What we know (and don’t) about how COVID-19 affects racial minorities on Vancouver Island

The largest First Nation in BC, located on Vancouver Island, looks like it’s preparing for battle as roadblocks and checkpoints are set up to monitor and control who goes in and out of the community.

In reality, the 4,800-member Cowichan Tribes First Nation is gearing up to enforce lockdown measures amidst a recent sharp rise in COVID-19 cases.

The community’s leadership recently took it upon themselves to issue a shelter-in-place order after 23 people tested positive for the virus in a span of five days, with more cases expected after Jan. 6.

“It is, of course, very worrying to see there are significant case numbers in Cowichan Tribes, and I expect that that’s being reflected in the wider community,” said Cowichan Valley MLA and BC Green Party Leader Sonia Furstenau in an interview with Capital Daily. “Communities are not separate and distinct.”

Information about this recent rise in cases came directly from the First Nation itself, and no details have been shared by Island Health, the First Nations Health Authority, or any other public health office.

“We’ve been pretty consistent in calling for more data to be coming from the government,” Furstenau said. “The more the public can know and understand what is informing decision-making, the better.”

Cowichan Tribes First Nation Chief William Seymour could not be reached for comment.

Since the beginning of the pandemic, experts and advocates have been calling for the province to collect and disseminate a regular breakdown of how racial minority groups have been affected by COVID-19 and associated restrictions.

Researchers studying health-care inequities, and those who work to support racial minorities in the province, say having this data would allow academics and policy-makers to pinpoint why cases surge in certain populations, roll out supports—like messaging in different languages—that target these groups to make sure they are able to follow public health guidelines, and avoid blaming racial minorities for spreading the virus when, in fact, those groups are among the hardest hit.

In BC, the number of new COVID-19 cases are released every weekday, broken down by health authorities: case numbers in the Vancouver Coastal, Fraser, Island, Interior, and Northern Health regions are updated on a daily basis. The First Nations Health Authority, which reports data from First Nations that are nested geographically within the other regions, is excluded from the daily updates.

Public health officials do collect data on how many First Nations peoples have thus far tested positive for COVID-19.

The latest update from the First Nations Health Authority in BC shows us that as of Jan. 4, 2021, Indigenous people have accounted for roughly 4% of all COVID-19 cases in the province.

That percentage rises when we zoom in on Vancouver Island.

According to the 2016 Statistics Canada census report for Vancouver Island, people of “North American Aboriginal origins” account for about 8.7% of the population.

However, Indigenous Peoples made up about 18% of all COVID-19 cases on the Island.

Number of COVID-19 cases by health authority in BC. Source: BCCDC

Ahousaht First Nation, located just off the coast of Tofino, is among the first remote and isolated First Nations in BC that began receiving the coveted COVID-19 vaccine doses earlier this week. But the road up to this point has not been easy, and was made more difficult by the lack of information provided to surrounding communities about what was going on in Ahousaht.

The nation’s elected chief, Greg Louie, is the latest First Nations leader to express a need for more information about how COVID-19 cases are spreading in these isolated communities.

“Like many other people, Ahousaht people travel across the Island because… we don’t have all the conveniences in our community,” said Louie.

“Finding out where the hotspots are, whether it’s a First Nation community [or not], is definitely important.”

In September 2020, Heiltsuk Nation, Nuu-chah-nulth Tribal Council, and Tsilhqot’in National Government filed an application to the Information and Privacy Commissioner for British Columbia to get the province to reveal approximate locations of COVID-19 cases to First Nations leaders.

That application was rejected in December.

“We are angry and disappointed by today’s ruling which will continue to allow the Ministry of Health to withhold the life-saving information we have been requesting since the COVID-19 pandemic began,” the Heiltsuk and Nuu-chah-nulth leaders wrote in a statement.

“ The situation is more urgent than ever given the exponential jump in infections, hospitalizations and deaths that are occurring to Indigenous peoples.”

At the moment, there are two First Nations on Vancouver Island experiencing a recent uptick in COVID-19 cases: aside from the Cowichan Tribes First Nation, the Snuneymuxw First Nation in Nanaimo currently has 21 active cases,

This information was not released by any public health authority, but rather by the Nations themselves.

What about other racial minority groups?

