Should Undocumented Immigrants Have Access To Social Services
PLoS Negl Trop Dis. 2020 Jul; xiv(seven): e0008484.
Disproportionate affect of the COVID-19 pandemic on immigrant communities in the Usa
Eva Clark
ane Department of Medicine, Department of Infectious Diseases, Baylor College of Medicine, Houston, Texas, The states of America
two Section of Medicine, Section of Health Services Research, Heart for Innovations in Quality, Effectiveness, and Safe (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas, Usa of America
3 Section of Pediatrics, National Schoolhouse of Tropical Medicine, Baylor College of Medicine, Houston, Texas, U.s. of America
Karla Fredricks
4 Section of Global and Immigrant Health, Section of Pediatrics, Texas Children'due south Infirmary, Baylor College of Medicine, Houston, Texas, U.s.a. of America
Laila Woc-Colburn
ane Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, U.s. of America
3 Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, Us
Maria Elena Bottazzi
iii Section of Pediatrics, National School of Tropical Medicine, Baylor Higher of Medicine, Houston, Texas, United States of America
5 Center for Vaccine Evolution, Department of Pediatrics, Texas Children's Hospital, Baylor Higher of Medicine, Houston, Texas, U.s.
half-dozen Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, The states of America
7 Department of Biology, Baylor University, Waco, Texas, The states of America
Jill Weatherhead
1 Section of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas, United states of america of America
three Department of Pediatrics, National Schoolhouse of Tropical Medicine, Baylor College of Medicine, Houston, Texas, Us of America
5 Eye for Vaccine Development, Department of Pediatrics, Texas Children'south Hospital, Baylor College of Medicine, Houston, Texas, United states of America
Victoria J. Brookes, Editor
In early 2020, a novel coronavirus (SARS-CoV-2) began to trickle through global communities, resulting in a pandemic of proportions not seen since 1918. In the US, while the disease caused by SARS-CoV-2, COVID-19, initially affected international travelers and their close contacts, it is now ravaging many disadvantaged communities. As in past pandemics, social and economic determinants will strongly influence susceptibility to and health outcomes of COVID-19; thus, it is predictable that low-income and vulnerable US populations will be disproportionately affected. Certain "hot spots" have already demonstrated loftier rates of COVID-19–related bloodshed in minority populations, particularly those of impoverished communities, likely due to increased prevalence of comorbid conditions every bit a upshot of diff socioeconomic factors and inadequate access to timely healthcare [ane–5]. We can anticipate similar outcomes in other vulnerable populations, particularly in immigrant communities, which have similar socioeconomic condition and rates of comorbidities. With over 46.7 million immigrants currently living in the The states, of which 11 million are undocumented [vi], a socioeconomic perspective of the ongoing COVID-19 pandemic inside the United states of america immigrant customs is necessary. Here, we will focus on the potential impact of COVID-nineteen on immigrant communities in the US, peculiarly those in Texas.
Why is the COVID-xix pandemic likely to disproportionately affect United states immigrants?
The intricacies of poverty, express admission to healthcare, and fear of legal repercussions identify vulnerable immigrant communities within the US at high take a chance for acquiring SARS-CoV-2 and developing severe COVID-19 (Fig 1). Houston is an excellent example of a large, prosperous The states metropolis that is made up of (and depends upon) immigrants. Currently, there are an estimated 1.vi million immigrants (23.three% of the population) living in Houston, the majority of whom are from Mexico (40.2%), El Salvador (7.half dozen%), Vietnam (5.9%), India (v.5%), and Honduras (3.6%). More than than 500,000 of these immigrants (37.2%) are undocumented [7,8]. In Texas as a whole, an estimated 32% of undocumented immigrants alive below the poverty level, and 64% are uninsured with express options to meet their medical needs [viii].
Take a chance factors and anticipated socioeconomic outcomes for the COVID-19 pandemic in vulnerable immigrant communities.
