When middle school social studies teacher Chantel Garcia asked her students to write about their summer activities, the responses overwhelmed her.
One boy wrote that he couldn’t eat until his aunt returned from work, explaining he didn’t know how to turn on the camping stove. Garcia soon learned the boy was living on the beach. For online classes, he would borrow a hot spot from the school, or wait until a relative could take him to McDonald’s to use the Wi-Fi.
The boy lives in Honolulu County's Waianae, a low-income coastal community where Native Hawaiians and Pacific Islanders make up 39% of the population.
In the picturesque stretch of mountains, palm trees and winding rivers, roughly a quarter of people lived in poverty when the pandemic struck. U.S. Census estimates show a per capita income of about $20,000, and about 30% of Waianae's residents are children.
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Living with various family members or in multigenerational households, the conditions were prime for the spread of the coronavirus.
After American Indian and Alaska Native children, Native Hawaiian and other Pacific Islander children had the highest rate of COVID-19 cases, at 585 per 10,000, followed by Hispanic children, according to an analysis of cases through Aug. 31 by the Kaiser Family Foundation. Among white children, the rate of infection was about 354 per 10,000. Researchers say health data collection on Native Hawaiians in general is poor, and the rates could be underestimates.
Along with a surge in COVID-19 infections and hospitalizations, Native children, who already suffer disproportionately from illnesses like obesity and asthma, saw their health worsen throughout the pandemic, doctors and other local leaders say. Extreme weight gain has been a major concern, along with depression and anxiety.
“It’s extraordinary, and I think the fallout is – we haven’t even seen the fallout yet,” said Dr. Vija Sehgal, pediatric director at Waianae Coast Comprehensive Health Center.
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While many children like Garcia’s student don't know when their next meal will be, many families relied on cheap fast food and rice-based dishes even more than they did before the pandemic.
Down Farrington Highway, less than a quarter mile from Waianae Intermediate School where Garcia teaches, are fast-food chains like Kentucky Fried Chicken, McDonald’s and Taco Bell. Garcia said many kids walk to and from school, sometimes with a caramel Frappe in hand or a sports drink from the 7-Eleven.
The pandemic brought the economy to a halt, and many people lost their jobs and livelihoods. Hawaiian parents often juggle multiple low-wage jobs to afford the high cost of living expenses. According to analyses, out of all states, Hawaii has the highest food cost per person, at about $556 per month, and doctors and local leaders call Waianae a food desert.
“In our community, if one paycheck goes missing, a family will not eat or utilities will shut off,” said Juanita “Aunty Nalani” Benioni, a kupuna, or community elder. “The frustration in families is great.”
'Astronomical weight gain'
Dr. May Okihiro, also a pediatrician at Waianae Coast Comprehensive Health, said the pandemic exacerbated the food insecurity crisis, setting off the alarming surge in obesity among kids throughout the pandemic, as well as an increase in mental health concerns.
“We have been seeing this astronomical weight gain in many of the kids we take care of,” said Okihiro, who leads the Hawaii Initiative for Childhood Obesity Research and Education. “Kids gaining 20, 30, 40 pounds, and more, in the last year to year and a half … we have had many kids also gain 60 pounds plus. And a few of us have seen 90- to 100-pound weight gains.”
Parents were reluctant to speak, but Garcia recalled several students who refused to turn their cameras on during online classes, or resisted returning to school when it reopened in August. The stigmatized, rapid changes to their body weight sparked insecurity and anxiousness. One boy was a star baseball player, but nowadays, she said, he quietly sits in the corner of the classroom in an oversized jacket and baseball cap.
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Rapid weight gain in childhood can set kids up for chronic diseases as they grow up, Okihiro explained.
“It is a reflection of all the destruction in their lives and the impact it’s had on our kids, and that’s going to have a lifelong impact on them,” Okihiro said. “On top of all the other disruptions in their lives, the mental health impact, the increased anxiety and depression that we’re seeing, along with the low vaccination rates that we see among our communities, we are very worried.”
Since Westerners arrived on the archipelago two centuries ago, Hawaii's people have suffered discrimination and traumatic lifestyle changes. Introduced diseases such as smallpox and tuberculosis decimated the population, a University of Hawaii population report detailed. Scholars link the longstanding health and social inequities with this complex past.
Physicians say the historical trauma, accompanied by misinformation about the COVID-19 vaccine, fuels vaccine hesitancy among Native Hawaiians. They made up roughly 40% of COVID-19-related deaths in the state last month alone, according to local media reports.
When fresh produce is a 'luxury'
Despite their large concentration in Honolulu County's Waianae, Native Hawaiians and other Pacific Islanders make up just 17% of vaccinations countywide and 19% statewide, state data shows.
Teacher Chantel Garcia's cousin Blane Garcia, a 30-year-old public health graduate from the University of Hawaii, is a community health educator. Through the Waianae Coast clinic's school-based health sites, he helps run several health programs, including an online youth suicide prevention support group, "Inspiring Hope Through Sources of Strength." Other initiatives provide stipends to students to help support themselves or their families.
Blane grew up in Waianae. He sees and knows the kids' struggles, noting his town has more fast food places than grocery stores.
"It makes me very emotional," he said through tears. "If I think about it back then and I was in their shoes now, I don't know if I could really make it. And I see these students not giving up. They're really, really struggling. It's hard. How do we help them as a whole?"
During the support group one Thursday night, a teen girl told him she felt "imprisoned," burdened by juggling school with laundry, dishes and taking care of her younger brother and sister as her parents spend long hours at work to make ends meet.
Another student told Blane she had trouble getting out of bed, no longer liked her body and "didn't feel pretty anymore."
"Youths' mental health is highly affected right now," he said. "Our coast is still the highest in active positive (COVID-19) cases in the whole state on average. There's something culturally that's happening out here that's affecting us."
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The Waianae Coast Comprehensive Health Center has been holding pop-up vaccination events at schools and elsewhere, but without parental permission, those under 18 can't receive the shot even if they want one.
Until recently, the center received grants to buy fresh produce from local farmers and set up food distributions along the coast for families on the weekends. Staff gave out boxes of fruits and vegetables, from the tropical breadfruit and pineapples to endive and taro root. Doctors like Sehgal are also writing "food prescriptions" to families to help them eat healthier.
“Imagine the burden of having to drive an hour to work your two, three low-wage jobs, and then come home and have to think about cooking a healthy meal,” Sehgal said. “(You can) sustain the family on fast food. And this is what’s happened.”
She said for many families being able to buy fresh produce feels like a "luxury."
"We're doing so much, as much as we possibly can. And it's still not enough," Sehgal said. "The key to improving the trajectory of children is to improve conditions under which they live."
This article originally appeared on USA TODAY: Native Hawaiian children suffer COVID-19-driven obesity, depression