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As Covid-19 sweeps across the country, many immigrant communities are being hit hard by the pandemic. Latino individuals are four times more likely to be infected with SARS-CoV-2, the virus that causes Covid-19, than non-Latino white individuals. Asian immigrant communities across the U.S. have also been hit hard by the pandemic.

Insights into why immigrants are at increased risk of contracting the virus can be gleaned from the hardships faced in places like Chelsea, Mass., and the Rio Grande Valley in Texas.

In Chelsea, a city of about 40,000 people just north of Boston, two-thirds of residents are Latino and nearly half are recent immigrants — and rates of Covid-19 are five times higher than the Massachusetts average. In the Lower Rio Grande Valley, where more than 90% of the population is Latino and one-third live in poverty, the surge of cases threatens to magnify inequalities even further.

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Communities like these have large populations of workers who earn low wages and make ends meet by working in essential jobs such as food services and the hospitality industry in urban areas and agriculture in rural areas. Few of these jobs provide adequate — if any — paid leave. What’s more, immigrants often live in multi-generational households, with larger household sizes and in close quarters. These factors combine to create an environment that allows for rapid transmission of Covid-19.

To make matters worse, the Trump administration has enacted policies making the spread of Covid-19 in immigrant communities even more likely. On January 27, 2020 — just one week after the U.S. confirmed its first case of Covid-19 — the U.S. Supreme Court allowed the Trump administration to begin implementing a new rule related to the “public charge” immigration policy.

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This rule determines the factors that can be used to deny immigrants permanent residency status (generally known as green cards). The administration’s new rule added the use of public programs like Medicaid, the Supplemental Nutrition Assistance Program (food stamps), and subsidized housing — in addition to overall health status — to the reasons for denying an immigrant a green card.

This policy may cause immigrant families to avoid seeking medical care during the pandemic. Without being tested, patients with mild symptoms may not realize they have Covid-19 and thus not take appropriate precautions to isolate themselves from others. Even worse, some may continue working while sick in order to pay their bills and secure food for their families, possibly to replace some of the social supports they normally would have received through public assistance programs.

Without testing, without treatment, and facing an economic necessity to work, these harsh realities undermine public health efforts to effectively combat the pandemic. Forcing immigrants to choose between their health and having food on their table, shelter over their heads, or safety from punitive immigration regulations will continue to perpetuate the cycle of infections and deaths from Covid-19.

In short, fear of the public charge rule will perpetuate the spread of Covid-19 in cities and towns across the country.

In our work as physicians in Boston, we see this play out in real time. Weeks before Covid-19 fully enveloped the region, a community health center that serves a predominately Latino immigrant patient population where two of us (F.M. and B.D.S.) work raced to contain the spread of fear and misinformation about the policy. The clinic’s triage line, and providers from doctors and mental health practitioners to social workers, saw an increase in anxious patients inquiring how to protect themselves against the rule. Other patients simply withdrew themselves from vital health and social services.

The evidence for this effect is not just anecdotal. In a recent survey we conducted in Texas, nearly half of respondents were concerned about how the rule might affect their families and friends, and nearly 1 in 8 low-income people reported knowing someone who had avoided public programs or medical care in the past year because of immigration-related concerns.

The Trump administration amended the public charge rule to clarify that seeking care for Covid-19-like symptoms will not be considered in an individual’s assessment, though enrolling in Medicaid and other public services like SNAP may still be used. The federal district court in Manhattan recently issued a temporary injunction halting enforcement of the new public charge rule during the pandemic, though the administration is likely to appeal that ruling.

Even so, given the general level of confusion and concern that the Trump administration has created among immigrant communities, it is unlikely that these nuances or a temporary reprieve will completely eliminate the policy’s negative effects.

So what can be done to address these policies and reduce Covid-19’s disproportionate impact in immigrant communities?

First, the administration should permanently reverse the change to the public charge rule and publicize that it has been eliminated. A public health emergency is the worst possible time for people to be avoiding medical care, and partial measures or temporary injunctions will leave many immigrants in limbo and fearful of obtaining care.

