A befuddling phenomenon: Why are Boston’s Asians underrepresented in coronavirus cases and deaths?

A street vendor sold fruits and vegetables on Beach Street in Chinatown, which ranks among the Boston neighborhoods with the lowest percentage of positive COVID-19 cases. Health officials say they are concerned the numbers may reflect a lack of testing among the city's Asian American population as well as fears of harassment.Lane Turner/Globe Staff

As the coronavirus pandemic ripped through China and tore across New York City, Boston’s Chinatown braced for its own tide of COVID-19 cases. Restaurants emptied. Residents hunkered down. Suddenly the neighborhood’s streets were deserted. Almost no one left home without a mask.

But the surge never materialized.

Today, the Chinatown zip code, 02111, where about half of the residents are of Asian descent, ranks among the Boston neighborhoods with the lowest percentage of positive coronavirus cases, according to Marty Martinez, the city’s chief of Health and Human Services. Of those tested for the viral disease, only 13 percent turned up positive — half as high as the citywide cumulative percentage of 26 percent.

While the novel coronavirus pandemic has ravaged communities of color across the United States, Asian Americans and Pacific Islanders in Boston remain vastly underrepresented in both COVID-19 infections and deaths, according to May 28 data from the city’s Public Health Commission. Although Asian Americans and Pacific Islanders comprise just under 10 percent of Boston’s population, they account for only 4 percent of confirmed COVID-19 cases and 6 percent of deaths.

The data has unsettled public health officials and community activists who were preparing for a wave of sick patients in Chinatown, Boston’s most densely populated neighborhood, as families returned from travel to China, the original epicenter of the pandemic, following the Lunar New Year in February. Many Chinatown residents are elderly and working-class, living in cramped apartments, sometimes with other families.

By comparison, Black residents, who represent a quarter of Boston’s population, account for 38 percent of COVID-19 infections and 35 percent of deaths, in cases where the race and ethnicity is known. Latinos, who make up nearly 20 percent of the city’s population, are similarly overrepresented in COVID-19 infections (25 percent), but underrepresented in deaths (11 percent).

Paul Watanabe, a political science professor who helms the Institute for Asian American Studies at the University of Massachusetts Boston and sits on the mayor’s COVID-19 Health Inequities Task Force, believes the data, while incomplete, is a reflection of the low level of testing among the city’s Asian American population. He noted that their percentage of deaths from COVID-19 is one and a half times the percentage of confirmed cases, which may indicate those with the disease are getting tested later, when they’re much sicker.

“It suggests people might be contracting the illness, unknown that they got it, and going straight to death... without having their situation diagnosed through a positive test or being dealt with, more importantly,” he said.

Indeed, when Tufts Medical Center opened a coronavirus screening clinic on March 31 at Chinatown’s Josiah Quincy Elementary School, city officials noticed only 11 percent of those tested for COVID-19 were Asian, Martinez said. To boost those numbers, Tufts has since begun offering mobile testing at Chinatown’s senior housing complexes.

Still, city officials remain concerned many Asian Americans continue to forgo testing. South Cove Community Health Center, the largest provider of health care services for Greater Boston’s Asian community, has declined to test patients for COVID-19. The health center has received three federal grants exceeding $1.7 million since March 24 to support its coronavirus response, according to the US Department of Health and Human Services’ Health Resources and Services Administration. That includes a $627,259 award intended “to expand the range of COVID-19 testing and testing-related activities,” an HRSA spokesman said in an email.

Eugene Welch, South Cove’s CEO and executive director, said Thursday the bulk of the federal funding is for personal protective equipment and supplies. Any funding earmarked for testing is being used for patient outreach, he said, and South Cove patients are referred elsewhere for COVID-19 screening.

“We’re not doing testing because there’s an abundance of places that are doing testing that can’t get patients [to come] in. What we’ve been trying to do is convince our patients to go for a test," Welch said.

“It would have been the biggest waste of taxpayers’ dollars,” he added, noting South Cove’s Chinatown clinic shares the building with Josiah Quincy Elementary School, where patients are referred to Tufts’ testing site.

Martinez said the city has reached out to South Cove and “urged to them to think about the testing they may need to be providing.”

Other factors curbing the number of infections among Boston’s Asian Americans may also be at play. Suzanne Lee, the former principal of Josiah Quincy Elementary School, has been impressed by precautions taken by her fellow Chinatown residents. As COVID-19 cases mounted in China, she noticed people in Chinatown started wearing masks around the neighborhood as early as January.

A pedestrian passed a mural advertising Kaze Shabu Shabu restaurant on Harrison Avenue in Chinatown on May 21.Lane Turner/Globe Staff

Before Governor Charlie Baker implemented a statewide order requiring the use of face coverings in public, employees at Ming’s Supermarket, an Asian grocer in the South End near Chinatown, chastised her for not wearing mask in the store. During a recent trip to distribute masks to residents of a Chinatown senior housing complex, some refused to open the door when Lee knocked, asking that she leave her donation in the hallway outside.

“They’re very cautious because they know the story coming out from China and they know a lot of people... in China, and news just travels how furious this virus is,” said Lee, who is also a member of the mayor’s inequities task force.

And while some in the US have resisted wearing masks to slow the spread of the virus, Asian communities here and abroad have long embraced the practice, said Andrew Leong, a philosophy professor at the University of Massachusetts Boston, owing, perhaps, to memories of the deadly SARS outbreak that originated in China in late 2002.

“Within the Asian American community, we have a little bit more sensitivity toward these things," Leong said. “We as a country in the United States really weren’t touched by [SARS], but, if you’re talking about Asians in this country, with extended family members in Asia and going back and forth, and also reading the news from Asia, we would be a little bit more educated."

But Dr. Elisa Choi, an internist, fears more insidious barriers may be contributing to the low caseload. Choi, who leads the Massachusetts chapter of the American College of Physicians, said anti-Asian racism — a disturbing consequence of the misinformation and scaremongering surrounding the virus — could discourage Asian Americans from getting tested, fearing the harassment they might face if they were identified as COVID-19 positive.

“The racism being directed at Asians as it relates to unfounded fears and ignorance about Asians being the source of, or the root of, or the cause of this pandemic... can really impact the psychology of how individuals who identify with being Asian may think about how they seek care for possible COVID-19," Choi said.

Fear of harassment, unfortunately, may be a potent incentive among many Asian Americans for sticking close to home. On a recent afternoon outside the Eliot Norton Park playground in Chinatown, Jen Lee, a 65-year-old retiree, explained through an interpreter in a mix of Cantonese and English how she feels safer in her neighborhood than in other parts of Boston, where, as a Chinese woman, she believes she’s more likely to be harassed.

Here in Chinatown, she said, residents are “anxious” about the virus. She rarely sees her neighbors in her multi-unit apartment building. She only hears them when they take out their trash. When the pandemic began, she said she already had a collection of masks at home and started wearing hers long before the governor’s order.

“At the beginning, when only the Chinese were wearing [masks], we got a lot of harassment,” she said. “Now so many more people wear masks, it’s not a big deal.”