A researcher works in a lab that is developing testing for the COVID-19 coronavirus at Hackensack Meridian Health Center for Discovery and Innovation. Photo by Kena Betancur | Getty Images
By now, everyone knows that COVID-19 is a highly contagious and lethal disease for which we currently have no effective treatment or a vaccine. Many of those who are infected—perhaps even most of those who are infected—are asymptomatic, but capable of infecting others with the virus. Though we have now surpassed 4.6 million confirmed positive cases in the United States and continue to be heading in the wrong direction in many places, the real total may well be many times that amount.
For this very reason, containing the pandemic through a well-executed and dramatically scaled-up testing, contact tracing, and care and support program must include everyone in our society.
If millions of people are directly or indirectly carved out of our nation’s response, including entire communities based on their immigration or citizenship status, our ability to identify, contain, and defeat the novel coronavirus will be compromised. It will also jeopardize our ability to safely send Americans back to work and our children back to school, both of which are necessary to resuscitate the U.S. economy.
Recently, associations representing America’s frontline medical and mental health practitioners wrote to Congress to explain that “a response that leaves out immigrants will be ineffective and detrimental to our efforts to stop this pandemic.” An identification and containment strategy—the only way public health scientists believe we can safely reopen our economy—requires a level of trust from and support of immigrant families and communities that does not currently exist.
That message appears to have been received by the House of Representatives, which passed legislation—the Heroes Act—that extends important protections without distinction based on citizenship or immigration status. An earlier deal reflected in the CARES Act denies coronavirus relief funds to every person, including U.S. citizens, in mixed-status households—a counterproductive position supported by just 9% of registered voters, according to a recent survey.
As a general matter, the country is still testing nowhere near the number of people that need to be tested on a daily basis to accurately understand the scope of the problem that we are facing—and comprehensive community testing and contact tracing efforts remain far off in the distance in most states and localities. For millions of people in the country today, these challenges are compounded by their own immigration or citizenship status. While a handful of states have taken smart public health steps to extend testing and care to all people regardless of immigration status, this should be explicit policy for all testing sites.
Unfortunately, it’s not just states that have failed to design a response that includes immigrant communities. None of the four coronavirus relief packages enacted by Congress have confirmed that testing and care constitute emergency medical treatment for purposes of qualifying for emergency Medicaid reimbursement, recklessly leaving millions of people out of the public health response to the virus. This includes not only undocumented immigrants, but also most lawful permanent residents who have held their green cards for less than five years.
It also includes DACA recipients and people with Temporary Protected Status, hundreds of thousands of whom are continuing to dutifully report as “essential critical infrastructure workers” around the country: doctors, nurses, and home health aides; farm workers and grocery store clerks; sanitation workers and child care providers.
The fact that these individuals have continued to work only heightens the need for them to have access to necessary testing and care, both because they are at greater risk of becoming infected and spreading the infection and because of the important work they are doing to benefit society at large.
Contact tracing efforts like those that have helped New Zealand successfully protect the public and begin to reopen their economy will also rely upon widespread trust in public health officials. This trust may be hard to obtain for both manual and digital contact tracing if essential privacy safeguards are not in place to, for instance, limit the collection of data and restrict its use for anything other than epidemiological contact tracing of the coronavirus. In hiring manual contact tracers, government officials must also take care to hire people with relevant language and cultural expertise for the communities in which they will serve, and outreach efforts must be guided by the explicit and unambiguous premise that all people should be able to cooperate without fear that it may affect their or their loved ones’ immigration status.
All communities must trust that they will get the care and support they need if they are identified as being infected—and that they won’t be stigmatized or banished from the country if they take steps to protect the general population.
The coronavirus does not discriminate on the basis of immigration or citizenship status, and in order for our public health response and subsequent recovery to be effective, we must not, either. If our response to the coronavirus pandemic is not comprehensive and inclusive of all communities, it will not be maximally effective. And that will not only jeopardize our collective public health, but also risk squandering the hard sacrifices that all Americans have made over the past few months and make the road to recovery that much longer.
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