What’s Really Killing Us?
What’s Really Killing Us?

Many South Asian Americans were facing poverty and other systemic issues long before the coronavirus hit. Now, the virus is making them much worse.

Nargis Mughal and her father, Zubair “Jimmy” Khan, who was one of the first 200 known COVID-19 cases in the Washington, D.C. area. (Nargis Mughal)

Nargis Mughal and her father, Zubair “Jimmy” Khan, who was one of the first 200 known COVID-19 cases in the Washington, D.C. area. (Nargis Mughal)

Nargis Mughal is a Kashmiri American social worker living in Arlington, Virginia. In early March, her father, Zubair “Jimmy” Khan, came down with a fever that just wouldn’t break. As states declared lockdowns, Khan took a test for COVID-19 on March 13, and five days later was diagnosed with one of the first 200 known cases in the Washington, D.C. area.

Khan, 50, had been working as an Uber driver and was most likely exposed to the coronavirus on the job. He spent the next two months in a life-or-death fight with the disease. “Every single day, I was afraid that we’re going to get a phone call that said, ‘Hey, your father’s passed away. You’re not going to even be able to do a funeral for him,’” Mughal said.

Khan’s story is one of many highlighting what immigration and racial justice advocates have been arguing long before the pandemic started: South Asian Americans are far from a uniform, well-to-do “model minority.” Many in the community were facing inequitable healthcare access, poverty, and limited access to government aid before the pandemic. And as the U.S. crosses two million coronavirus cases and infections continue to rise in at least 21 states, the pandemic is making those issues worse — especially for those at high risk in “essential” occupations.

As Khan’s body temperature reached 110 degrees Fahrenheit, he was barely able to breathe and was admitted to nearby Fairfax Hospital. Mughal and her family spent the next two months in near-constant tears. Khan had been in prime health for his age, according to Mughal. But many South Asians in the U.S. are not so lucky: the community is seven times more likely to have Type 2 diabetes than the general population, and has a 40% higher chance of mortality from heart attacks. 

Yousra Yusuf, president of the South Asian Public Health Association (SAPHA), said those predispositions translate to higher risks of developing severe complications from the coronavirus. COVID-19 infection and mortality data for South Asian Americans are still not available — South Asians are counted under a more general Asian American category, sometimes along with Native Hawaiians and Pacific Islanders. “Not having that data puts us at a disadvantage of knowing where and which communities need help,” Yusuf said. In New York, for example, South Asian community leaders say that the city’s official numbers don’t represent the community’s true death toll.

Mughal said her father is still alive because his doctors connected him to an ECMO (extracorporeal membrane oxygenation) machine — a rarely available treatment, which combined with a ventilator, took enough pressure off of Khan’s lungs for them to heal. But the treatment threatens to drown his family in debt: the ECMO machine alone costs up to $10,000 per day. The average COVID-19 stay for commercially insured patients costs $38,221, while the average cost for uninsured patients is $73,300. Khan, in a phone interview once he was well enough to speak, estimated that the cost of the ECMO machine, two months in the hospital, and two weeks of rehabilitation could total more than $1 million.

Zubair Khan with his granddaughter, Zarwa, after coming home from treatment. “The reason I came home is that I was playing with her in my dreams. I knew I had to come back home to see her and play with her,” he said. Khan lost 60 pounds while battling COVID-19 but is now able to talk and take short walks. (Nargis Mughal)

Zubair Khan with his granddaughter, Zarwa, after coming home from treatment. “The reason I came home is that I was playing with her in my dreams. I knew I had to come back home to see her and play with her,” he said. Khan lost 60 pounds while battling COVID-19 but is now able to talk and take short walks. (Nargis Mughal)

Even before the pandemic hit, many South Asian households that relied on one person’s rideshare driving income had lived paycheck-to-paycheck with little or no savings. Not everyone has received government stimulus checks, either.

Khan was one of the D.C. area’s first Uber drivers in 2011, and said his earnings dropped from $3 per mile in the early days to just $0.62 for the same distance. He had to work 70 to 80 hours a week to earn enough to support his family. “We work like donkeys,” Khan said.

Uber’s most recent demographics, released in 2015, showed that its drivers are disproportionately Asian (15%) compared to the U.S. population (5% that year); there is no specific breakdown for South Asian. 