The lack of readily accessible, affordable healthcare [9,10] is particularly consequential during the COVID-19 pandemic. Starting time, early diagnosis and monitoring of persons with COVID-19 is disquisitional both to optimize the private patient's effect and to foreclose further community transmission. Many vulnerable immigrants are under- or uninsured [11] and thus depend upon Federally Qualified Health Centers (FQHCs), safety-net public health systems, or free clinics. These organizations are oftentimes underfunded, limiting their ability to provide testing, management, and follow-upward services to their patients. Second, lack of access to preventive medicine leads to increased gamble of underlying wellness weather condition such equally obesity, hypertension, and diabetes-—comorbidities that have been linked to more astringent COVID-19 manifestations [9,12–15]. In a national evaluation of health conditions in immigrant populations, nearly a third (27.seven%) of those from United mexican states, the Caribbean, and Primal America had hypertension, 71.five% had obesity, and 9.6% had diabetes [fifteen], compared with the age-adapted prevalence of 45.4%, 42.4%, and 8.two%, respectively, in the US general population [16]. All the same, within the US general population, these comorbidities tend to be college in minority groups compared to whites; for instance, while the prevalence of diabetes in the US general population was eight.two% overall, information technology was 12.5% for people of Hispanic origin, xi.7% for non-Hispanic Blacks, and 7.5% for not-Hispanic Whites [17]. Third, depending on their fashion of entry into the US, many immigrants may be at risk for excessive stress related to poverty, trauma, and poor social support, which leads to mental wellness conditions such equally mail service-traumatic stress disorder, depression, and feet [xviii]. These psychological stressors may be worsened during a pandemic, certainly for those with limited healthcare resources, loftier run a risk of job loss, or high chance of SARS-CoV-two exposure.
Regarding chance of SARS-CoV-2 exposure, many immigrants are at increased run a risk both because their economic situation requires continuation of work despite "social distancing" and "stay-at-home" recommendations and considering the types of jobs about usually worked by immigrants often require face-to-face interactions. Immigrants brand upwardly more than 20% of the Texas work force and are employed most usually in construction, accommodation, nutrient services, healthcare, and manufacturing industries [eight,19]; these are "essential" professions that exercise non lend themselves to working from abode [20]. In addition, immigrants who continue working are more likely to apply public mass transit to become to their jobs, which farther increases their take chances of SARS-CoV-ii exposure [21].
In the home, immigrants are more likely to live in large, multigenerational family groups or with multiple roommates. Nearly 29% of Asian, 27% of Hispanic, and 26% of Black Americans live in multigenerational households, a exercise that is particularly common in those who are foreign-born [22]. Logically, if i person living in a crowded domicile is infected with SARS-CoV-2, their cohabitants, including elderly and immunosuppressed ones, will likely be exposed every bit well. Finally, recent immigrants and their families are less likely to take prison cell phones or internet access [23] and to speak and read English; in Texas, for example, approximately 50% of undocumented immigrants lack English proficiency [viii]. Consequently, immigrant communities with limited English language skills may exist less likely to receive and understand public health messages, warnings, and updates.
What is the potential socioeconomic impact of the COVID-19 pandemic on United states immigrants?
One of the ways US immigrants play a pregnant part in the Usa economy is by paying federal, land, and local taxes. In 2018, immigrants in Texas paid 38.6 billion dollars in taxes, of which undocumented immigrants assigned Individual Taxpayer Identification Numbers (ITINs) contributed an estimated $4.2 billion [24]. Despite this, ITIN holders practise not qualify for COVID-19 federal economic relief through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Families with mixed immigration status who file jointly, such as undocumented adults with children or spouses who are US citizens, are too excluded because all individuals included in a tax render must have valid Social Security numbers to be eligible [25]. Equally such, despite paying into the The states economy and experiencing equal, if not more severe, consequences from the COVID-19 pandemic, many immigrants will not receive any COVID-19–related economic relief from the Us government.
