Simultaneously Blamed and Ignored: Cross-Sectional Rapid Assessment on Barriers, Behaviors, and Impact of COVID-19 on Asian Americans (Preprint)

BACKGROUND The diverse Asian American population is impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities for this population are hidden. OBJECTIVE The study aimed to describe the Asian American community's experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center's (FQHC) health care services and response to challenges faced by the community. METHODS We conducted a cross-sectional survey between May 20 to June 23, 2020 using a multi-pronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey questions included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. RESULTS Among 1,297 Asian American respondents, only 3% were tested, and 49% stated that they could not find a place to get tested. Three-quarters of respondents reported feeling stressed, and about 23% reported feeling depressed. About 6% of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32% had lost their regular jobs and 23% had reduced hours or reduced income. Additionally, 70% of respondents shared that they avoid leaving their homes to go to public places (e.g., grocery stores, church, and school). CONCLUSIONS We found that Asian Americans reported lower levels of COVID-19 testing and limited access to testing, high prevalence of mental health issues and economic impacts, and high prevalence of risk-avoidant behaviors (e.g., not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the COVID-19 impact on Asian American communities served by an FQHC and underscore the longstanding need for culturally- and linguistically-appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multi-lingual and multi-cultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccines. CLINICALTRIAL Not applicable.