Uber said that drivers who either have a confirmed case of COVID-19 or can prove that they are at high risk are eligible for 14 days of financial assistance, based on prior earnings. But the process has been messy. When her father first got sick with COVID-19, Mughal contacted Uber for financial assistance and a representative told her to apply through the app. It’s now been three months of back and forth providing documentation, and Khan has received no support yet. Uber representatives now tell him that he should expect a decision shortly. 

Hashmat, an Arlington resident who requested his name be changed to avoid retaliation from former employers, also drove for Uber before the virus hit. The 51-year-old said that even before the pandemic, he wasn’t making enough money to support his wife and three kids. “Working with Uber is OK, but they steal everything that we make.” A 2018 study found that Uber takes about a third of a fare in fees — so drivers were making a net income of only $11.77 an hour. 

Hashmat has been living in the U.S. since he was 16, and served as an interpreter and cultural advisor with U.S. armed forces in Afghanistan, his country of birth. But despite his years of military service, he isn’t entitled to any veterans’ benefits because he was a contractor. He must pay for medical costs — including to treat two blown-out eardrums, an injury he got from an explosion while serving — himself. Though the military helped him get an earpiece and funded one surgery, he has had to pay for successive operations and is putting off further surgeries.

Hashmat hasn’t driven for Uber since the pandemic hit his neighborhood in early March. He’s at high risk because of diabetes and is afraid of passing the virus to his wife and three young children.

While Hashmat received stimulus money and aid under Virginia’s Pandemic Unemployment Assistance program, most of the money has already gone toward rent and other expenses. Like Khan, he’s also applied for assistance under Uber’s coronavirus policy, but the company is prioritizing drivers who completed their last ride within 30 days of requesting aid. He’s been borrowing money from friends and relatives, and if aid doesn’t arrive in the next week, he said he has no choice but to return to work. “I don’t want to catch coronavirus and give it to my kids, but I have to bring them some food on the table,” he said. “I have to put my life in danger to go to work...the government doesn’t help, so that’s what I have to do in America.” 

Community organizers in Virginia have advocated for the state to lift its ban on rent control. (Asian American Pacific Islander Civic Engagement Collaborative)

Community organizers in Virginia have advocated for the state to lift its ban on rent control. (Asian American Pacific Islander Civic Engagement Collaborative)

He’s also participated in organized efforts to push Virginia to lift its ban on rent control. Early in May, he and over 100 other immigrants from Pakistani, Mongolian, Afghan, and other communities drove their cars in a caravan through downtown Arlington to rally for housing justice. But the state’s eviction moratorium is still set to expire on June 28.

In California, where COVID-19 cases are rising, thousands of South Asians — largely middle-aged, Punjabi-speaking women — work in food and meatpacking plants in the state’s Central Valley. Like rideshare drivers, these workers have faced a similar conundrum: go to work and risk contracting the virus or stay at home and risk losing income or even their jobs. U.S. meatpacking plants have faced high infection rates due to personal protective equipment shortages. As of Friday, at least 312 meatpacking and food processing plants and 39 farms and production facilities have confirmed COVID-19 cases, yet remain open. At least 29,784 plant and farmworkers are COVID-positive, and at least 99 have died. 

Naindeep Singh runs the Jakara movement, a California-based Sikh advocacy organization representing many Punjabis who work in Central Valley poultry and other food processing plants. He said that as many as 2,000 Punjabis work at Foster Farms poultry processing plants alone, with as many as 7,000 to 10,000 working at meat and food plants across the Central Valley. 

Jakara contacted Foster Farms in mid-March to alert them of safety concerns in their Central Valley plants. In a letter to local media, children of South Asian Foster Farms workers wrote: “Their company does not prioritize their safety, forcing them to look at their colleagues and friends with suspicion: suspicion of being asymptomatic; suspicion of others gambling for their family’s livelihood and survival over their coworkers’ health.”

Foster Farms did not respond to The Juggernaut’s request for comment. But company spokesperson Ira Brill told KQED in late April that the company monitors employee temperatures and COVID-19 symptoms. Foster Farms has also said that it is expanding sanitation, encouraging face coverings, and installing dividers to maintain social distancing.

