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South Asian, Chinese New Yorkers among the hardest hit by Covid, study shows

The research shows the importance of disaggregating data for Asian American patients — and the need to do more, advocates say.
Image: Patient wheeled inside Mount Sinai Hospital during coronavirus disease (COVID-19) pandemic in New York
A patient is wheeled across a bridge connecting buildings inside Mount Sinai Hospital in New York City on Dec. 3, 2020.Mike Segar / Reuters

Amina Burhan was home from college in April when she and her entire family got Covid-19. All seven people living in their home in Queens, New York, including Burhan’s mother and aunt, who are health care workers, came down with fevers, fatigue and temporary loss of smell and taste.

“It was like dominoes,” Burhan, 18, told NBC Asian America. “My aunt had it first. Then my grandparents caught it, and they had it really bad — they were coughing, they couldn’t breathe — and it was pretty terrifying for a good week-and-a-half.”

Burhan said they were too scared to go to the hospital, but the family eventually recovered. (She said she got the virus a second time in November after she went back to her college campus.)

According to a new report, South Asians were among the racial and ethnic groups hit hardest by the Covid-19 pandemic in New York City. At 30.8 percent, South Asian Americans had the second-highest rate of test positivity, after Hispanics, and at 54.7 percent, had the second-highest rate of Covid-19 hospitalizations, after Black people, between March and May. (South Asian death rates were lower than for whites and Asian Americans as a whole.)

The first study to offer disaggregated Asian American data shows Chinese New Yorkers have had higher Covid death rates than any other racial group at 37%, and South Asians in the city have had the second highest rate of test positivity behind Hispanics.

The study was posted on medRxiv, a "preprint service" that distributes unpublished medical papers before they've been peer reviewed. The study is the first of its kind to offer some disaggregated data on Asian American Covid-19 patients. The analysis examined more than 85,000 patients who sought care in the New York City Health and Hospitals system — the largest public health care system in the United States — and used last name databases and language information to disaggregate, or separate data, about the city’s two largest Asian American subgroups, South Asian and Chinese.

The results also show that while Chinese New Yorkers had lower test positivity and hospitalization rates than South Asians, they had the highest mortality rate of all racial and ethnic groups. Chinese New Yorkers had a mortality rate of 35.7 percent, compared to 25.5 percent for all Asian Americans and 23.7 percent for Black New Yorkers. They were also about 1.5 times more likely to die from Covid-19 than white patients.

The researchers said the communities surveyed have several clinical risk factors such as higher rates of obesity, diabetes and high blood pressure. Because of the patient population of the hospital system, they’re also more likely to be lower-income front-line workers, including taxi drivers and restaurant, retail and domestic employees.

“I think so much of this really speaks to the social factors — multiple generations living in crowded housing, not being able to work remotely. I think we’ve been missing that for so long."

Roopa Kalyanaraman Marcello, study co-author

“I think so much of this really speaks to the social factors — multiple generations living in crowded housing, not being able to work remotely. I think we’ve been missing that for so long," said Roopa Kalyanaraman Marcello, study co-author and a senior director of research and evaluation for the city hospital system’s Office of Population Health. When Asians are all lumped together, she said, "we don’t see those differences in socioeconomic status.”

Without disaggregation, Asian American hospitalization and death rates are lower than for whites.

Nadia Islam, another co-author and an associate professor at New York University Langone Health, said that Asian Americans have long been left out of conversations about disparities. “That’s why this analysis is so important, because it really does shed light that this is a significant population,” she said.

Even before this new data was released, South Asian American community leaders had long been concerned about the virus’ disparate impact. Sophia Qureshi, the interim executive director for South Asian Americans Leading Together, said that the advocacy group had been hearing about the challenges faced by South Asians across the country, from working-class communities in Chicago to agricultural and meatpacking workers in California’s Central Valley, and that the study had confirmed these accounts.

“Early on the pandemic, we were hearing from South Asian community based organizations in NYC that the pandemic was hitting them hard, and that that impact wasn’t reflected in the public information out there because of a lack of disaggregated data on Asian communities,” she said in a statement. “The recent findings from the NYC public hospital system affirmed what we had suspected based on interviews we did in those early months — that South Asians were being hit hard by the pandemic because of these vulnerabilities that are so rarely talked about.”

Islam said that she hopes such disaggregated data will help health care systems better target resources and reach out to Asian American subgroups. New York’s public hospital system, for example, is now translating more Covid-19 education materials into additional Asian languages, including Hindi, Mandarin and Cantonese.

The study didn’t disaggregate all Asian American subgroups, including Filipino Americans, another large subset of New York Asians whose presence in the medical field has made the community particularly at risk for Covid-19.

But getting data on any additional Asian subgroups is helpful, advocates say.

“Disaggregated data is absolutely critical,” said Juliet Choi, CEO of the Asian & Pacific Islander American Health Forum, a health advocacy organization. “For the Asian American, Native Hawaiian, Pacific Islander community, we represent over 50 different countries and we speak more than 100 different languages. So to really understand both the wellness — or the lack of wellness — experienced by our communities, we need that disaggregated data.”

Jeffrey B. Caballero, executive director of the Association of Asian Pacific Community Health Organizations, said that without further disaggregation, some Asian subgroups will continue to be invisible, particularly Native Hawaiian and other Pacific Islander communities.

“I hope Covid teaches us all a lesson about how communities that are left out might be untreated, and how we might never be able to get over Covid if we leave people out from vaccination programs and screening programs,” Caballero said.

While South Asians, Chinese and Filipinos comprise a majority of the Asian American population, more studies are still needed to understand the pandemic’s impact on smaller Asian American subgroups, Arnab Mukherjea, an associate professor of health sciences at California State University, East Bay, said.

“We are likely missing comparable or greater disparities in the Covid outcomes studies among Vietnamese, Korean and Japanese populations, as well as Southeast Asian communities,” Mukherjea said.

And while the study’s methodology of disaggregating by analyzing surnames is common, it also “underscores the need for standard and uniform data collection which separates out large Asian American subgroups,” he said.