of the Philippines in the first half of the 20th century, when Americanized nursing programs were created, Choy said. And when the U.S. experienced a shortage of nurses in the 1960s following the establishment of Medicare and Medicaid, it recruited nurses from the Philippines.
As of Aug. 24, at least 193 registered nurses in the U.S. have died of COVID-19 and related complications. Of those, about 30 percent were Filipino.
According to National Nurses United, Filipinos account for 4 percent of registered nurses across the U.S. In California, they constitute nearly 18 percent of registered nurses. And the group has been hit hard by COVID-19.
Data compiled by National Nurses United found that as of Monday, at least 193 registered nurses in the U.S. have died of COVID-19 and related complications. The number is based on media reports, social media posts and obituaries, but the group says it's likely to be an undercount because many deaths aren't publicly reported. Of those, about 30 percent were Filipino.
"That's relatively high, knowing that only 4 percent of U.S. nurses are Filipino," said Zenei Cortez, president of National Nurses United and the California Nurses Association.
Cortez, who immigrated to the United States from the Philippines in 1974, attributes the deaths to several factors, specifically the shortage of personal protective equipment, raising nurses' risk of contracting COVID-19.
She also noted a lack of testing among front-liners: A survey conducted by National Nurses United found that 77 percent of nurses aren't being tested for COVID-19.
It's an experience Cortez endured after she requested a test from her employer when she developed a sore throat and a fever. Because she had only a few symptoms, her request was declined.
A recent survey conducted by the University of California, Davis' Bulosan Center for Filipino Studies also revealed low rates of testing in the community, research director Roy Taggueg said. He said the reasons for the low rates of testing need more analysis, but he said they're linked to the model minority myth, the perception that all Asian Americans are successful and don't need extra resources.
He said about 40 percent of respondents reported that either they work in health care or have family members working in health care. And because Filipino Americans often live in multigenerational households, the community's risk of infection is increased.
"One person might be going out, but they definitely are bringing everything back with them when they come home from work, because they're forced to work out there on the front line," he said. "We're talking about their parents, their kids, all of that. It's a very particular position to be in, and it's one that I think is unique to the Filipino and Filipino American community."
Alexander Adia, a co-founder of and researcher with the Brown University Philippine Health Initiative for Research, Service, and Training, said that the effects of COVID-19 on Filipino Americans weren't unpredictable but that they were masked because of the aggregated collection of health data.
Data from American Public Media Research show that Blacks and Native Americans have suffered the highest rates of COVID-19-related deaths, while Pacific Islanders and Latinos have recently had their highest spikes in numbers of deaths. Meanwhile, Asian Americans, who account for 5.7 percent of the U.S. population, represent 4.2 percent of COVID-19-related deaths.
But in California, where Filipino Americans are about 25 percent of the state's Asian population, they represent at least 35 percent of coronavirus deaths in that group, according to data compiled by the Los Angeles Times.
Research by the Bulosan Center found that Filipino Americans are also more vulnerable to COVID-19 because of factors like the community's undocumented population, economic insecurity, lack of health insurance and high rates of pre-existing conditions.
A study published this year by researchers at Brown University and UCLA highlighted that among some Asian subgroups, Filipinos appeared to be in the worst health, with a greater prevalence of high blood pressure, asthma and heart disease.
Filipino Americans who work in health care, for instance, may have long commutes, stand on their feet for lengthy shifts and return home to care for members of multigenerational households, leaving little time and energy to exercise or cook healthy food, he said.
"The commentary on being sedentary and eating a high-fat, high-caloric diet — these are products of stress. You don't have to be Filipino American to stress eat. But if Filipino Americans are bearing a lot of these stressors, then it's of course going to result in behaviors like that," Adia said.
Given the disparities, Taggueg said, it's crucial that information about COVID-19 is disseminated in a culturally sensitive way.
Filipinos and Filipino Americans deserve to be looked at and not brushed under the table as part of this larger Asian American community.
Taggueg said disaggregating data is another key.
"Filipinos and Filipino Americans deserve to be looked at and not brushed under the table as part of this larger Asian American community," he said. "Everyone's experiences are unique, and to put us all under this umbrella and treat us as if we're doing great is highly damaging to our community members."
Faustino, the Nevada nurse, said adequate protective equipment should have been supplied to medical professionals long before the pandemic reached its current magnitude.
"I shouldn't have to put my life in danger just to do my job," she said in tears.
After having recovered, Faustino returned to work last week. She said she was looking forward to caring for patients again, as she's done for the past 20 years.
"But am I scared? Of course I'm scared," she said. "The worst thing imaginable is bringing it home to my family, and that's exactly what happened. But I still have to do it, because if the front-liners aren't there, who's going to take care of the sick?"