Second, states should create safe temporary housing for individuals who have tested positive and need to be isolated, and whose own homes do not allow for safe distancing from other family members.

Third, Congress needs to ensure adequate paid sick leave for individuals working low-wage essential jobs. While an earlier law requires Covid-19-related paid sick leave for many workers, large loopholes remain.

Fourth, U.S. policymakers must realize it is impossible to create a healthy and safe society when millions of our neighbors are in limbo, unsure of their futures in the country where they live, work, and — yes — pay taxes. As the United Nations and countless others have declared during the pandemic, “We’re all in this together.”

The coronavirus doesn’t check anyone’s immigration status. Until we start working to fight Covid-19 in all populations in the U.S., the virus will continue to spread.

The authors are physicians at Brigham and Women’s Hospital in Boston. Figueroa and Sommers are also faculty members in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health.

  • This is just one of the consequential negative payoffs from efforts by those who promote unrestricted immigration into the US. While it is and always has been a fact that immigration is a very good thing for the US, this is only true if there’s valid control to avoid flooding available resources. Properly admitted immigrants should have no fear of interacting with authorities of any sort and should be entitled to any of their services, especially healthcare (in reference to this article) just like any other US citizen. Yet, in our current upside down political environment, Trump or any other official who attempts to correct the many problems caused by overwhelming undocumented immigrants are pointed to as the cause of the consequence rather than those who created it in the first place.

  • How is it that the most loyal of Trump supporters call themselves ‘Christians’….DJT’s policies and certainly his rhetoric violate the most basic of Christian values, as evidenced by his harsh and inhumane treatment of those devastated the most by this pandemic. Trump is not a Christian, never was and never will be.

    • Ok and who are you to judge what Trump is or isn’t? God, Jesus, Joseph? Seems a little hypocritcal if you are a Christian believer dont you think? Sorry but if you really believe that Trump is not for the people and not on the devil sides agenda, you will learn the hard way unfortunately that this country will turn into, and California for sure is, a socialistic then communistic country. Wake up and smell the roses please do all your fellow faith driven people some hope that not all humans are just blantantly oblivious to the obvious that is going on. The mere fact that the Democrats have been trying to undermine and prove something on Trump, doesnt that make you at least turn on that common sense that something is off? What other president in our times, besides the ones that were assassinated, did our county make themselves look like the laughing stock of the entire planet?? Trump has not backed down, and will continue to fight for the same rights that you want just as much as anyone else, and for that reason, I support him 100 % and believe that he was put in for a reason. Dont forget the utter shock the media faced during the 2016 election because Trumps win was totally not on their agenda and the lies and ridiciulous stories they report daily, is a bribe cuz they are paid by the Democrats just like most of the fake ass movie stars and musicians that just preach the blue choir because it benefits them.

  • Perhaps if the past three administrations had been enforcing the immigration policies there wouldn’t be so many ILLEGAL immigrants in the country adding a burden to a stressed healthcare system. Generations of LEGAL minorities are unable to afford cost effective health care but yet ILLEGALS get healthcare.
    Asinine logic.

    • Exactly. I have no problem with a person that works to get their citizenship rights and has rights to be here but we are feeding their poor before ours and giving them free medical out of our tax dollars cuz lets face it, they don’t pay the bill, they just flee to their country again. Yet valid citizens are being refused or have a hefty bill to pay and you cant file bankruptcy on that debt. For once in a very long time, our veterans are being taken care of thanks to Trump and getting employed. Imperial County had a vast amount of cases in a short period of time and it was partly due to Mexicali not wanting to deal with anyone that was suspected of having COVID so if they had a green card, they sent them over the border and Imperial County is already a duressed county with little medical availability so of course their hospitals are getting too full and they start transporting them to San Diego or a close county so there goes the available hospital beds for our own citizens. The bottom line is, we would not just freely be accepted in any other country and be granted citizenship freely and access to the benefits that their citizens receive. That is why borders and countries and things like that exist and people do not understand that. The other bad part of this is, we are getting their criminals because we freely accept them and they are killing our children, mothers, fathers, etc.

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