David and Lucinda Anitok never expected to shut themselves in a hotel room, caught between their kids and COVID-19 and allegiances to their close and extended Marshallese families.
But the pandemic brings unforeseen trials, particularly for people from the Marshall Islands, a mid-Pacific nation scarred by U.S. nuclear weapons testing during the Cold War. In a set of colliding conditions, the coronavirus is exacting an outsize toll on the population of Marshallese in the United States.
In eastern Washington's Spokane County, Marshallese make up less than 1% of the population — but 22% of the COVID-19 cases. As of Wednesday, more than 394 of the 3,000 Marshall Island citizens in the county had tested positive, and three had died.
In northwest Arkansas, another region where people from the Marshall Islands have settled, they make up 3% of the population — and roughly half the deaths. Across Arkansas, where Pacific Islanders make up less than 1% of the population, they account for 7% of confirmed COVID-19 cases.
From Hawaii to Oregon to Orange County, Calif., the coronavirus is clobbering Marshallese and Pacific Islands communities. In Washington since early May, Pacific Islanders including Hawaiians were 17 times more likely than white people to contract COVID-19, a per capita propensity higher than Latinos, a study shows.
Marshallese health experts and advocates say these people are uniquely vulnerable to the virus: Immigrants from the Marshall Islands are often employed in front-line jobs in places such as meat processing plants, canneries, hotels and restaurants; they are predisposed to diabetes and high-blood pressure; they embrace traditions that encourage closeness and gatherings; and many don't have access to preventative and routine medical care.
In Arkansas, the virus was slow to arrive in the community, but “once it got here, it got loose. Infection rates skyrocketed,” said Sheldon Riklon, a Marshallese physician at the University of Arkansas Medical Center’s Northwest center.
Dr. Bob Lutz, health officer in Washington's Spokane County, said that Marshallese essential workers unwittingly bring the disease home to multigenerational households common in their community. "If we have one case, we have 10 cases" by the time a household is tested, he said.
Lutz first learned of the concentration of Marshallese near Washington's eastern border in 2016, when a mumps outbreak swept the state. A small but vocal contingent of vaccine opponents attended public hearings in Spokane, unfairly branding the outbreak the “Marshallese mumps,” he said.
The scapegoating made some Marshallese, already wary of authorities due to broken promises since the nuclear tests, reluctant to trust health officers and to seek treatment when ill. In 2018, a 19-year-old Marshallese woman in Spokane died of tuberculosis, which Lutz learned was endemic in the islands.
He hired Taruwe Rilometo, a Marshallese community health officer, whom he describes as instrumental during the pandemic. She has cut through language barriers that initially prevented many Marshallese from understanding the urgency of washing hands and wearing masks, lapses that allowed the coronavirus to gain a foothold.
Last month in Rilometo’s household, which has four generations, her 80-year-old mother contracted COVID-19. Soon, Rilometo caught it, followed by her daughter and a grandchild. All of their cases were mild, and they have recovered.
For many Marshallese, the pandemic poses a tragic irony. Thousands of them left the Marshall Islands — a string of 1,156 islands and islets spread across 750,000 square miles of ocean — to seek better jobs and a healthier life in the United States, where they can work without visas. Now they find themselves facing a lethal crisis while their distant homeland so far remains free of COVID-19.
The Anitoks are two Marshallese navigating perilous extremes in the United States. David, 38, leads an organization trying to reclaim U.S. healthcare benefits for Pacific Islanders. He and Lucinda, 37, are raising four children in Sedro-Woolley, Wash., a city in the northwest corner of the state, with help from her parents, who live nearby.
Last month, David, Lucinda and her mother traveled to Spokane, 350 miles southeast across Washington, to attend the funeral of Lucinda's uncle, Laki Jitiam. He had died of COVID-19, becoming the first Marshallese there known to have succumbed to the virus.
The three Marshallese returned to Sedro-Woolley shocked by the extent of the outbreak in Spokane. To protect their children, David and Lucinda decided to quarantine themselves for more than two weeks in a hotel.
