LACK OF DATA COLLECTION BLOCKS EFFORTS TO ASSESS COVID-19 IMPACTS ON LOCAL MIDDLE EASTERN COMMUNITIES

Hear our  interview with Dr. Raed Al-Naser for KNSJ radio: click here.

By Briana Gomez

Photo, left: Doris Bittar

“Arab Americans are largely considered Caucasian, other, or unknown.  We are a disappeared minority, rendering us nearly invisible in the media and in medicine.” – Doris Bittar, President, Arab American Anti-Discrimination Committee, San Diego chapter

June 25, 2020 (San Diego’s East County) -- Minority communities across the US are being disproportionately affected by COVID-19. For example, nearly 67% of cases in San Diego are among Latinos and Hispanics, who comprise only 30% of the population, according to County Health Department  figures as of June 20.  But a lack of data on Arab and Middle Eastern Americans makes it impossible to accurately assess impacts of the pandemic on this population locally and nationally.

Dr. Raed Al-Naser is a pulmonologist and critical care physician at Sharp Grossmont Hospital. He is also the president of the San Diego chapter of the National Arab American Medical Association.

Al-Naser provided an opinion-editorial for the Union Tribune in May saying, “San Diego County publishes a breakdown of COVID-19 cases, according to race and ethnicity that mirrors U.S. Census criteria. Unfortunately, the census does not identify Arab or Middle Eastern persons.”

Al-Naser (photo, right) also spoke directly with East County Magazine. “At the onset of the outbreak, there were [a] considerable number of patients in the ICU from the local Middle Eastern Community in El Cajon. In the last few weeks things had settled down and we do not see many patients from that community.”

Al-Naser noted that now most of the patients he sees are Hispanic/Latino, another group which has been historically undercounted and underrepresented. 

Counting cases of COVID-19 in the Middle Eastern community should be imperative information in East County, he believes. 

El Cajon, for example, boasts the second largest population of Iraqis in the United States. Iraqi refers to national origin, not ethnicity. Some Iraqi-Americans identify as Chaldeans, others as Kurdish, Arabic, or other identities. There are also many local immigrants from Middle Eastern nations other than Iraq, such as Syria, Iran, and Lebanon.  

A lack of accurate data has historically under-reported the number of Middle Eastern residents in El Cajon and other communities in San Diego’s East County.

“Locals estimate that about half of the city’s population of about 100,000 is of Arab [or Middle Eastern] descent. Official counts are much harder to come by, in part because the U.S. census hasn’t consistently sought the ethnic backgrounds of people from Middle Eastern countries, who are typically forced to mark ‘white’ or ‘other,’” wrote Shaya Tayefe Mohajar in a feature piece on El Cajon for Curbed, saying there are approximately 50,000 Chaldeans in El Cajon city and surrounding areas. 

County health data does not reflect any of these numbers and does not provide a specific category for Arab and Middle Eastern Americans. This is detrimental for tracing causes of high infection in a pandemic scenario. However, San Diego County has no way of tracing proper data in these communities without identifying the individuals. 

“I am not sure how San Diego County can extract data without proper identifiers,” said Dr. Al-Naser. 

East County Magazine reached out to the County of San Diego Health & Human Services Agency requesting that they compile data on COVID-19 cases for individuals who identify with Middle Eastern languages – Arabic, Aramaic, Dari, Farsi, Hebrew, and Kurdish.  

Photo, left: map from https://www.natureasia.com/en/nmiddleeast/article/10.1038/nmiddleeast.2020.40

This linguistic selection of course would not account for Arab/Middle Eastern Americans raised outside of the Middle East (whose primary language is English, for example), but it would provide a good start for identifiers regarding the immigrant portion of the Arab/Middle Eastern community. ECM attempted this effort based on a lack of other identifiers taking place during patient triage and healthcare in-take forms. 

ECM received a response from Craig Sturak, Communications Officer for this agency. 

“…the data we have on the website and dashboard is the most detailed we have available…I will share your request with our data team so they are aware, but I don’t expect to have anything more detailed,” said Sturak.

Doris Bittar, President of the San Diego Chapter of the Arab American Anti-Discrimination Committee (ADC) finds this problematic. 

“Arab Americans are largely considered Caucasian, other, or unknown,” Bittar told ECM, “We are a disappeared minority, rendering us nearly invisible in the media and in medicine.”

Not only are Arab Americans not properly counted, but the information collected on this group could skew data for other Caucasians.

