Cultural Habits May be the Secret to Pandemic Survival

Since the start of the COVID-19 pandemic in December 2019, countries around the world have been put in the spotlight. Their successes and failures in relation to the virus have been closely analyzed and compared.

We are amidst the first pandemic of the Information Age (1). We can access continuously updated public data and information as the virus spreads--something that has never been possible with any pandemic before. Average people can now easily analyze trends and hypothesize on what is going wrong or what can be done differently.

As of January 20, 2021, the United States leads the global charts with over 24 million cases of COVID-19 and just over 400,000 deaths (2). Once thought to have one of the strongest public health systems in the world, the United States has blundered in the face of COVID-19. We are pressed to find out why.

The success story of Little Saigon, a small Vietnamese-American community in Orange County, California provides an idea of what might be going wrong in the rest of the country. Little Saigon sits within an area of California that has struggled greatly with high COVID-19 cases and deaths. Despite this, numbers within the community have been significantly lower. A pediatrician in the area suggests that this disparity is a result of "ingrained cultural habits: respect for authorities, reverence for elders, and a believe in the importance of collective welfare." Members of the community were also accustomed to wearing a mask even before the COVID-19 pandemic as a means to prevent transmission of other diseases. (3)

Members of the community in Little Saigon have "ingrained cultural habits: respect for authorities, reverence for elders, and a believe in the importance of collective welfare."

I focus my case study on New York City because it has the highest population of Asian people of any city in the United States. According to the 2010 US Census, there are 1,134,919 Asians in New York City, making up 13.8% of the population (5).

Notice the circled regions containing many red dots, to the left, in Figure 1. Circles represent areas of significant Asian populations in New York City.

I want to find out if COVID-19 case rates in the circled regions of NYC, where Asian people make up a higher percentage of the population, are significantly lower than in other parts of the city. This information would support the assertion that Asian people are wearing masks at higher rates than other groups, perhaps due to "ingrained cultural habits"

Figure 2, below, displays COVID-19 Case Rates with graduated yellow circles on top of a choropleth map of percent Asian population. Larger circles represent higher case rates per 100,000 people while darker purple shades represent higher Asian populations. Select individual polygons to view pop-ups with more detailed information for a given neighborhood.

It is difficult to discern areas of significance in this map. Next, we must perform a statistical analysis.

Next, we look at COVID-19 Death Rates. Although death rates are not directly affected by the "ingrained cultural habit" of mask-wearing, lower case rates in a given neighborhood would allow more hospital beds to be open for fewer patients. If hospitals are not at capacity, doctors are able to spend more time with individual patients, ensuring optimal patient care and therefore fewer deaths. In addition, use of traditional Chinese herbal medicines that have been proven effective in alleviating symptoms associated with COVID-19 as well as preventing progression of COVID-19 to more severe stages including death, are more commonly used and accepted by Asian populations, especially those living in Chinatown (6).

I want to find out if COVID-19 death rates in areas of higher Asian population, are significantly lower than in other parts of the city. This information would support the assertion that Asian people are wearing masks at higher rates than other groups and could support the assertion that Asian people are using herbal medicines more than other residents of New York City.

Figure 4, below, displays COVID-19 Death Rates with graduated red circles on top of a choropleth map of percent Asian population. Larger circles represent higher death rates per 100,000 people while darker purple shades represent higher Asian populations. Select individual polygons to view pop-ups with more detailed information for a given neighborhood.

Again, it is difficult to discern areas of significance in this map. Next, we must perform a statistical analysis.

In showing data based on an extremely large demographic--"Asian populations"--encompassing many cultural and ethnic groups, it is difficult to reveal a definitive conclusion. It is apparent that COVID-19 case rates and death rates in and around Chinatown in New York City are significantly lower than other neighborhoods of the city. But, other neighborhoods that have high Asian populations do not follow this trend. Therefore, I cannot conclude that case rates and death rates are lower in all neighborhoods where Asian populations make up a larger portion of the population.

I am also unable to determine with certainty whether ingrained habits of mask-wearing and/or potential use of herbal medicine among Asian populations in New York City can explain the lower COVID-19 case rates and death rates in and around Chinatown.

When total populations of races and ethnicities in New York City are observed, however, we see that the Asian/Pacific-Islander group has a lower case rate and death rate than the White, Black/African-American, and Hispanic/Latino groups (see figures 6 and 7 below).

Many other factors, aside from cultural habits, are at play when mapping COVID-19 case rates and death rates. In order to fully understand the disparity in how different populations are affected by the pandemic, population density, socioeconomic status, preexisting conditions, proximity to hospitals, etc. should be taken into account. Additional research on use of herbal medicines among different populations in New York City would also be vey interesting.