The province is at least collecting data about COVID-19 cases among Indigenous populations. That data collection helps drive decision making.

The same cannot be said for other racialized minorities across the province.

Since the start of the pandemic, various experts and advocacy groups have been calling on public health officials in BC to start collecting COVID-19 case data by race.

“It is critical that the government of BC collect and analyse disaggregated data to identify inequalities and advance human rights in this province and country—particularly as the COVID-19 pandemic aggravates existing injustices,” said BC’s Human Rights Commissioner, Kasari Govender, in a statement in September.

“This is the time for commitments to address systemic racism and oppression across British Columbia. We cannot act on what we do not know, so data collection is often the first step in making change.”

The provincial health officer, Dr. Bonnie Henry, has been questioned multiple times on why the province does not simply collect race-based data on an ongoing basis, and why there are no plans to start now.

“We don’t, frankly, have a co-ordinated information technology system, an IT system, that allows us to easily transmit and share that information,” she said at a press briefing on Nov. 7.

“So, we are not able to do that on our case-based investigations. We’re focusing on the health actions that we need to take with each individual person in the midst of this pandemic.”

The barrier, she maintains, is the time it would take to ask patients the additional questions needed to gather their ethnicity and enter that information into the system.

But experts maintain that having this information would help provide a better sense of how the virus may be disproportionately impacting racial minorities in the province, as it has been proven to do in other jurisdictions.

For example, in Ontario’s Peel region, the results of race-based data collection show that South Asian people account for 58.7% of COVID-19 cases, while making up just 31.6% of the population.

In BC, the second wave of the COVID-19 pandemic was largely driven by rising cases in the Fraser Health region, and again, the region’s large South Asian community was highlighted for fuelling the surge.

According to Dr. Henry, this uptick could be attributed to several factors, including the fact that many essential front-line workers reside in the Fraser Health region.

“I know many of my colleagues and friends who are from [the] South Asian community,” she said during a press briefing on Nov. 19.

“For example, you know, having two-to-three hundred people in your immediate family is normal, and is important, and is part of how life is lived.”

The exact number of cases among South Asian communities in BC will never be known.

According to Dr. Karen Kobayashi, a sociology professor at UVic and expert in researching the intersections of health care and racial inequities in Canada, highlighting disparities in how COVID-19 affects racial minorities is just one of the reasons why it’s important to collect this type of disaggregated data.

“What has been happening is these racialized minority communities have been scapegoated. The finger is being pointed at them for making supposed choices that run counter to public health guidelines—when what is really happening is that they’re unable to stop working,” Kobayashi said in an interview with Capital Daily.

In places like the Peel region and in Surrey, many South Asian people work in essential industries like long-haul trucking and go home to multigenerational households where there are older adults who are more at risk of contracting serious illness due to the virus.

But as many of those workers are the breadwinners of their family, Kobayashi says, they feel an obligation to keep working, even when sick or if they’ve been exposed to the virus. That in turn can help spread the virus further.

“The media focused for a while on large weddings and religious gatherings in racialized minority communities, and I think that was unfair because it scapegoated those communities early on,” said Kobayashi.

Similar trends on Vancouver Island

Even less is known about which population groups are more affected by COVID-19 on Vancouver Island, given its relatively few cases compared to other parts of the province and the dearth of information regarding what has caused surges in cases on the Island.

What we do know comes from a mix of information about where exposures and outbreaks have been, demographic details, and anecdotal and observational evidence from experts.

According to Kobayashi, one of the groups most disproportionately affected by the pandemic, specifically in Victoria, are Syrian refugees.

“When you look at Victoria… a large proportion of that group [of people who have had to continue to work] are refugees and they’re not able to take sick days; they don’t have the same kind of access to the supports at work that others would have.

“They’re just trying to gain access to higher education and re-credentialization, and then full-time employment, but they’re not quite there yet, so they’re working in service industries.”

In urban areas like the capital city, front-line caregivers in long-term care, assisted living, and community care are largely racialized minority women.

“A lot of that is not because we have a lot of immigrants who want to work in health care,” says Boma Brown, founder of the Support Network for Indigenous Women and Women of Colour based in Victoria. “It's the fact that sometimes immigrant women cannot find any other source of employment... because these places often need the help and often are willing to hire an immigrant woman with no ‘Canadian’ work experience.”

