Updated: Aug 26
On January 22, the CDC reported the first case of the Novel Coronavirus in the United States. On February 11, the virus was given its official name: “COVID-19”. A month later, when the World Health Organization declared COVID-19 a pandemic, diagnosed cases in the US totaled just over 1200.
Within a remarkably short time span, many Americans have found themselves confronted by unfamiliar concerns of scarcity: empty shelves and questions of where they could find everything from hand sanitizer and toilet paper to baby formula and bread. Those whose jobs allowed remote work and salary continuity are struggling to adjust. With schools closed and daycare facilities shut down, teleworking parents are trying to figure out how to teach their school-aged children and care for their toddlers, while also juggling work demands. Millions of others, particularly hourly wage-earners such as restaurant workers, “gig workers”, and those in the hospitality industry, are now out of work entirely. Individuals considered “essential” (e.g., grocery store employees, transit workers, delivery drivers) suddenly find themselves in battlefield-like conditions, facing inconceivable risks and harms, and even death.
The transformation of the lives of most Americans into the “new normal” necessitated by the response to COVID-19 is truly unparalleled. However, many aspects of this “new normal” are sadly not new for the most marginalized and under-resourced in our society: those living in poverty, those with mental illness or substance use disorders, those experiencing domestic violence, the homeless. These individuals are the most vulnerable to the devastating economic, social and psychological effects of COVID-19. Unlike many of us for whom scarcity, chronic stress related to food and housing insecurity, and a lack of childcare is new, this scenario depicts their everyday “normal”. And so, for the most vulnerable members of our society, this crisis has only served to further entrench preexisting conditions, constraints and fears. Many live within a perilous intersectionality: poverty, food and housing insecurity, and lack of access to quality schools, health care and childcare. Immigrants – whether undocumented or documented – most often occupy this space.
The harsh reality for immigrants is that while they assume valuable positions in our society, they accept lower wages and their work poses greater hazards and fewer protections against injury, including the contraction and circulation of illnesses like COVID-19. Several meat packing plants, where workers include refugees who have immigrated from around the world, have become COVID-19 hotspots; e.g., a plant in South Dakota, where many employees are immigrants, comprises over 40% of the state’s positive cases. Having survived warzones and agonizing nights of hunger in refugee camps, these immigrants now grieve the deaths of family members, friends and co-workers, and are themselves becoming ill from COVID-19.
Regardless, even under these worst of circumstances, they must return to the grueling work their families’ futures depend on. Meat packing plants have been designated “critical infrastructure”, and employees must return to work, even as there is a push to limit the liability of companies should workers become sick from the close working conditions that contributed to the outbreaks and that will continue to increase the risk for COVID-19 transmission. And for undocumented immigrants who are classified as “essential” because they tend to the food supply, concerns are two-fold: arrest by ICE and an elevated risk of contracting COVID-19 due to working conditions.
Immigrants face uniquely devastating vulnerabilities in the face of COVID-19. ICE may target “sensitive locations,” such as medical facilities. Further, the “Public Charge” rule, implemented in late February by US Citizenship and Immigration Services (USCIS), means that those seeking to change their immigration status or extend a current stay in the same status will be judged according to whether they are “likely at any time in the future” to receive public benefits, such as Medicaid, and forms of cash and non-cash benefits, including food and housing assistance. This determination of “likelihood” involves judgments of whether individuals suffer from a serious medical condition, are uninsured and unable to obtain private health insurance, and lack financial resources to pay for their own future medical costs. Further, “an alien who has received, or has been certified or approved to receive, one or more public benefits for more than 12 months” in any 36-month time span will be ruled inadmissible for stay in the US. Although the USCIS has posted an alert to their website concerning COVID-related help-seeking, it is not clear how COVID-related disruptions in work or access to public-provided health care will be judged, and immigrant communities live in fear not only of the virus but of seeking help should they contract it.
There are also concerns of undetected community spread among immigrants. In New York, public officials tried to communicate that no one should worry that their legal status would be questioned if seeking medical help for COVID-19 symptoms. And in Washington DC, at a press conference on March 30, Mayor Bowser assured the city’s residents that first responders would not inquire about immigration status – this after several immigrants are believed to have died at home from the virus.
In the 138 ICE detention facilities across the US, visitation is suspended, and detained individuals and their families are entirely cut off from one another. COVID-19 cases have been diagnosed in these facilities along with reports of conditions that elevate the risk of transmission. In implicit acknowledgement of these reports and under pressure from advocates, ICE has moved to release those deemed to be at highest risk for contracting the virus. Ordered by a federal judge, ICE compiled a list of medically vulnerable individuals eligible for immediate release. One of the names on the list was that of a 57-year-old man, Carlos Escobedo Mejia, who was being held in a California facility. Escobedo Mejia, who had lived in the US for four decades, was the first ICE-confirmed COVID-19 death.
Adding to the physical risks, COVID-19 is also considered a “mass trauma” that will exert ongoing impacts on the psychological well-being, population-wide. Those who live at the periphery of our society, without access to mental health services, are particularly vulnerable to the enduring psychological burden of COVID-19.
Public officials, disease specialists and media commentators reassure us that the challenge we face is temporary, and that we will soon reopen the economy. The most likely scenario is that we will, ultimately, reclaim our normal lives in some form. However, for immigrants and other vulnerable populations, the current “new normal” is simply a variation on their old normal, and the other side of COVID-19 will likely find them even worse off.
The virus itself does not care about racial or ethnic categories, social or economic class, or immigrant status. The virus is random, but the differential susceptibility to COVID-19 among subgroups in the US is predictable. The effects of the virus—whether direct risk of infection or the associated economic, health, and psychological impacts—have been predetermined by policy decisions made at local, state, and federal levels. A return to a “normal” created by policies that channel the burden of this virus onto the most vulnerable is unacceptable.
As we strive to return to a “normal” that was comfortable for many, be discomforted by the knowledge that normal for immigrants are conditions that persistently endanger their lives and livelihoods, despite the critical niches they fill in our society. It is incumbent upon policymakers and federal agencies to address the structural and systemic barriers to health and wellbeing among vulnerable groups.
Informed by prevention scientists, psychologists, public health experts and neuroscientists, government at all levels has potential to lift up these families by embracing policies that humanely address the needs of immigrants and, at the same time, reduce costs for society. Science has generated scores of evidence-based strategies pertinent to the age of COVID-19; e.g., systems-change to reduce structural racism and concentrated poverty; criminal justice reform at court and corrections levels; interventions to address health disparities, provide mental health support for individuals and families, and reduce domestic violence; and effective public health messaging. These and many other science-based preventive strategies promise to support families and communities, enabling them to confront and, in fact, overturn existing structural and systemic barriers to leading productive lives.
By envisioning and realizing a more just, more humane “normal,” we can improve the everyday wellbeing of those most impacted by COVID-19, and as a result we will all be more protected and secure when we face the next crisis – truly together.
Goldie McQuaid, Ph.D. is a postdoctoral fellow in the Department of Psychology, George Mason University and a member of the National Prevention Science Coalition to Improve Lives
Diana Fishbein, Ph.D. is a Professor at The Pennsylvania State University, Director of Translational Prevention Research at the University of North Carolina, and Co-Director of the National Prevention Science Coalition to Improve Lives
Also published as an op-ed in The Hill: