Power Up: Policymakers concerned that immigrants avoiding coronavirus testing and care

Originally published by The New York Times

The People

FEAR OF CARE: Many immigrants are avoiding testing and coronavirus treatment amid worries about being deported or hurting their chances of becoming legal permanent residents.

State and national policymakers say they're increasingly concerned about the public health implications of this — especially as the case data starts to show the disproportionate toll that the novel coronavirus is taking on Latinos across the United States.

“We are seeing a reduction in services used by the Latino population,” Milwaukee's Health Commissioner Jeanette Kowalik told Power Up in an interview, adding that Hispanics make up about 30 percent of the Wisconsin city's coronavirus cases — even though they only comprise 19 percent of its population.
The Trump administration's hard-line immigration policies are a big reason, she said: “Fears of being detained and questioned are one of the reasons why they are not wanting to deal with any government entities … People are fearful of being engaged with the government. There's a lack of trust.”
It's on Capitol Hill's radar, too: “Part of the fear of coming forward for testing or treatment has to do with the Trump administration's virulent hostility toward immigrants over the years and the fear that even getting tested for the coronavirus could get them deported and separated from their families,” Rep. Joaquin Castro (D-Tex.), the chairman of the Congressional Hispanic Caucus, tells Power Up.

The Trump administration's recent update to the “public charge” rule has made immigrant communities more concerned about public services. The new rules “make it harder for immigrants to enter or stay in the United States if they’re considered likely to use taxpayer-funded benefits like Medicaid,” our colleague Paige Winfield Cunningham reported.

The changes “went into effect in late February, just as the virus was beginning to sweep through communities [in Los Angeles],” where one-third of county residents are foreign-born and one-fifth are either undocumented or living with someone who is undocumented, per Stat News's Usha Lee McFarling.
“The edict, which tightly limits noncitizens’ use of government programs, has left many immigrants increasingly afraid to seek any public services, including medical care, because they fear doing so could lead to deportation or prevent them from receiving permanent residency in the future.”

Immigration authorities announced an exception for coronavirus care: “On March 16, U.S. Citizenship and Immigration Services officials announced that the public charge rule would not apply to those who seek testing or treatment for the novel coronavirus. But many physicians fear news of the decision is not getting out.”

“Edgar Chavez, a family practitioner, founded and runs Universal Community Health Center, which operates three clinics in some of LA’s poorest neighborhoods. He says many of his patients are afraid.”
“I have one family where one person is very sick with pneumonia and the whole family has probably been exposed [to the coronavirus], but they say, ‘We’re afraid to get the test. We’ll be deported,’’ Chavez told Stat.
These concerns are also present in the D.C., Maryland, and Virginia region — where our colleagues report Latinos make up about a third of coronavirus cases despite only comprising about 10 percent of the population.
“Jair Carrasco, an organizer with D.C. street-vendor advocacy group Vendadores Unidos, has heard from immigrant families afraid to take sick relatives to a hospital that they are concerned immigration agents could be lurking there,” our colleagues Antonio Olivo, Marissa Lang, and John Harden report.

Immigration authorities said in a March statement that enforcement actions more broadly would be reduced in light of the pandemic. Agents would focus enforcement on “public safety risks and individuals subject to mandatory detention based on criminal grounds” and wouldn't carry out operations at health care facilities, per the statement: “During the covid-19 crisis, ICE will not carry out enforcement operations at or near health care facilities, such as hospitals, doctors' offices, accredited health clinics, and emergent or urgent care facilities, except in the most extraordinary of circumstances. Individuals should not avoid seeking medical care because they fear civil immigration enforcement.”

