In March and April of last year, something was gnawing at Dr Raed Al-Naser.
The pulmonologist and critical care physician at Sharp Grossmont Hospital in La Mesa, California, had been on the front lines of the pandemic from the very beginning. The Jordanian-American doctor quickly noticed he was treating a disproportionate number of Arab Americans suffering from Covid-19.
“It was a simple observation from doing my regular rounds. I see the patients are either ethnically Hispanic, Latinos or Middle Eastern. In our particular area, we have larger communities of people from Iraq, Syria and other countries in the region,” he said.
There is no way to identify as Arab on the US government census, meaning it is hard to know how many Arab Americans are living in the country. The conservative estimate is around 3.7 million.
In the San Diego area, where Dr Al-Naser works, the community likely numbers around 150,000.
“We should have been counted in the census 10, 15 years ago, and there was a snag there. They don’t want to give us any kind of agency or particular attention,” said Doris Bittar, president of the San Diego American Arab Anti-Discrimination Committee.
When Arab Americans are admitted to hospital, they must check “white” or “other" on the admissions forms. This poses a problem, as it means there is very little information coming in relating to this particular community's health issues.
Dr Al-Naser took his observations and started asking his colleagues around the country if they were seeing a similarly disproportionate number of Arab Americans suffering from the disease.
“I had called a few friends in New Jersey, in the Midwest, in Michigan and they had similar observations,” he said.
Michigan is home to one of the largest populations of Arab Americans in the US. The Detroit metropolitan area is home to the largest concentration of Arab Americans in the country.
Dr Rena Daiza is a primary care physician at Henry Ford Medical Centre in Bloomfield Township, just outside of Detroit. She, too, noticed a large number of Arab and Chaldean Americans, who originally come from Iraq, with Covid-19 symptoms.
"I think at some point, it was definitely disproportionate. A lot of our inpatients with Covid and [intensive care] patients were of Middle Eastern descent, particularly Chaldeans," she told The National.
Dr Al-Naser is currently leading a study at his hospital, combing through records, trying to figure out just how many Arab Americans suffering from the virus have passed through the hospital's doors.
“From preliminary raw data at this time ... about 11 per cent of the patients being admitted to hospital or [who] went through the emergency room, we could identify them as Arab Americans,” he said.
Dr Al-Naser says that is a little more than double the usual percentage of Arab Americans being treated at his hospital. He says most of the physicians he has spoken to around the country have noticed a similar jump in this percentage.
Dr Al-Naser is hoping his study will help convince hospitals to add the Arab ethnicity to admissions forms. It could have a profound effect on public health.
“If you don’t have good data on how any disease is affecting communities, there will be no way to identify it and also that will be reflected on the allocation of resources and interventions and funding from the state and local governments,” he said.
The Arab-American community in San Diego is mostly made up of newer immigrants from Iraq and Syria. They work in front-line industries like health care, transport and cleaning in which they do not have the option of working from home. Many in the community also suffer from pre-existing conditions.
“There is also a prevalence of pre-existing medical conditions that put this population at risk: diabetes, hypertension, heart disease, chronic lung disease, smoking-related disease — these are all factors that contribute to the severity of the Covid-19 illness as well as mortality,” said Dr Al-Naser.
Without a proper identifier, health trends in the Arab-American community may continue to go unnoticed.
“We as a community are invisible when it comes to our health and socio-economic problems. As a community, we are not getting our fair share of support from state and local government for tackling the health disparities that our community is facing, and so we want to prove that point so we get that [Arab] identifier implemented in health records,” said Dr Al-Naser.