Immigrants Are at Particular Risk of COVID-19. Here's What Congress Can Do.

Physicians, residents, and medical students around the country are seeking signatures for Congress to take action for immigrants in light of COVID-19. There are two specific issues brought on by the current public health crisis: the health risk of detainees in immigrant detention centers, and the need for undocumented immigrants to have access to COVID-19 testing, treatment, public health information, and relief benefits. It is of utmost importance that Congress takes on these issues to ensure immigrants have equitable protection from COVID-19 and appropriate access to health care.


Releasing Immigrants in Detention Centers


Immigrants, refugees, migrants, and asylum seekers in detention centers need to be released and safely incorporated into communities in order to ensure immigrant and greater community safety and to secure the greatest public health benefit as our nation fights the current pandemic. Detention centers place the detainees at an increased risk of communicable diseases, including COVID-19. Even under normal circumstances, immigrant detention centers find it difficult to prevent viral outbreaks of mumps, chickenpox, and influenza. Influenza virus, in particlar, has a lower viral replication number (R0) than COVID-19. Recent Lancet, New England Journal of Medicine, and Health Affairs articles cite the inability to remain distanced in enclosed spaces, limited access to healthcare services, and frequent turnover of people as ideal conditions for COVID-19 to thrive and decrease the effectiveness of mitigation strategies at large. Within the past few weeks, ICE has reported 90 confirmed COVID-19 cases among its detainees and more than 20 cases among its employees. These totals may be lower than the actual number of cases in these facilities for many reasons, including the ongoing lack of testing capacity in the United States. Internationally, a German refugee camp experienced a 3,486% increase in cases over five days due, in part, to conditions similar to those in U.S. detention centers. Not taking appropriate actions to reduce the number of detainees in immigrant detention centers endangers the lives of employees, detainees, and the broader community.


While the American Civil Liberties Union (ACLU), physicians, and other groups have been effective in advocating for the release of nearly 700 detainees, over 30,000 people still remain in ICE detention centers. These efforts have included public statements, letters to Congress, and many immigrants and advocacy groups filing lawsuits asking for their release. Additionally, the delayed response by ICE has led to the development of the Federal Immigrant Release for Safety and Security Together (FIRST) Act, which was just unveiled last week by Senator Cory Booker. Considering most individuals in immigrant detention centers have never been charged with a criminal offense, it is in the public's health interest for those without violent offenses to be released or placed in Alternative to Detention (ATD) Programs, which are cheaper than current detention programs and have demonstrated high compliance.


Ensuring Access to Care for Undocumented Immigrants


It is critical to highlight the effects that this pandemic is having on our country’s undocumented immigrants. Immigration advocacy groups such as the Migration Policy Institute, the Centers for American Progress, and the ACLU have recently raised concerns that many vulnerable groups such as DACA recipients, undocumented immigrants, and certain lawful permanent residents do not have equal access to provisions for COVID-19 testing and treatment within the Coronavirus Aid, Relief and Economic Security (CARES) Act and Families First Coronavirus Response Act (FFCRA). The expansion of care provided by the current legislation failed to include provisions for immigrants or remove certain health care eligibility restrictions on immigrants. For example, many immigrants rely on emergency Medicaid in order to qualify for access to care in many states, and this provision was not expanded in Congress's initial response packages. Additionally, current immigration policies, namely the public charge rule, have the potential to negatively impact both individual immigrants and family units’ willingness to access care due to fear that this assistance will be counted against their ability to apply for legal permanent resident status in the future. The barriers that remain in place despite the unique circumstances during COVID-19 make access to necessary care far more difficult, if not impossible, for these populations. H.R. 6437 (Coronavirus Immigrant Families Protection Act) was introduced earlier this month to ameliorate the shortcomings of the earlier legislation in regard to immigrant families and ensure their protection from COVID-19. The additional provisions of this legislation, along with the suspension of the public charge rule, are critical for every person in our country to have the necessary resources to make it through this crisis. We need legislation that remedies the inadequate care provided to undocumented immigrants in light of COVID-19, as this care is integral to overcoming this pandemic as a nation.


Legislation Needed


It is vital that our country begins to address the health concerns for immigrants, refugees, migrants, and asylum seekers during this current pandemic, which can be addressed by the following actions:

  • Legislation that seeks to release detainees from detention centers and improve the medical conditions for those that must remain in detention (like the FIRST Act)

  • Legislation that will provide the necessary resources that undocumented immigrants in the U.S. need in order to remain healthy during the current pandemic

As current and future medical professionals, we have the power to raise concerns about this vulnerable population and improve our country’s public health by advocating for Congress to speak on behalf of these immigrants, refugees, migrants, and asylum seekers.


