Takeaway
All people, including immigrants in the U.S., need comprehensive care at this time. Clinicians should be aware of the resources to help immigrant patients obtain medication, food, housing, and mental health support.
One of us (Dr. Berger) has seen many Latinx patients in the past months with COVID symptoms. Just this past week, he treated a family of five, who were unable to self-isolate and ready to go to the “quarantine hotels” provided by Baltimore and leading institutions. At the last minute, the family declined, perhaps owing to fears of federal deportation.
Immigrant patients’ testing, diagnosis, treatment, and follow-up are beset by inequities. The Migration Policy Institute estimates that over six million immigrants, both documented and undocumented, have been classified as essential workers during the pandemic. 1.7 million immigrants and 27,000 Deferred Action for Childhood Arrivals (DACA) recipients provide care for COVID-19 patients as doctors, nurses, and paramedics. But immigrants are not getting the care they need, as patients or as providers.
Gaps in support for immigrants with documentation
Testing and treatment are basic to protecting the U.S. from COVID-19. Effective measures would include all U.S. residents. However, recent relief efforts by Congress such as the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) and Families First Coronavirus Response Act (Families First Act) exclude undocumented people and many Green Card holders from resources for COVID-19 testing and care, as well as unemployment benefits. This coincides with the phase-in of the “Public Charge” rule, which penalizes applications by potential immigrants who the government deems likely to become “dependent” on assistance, including federally administered healthcare benefits. Although the impact of this rule isn’t fully understood, Kaiser Family Foundation reported that one in five adults from low-income immigrant families expressed fear of enrolling in public benefit programs because of this rule.
Gaps in support for immigrants without documentation
Undocumented people face many barriers when seeking healthcare. They’re less likely to have health insurance, and more likely to experience poverty than the general population. In most cases, undocumented people aren’t able to file for unemployment.
For those in ICE immigration detention centers, the situation is much worse. In crowded spaces not designed to mitigate airborne disease, both people in detention and facility staff are at increased risk of infection with COVID-19 and transmission to the community. These facilities are often located in rural locations, with sparse health capacity to match an outbreak in crowded detention facilities. A number of staff and people detained in ICE facilities have already died from COVID-19, with more likely to follow if reports continue of ICE staff failing to follow COVID-19 best practices, such as wearing masks and gloves, and extending these same precautions to persons in detention.
Top 5 tips for what you can say and do to support your immigrant patients—suggested language:
1. “Many people are experiencing stress these days because of attitudes towards immigrants. Has that affected you? How?”
2. “Do you have difficulty affording medications? Here are some ways I could help with that.”
3. “Many patients of mine have difficulty affording food or finding stable housing. Does this apply to you as well?”
4. “I see many patients who’ve experienced different kinds of trauma either in their home countries or on their paths here to the U.S.. Does this apply to you? There are resources that I can provide if that is the case.”
5. “I want you to know that I’m committed to giving you the best care, and won’t ask about your immigration or documentation status.”
What else can you do?
Clinicians can join the call for the expansion of emergency Medicaid to all to ensure universal COVID-19 prevention, testing, and treatment services. Moreover, request elimination of the public charge rule and requirements for supporting documentation when applying for health aid. You can also advocate for the release of all persons in detentions from ICE facilities, and for transparency and accountability in adherence to CDC guidelines on COVID-19 suppression and prevention. Finally, ask state and Federal governments to expand current policy and make future policy inclusive of immigrant communities, with additional unemployment benefits and funding for culturally appropriate outreach.