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Lost in the Shuffle: The Impact of COVID-19 on Immigrants in Need

The recommendations for healthy people who have symptoms consistent with COVID-19, the illness caused by the corona virus called SARS-Co-V2, is to stay at home, get plenty of rest, drink fluids and control fever and body-aches with a non-steroidal medication. For people with pre-existing medical conditions, the elderly or those with more serious symptoms, an evaluation by a healthcare provider is warranted. This is a reasonable recommendation given that for most healthy people, the symptoms are uncomfortable but not life-threatening. There is a population however, that regardless of the severity of their illness, may stay at home and not seek medical care, even when things are serious. Fear of arrest and deportation is a real issue for undocumented immigrants and calling an ambulance or going to a hospital can put them at risk for these actions. The result is that some very sick people may not seek appropriate medical care. In addition, they may be taken care of by people that don’t have the appropriate personal protection, putting even more people at risk.

Current administrative policy on immigration is likely to exacerbate this issue. Homeland Security started to enforce the public charge rule on February 24th of 2020, though it has been on the books since 1882. This rule made many immigrants ineligible for visas or residency if they are considered a public charge – those who by definition of law are considered a potential financial burden to the country. Even documented immigrants on visas or green cards can be affected, and as a result, many are not enrolling in or dropping their federally funded insurance plans. As a result, these groups are unlikely to seek care, and even if they do, will not have the necessary protections or coverage needed to provide them with appropriate care.

Some may say that this is fine. That we shouldn’t be bringing more people into the country during this crisis, nor should we support those who cannot support themselves. The travel restrictions enacted by this administration were put into force for just that reason. Restricting entry may have some validity, especially from areas with known cases. But not treating or deporting individuals already here is not only against the grain of our country’s spirit, it is also a departure if not violation of our humanitarian responsibilities.

There are also some risks to these policies. In-line with the epidemiologic data we have to date, those with mild symptoms should stay home and will likely do fine with just supportive care. That is fine if you can work at home, have access to resources and either a policy in place or enough earned time to weather the storm. The same cannot be said of people who aren’t protected and who often work under the table. These include people in industries from hotel service to agriculture. It is a “hidden” workforce that while denounced by the current administration, is the backbone of many of these industries. These people are likely to still go to work, despite symptoms, which puts everyone at risk.

While some might argue that deporting them is the answer, it is not. This is a pandemic and a humanitarian crisis. While we certainly don’t have the best healthcare system in the world, we do have one, and we owe it to the people living here to offer what we can. This could be temporary support public assistance programs for these individuals working in these industries. Even if there are eventually limitations to this support, the benefit of support rather is likely to outweigh the risk of ongoing viral spread.

Treating those who are critically ill is also an imperative. Providing access to hospital care is not only the right thing to do, it also protects the families and friends that would otherwise be caring for them at home. Fear of accessing care cannot be a barrier. This is unjust and risky and deteriorates the moral thread of our country. Nor should the burden be placed solely on safety-net clinics or hospitals. We are all in this together and everyone will have to tighten their belts and step up to the plate to help during this crisis.

There is a lot to iron out. Ignoring immigration status during this crisis is essential but will come at a cost. Undoubtedly some of these individuals will fear the consequences of what happens after we lift these protections. There will be widespread financial implications as well. There will be factions on both sides and each will have valid points about cost, access to care and our responsibilities as a nation.

It is an imperative to think about how we as a nation can address this issue from a humanitarian perspective first. As a wise lady once said, “Give me your tired, your poor, Your huddled masses yearning to breathe free”. This applies now as it did then, and we must not turn a blind eye to our responsibilities as a country.



Stephen Wood

Stephen P. Wood, MS, ACNP is an acute care nurse practitioner practicing emergency medicine in Boston, Massachusetts, and a fellow in bioethics at the Center for Bioethics at Harvard Medical School in Boston.

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