Tristan Mackey is a medical student at the University of South Carolina - Greensville School of Medicine. Thomas Pak is a medical student and PhD candidate at the University of Iowa Carver College of Medicine.


Acknowledgements: Dayna Isaacs, Sally Midani, Titus Hou, Huan Khong, Daniel Park, Daniel Lee, David Long, Zoe Moyer, Haritha Pavuluri, Keanan McGonigle, Drayton Harvery, Rohan Khazanchi, Pooja Patel, Claire Justin


References:

  1. http://dx.doi.org/10.15585/mmwr.mm6834a4

  2. https://www.ice.gov/doclib/detention-standards/2019/nds2019.pdf

  3. https://www.nytimes.com/2019/05/22/us/flu-outbreak-border-detention-center.html

  4. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30295-4/fulltext

  5. https://www.healthaffairs.org/do/10.1377/hblog20200310.290180/full/

  6. https://www.nejm.org/doi/full/10.1056/NEJMp2005953

  7. https://www.npr.org/sections/coronavirus-live-updates/2020/04/16/835886346/ice-releases-hundreds-as-coronavirus-spreads-in-detention-centers

  8. https://www.nytimes.com/interactive/2020/04/17/us/coronavirus-testing-states.html

  9. https://www.nytimes.com/2020/04/19/us/coronavirus-governors-trump-tests.html

  10. https://www.theguardian.com/world/2020/apr/15/refugees-in-german-centre-fear-lack-of-protection-as-covid-19-cases-soar

  11. https://www.aclu.org/letter/aclu-letter-ice-civil-immigration-enforcement-and-detention-during-covid-19-pandemic

  12. https://www.aclu.org/press-releases/aclu-demands-ice-suspend-civil-enforcement-release-detainees-during-covid-19-pandemic

  13. https://www.aclu.org/press-releases/aclu-statement-first-confirmed-case-covid-19-ice-detention

  14. https://www.usatoday.com/story/news/nation/2020/04/14/immigration-amid-covid-19-evangelicals-urge-release-some-detainees/2991399001/

  15. https://www.aila.org/advo-media/aila-correspondence/2020/aila-sends-letter-to-ice-regarding-ice-facilities

  16. https://www.vice.com/en_us/article/4agp4w/thousands-of-doctors-demand-ice-release-detainees-to-stop-a-covid-19-disaster

  17. https://nylpi.org/wp-content/uploads/2020/03/FINAL-LETTER-Open-Letter-to-ICE-From-Medical-Professionals-Regarding-COVID-19.pdf

  18. https://www.documentcloud.org/documents/6816336-032020-Letter-From-Drs-Allen-Rich-to-Congress-Re.html#document/p4/a557238

  19. https://www.aclu.org/press-releases/immigrant-rights-groups-sue-ice-release-maryland-detainees-most-risk-covid-19

  20. https://www.splcenter.org/sites/default/files/redacted_gayle_complaint.pdf

  21. https://www.splcenter.org/news/2020/04/16/covid-19-updates-splc-continues-fight-against-injustice

  22. https://www.documentcloud.org/documents/6839034-Lawsuit-against-ICE-on-behalf-of-detained.html

  23. https://www.healthaffairs.org/do/10.1377/hblog20200418.472211/full/

  24. https://www.booker.senate.gov/imo/media/doc/MDM20356.pdf

  25. https://trac.syr.edu/immigration/reports/530/

  26. https://www.immigrantjustice.org/research-items/report-better-way-community-based-programming-alternative-immigrant-incarceration

  27. https://www.cato.org/blog/alternatives-detention-are-cheaper-indefinite-detention

  28. https://greateras1.org/wp-content/uploads/2020/04/Organizational-Sign-On-Ltr-re-COVID-4-Refugee-Priorities.pdf

  29. https://www.aclu.org/news/immigrants-rights/covid-19-doesnt-discriminate-neither-should-congress-response/

  30. https://www.migrationpolicy.org/article/crisis-within-crisis-immigration-time-covid-19

  31. https://www.americanprogress.org/issues/economy/news/2020/04/16/483329/phase-4-coronavirus-relief-bill-must-include-protections-undocumented-immigrants/

  32. https://time.com/5823491/undocumented-immigrants-essential-coronavirus/

  33. https://www.nilc.org/issues/economic-support/impact-of-covid19-relief-bills-on-immigrant-communities/

  34. https://www.nilc.org/2020/04/03/coronavirus-immigrant-families-protection-act-introduced

  35. https://www.congress.gov/bill/116th-congress/house-bill/6437?q=%7B%22search%22%3A%5B%22h6437%22%5D%7D&r=1&s=1

  36. https://www.hirono.senate.gov/news/press-releases/hirono-harris-chu-grijalva-correa-introduce-legislation-to-provide-critical-assistance-to-vulnerable-communities-impacted-by-covid-19-


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