Bittar added, “When we are not counted then our resources for our health, civil, educational and other issues are not allocated…issues such as the larger proportion of hypertension, heart disease, and other issues are lumped into Caucasian.”

 According to data from the World Health Organization, a map of Arab countries affected by COVID-19 reflects a disproportionate number in the gulf countries, the gulf areas (such as Saudi Arabia, Qatar, UAE) of the Middle East typically reflect larger amounts of wealth than the Levant and North Africa. 

This data could potentially suggest that high concentrations of COVID-19 cases are not only in underrepresented/low-income groups but could also be linked to dietary, lifestyle, or genetic factors as opposed to traditional factors related to income inequality. However, no studies have been done to determine this. 

Recently, Time magazine reported that the Public Health England study found that the U.K.’s ethnic minorities had a higher risk of death for COVID-19 – specifically that people of Bangladeshi ethnicity had twice the risk of death as white Britons. 

The U.K. also has large groups of Indians and Pakistanis which some consider part of the general Middle Eastern discourse when speaking on ethnicity. 

The study neglected to account for co-morbidity factors.

Dr. Wilma Wooten, County Public Health Officer, told ECM that co-morbidity factors such as heart conditions and COPD in minority communities account for the high rates of COVID-19 seen in San Diego County’s minority communities.

However these co-morbidity factors are inherently linked to things like a lack of resources, education, and access to healthcare which doesn’t fit the Middle Eastern community in the United States.

In fact, according to a study from Columbia University, Arab Americans are more educated and have higher incomes than the average U.S. American.

A 1990 article in the LA Times suggests the same of Iranian Americans, reflecting another Middle Eastern group which has thrived as immigrants. 

Meanwhile, according to the Migration Policy Institute, [East] Indians are the largest group of foreign born immigrants in the United States and are highly educated, working mostly in STEM fields. 

A feature article from UC Santa Cruz calls Indians, “the wealthiest and most highly educated immigrants in the country.”

Additionally, other groups like Mizrahi Jews or Armenians may also consider themselves to be Middle Eastern and reflect similar success in the United States, food or ethnic customs, as well as histories of Diaspora across the Middle East but are largely excluded from the overall narrative. 

On the surface, Middle Eastern Americans don’t necessarily face the same health and economic disparities as other minorities. However, a 2018 study in the Frontiers in Public Health journal suggests that Arab Americans are an under-studied demographic in the United States and that there has been poor documentation of their health risks, historically.

However, Doris Bittar points out that the more recent immigrants from Arab countries are facing the same economic disadvantages as other minorities. 

“We have also had a more recent influx of poorer and working class immigrants from Iraq, Palestine, Syria, Somalia, and Sudan,” said Bittar, “These recently arrived communities mirror the poor immigrants of the past who have to overcome many barriers. The ADC did not have a complete legislative agenda on the list of their concerns 20 years ago, but now they do because of increase in poverty, lack of health care and educational services that our community suffers.”

Dr. Al-Naser agrees with that information.

“In general, the Arabic and Middle Eastern community in San Diego County is heavily concentrated in the City of El Cajon. The majority of this community. especially the most recent immigrants, have limited income as well as limited level[s] of education,” said Al-Naser.

Many came as war refugees, lacking the financial resources of earlier waves of Middle Eastern immigrants.  In East County, a substantial number have large families, often living in crowded conditions due to the high cost of housing.

Al-Naser is working with the San Diego COVID-19 equity task force in conjunction with San Diego State University on getting a COVID-19 testing program that serves ethnic minorities in the community which would include Arab and Middle Eastern communities. 

The task force is looking to hire community health workers who speak Middle Eastern languages.  To find out more about job openings with the task force, visit http://listentosandiego.org.

Briana Gomez holds an MBA from the University of La Verne and a Bachelor of Science in International Business from Azusa Pacific University. A freelance journalist, she is originally from La Mesa and lived in Japan for five years in her youth. She later took an interest in travelling and learning about global cultures and cultural identities  She taught English in Hungary in 2013 before obtaining her master’s degree, then returning to the U.S.  to pursue journalism and research multicultural communication. 

Gomez has written for online and local publications in Budapest and in her native San Diego, including coverage in East County Magazine on multicultural communities. She is passionate about human rights and minority issues, bringing awareness to ethnic groups in our region. She also sits on the committee for the Arab and Muslim Community Coalition and is an active member of the San Diego Arab-American Anti-Discrimination Committee and San Diego House of Lebanon.