Counting the hours and days, the couple received another blow in late June. Back in Spokane, Lucinda's first cousin, Erisa Ankien, pregnant at 39 with her eighth child, was seriously ill with COVID-19.
They heard that Erisa's husband, Jejon, an assistant pastor in a local church, was spending nights on a bench in the hospital lobby. No visitors were allowed.
A few days later, Erisa died. As with many COVID-19 patients, family members could not be with her. A nurse enabled final goodbyes by video.
In their grief, David and Lucinda debated what to do. Should they make the 700-mile round-trip again for Erisa's funeral, leaving the children once more? Quarantining two more weeks would mean more than a month apart from the kids.
David thought of the look of confusion on their 2-year-old’s face as she waved at him from her grandparents' front yard. He thought of the home-cooked meals that the older daughters made for them to eat at the hotel.
He and Lucinda also considered their duty to her cousins.
And yet, as the couple mourned, they also gave thanks. With Erisa’s passing, a miracle had come. "They saved the baby, but we lost the mother," David said.
The dying mother had left her family a healthy little girl.
Road trips filled with sadness
The Marshallese are known for undertaking epic journeys in their spread-out island homeland to maintain family ties.
In recent months, many Marshallese in the United States have similarly traveled long distances — to attend funerals of their loved ones.
In early June, Kelani Silk and Christina Kalles drove roughly 1,600 miles from Garden Grove to the northwest corner of Arkansas, to say goodbye to Kalles' sister.
The area around Springdale has one of the largest Marshallese populations in the country. Until this year, it was the largest community in the continental U.S. — although according to a recent federal report, more Marshallese now live in Washington state.
Many of the Marshallese who live in northwest Arkansas work at Tyson poultry processing facilities, which have become hotbeds for the virus. In late June, 3,748 employees were tested in the company's Benton and Washington county plants: 481 tested positive for COVID-19, and 455 were asymptomatic.
Kalles, 44, heard in early June that her sister in Arkansas, Ann Heran, had been hospitalized with the virus, and was unlikely to survive. After Heran was admitted to the hospital in Springdale, Kalles and Silk took to the road on June 6 for the 1,600-mile drive. They got there Sunday morning, just in time for for Kalles to say goodbye.
Heran died a few hours later.
Silk, 43, and Kalles live in a four-bedroom home with nine other family members, including Silk's mother and her two sons. She knew she could have been exposed to the disease on her journey, and wasn't going to risk her family's health, so she isolated herself in a hotel after returning home.
Despite her precautions, her mother contracted the virus while Silk was isolated, and was hospitalized on June 27.
Nobody else in the house got the virus.
Kalles, who returned several days after Silk, also self-quarantined.
"It is a pain doing this," said Kalles, who was still isolated in a hotel when she spoke with a reporter last week. But the thought of not going to see her sister, or being there for her funeral, was simply not an option.
Silk said it was devotion to community and family that helped the Marshallese persevere through foreign occupations during the 18th, 19th and 20th centuries.
“We’re family first,” she said. “It’s the Marshallese way.”
Yet, said Silk, it’s also what makes them vulnerable now.
"It's a double-edged sword," she said.
Trade-offs in maintaining traditions
In northwest Washington, David and Lucinda Anitok continue pondering whether to repeat their road trip to Spokane. They tested negative for COVID-19 and reunited Friday with their children at home.
Relatives in the Marshall Islands, appalled by the resurgence of the coronavirus across the United States, urge family members here to postpone gatherings — even funerals. But in Washington, Oregon and Arkansas, Marshallese see businesses reopening.
David and Lucinda are leaning toward returning for Erisa's funeral. "We feel like maybe we should continue the ways of our lives," he said.
"We'd make sure that everybody wears masks and sanitizes, and keeps distance," he said. "But in the moment, in that rush of emotion, it is so easy to slip up, just to give a hug."