SAN FRANCISCO – Mandy Rong was terrified her 12-year-old daughter had COVID-19. It was 2 a.m. and the young girl was hours into a fierce fever and a racking cough. She was weak and didn’t want to eat. What few medications were on hand had expired. She sipped warm water instead.
“Mommy, why are my eyes on fire?” asked Amy Rong.
The mother and daughter, along with Rong’s parents, live in an 80-square-foot windowless single-room-occupancy Chinatown building that is a home of last resort for many impoverished Asian immigrants. Hallways are cramped, bathrooms and kitchens are communal. A ripe setting for the spread of the highly contagious novel coronavirus.
That early March night felt endless. Rong, 42, repeatedly touched Amy’s forehead, wondering if her child would die in the small loft that the two shared. Down below, her father slept on the floor while her mother took the lone sofa bed. The grandparents were eager for updates on Amy’s fever, but they worried their whispers would wake her.
In the morning, the fever had vanished, only to return a week later. Once again, the family endured a restless night. Rong made soup, but Amy wouldn’t eat it. She cooked porridge and spoon-fed it to her daughter.
Getting tested for COVID-19 didn’t seem like an option for the Rongs. The rumor was that the tests were expensive. Rong also feared the reaction from neighbors.
“If you test positive, everyone would be scared of you,” said Rong. “Everyone would think you are the devil.”
It is easy to mistake San Francisco for a thriving Asian American haven. The city, which is its own county, boasts a bustling Chinatown, as well as a popular Japantown. Native Hawaiians, Pacific Islanders, Vietnamese, Indians and Filipinos also have made their homes here. All told, Asians in San Francisco represent upward of 20 countries.
But many Asian American immigrants in the county lead a fragile existence rendered even more precarious with the arrival of COVID-19. So far, 38% of the 123 COVID-19 deaths reported by the San Francisco Department of Public Health are Asian American residents, the most of any ethnicity.
Experts also are concerned that positivity rates among Asian Americans in San Francisco could be far higher than the 12% reported, a by-product of the decades-in-the-making model minority myth, which characterizes this ethnic group as financially successful, physically healthy and upwardly mobile. This belief has caused segments of the Asian American community to long be overlooked when it comes to social services for housing, employment and health.
San Francisco is one of the few places in the nation tracking data on Asian Americans and COVID-19 deaths at a time when officials don’t know the ethnicity of the person affected in nearly half of the nation’s 7.8 million coronavirus cases. Around 17 million Americans are of Asian descent, or 5.6% of the population.
In many cases, Asian Americans in this city have received imprecise or no information in their native language about testing, safety tips, housing and other critical care services during the pandemic. At the same time, the community is struggling with inadequate access to comprehensive health care, the need to keep front-line employment and growing incidents of anti-Asian hate crimes.
“This model minority thing, that’s not us,” said Judy Young, executive director of the Southeast Asian Development Center, a San Francisco nonprofit that helps area residents from Vietnam, Laos and Cambodia. She said 80% of her clients have lost their mostly service industry jobs during the pandemic.
“There is the language barrier and our community is small,” Young said. “So the city doesn’t think we have any problems when we do.”
That risk of invisibility is only heightened by the pandemic. Since city health officials do not break down COVID-19 statistics beyond “Asian American,” many advocates for the city’s various groups said they are left to speculate about coronavirus infection and death rates within their individual communities. How many people are dying, and are those people Japanese Americans? Vietnamese? Korean? Filipino? No one knows.
“There’s this feeling that there's excess death out there,” said Jeffrey Caballero, executive director of the nonprofit Association of Asian Pacific Community Health Organizations. “That high mortality rate among Asian Americans means either there isn’t enough testing or people are waiting far too long to get care.”
What is the model minority myth?
Xing Tam’s mother tested positive for COVID-19 in March. Her symptoms were mild. Medical officials told her to quarantine at home and avoid others.
Suddenly, the working class Bayview district home where Tam, his mother and 17 other relatives and friends live together became uncomfortably crowded. Tam's mother was given one of the three-story home's 12 rooms. For weeks, everyone in the two-story house feared they would be next.
As his mother recovered, Tam, 39, fretted about the cost of health care if he got sick. He worried the doctors wouldn’t be able to speak to him in words he could understand.
Before the pandemic, life had started to improve for Tam. Five years ago, San Francisco relatives urged him to leave China's Guangdong Province and try his luck in the U.S. He learned some English and landed a job at a hotel in catering. But when COVID-19 hit, his job vanished.
The cost of housing in San Francisco is so expensive, his family has no option but to live together.