Thus, there is much concern that the COVID-nineteen pandemic will issue in particularly high rates of unemployment and financial strain within immigrant communities [26]. Between February 2020 and April 2020, the unemployment rate for immigrant women increased from 4.three% to 18% and for immigrant men from 3% to fifteen.three%, while for US-born women, information technology inverse from 3.3% to fifteen.3%, and for US-born men, information technology increased from 4.3% to 12.8% [27]. Considering undocumented immigrants are ineligible for national unemployment benefits in addition to CARES Act benefits, job loss or reduced piece of work hours due to the COVID-19 pandemic may pb to significantly decreased fiscal reserve in immigrant households. For the 57% of immigrants who have private insurance [1], loss of a job could also mean loss of health insurance for the employee and their family unit, leading to further difficulty accessing healthcare. Those who are able to retain their jobs, as discussed above, may work in sectors not acquiescent to working from home or that do not permit sick leave [twenty,28]. College numbers of uninsured immigrants combined with those working in high SARS-CoV-2 exposure hazard jobs will undoubtably result in increased COVID-19–related morbidity and mortality in immigrant communities. Additionally, in the context of extended school closing equally a result of COVID-19, many parents have limited childcare options, putting additional financial, wellness, and social pressure on families.
Equally the COVID-19 pandemic causes instability in global supply chains, concern for worsening food insecurity is growing in many disadvantaged communities. Immigrants are at peculiarly high risk, particularly those who take resided in the US for less than five years [29]. This may exist considering immigrant families newly arrived in the US have more significant language barriers and less exposure to a stable education system and jobs than those who take lived in the Usa for longer periods of time. However, fifty-fifty immigrant families who have lived in the U.s. for more than 10 years are at college risk of nutrient insecurity than U.s.a.-born households. According to ane study, more than thirty% of children born to Mexican and Fundamental American immigrants are already subject to food insecurity [29]. Additionally, the federal authorities stipulates that adults (with some exceptions) with legal permanent resident condition (i.e., green card holders) must wait 5 years before they can apply for the Supplemental Nutrition Assist Program (SNAP) [30]. Furthermore, despite being eligible for SNAP, low-income Us citizen children with immigrant parents have decreased utilization of this benefit in recent years [31]. Although children with greenish cards are non field of study to the five-year waiting flow and may authorize for SNAP along with low-income US citizen children, studies accept shown that eligible children of ineligible parents are less likely to participate in assist programs [32]. This has become increasingly apparent in recent years because of business organization over the "Public Charge" rule (implemented on February 24, 2020), which limits the power of immigrants to adjust to legal permanent resident status if they have used certain public benefits. The fright of displacement and chilling upshot of this rule have led many immigrant families to forgo participation in all federal assistance programs, including nutrition assist, fifty-fifty if they are eligible and not subject to a public charge determination. The factors driving this downward tendency will probable too forestall many eligible immigrant families from applying for Pandemic Electronic Do good Transfer (EBT), a provision of the Families Offset Coronavirus Response Act allowing states to provide money to families whose children were receiving free or reduced cost meals through their schools. This would have a far-reaching impact considering, unlike SNAP, Pandemic EBT is available to children regardless of clearing status. Expansion of "food deserts" as a result of express transportation options and restaurant restrictions, reduced grocery shop supply, and diminished resources in food banks may further limit nutrient availability in at-risk immigrant communities [33–35].
Finally, due to the implementation of contempo immigration policies such as the "Public Charge" rule, the utilization of available health resource among immigrants and their families has finer decreased as a consequence of widespread fear of immigration enforcement and/or business that using these services would impair their success of time to come naturalization. In improver, mounting health, psychosocial, and financial concerns—together with fears of legal exposure—may inhibit immigrant participation in the ongoing 2020 census data collection [25]. In the long term, inadequate enumeration of the United states immigrant populations volition manifest as decreased funding for sorely needed health, teaching, and socioeconomic programs in many disadvantaged communities.
Déjà vu: Comparing COVID-19 to H1N1
The COVID-19 pandemic is certainly not the first pandemic to reveal underlying health disparities. Most recently, the 2009 H1N1 influenza pandemic provided opportunity to sympathise health inequalities in vulnerable Usa populations that parallel those emerging in the current COVID-xix pandemic (Fig 2). Both suggest poor health and economic outcomes in disadvantaged populations such as at-risk immigrants.