“From our perspective, people should have no fear of receiving any kind of medical treatment or testing related to coronavirus that it would lead to any kind of enforcement action in 99.9% of circumstances,” an ICE spokesperson told Power Up.
On the public charge rule specifically, USCIS released a statement encouraging all immigrants “to seek necessary medical treatment or preventive services” during the pandemic: “Such treatment or preventive services will not negatively affect any alien as part of a future Public Charge analysis.”
Deportations appear to be down, too: In April, ICE completed 9,417 overall deportations, according to an agency spokesperson. “Between January and March, ICE deported an average of 20,881 people per month,” our colleagues Kevin Sieff and Nick Miroff reported in late April.
But the administration is sending some infected migrants to their home countries, they note: Since coronavirus “struck the United States, immigration authorities have deported dozens of infected migrants, leaving governments and nonprofits across Mexico, Central America and the Caribbean struggling to respond.”

Jane Delgado, the president and chief executive of the National Alliance for Hispanic Health, told Power Up that immigrants' long-running distrust of the Trump administration lingers despite the guidance — and are concerned it might reverse course on enforcement: “The government has shown itself not to be reliable partner that we want but it’s the partner we have,” Delgado told us.

She urged people to go get tested at “trusted service providers in their communities that they know will protect them as best they can,” but noted: “All of us are in a situation where we don’t know what the government will do.”

Castro says the Trump administration can do more on this front: “What the administration needs to do is invest in community-based workers that these communities trust to go in there and get the word out that it's okay to get tested and treated — because otherwise you still have this lingering fear and suspicion.”

He argues that the Heroes Act, the $3 trillion coronavirus relief bill that House Democrats passed earlier in May, would help, too. The bill would include “another round of direct payments to individuals, up to $6,000 per family, including to unauthorized immigrants; $200 billion for hazard pay for essential workers,” according to our colleague Erica Werner.
The bill also requires that the Occupational Safety and Health Administration (OSHA) to issue temporary standards to protect vulnerable populations, such as undocumented immigrants, who are in jobs with an occupational risk.

Coronavirus has exacerbated long-running social and health disparities among communities of color. The higher rates of infections among Latino populations are also in part tied to the virus spreading in places of essential employment where physical distancing is not an option. People of color are more likely to be considered essential workers during the pandemic that has killed nearly 100,000 Americans; one study from a liberal research group found that black and Hispanic workers are far less likely to be able to telework than white and Asian workers.

Our colleagues Reis Thebault and Abigail Hauslohner report that in rural America, “infection has raced through immigrant worker communities, where poverty or immigration status prevent some of the sick from seeking care and language barriers hinder access to information.” Immigrants and the undocumented are some of the “‘essential’ workers who have kept the country’s sprawling food industry running, but who rarely have the luxury of taking time off for illness.”

“In Texas County, Okla., patients pouring into the hospital with covid-19 symptoms are predominantly Hispanic and work in the local Seaboard Foods pork processing plant, which like many others has stayed open even after becoming the locus of an outbreak,” they write.

Our colleagues Aaron Williams and Adrian Blanco have an excellent graphic story about the disproportionate toll the virus is taking on communities of color. “In cities like New York, Chicago and the District, coronavirus deaths were disproportionately affecting black and brown communities. Additional data suggested that certain chronic health conditions, such as hypertension, diabetes and others, were associated with complications from covid-19, the disease caused by the coronavirus. What once was perceived as a disease that affected only the elderly in a few areas was now wreaking havoc in the bodies of 20- and 30-year-old people of color across the nation.”

But health conditions are only part of the story: “Risk is increased when factoring in living conditions and access to health care. Communities of color may be more likely to live in densely populated areas in cities because of the history of racial segregation in the United States. And black and Latinx Americans are also two to three times more likely than white Americans to be uninsured, according to a report on covid-19 and race from the CDC.”

Take the Bronx in New York: According to Census Bureau, the Bronx is over 56 percent Hispanic or Latino. In April, the New York Times described the Bronx as the city's “coronavirus capital.” A month later, the borough, the poorest in the city, “has the highest rates of coronavirus cases, hospitalizations and deaths in the city, while the most well-off borough, Manhattan, has the lowest rates,” the Times's Kimiko de Freytas-Tamura, Winnie Hu and Lindsey Rogers Cook report.
From The Post:

Power Up: Policymakers concerned that immigrants avoiding coronavirus testing and care