“Even if I test positive, I feel there is nothing the government will do to help me more,” he said. “I can see why some people look at Asians here and feel we are all well-off because we work hard and save whenever we can. But for many of us, it’s very challenging.”
For many Asian Americans in San Francisco, the high rate of COVID-19 deaths is directly linked to the corrosive and distorting effects of the model minority myth, said Dr. Tung Nguyen, a University of California, San Francisco professor of medicine.
Nguyen co-authored a report in May by the Asian American Research Center on Health that called attention to the fact that 50% of San Francisco’s 31 COVID-19 deaths at that time were among Asian Americans, disproportionately high considering they make up just over a third of the population.
Although that percentage has since dropped, Nguyen said a lack of detailed data about Asian Americans often means that city funds aren’t allocated to this group.
“The truth is we are the ones who lose out as a result of this stereotype,” he added.
To be sure, the fortunes and contributions of many Asian Americans have skyrocketed in past decades. The median annual income of households headed by the nation’s 22 million Asian Americans is $73,060, compared with $53,600 for all U.S. households, according to the Pew Research Center.
But these success stories obscure the troubling reality facing many Asian Americans.
“You simply cannot look at Asian Americans as a monolithic group because if you do that, you’re going to miss how different communities experience the pandemic,” said Jarvis Chen, a lecturer in social and behavioral sciences at Harvard University’s T.H. Chan School of Public Health in Massachusetts.
A closer look at San Francisco's two dozen Asian ethnicities reveals many groups within this broad categorization are struggling financially and remain outside the mainstream. About 43% are non-English speakers, according to a USA TODAY analysis of U.S. census data. About a third of San Franciscans are foreign-born, and 13% are not U.S. citizens.
“With Asian Americans, the average always is pulled way up by those doing very well, which means you miss the groups who clearly are not,” said Margaret Simms, a nonresident fellow with The Urban Institute in Washington, D.C., who specializes in race and labor economics. The think tank found nearly 13% of Asian American senior citizens live in poverty compared to a 9% national average.
Discrimination also is keeping some Asian Americans from getting tested for COVID-19. The website Stop AAPI Hate, the acronym for Asian American Pacific Islander, has logged more than 2,500 incidents of discrimination across the U.S. since mid-March. The attacks have ranged from verbal assaults to acts of physical violence.
When Asian Americans hear President Donald Trump, who contracted COVID-19 in October, repeatedly call the virus the “China virus” and “Kung Flu,” “it makes them less likely to seek help, a bit like early in the AIDS epidemic when the gay community was stigmatized,” said Karthick Ramakrishnan, professor of public policy at the University of California, Riverside and chair of the California Commission on Asian and Pacific Islander American Affairs. “We fear many Asian American families have gone underground.”
Decades of racist policies have limited Asian American’s standard of living
Chinese citizens began passing through San Francisco’s then bridgeless Golden Gate en masse during the Gold Rush of 1849. By 1851, some 25,000 had arrived, lured by the hope of riches in a land called Gum Saan in Cantonese, or “gold mountain.”
By the late 1800s, the Chinese were not just vilified but outright barred from entering the country, with few exceptions, by the Chinese Exclusion Act of 1882. White officials charged they were taking jobs from other Americans, despite having been integral to the Gold Rush’s boom and the construction of the Transcontinental Railroad.
At the height of World War II, Japanese Americans around the country were rounded up and sent to internment camps, feared as the traitorous “yellow peril” after years of citizenship. Despite painful and humiliating treatment at the hands of the U.S. government, many Asians resolved to engrain themselves in the society at large with an image of themselves as patriotic, hardworking Americans. Japanese Americans were among the most decorated U.S. soldiers during the war, and others excelled in academics and commerce.
The model minority image gained momentum during the civil rights movement of the 1960s. Asian American success stories were highlighted by white U.S. officials both as a way of signaling to other nations, namely the Soviet Union, that America was not racist, but also to shame other ethnic groups, notably Black Americans.
The logic went that if Asian Americans were doing so well, surely failure on the part of other ethnic groups was their own fault.
Then came the Vietnam War, a quagmire that resulted in a U.S.-sponsored evacuation of 125,000 refugees followed by countless others who escaped Southeast Asia in rickety boats. Many landed in San Francisco.
“The stereotype about us is broad and includes the notion that we’re all studious, we don’t get into trouble and commit crimes, and even the poor don’t have health care issues,” said Ellen Wu, author of “The Color of Success: Asian Americans and the Origins of the Model Minority” and history professor at Indiana University in Bloomington. “That’s quite the change from before World War II when many of us were seen as unclean and prone to diseases.”
