In the last few months, states have lifted restrictions on large events and masking en masse. Restaurants across the country are seating at full capacity, airplanes are packed with unmasked travelers, and large conferences, concerts, and festivals are taking place as they did before the pandemic.
For some, the return of pre-pandemic norms is a relief. But with the recent uptick in infections, many hospitals across the country are seeing the new laissez-faire attitude toward COVID-19 take a toll on communities that are the most vulnerable, particularly BIPOC.
The U.S. is now seeing about 100,000 new reported COVID-19 cases every day, nearly double the rate from April. Health experts say that number could actually be 30 times higher than reported. As states close mass testing and vaccine sites and more Americans resort to at-home testing, health officials have fewer means of tracking the virus’ reach. Black, Indigenous, and Latinx communities have had the least access to COVID-19 testing sites over the course of the pandemic, a trend that has continued to be a factor in disparate rates of infection.
The three U.S. administrative regions that are reporting the most COVID-19 cases right now are Puerto Rico, Hawaii, and the U.S. Virgin Islands, all places where BIPOC and Latinx people make up the majority of the population. On the national level, between May 8 and June 8, Asian Americans and Pacific Islanders saw the highest rates of COVID-19 cases per 100,000 residents, followed closely by Latinx people.
In Hawaii, a significant influx in tourism and the reemergence of large events such as school proms have contributed to an alarming surge of COVID-19 cases in the state, which is ranked second in the U.S. in infections per 100,000 as of June 10.
“I know of cases of COVID-positive, symptomatic people flying on a commercial plane over and exposing everybody who is on that plane but doesn’t know it, so I’m sure that’s just a fraction of what exactly happens,” said Rosalee Agas-Yuu, a transport nurse at Kapiolani Medical Center.
On June 2, 800 frontline workers across the state called out sick with COVID-19, leaving a worrisome shortage of staff as an influx of COVID-positive patients arrived in need of care. Some hospital departments have found traveling nurses to alleviate the shortage, but many are still struggling to manage increasing caseloads.
“These nurses, they come in and work a 12-hour shift, and they kind of have an idea if they’re going to end up working a 16-hour, not by choice, because everybody is getting tired,” said Agas-Yuu. “I see it a lot with our respiratory therapists that are in our hospital as well. I see night shifts here, and they’re tired, but there is nobody to fill their role.”
In Hawaii, Filipinos and Native Hawaiians have suffered the highest COVID-19 death rates compared to other racial groups. Nationally, of the 14 out of 27 states with relevant data, Native Hawaiians and Pacific Islanders also have the highest death rates.
Puerto Rico has the most COVID-19 cases in the U.S. per 100,000, reporting a per capita rate of around four times the national average. Puerto Rico’s cases rose only days after the island dropped its pandemic restrictions. Celebrations during the April Holy Week, a series of largely unmasked concerts, and a steep increase in tourism have all contributed to the island’s increase in positive cases.
“Tourism is complicated,” said Jose Pérez Ramos, an assistant professor of public health sciences at the University of Rochester. “It’s one of the biggest income resources in Puerto Rico currently, however, without the health measurements or cautions, it can go out of control, particularly in COVID cases.”
Puerto Rico’s status as a territory has made life particularly difficult for islanders throughout the pandemic. Federal stimulus checks to Puerto Ricans were delayed. The CARES Act guaranteed far less funding for territories than states. During the Trump administration, the White House COVID-19 Task Force provided weekly reports and recommendations to state governments on dealing with the pandemic but excluded this assistance to U.S. territories.
Perez-Ramos said part of the problem in Puerto Rico is that there has been a significant increase in tourism in combination with a drop in masking and quarantine requirements. While some restaurants and individual businesses may ask visitors to mask up, power dynamics on the island may make locals reluctant to enforce these rules.
“A lot of people don’t want to deal with it, particularly if you’re a North American, because there is this colonialism mentality, which basically is the people who come from the north are better than us and you have to serve them, and that happens a lot honestly, and you don’t want to bother to aggravate them,” said Perez-Ramos. “I feel that contributes to the rise in cases, because at the end of the day, if there are no controls, then you let that be a personal choice, then you run the risk of having people not making the wisest decisions for the community.”
Perez-Ramos does not think restrictions will return any time soon. Going forward, individuals will be responsible for making their own moral calculations about their behavior and how it affects the people around them.
“COVID has become more of a personal thing than a community or country-wide thing, like it or not,” said Perez-Ramos. “As a public health person I don’t think [the personal approach to COVID-19] is a good idea.”