By Amanda M. Gutierrez, Jacob Hofstetter, and Mary Majumder
The burdens of the COVID-19 pandemic are not borne equally. Immigrant communities, along with communities of color and people experiencing existing health inequities, are expected to face disproportionate effects.
This piece provides an overview of the spectrum of COVID-19-related risks – including socioeconomic hardship, vulnerability to infection, and challenges in access to care – faced by many of the 45 million immigrants in the U.S., especially those who are low-income or undocumented.
Socioeconomic Status and Access to Benefits
Immigrants, particularly those with temporary or no legal status, may carry a greater burden from the COVID-19 pandemic due to their inability to access public benefits and the fact that immigrants are overrepresented in frontline jobs.
Many immigrants are not eligible for states’ public health care programs, despite being low-income as well as working jobs that pay hourly wages and do not provide health insurance. Likewise, undocumented immigrants are unable to access any public benefits under the new Coronavirus Aid, Relief, and Economic Security (CARES) Act. These challenges could lead to greater incidence of homelessness, hunger, and financial hardship for immigrants both with and without status.
Without government support, many immigrants may be forced to continue working during the pandemic, often in frontline jobs that put them at greater risk of contracting to COVID-19. Additionally, many immigrants live in densely packed urban areas that are more susceptible to COVID-19.
Although less discussed, rural areas, where health care access is already strained, also have sizable immigrant communities. Immigrants make up three-quarters of the 2.4 million farm workers, half of whom are undocumented. These workers may face even greater burden, since new policy proposals would cut their wages amid increased economic strain.
Immigration Status and Access to Care
Concerns around immigration enforcement may hinder many immigrants’ efforts to access COVID-19 testing and treatment.
Even though state and federal governments generally are not collecting information about individuals’ legal status at hospitals or testing sites, fear of contact with government may cause immigrants to avoid testing or treatment, frustrating attempts to control the spread of the virus.
Further, immigrants may be reluctant to receive health services because of the Trump administration’s public charge rule, which counts receiving public benefits against some green card applications, despite reassurances that any aid related to COVID-19 will not count toward this rule.
The fact that many immigrants live in mixed status households may also mean the scale of this problem is larger than expected. Families with at least one undocumented member may be wary of contacting health authorities or seeking treatment to avoid attention being brought to a family member without legal status. Consequently, the number of households and individuals at risk of avoiding COVID-19 testing or treatment may be greater than the 11.3 million undocumented individuals in the country.
Individuals in immigration detention may also be at higher risk of exposure to the virus. About 40,000 people are currently being held in U.S. immigration detention centers, including substantial numbers of asylum seekers. Detainees are kept in densely-packed, often unhygienic facilities that have poor track records providing for detainees’ health. These conditions will only leave individuals in immigration detention more vulnerable to COVID-19 outbreaks.
Language Access and Health Communication
A lack of language access in health settings may lead limited English proficient (LEP) patients to receive worse quality care. Half of all immigrants in the U.S. are LEP, representing about 25 million individuals. Language barriers between LEP patients and health providers already cause medical mistakes and death. Health communication barriers experienced during this pandemic may further strain fast-paced interactions, especially when difficult decisions are being made as to who receives limited health resources.
Language barriers also hinder successful implementation of public health measures in LEP immigrant communities, where there is little translated information on COVID-19 prevention, testing, and treatment. Without linguistically welcoming (and culturally sensitive) outreach at all levels of government, immigrant communities with high concentrations of LEP individuals may have little accessible information on the best ways to protect themselves and when to seek testing and treatment.
Ways Forward
The COVID-19 pandemic will almost certainly weigh more heavily on immigrants than native-born Americans. This disparity represents not only an ethical and humanitarian concern but also a serious challenge for efforts to control transmission of the virus. Successfully reducing the impact of COVID-19 will require all levels of government to address the unique challenges the pandemic has created in immigrant communities.
First, to reassure individuals that no undocumented immigrants will be subject to current or future arrest after seeking COVID-19 testing or treatment, local governments should begin aggressive outreach efforts to immigrant communities through print media, radio, and television. Outreach efforts should also publicize that use of COVID-19-related services will not be considered under the new public charge rule.
Second, Immigration and Customs Enforcement (ICE) should release detainees who are not a threat to public safety and focus on preparing detention centers for further spread of COVID-19 by increasing transparency about outbreaks, creating prevention and response plans, and improving access to basic hygiene tools and necessary medical care. ICE has begun to take these steps by releasing some detainees at high-risk for COVID-19 complications.
Third, the U.S. health care system must prepare to accommodate the diverse linguistic needs of the immigrant population. Readily available interpretation services, whether remote (web-based or via phone) or in-person should be made available in all health settings. Medical and legal documents should also be translated into patients’ preferred language.
Lastly, government officials should ensure accurate COVID-19 information is available in immigrant communities in the languages spoken by significant numbers of immigrants. Some states, including New York and Massachusetts, have begun improving language access around COVID-19 information. However, states like Texas and California, which have the largest LEP populations, are lagging behind in providing timely outreach in languages besides Spanish, though over 150 languages are spoken in both states.
Without these measures, health and other disparities between immigrants and native-born Americans will continue to worsen during this pandemic. For the broader public, a failure to account for how immigrant communities fit into the national, state, and local response to COVID-19 may delay our ability to bring the pandemic under control.
