Native Hawaiians and Pacific Islanders have become infected with the coronavirus at higher rates than other minority groups, including high-risk African Americans and American Indians in western states, according to the University of Hawaii John A. Burns School of Medicine.

In California, with the second-largest population of Native Hawaiians and Pacific Islanders outside Hawaii, the group had the highest rate of COVID-19 infections at 217.7 cases per 100,000, compared to all confirmed cases statewide at 62.4. In Utah, the group’s infection rate was 197.6 versus 142.2 for the total population, and Washington’s King County reported a rate of 189.5 cases per 100,000, compared to 182.1, according to Keawe‘aimoku Kaho­lokula, professor and chairman of Native Hawaiian Health at JABSOM, which examined data released by several mainland states with large populations of Polynesians.

“We’re a community that loves to be close to each other — we honi, we kiss, we hug. We show our aloha (that way),” he said, “which is challenging given the shelter-in-place and social- distancing orders.”

The increased risk for COVID-19 is not surprising, with Native Hawaiians and Pacific Islanders already known to have “underlying inequities in the social determinants of health” — conditions that limit access to quality health care, nutritious foods, exercise, education and safe environments.

They tend to work in jobs considered essential — the military, security, service and health care industries — where they are at increased risk of contracting the virus.

“More of our people work in the service industry and are essential workers, which means they’re around more people and exposed,” Kaho­lokula said.

They also tend to have larger families and live in multigenerational households, where it is difficult to self-isolate.

What’s more, the group already has among the highest rates of chronic disease and associated mortality rates, and high rates of smoking and vaping — especially among adolescents and young adults — making them more susceptible to severe illness and death once infected.

“Once we get it, it can make symptoms and hospitalizations more likely,” he said. “That’s just really contributing to the disparities we’re seeing in COVID-19 cases or risks.”

Native Hawaiians and Pacific Islanders also are disproportionately incarcerated and homeless, with Native Hawaiians alone comprising 43% of prison inmates in Hawaii and 39% of the homeless population on Oahu, the data shows.

“It is difficult to practice social distancing in prison or while living on the streets, and the conditions are unsanitary in these environments,” Kaholokula added.

In Hawaii, Department of Health statistics show that Native Hawaiians and Pacific Islanders account for 14% of total COVID-19 cases, though they represent only 10% of the population. The DOH did not account for part-Hawaiians in that calculation, so that is likely an underestimate of the true number of cases in that population, which is largely multiethnic.

Caucasians were the only other higher infected group in Hawaii based on population, accounting for 31% of cases though they represent 26% of the population, according to the Health Department. Those numbers are higher because it reflects military members and tourists who tested positive in the islands, the DOH said.

As of Friday, Hawaii’s coronavirus cases stood at 619, with 16 deaths — the lowest in the nation. A total of 532 patients have recovered since the start of the outbreak — nearly 86% of the people who have been infected. Of the 31,157 coronavirus tests conducted by state and clinical laboratories in the islands, just under 2% have tested positive.

“We never paid attention to those inequities the way we should have. This is a wake-up call for us to begin going forward addressing the inequities,” Kaholokula said, adding that more attention needs to be given to Native Hawaiians and Pacific Islanders as part of the state’s response and recovery plan.

“This is a community that’s going to be hit the hardest. The financial situation was already not the best before this,” he said. “Now imagine after this, these are folks working in jobs that don’t provide livable wages. Now many are laid off and on unemployment. This is going to have long-term negative effects on families and communities long after this virus is over.”