California Assemblymember David Chiu, a Democrat who represents the eastern half of San Francisco and chairs the California Asian & Pacific Islander Legislative Caucus, said lawmakers must recognize that Asian Americans are a loosely linked group of immigrants with distinct challenges and needs.
“The attention being paid to the disparities endured during the pandemic by Black and Latinos is important, but our issue hasn’t gotten the attention it deserves,” he said.
One small demographic victory for Asian Americans came in 1997 when President Bill Clinton directed the Office of Management and Budget to expand its data classification system to break out “Native Hawaiian or Other Pacific Islanders” from the Asian American group. That geographic list includes countries such as Micronesia, Tonga, Vanuatu, Guam, the Marshall Islands and Fiji.
As a result, we know today that Pacific Islanders rank third in terms of COVID-19 deaths, behind Native Americans and Black Americans.
But many other Asians said they are largely neglected by government officials.
What disappoints Marc Belocura most, he said, is that he feels ignored despite living in a part of town that city officials once highlighted as a bastion of Filipino culture.
"Since the city obviously knows we are here, why is there not more outreach that is culturally sensitive and linguistically appropriate?" said Belocura, 23. "Or maybe we just are not on their radar."
Belocura girds himself each time he prepares to leave the one-room studio he shares with his parents and sister to shop for food and supplies.
Even before COVID-19, his aging neighborhood just south of Market Street was crumbling. Now more storefronts have shuttered. To avoid the homeless camps that have mushroomed across the area, Belocura walks in the street and hopes he doesn’t get hit by a car.
When he makes it home, he must then navigate a narrow stairwell to get into his one-room apartment on the second floor of a five-story building.
Belocura's parents, who are 71 and 60, share the lone bed. His sister, 35, and he put pillows on the floor each night. Transmission in the studio’s confines would likely be immediate.
"That's why I just can't get COVID when I go out,” he said. “I can’t.”
COVID-19 information hard to find in other languages
Asian American communities in San Francisco speak a range of languages including Mandarin, Cantonese, Japanese, Korean, Tagalog, Laotian, Samoan, Tongan, Vietnamese and Hindi. The city’s website notes that COVID-19 information is available in English, Chinese, Filipino and Spanish.
Efforts by city health officials to inform Asian residents about COVID-19 safety precautions and testing in their native languages have sometimes resulted in confusing or alienating translations.
For example, information about pop-up virus testing sites sometimes can come across as demands, while in other cases the language is just plain confusing.
One flyer written in the Filipino language of Tagalog told people to “cover their entire face,” said Luisa Antonio, executive director of the Bayanihan Equity Center, a Filipino American support group.
In another instance, an Aug. 11 health advisory issued by the city showed Tier 1 Priority were those hospitalized with symptoms, Tier 2 was anyone with symptoms or close contact with confirmed cases, and Tier 2A included a list of ethnic groups “experiencing marginalization, systemic inequity and health inequities.”
Black, Latino, Native American and Pacific Islander residents were mentioned – but no other Asian groups, said Dr. Amy Tang, director of immigrant health at North East Medical Services, a health clinic that focuses on the city’s Chinese American population.
“To not include other Asians among ethnic minorities who should get tested is pretty appalling,” said Tang.
Department of Public Health officials declined an interview request about outreach efforts. An e-mailed response from the city’s COVID-19 Command Center offered condolences to the loved ones of those who died from COVID-19 and noted that a majority of people who died were over 60 and had underlying health conditions.
In California, about 5 million of 40 million state residents are Asian American, and in three-quarters of those homes, languages other than English are spoken regularly, according to the U.S. census.
Sasanna Yee, co-founder of the nonprofit Communities as One, said city officials need to pay closer attention to capturing the cultural nuances that are sometimes lost in poor translations.
Depending on how things are written, they can trigger alarm, Yee added. “Who is asking me to come out? What is this information used for? Can I trust who is asking me to do this?”
Even some Asian Americans who speak fluent English said government officials have not made it easy to get information about the virus.
Huiting "Rita" Huang grew alarmed when her mother-in-law told her that there had been a positive coronavirus case among the Chinese emigres to whom she was providing nursing services. The mother-in-law was unsure what to do and feared her poor English would make getting information about where to get tested even harder.
Huang felt confident she could help. Her English was solid and she had experience getting COVID-19 information as a project coordinator and health educator for the nonprofit NICOS Chinese Health Coalition.
Instead, she wound up mired in a bureaucratic doom loop. After pursuing a series of online testing-site leads through a variety of city- and community-run websites – all requiring fluency in English – Huang soon learned that there were no available appointments at testing facilities close to their neighborhood.