But Singh said that plant workers still don’t feel safe on the job, due to uneven implementation of COVID safety measures and management’s poor communication about infections among staff. Many workers he’s spoken with don’t want to risk losing an essential source of income and feel like they have no choice but to go back to work despite their fears of infection as California’s cases rise.

Thousands of South Asians work at California Central Valley food and meat processing plants, and many feel they are not adequately protected on the job. (National Chicken Council)

Thousands of South Asians work at California Central Valley food and meat processing plants, and many feel they are not adequately protected on the job. (National Chicken Council)

In most Central Valley counties, Punjabi is the third-most spoken language after Spanish and English; Punjabi American communities there date back to at least the early 20th century. Language access gaps have compounded the risk of infection.

People who have limited English proficiency are less likely to have a regular source of primary care or to receive preventive care — and may be at increased risk of experiencing medical errors. Similar to the Hispanic population, about 35% of Asian Americans have limited English proficiency — 4% don’t speak English at all, 12% speak English “not well,” and 19% speak English “well” but short of “very well.”

In Fresno, California, Singh said that one Punjabi American woman returned home from Clovis Community Medical Center after taking a COVID-19 test. “She assumed she was being discharged and that she was OK, but she ended up infecting a whole family,” Singh said. “Luckily, all of them recovered, but when you don’t have proper language provision that could happen.” Singh is aware of numerous similar cases.

“It’s hard for people to even know about what the stay-at-home orders from the governor or from the mayor even mean if they’re not receiving that information in a language that they can understand,” said Angie Lobo, executive director of the Indo-American Center, a Chicago-based immigrant services organization that has translated public health information into Hindi, Gujarati, Arabic, Urdu, and Bengali.

During the pandemic, incidents of domestic abuse have also risen. Rachna Khare, executive director of Daya, a Houston-based domestic violence organization, said economic and immigration-related strain can add tension in abusive relationships. A community sample of South Asian American women found 38% experienced some form of abuse in the prior year. Though this rate is similar to the overall national domestic violence rate, South Asians may be prone to underreport incidents.

“[For] folks who are living with their abuser, the abuse is getting more frequent and it’s getting more severe,” Khare said.

For some Daya clients who received stimulus checks, the check may have directly deposited into the abuser’s account, with the survivor unable to access it. “We especially see this happening when the abuser or the survivor or both are on a work visa,” Khare explained, adding that “abusers are feeling more out of control” because of employment and food insecurity issues during the pandemic. “They want to feel a sense of power again.” Khare said this can manifest into physical or emotional abuse — behaviors such as controlling a partner’s access to food. 

“What’s important to understand is that a large number of community members who are suffering greatly were already at a disadvantage due to socioeconomic status, language access, and citizenship status,” said Shikha Bhatnagar, executive director of the Los Angeles-based immigrant services organization, South Asian Network. 

Undocumented South Asians often can’t access unemployment benefits or other government assistance programs, including stimulus checks and Medicare. In 2017, Asian Americans accounted for 1.45 million of the country’s total undocumented immigrant population of about 10.5 million, with the largest Asian country of origin being India.

“This pandemic only exacerbates systemic inequities,” Bhatnagar added. “The greater South Asian community, the fastest-growing community, needs to recognize this; that the story of low-income communities is a South Asian American issue as well.”

Asians are the most economically divided demographic in the U.S. — from 1970 to 2016, the gap in the standard of living between Asians near the top and the bottom of the income ladder nearly doubled. Among South Asians, Indian Americans have the highest median income in the country ($110,026), while Bangladeshi ($46,806) and Burmese ($41,227) Americans have some of the lowest.

Back in Arlington, Zubair Khan is now well enough to speak and take short walks. As he recovers, Mughal said that the family still doesn’t know what Medicaid will cover. “At this point, we’re just grateful that he’s alive,” she said.

Ashish Valentine is a Chicago-based journalist and producer. He’s currently the Reflect America Fellow at NPR, and has worked at Chicago Public Media, City Bureau, and Kartemquin Films.

Anna Luy Tan is a writer and documentarian. Her work ranges from co-organizing Chicago’s first Southeast Asian Film festival to interning at Kartemquin Films, where she began filming a documentary about environmental justice set in Detroit and the Michigan Upper Peninsula. She studied neuroscience, film, and critical theory at Northwestern University.

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