Low number of Asian residents tested is concerning and perplexing

Tufts Medical Center opened a Covid-19 screening clinic on March 31 at Chinatown’s Josiah Quincy Elementary School and has provided mobile testing at senior housing complexes in the neighborhood. The goal is to make testing readily accessible for people who live in the area code of 02111, especially Chinatown. It is one of the most densely populated neighborhoods in Boston, which makes it a high-risk area for a cluster outbreak of Covid-19, the disease caused by the novel coronavirus.

Tufts Medical Center partnered with the city and Boston Public Schools to open the Covid-19 screening site at 885 Washington Street. The lab processing is conducted at the Tufts Medical Center and results are completed within two days.

After more than two months of testing, data collected at the site has revealed a much lower rate of participation by the Asian population, specifically residents of Chinatown.

The total number of registered patients from April 1 to June 16 tested for Covid-19 at the Josiah Quincy Elementary School totaled 7,242 people, with 953 registered as Asian (9.9 percent). The number of positive tests overall was 11.9 percent. The total number of patients with a contact address zip code of 02111 was 177 (9 percent); of those tested in that zip code, 65 patients registered as Asian (10.8 percent).

According to statisticalatlas.com, data gathered in September 2018 shows a total of 6,871 people living in the 02111 area code with Asians making up 52 percent of the population at 3,596.

With these numbers in mind, the number of Asians being tested for Covid-19 in the area code remains extremely low; specifically, how many Chinatown residents may have contracted the coronavirus is still a gray area, and one that concerns Doron and other infectious disease doctors.

“If you were to try to compare the percentage that tested positive, I worry that you may not have a good representative sample there,” Doron said during a phone interview. “We’ve made it incredibly accessible using the Josiah Quincy School, which is typically used by this neighborhood, and so that’s a lot of the Asian community. It would be a place that people know how to get to and feel comfortable going to.

“We don’t turn anybody away. We have long hours, weekdays and weekends. So I think we’ve done all we can to make testing accessible. Whether certain populations differ in their interests or willingness, is something that should be studied. Interest and willingness to go get tested. This talk of there being a stigma associated with testing, with positive tests – that could be a deterrent, for example. And that may be different in different populations, but I don’t know whether that is relevant in the Asian population.”

Early on, when the coronavirus had broken out in China in January, residents and business owners in Chinatown were exercising more vigilance, and the majority residents wore masks. In fact, when this reporter tried to enter a store in Chinatown in mid-February without wearing a mask, I was turned away.

During a discussion with a senior housing facility director in Chinatown, she said that the seniors living there have been very cautious during the pandemic, not leaving their rooms or building often, and always wearing masks when in the company of others. So could the more vigilant practice of wearing masks by residents of Chinatown, especially early on in the pandemic, be part of the reason for the low positive test results and lack of testing overall?

“In fact, they were wearing masks anyway when it began because that’s what they do during flu season, during respiratory virus season in the winter,” she said. “And, you know, there were questions raised early on about whether that (wearing masks) was scientifically based and ultimately the CDC (Centers for Disease Control) did come out with a statement that everybody should be doing that. And since then, there have been some studies that have shown that wearing a mask routinely can decrease the risk for that population if enough people do it, and so, you might wonder if communities that were doing that starting from an earlier time period might have seen lower rates of transmission.”

But with the low number of tests by Asians in Chinatown, the greatest concern is that there may be coronavirus deaths going undiagnosed or unreported. Doron said the hospital is not looking at that granularity in the hospital concerning who has died while in the hospital. She did say, though, that there were a lot of discussions early on, not about concerns that people were dying at home because of the virus, but regarding the fact that hospitals weren’t seeing the typical diagnosis usually seen in hospitals, such as heart attacks, appendicitis, and other prevalent health illnesses.

She said the governor’s office did some research analyzing death certificates and death data during the last few months and did not see an increase in the rate of people dying at home during the pandemic.

Doron said data analysis has been conducted in other parts of the world, particularly in areas where hospitals became overwhelmed and couldn’t accommodate all of the Covid-19 patients, and it revealed an increase in the rate of people dying at home.

“That’s not happening in Boston, so that’s good,” she said. “I don’t think that the Chinese population around Chinatown is not going to the hospital, not being tested, not being counted, and then dying at home.”

To clarify when somebody should be tested for the coronavirus, Doron said the CDC and Department of Public Health are not recommending that everybody be tested in the absence of symptoms. “It’s not that they shouldn’t,” she said, “it’s that if they were to say that, they would have to say how often. And then if they said that, they would have to make sure that there was really testing capacity. Testing capacity is improving, but we’re certainly not at a place, nor will we ever be, to test every member of the population of the United States every day. Imagine that number of tests you would need. And, so, what is the frequency of testing, and would you even operationalize that to get it to everybody that needs it.”

With that said, Doron stressed that everybody with symptoms should be tested. And she said maybe it’s possible that Chinatown residents have had no respiratory illness symptoms in the last two months – but maybe not.

She said one must ask the question: are people in Chinatown with mild respiratory symptoms staying at home, and remaining isolated while they wait to recover? “Is that okay? That’s probably okay if they didn’t transmit it to somebody else,” she said. “All it does is not give us the numbers that we need to do our modeling.”

But she reiterated that they want everybody that lives in the Chinatown neighborhood that has symptoms of the coronavirus to get tested, and follow health protocols.

“At the first sign of any respiratory symptom, while waiting for the test, they should isolate themselves from others,” she said. “And to answer the phone if the public health commission is calling because they may be calling to see if they’ve been in close contact with somebody who tested positive. If you were in close contact, the new protocol is that you get one test at some point during the quarantine period, but you still quarantine for 14 days. And then if you develop symptoms, you get tested again.”

Close contact is defined as spending at least 15 minutes within six feet of somebody who tested positive. Boston Public Health, she said, does contacting tracing if a report of a positive test comes back from a person in a neighborhood, which entails questions about who a person has contacted and where they have been during the entire period that they were communicable, which usually goes back two days prior to the onset of symptoms. They also compile all the names and phone numbers of people they were in contact with and then call those people.

Currently, there is a downturn in Covid-19 positive tests in the state, but there could be a surge in any given neighborhood at any time, and densely populated areas like Chinatown remain most vulnerable. So maintaining vigilant testing is a must in containing the virus in the long-term.

The Covid-19 test site at Josiah Quincy Elementary School will operate only until the children return to school, Doron said. The school also has to go through preparations for the returning students, and at that time, the site will be closed. No alternative site has been identified to replace it, she said.