Huang eventually found a city-run testing site near Pier 30 along San Francisco Bay. The test was negative.
"That was frustrating for me, and I speak English," said Huang. "I can't imagine what it would be like for someone like my mother-in-law. Well, I imagine you would simply give up on the hope of getting tested."
Some residents refuse to get tested
Asian Americans in San Francisco are often left behind by city partnerships aimed at helping vulnerable populations. Efforts to increase COVID-19 testing sites largely involve Latino groups, such as Unidos En Salud. The city's various isolation and quarantine sites for the homeless and partially housed also are being used largely by the city's Latino population, with Hispanics making up 45% of those in shelters while Asians account for 7%.
Asian activists and health care workers trying to fill the void said they face a population that often is wary of Western medicine, fatalistic about getting the virus, culturally averse to passing along bad news to elders and nervous about losing employment.
Natalie Ah Soon, health planner with the Asian Pacific Islander Health Parity Coalition advocacy group, said some people have told her, “If God means for me to be COVID-19 positive, then OK.”
Kent Woo, executive director of the NICOS Chinese Health Coalition, said residents sometimes are suspicious of health care workers when they visit local low-income buildings to talk about coronavirus safety tips.
"Folks say, 'What's the point of being tested?' or 'We don't know where to go if we get infected,'" he said. "When we offer the option to anyone who tests positive to leave the premises and go to a hotel, they refuse."
Teams have started to be more proactive, he said, heading to single-room occupancy residences and other housing complexes before there is any rumor of a positive test. The goal is to prepare residents so they know how to respond if someone falls sick.
The need is dire. Amy Dai, project coordinator for the Chinatown Community Development Center, an advocacy group that also manages low-income properties, learned that in a building she manages, 10 residents out of 30 families had tested positive.
When she approached two of the residents who had come down with a fever, they assured her they couldn’t be positive because they had not left the building. A subsequent visit to a doctor confirmed they had COVID-19.
If they had not waited to get tested, “it could have prevented the other infections,” said Dai.
The virus has many of San Francisco’s Asian Americans living like shut-ins.
Only reluctantly did Sisong Thepkaysone, 70, recently make her way from her public housing building overlooking a freeway to her doctor’s office for a routine check-up. She hasn’t seen any information about COVID-19 testing in her native Laotian. All she knows is she must stay healthy.
The trip filled her with dread. With some public transportation routes canceled, she had to change buses, prolonging her exposure. Worse yet, some passengers weren't wearing masks.
“I’m old, I have asthma,” Thepkaysone, a former Thai-restaurant cook who fled war-torn Laos with three young boys and no husband in 1981, said through an interpreter. “I’m not sure what I would do if I got the virus.”
Once at the doctor’s office, an interpreter was called by phone to translate medication directions. Thepkaysone grew upset. She expected quality medical care after the risk she had put herself through, not a faceless voice.
“It was not a personal experience, she said. “I didn’t like it.”
Thepkaysone prefers to spend her days at home making Laotian dishes for relatives. She used to go out to shop and visit a local Buddhist temple to give alms. But now her children shop for her and the temple is closed. Sometimes she checks in on friends through Facebook. She watches television, but her limited knowledge of English renders programs a pantomime.
“I’m careful,” she said. “All I know is the virus is easy to get.”
No end in sight
Rong never found out whether her daughter had COVID-19. But her days remain filled with dread.
For the past few months, the family has had little money for food or rent, which is $750 a month. Sometimes, neighbors give them something to eat; other times she goes to the local food bank.
“We eat lots of potatoes,” she said.
It’s a far cry from the life she envisioned for herself. In Guangdong Province, Rong had a promising job as a clothing store clerk. At the urging of her former husband’s parents, she emigrated 12 years ago to California, where she found work as a janitor to keep the family afloat. Since the pandemic hit, she has been on unemployment insurance.
That’s left the family with no option but to remain in their Chinatown apartment. The communal kitchen isn’t cleaned regularly. Sometimes, leaks from a floor above make their way to the shower on the floor below. Often, the leaking fluid smells like urine.
“Smell me, Mom, I’m more dirty than before I showered,” Amy Rong once told her mother.
Rong doesn’t know anyone who has contracted the virus. For her neighbors in the building, getting tested remains a common fear.
Mostly, Rong waits for the day when the pandemic is over. For a day when it will feel safe to venture outside. For a day when her American dream can resume.
Contributing: Myron Lee, Mark Nichols
Follow USA TODAY national correspondent Marco della Cava: @marcodellacava
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This article originally appeared on USA TODAY: COVID, Asian Americans: Racism drives high death rate in San Francisco