Comparison of COVID-19 and 2009 H1N1 influenza pandemic timelines in the context of events affecting vulnerable immigrant communities in the US.
CDC, US Centers for Disease Control and Prevention; EUA, emergency employ authority; FDA, Us Nutrient and Drug Assistants; Ice, US Immigration and Customs Enforcement; USCIS, US Citizenship and Immigration Services; WHO, World Health Organization.
In the jump of 2009, United mexican states reported a number of cases of influenza-like disease caused by a novel H1N1 virus. This virus disseminated rapidly, and the Earth Wellness Organization (WHO) declared H1N1 influenza a pandemic in June 2009 [36]. The final brunt of H1N1 disease in the U.s. was estimated to exist approximately 60.viii million cases, with more than 274,000 hospitalizations and more than 12,000 deaths [37]. Similar SARS-CoV-2, H1N1 oft caused severe lung injury [38]. Specific risk factors for severe H1N1 disease included obesity, pregnancy, immunosuppression, lung disease, HIV infection, poverty, and lack of access to healthcare [39–41]. Additionally, factors such every bit limited access to and use of preventive medical intendance [42], large household sizes [28], difficulties complying with work-from-home directives (fifty-fifty when ill) considering of the need to work [20,28], and reliance on public transportation [21] placed immigrants at high hazard of H1N1. Surveillance case reports during the 2009 H1N1 pandemic were disproportionately loftier among all disadvantaged groups, and the Hispanic population specifically was noted to accept increased influenza-associated hospitalization and pediatric mortality [43]. The disproportionate effect of the H1N1 pandemic on Spanish-speaking Hispanics may accept occurred because of increased adventure of H1N1 exposure and greater disparity in access to healthcare compared with other disadvantaged groups [28]. All the same, there are thin data on outcomes for other immigrant populations during the H1N1 pandemic considering of express surveillance. In addition to clinical effect inequalities, the H1N1 pandemic exemplified the disparities in pandemic preparedness, response, and recovery for disadvantaged populations, including immigrant communities [21]. Unfortunately, since the H1N1 pandemic, health disaster preparedness for immigrant communities has largely remained inadequate.
Conclusions and next steps
SARS-CoV-2 has severely impacted our global customs, placing marginalized populations at high take chances of contracting the virus and of developing severe COVID-19. Equally we learned from the H1N1 pandemic, it is imperative that we human action urgently to support disadvantaged communities during this COVID-19 health and economical crisis. Taking activity at local, country, and national levels to improve healthcare access also as economic and legal protections for immigrant communities is critical [44]. Acutely, healthcare facilities should be designated as locations where clearing enforcement is prohibited. Such action will decrease the fright of seeking healthcare services. For those states that have not already done so, opting into Medicaid expansion would increase health insurance coverage for more low-income adults, including documented immigrants. Additionally, states should change their eligibility criteria for the Children's Health Insurance Programme (CHIP) to allow all children—regardless of clearing status—to be considered, thus increasing the number of immigrant children with healthcare coverage. Hereafter COVID-xix–related relief packages should include vulnerable immigrant groups and meliorate the availability of health services through the expansion of condom-net health systems in all disadvantaged communities [45]. Testing for SARS-CoV-2 should be made widely bachelor, hands accessible, and free. Policy changes to prevent or mitigate devastating healthcare costs for uninsured patients with COVID-19 must be instituted. In the long term, improving primary intendance resource to diagnose, treat, and control comorbidities in high-risk populations may reduce poor outcomes in vulnerable immigrant communities during futurity pandemics. Additionally, measures to create and maintain rubber employment opportunities would help to relieve immigrants' economic brunt while not increasing their exposure hazard. Further, developing tools to speedily disperse culturally and linguistically appropriate public health messages to at-hazard immigrant communities will amend health education, preparedness, and response time. The intendance of disadvantaged communities—including immigrant populations—in the US must be prioritized to reduce the devastating, inequitable health and financial costs repeatedly and predictably accrued by immigrant populations during epidemic illness outbreaks.
Funding Statement
The authors received no specific funding for this work.
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Should Undocumented Immigrants Have Access To Social Services,
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