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Why has coronavirus taken such a toll on SF’s Asian American community? Experts perplexed over high death rate

The coronavirus has taken a grim toll on San Francisco’s Asian American community, which accounts for half of the fatalities from COVID-19 and has a high death rate among those who have tested positive for the disease.

Eighteen of the 36 people who had perished from COVID-19 in San Francisco as of Sunday were Asian American, even though the group makes up just over a third of the city’s population.

Meanwhile, 6.6% of the confirmed coronavirus cases among Asian Americans in the city have been fatal, compared with 1.7% for the population at large, according to a recent research brief by the Asian American Research Center on Health, or ARCH. The disparity also exists to an extent throughout California.

The number of COVID-19 deaths in San Francisco remains relatively small, prompting health officials to caution against drawing strong conclusions.


It’s possible, for example, that lower testing rates in the Asian American community could make the case-to-death ratio appear artificially high. Some health care providers said that older Asian Americans in the city have sheltered in place so diligently that they may not be venturing out to be tested for the coronavirus, especially if they have mild symptoms.

Still, researchers, local politicians and advocacy groups are asking the city to look more closely at the disparity, especially as the region begins to loosen social restrictions. Some have requested more detailed information to understand what’s driving the imbalance.

The city releases aggregate data on cases and deaths, but it’s impossible to dig into the common factors that might connect them.

“This data just points out a problem: Is the problem too many deaths, or is the problem too few tests?” asked Dr. Tung Nguyen, a UCSF professor of medicine and one of the authors of the ARCH report. “Those are questions that need to be answered.”

The ARCH paper lists several possible reasons for the high case-to-death ratio among Asian Americans in San Francisco, including limited access to health care, higher rates of underlying health conditions and an older population.

Nguyen said the likelihood that coronavirus cases become fatal is a good indication of the severity of the disease among different groups, but it can be muddied by inconsistent testing that makes it impossible to get a clear picture of how many people have been infected with the virus.

When other researchers have compared COVID-19 cases and deaths to the population, the biggest racial disparities have emerged among the black and Latino communities — both in the Bay Area and California.

“There are still a lot of questions to get a richer understanding of this data,” Yee said.

The San Francisco Department of Public Health did not make someone available to discuss the topic, despite requests by The Chronicle.

At a Board of Supervisors meeting last week, Public Health Director Grant Colfax said the overall number of COVID-19 deaths in the city is still low, making it difficult to draw any firm statistical conclusions.

He added that the death cases among Asian Americans in the city were “very much correlated with age” — roughly 90% were older than 60 and many were residents in long-term-care facilities. Some were connected to cruise ships, though health officials did not provide additional details.

Community groups and health care providers, however, were still taken aback by the figures.

“We understand our population is more elderly and might have more comorbidities, like diabetes or hypertension, but when the deaths are 50% it really wakes you up,” said Dr. L. Eric Leung, board chairman of San Francisco’s Asian American Medical Group. “That number is striking to me as someone who has been practicing in our community for over 40 years.”

Local politicians and researchers have asked the city to release more information about the people who have died from COVID-19 to better understand what’s driving the disparity and to alleviate growing anxiety among the Asian American community.

Were the residents concentrated in certain assisted living facilities? What health ailments, if any, did they share? How many had access to health care?

“We want to find out the common medical and social factors among these cases that have progressed to deaths so that we can protect communities that seem to be at higher risk,” said Brandon Yan, a UCSF medical student and lead author of the ARCH report. “We don’t have sufficient data right now to answer the questions we would like to answer.”

Across the Bay Area, people have been clamoring for more details on COVID-19 cases and deaths, but health officials have had to juggle the public’s right to information with patient privacy. The balancing act has sometimes left policymakers dissatisfied.

San Francisco Supervisor Aaron Peskin, who represents Chinatown, said knowing if the COVID-19 deaths were clustered among certain professions, or concentrated in high-density housing such as single room occupancy hotels, would help the city better protect those who are especially vulnerable.

Supervisor Gordon Mar, who represents the Sunset in western San Francisco, said he has pressed the city for more information on the high numbers of Asian Americans who have died of COVID-19, but has yet to receive anything beyond what was shared at the supervisors’ meeting last week.

And Nguyen, at ARCH, said he has gotten several questions about the impacts of COVID-19 on California’s Filipino American community due to the high numbers who work in health care, but it’s impossible to measure due to data limitations. Currently everyone with Asian ancestry is grouped together in state and city data.

“If we could just get a profile, that would be helpful,” said Kent Woo, executive director of the NICOS Chinese Health Coalition in San Francisco. “We’re the ones doing the health messaging, we’re the ones making visits to homes, we’re the ones setting up food pantries. Who do we need to target? What do we need to do?”

The disparity in San Francisco could be because Asian Americans are less likely to get tested for the coronavirus than other races and ethnicities, an observation made by several health care providers, as well as in the ARCH report. With fewer confirmed cases, the mortality rate could appear higher.

Dr. Amy Tang, director of immigrant health at the North East Medical Services, said that many older residents in San Francisco’s Chinatown began sheltering in place well before the official orders were announced, and have continued to remain inside their homes unless they need to leave.

The cautious behavior should help tamp down the spread of the virus, but it could also lead to lower testing rates and health outcomes that appear worse, Tang said. Of the four Bay Area testing sites that North East Medical Services runs, the Chinatown location has the least traffic, and a disproportionate number of requests for tests have come from non-Asian patients.

“I want to explore whether that’s because there’s a lower burden of COVID-19 in the immediate community, or for other reasons, like a fear of getting tested or leaving the house,” Tang said. “I don’t want our patients waiting until the last minute — when they’re very, very ill — to acknowledge they may have the virus.”

Joaquin Palomino is a San Francisco Chronicle staff writer. Email: 

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