“The hospital was packed and the ICU was at full capacity,” the ICU pulmonologist told CNN. “And I saw a disproportionate number of Arab Americans in the ICU.”
This realization, and a lack of public health data on the Arab American community, motivated Al-Naser to conduct his own research based on the patients he was seeing at Grossmont Hospital and his own private practice.
“There is a large Arab American community nearby in East San Diego, specifically in El Cajon county,” Al-Naser said. “And because there is no identifier for the group, they’re all being counted as White Covid-19 patients and no one was noticing how the virus was specifically affecting this population.”
Arab Americans trace their origins to the Middle East and North Africa, which is traditionally comprised of 22 Arabic-speaking countries. They are not a monolith and can be White, Black and brown. Los Angeles and New York City have the largest populations of Arab American residents in the country based on data from the 2015-2019 ACS Ancestry survey. Both areas have been hit hard by the Covid-19 pandemic, which has disproportionately affected minority and immigrant populations.
Through his research, Al-Naser found that around 15% of Covid-19 patients classified as White were actually Arab American. Also, about 30 to 35% of Covid-19 patients in the ICU classified as White were Arab American.
“The Arab American community is a historically understudied group because it has no identifiers, so Covid-19 exposed the invisibility of the group rather than created it,” he said. “It’s key to identify people at risk or else they’ll go unnoticed and the disparity will deepen.”
Health disparities in the Arab American community
Dr. Nadia Abuelezam, epidemiologist and assistant professor at Boston College’s Connell School of Nursing, has studied health disparities among the Arab American community throughout her career.
“There are a lot of disparities in the community and they’re not well known because of the whitewashing that’s happening,” Abuelezam said. “The lack of identifiers limit our ability to use national data sets and receive funding to understand Arab and Middle Eastern American health results.”
New York resident Mohamed Madboly, 26, is all too familiar with this as a first-generation Arab American.
Last year, Madboly, his diabetic father and his mother, who has hypertension, all became infected with Covid-19.
“I feel like America is intentionally neglecting Arab identities,” said Madboly about the lack of data on the community. “We’re blinded from our own statistics. This makes it very difficult for experts to draw accurate conclusions to help our community not only improve but get better. Especially in a time like now, where we need it more than ever.”
Although public health data on the community is limited, prior samplings and independent studies show that Arab Americans’ health outcomes and needs are distinctly different from the outcomes of White non-Hispanics, according to Abuelezam’s study.
Research done by Al-Naser in East San Diego also found that most of his Arab American patients were socioeconomically underprivileged and had less access to insurance than his Black and Hispanic patients.
So, not only is asking Arab Americans, like Madboly and his parents, to identify as White inaccurate, but it can also skew Covid-19 data, according to Abuelezam and Al-Naser.
Arab Americans and the Census
“It’s definitely an undercount,” Maya Berry, executive director of the AAI, told CNN. “The Census is about providing an accurate count of the community, so that its members can participate fully in our democracy. The limited publicly available data has always been used against the community.”
Samer Khalaf, president of the ADC, which estimates Arab Americans at the 4.5 million range, agrees.
“It’s an underserved community when it comes to social programs and mental health programs, because we can’t get the proper finances and resources to help the community,” Khalaf said. “And it’s not different with Covid. How can we tell how hard-hit the community is? How do we advocate for a proper allocation of resources, like the vaccine, in these communities if we can’t show what our concentrations are?”
Advocacy groups expected the adoption of a MENA category in 2015 and 2017, according to Khalaf, but the OMB abandoned the motion upon the emergence of the Trump administration.
CNN has reached out to the OMB for comment.
“The Trump Administration politicized the 2020 Census, putting marginalized communities at risk of a drastic undercount, and abandoned the addition of a MENA category on the Census,” reads the Biden-Harris partnership plan.
Khalaf is cautiously optimistic that the Biden-Harris administration could be open to adopting a correct categorization for the community. But he emphasized that this should have never been a partisan issue.
“With the Biden administration, at least now we have a cabinet that will listen, said Khalaf. “Whether or not they act upon it is a different story.”
Nadeem Muaddi and Priya Krishnakumar contributed to this story.