Over the course of the pandemic, Brown says she has observed that women of colour and immigrant women in Victoria face a higher risk of contracting COVID-19, but whether this is because they are more likely to work in health-care sectors, more likely to have lower income, or more likely to live in multi-generational households is unknown. That information is not collected or shared in any organized way by official sources.

Data does tell us that the Central Island region is where most of Vancouver Island’s cases came from during the second wave of the pandemic.

While a breakdown of data showing the number of cases in each city or town is not provided by public health officials, Port Alberni holds the dubious honour of having had the most number of COVID-19 outbreak and exposure alerts.

It also, as pointed out by Kobayashi, has a known high concentration of immigrants and visible minorities who work in lumber mills.

Historically, she says workers from Japan, China, and India began arriving in places like Port Alberni to work in the logging industry in the late 1800s and early 1900s.

“Of course with the internment of the Japanese, the Japanese have pretty much disappeared from the Island and from most parts of the province, and after they returned, they were dispersed,” said Kobayashi, who is herself a third-generation Japanese-Canadian whose father was born in Port Alberni.

“That didn’t happen to South Asian populations who continued to work in the lumber industry... there are larger proportions of Indo-Candian adults and families [today] living in areas like Duncan and Port Alberni where the lumber industry is still quite significant.”

Census reports from 2016 show that after First Nations people, South Asians make up the largest visible minority group in Port Alberni.

Inklings of how racial minorities have been affected by restrictions

Back in the early days of the pandemic, in May 2020, the BC Centre for Disease Control launched a month-long province-wide survey with the ambitious goal of trying to find out how lockdowns, and other restrictions imposed to curb the spread of the virus, affected various groups in every part of the province.

In doing so, public health officials may have bitten off more than they could chew: the results of the survey, taken by nearly 400,000 people, were not released until seven months later in December when we were already in the throes of the second wave of the COVID-19 pandemic.

The timing of the release of these results and the fact that the survey only encompasses experiences collected after the first two or three months of the pandemic limits what we know. But this survey is the only time the province has collected any race-based data about the impacts of the pandemic outside of First Nations communities.

“It confirmed some of the things that we in public health are always concerned about,” said Dr. Reka Gustafson, deputy provincial health officer, in a press briefing on Dec. 4.

“We know that emergencies tend to exacerbate health inequities, and the results around young adults and people who are already vulnerable due to economic disadvantages feeling the pinch even more than others is not surprising.”

The comprehensive dashboard that breaks down these results shows exactly which racial groups experienced what type of hardship on Vancouver Island.

For example, 28.7% of Southeast Asian/Filipino people on the Island reported being concerned about food security, compared to 11.7% of white people.

Southeast Asian/Filipino, Latin American/Hispanic, and West Asian/Arab people were also far more likely to report feeling financial stress than any other group on Vancouver Island.

One group that is missing from this dashboard is Indigenous Peoples. The survey did account for their responses, but that data was sent instead to the First Nations Health Authority and Métis Nation BC.

The First Nations Health Authority did not respond to a request for comment on these results.

However, Ahousaht Council Elected Chief Greg Louie said the primary impacts of COVID-19 lockdown measures in his community were worsening mental health and spiritual wellness, as well as feelings of stress, anxiety, fear, and anger.

“There were some triggers for some people being in lockdown,” said Louie.

“Some people talk about residential schools and [how lockdowns remind them of] not being able to leave the residential school grounds for months on end.”

For the most part, when discussing the results of the survey, BCCDC experts said there were two determinants that stood out when trying to gauge who has been most severely impacted.

“Although there were some differences along [racial] domains, the important determinants of how people are experiencing the COVID-19 pandemic turned out to be age, income, and whether or not you’re a family with young children,” said Gustafson.

According to Kobayashi, all those factors intersect when it comes to racial minority groups, especially when considering this survey was taken in May when schools were closed and children were doing classes from home online.

“Racialized minority communities were disproportionately affected because, again, the parents couldn't afford to stay at home with the kids to support them with online learning,” she said.

“You also saw a disproportionate number of kids from First Nations communities and visible minority immigrant communities not having access to stable Wi-Fi. So it negatively impacted their learning.”

There are no known plans for public health officials to conduct a second survey to gauge how the pandemic and its restrictions are affecting communities today.