If Brenda, a 30-year-old agricultural worker in Goodyear, Arizona, suddenly comes down with symptoms of the 2019 novel coronavirus, she’ll think twice about seeking treatment.
“I might go just because it’s not normal for me, but I will be scared to have the government monitor me. They just might do more harm,” she told The Daily Beast.
Brenda is an undocumented immigrant, and asked that her last name not be used in the event that the government took an interest in her. This attitude—both about being identified in general but also about coming forward with health problems—is fairly typical, according to Mariana Magaña Gamero, policy advocate for the Coalition for Humane Immigrant Rights in Los Angeles (CHIRLA).
“People fear—and it’s a very valid fear—that if you’re providing your information to any government entity, that somehow will be shared with the feds, or the feds will have access to it,” she said. Whatever their reasonable concern may be—be it a crime, a request for financial aid, or a health scare—“folks don’t report, and would rather stay silent,” she explained.
The Los Angeles metro area has the second-largest population of undocumented immigrants in the U.S.—925,000 in 2016, according to the most recent numbers from Pew. Meanwhile, the County of Los Angeles has declared a local state of emergency over COVID-19, and the state has followed suit. The LA area’s second patient with the novel coronavirus was placed in isolation in one of several local Kaiser Permanente hospitals.
According to a statement by County Supervisor Hilda Solis, declaring an emergency after the second detected case was meant “to allow us to further draw down resources from both the federal and state level of government.” But federal involvement could create a symbolic obstacle members of the undocumented population have a hard time surmounting. After all, last month, the Trump administration announced “tactical agents” normally used to sniff out drug smugglers would be deployed to sanctuary cities like Los Angeles in order to make arrests.
In other words, a novel health scare is hitting one of America’s largest immigrant communities even as people have every reason to be more fearful than ever of seeking help.
“Any time you get services where they ask for your address, phone number, and social security number, there’s a pretty understandable concern that people aren’t going to come in,” said Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities. For instance, he said, “a thing we see fairly commonly in these communities is tuberculosis. People will cough and cough and cough, and the next thing you know, you’ve got lots of people testing positive for TB.” The high rate of contagious tuberculosis among migrant farm workers is a problem the CDC has been following since the 1980s.
Contrary to the stereotype that immigrants are somehow unclean, and bring contagions into the US, the CDC notes pathogens like the ones that cause tuberculosis spread among migrants for several reasons. The language barrier can get in the way of care; often semi-nomadic lifestyles don’t allow people to stay put long enough to form substantial physician-patient relationships; and migrants are forced to “live in substandard housing and in very crowded conditions.”
According to Wynia, the myth made famous in 2015 by then-presidential candidate Donald Trump that "tremendous infectious disease is pouring across the border," adds to the problem. “You call a group unclean, and don’t give them resources, and the next thing you know, there’s a ghetto, and they are unclean. It’s a self-fulfilling prophecy,” Wynia said.
To make matters worse, if infected migrants are rounded up by federal authorities, such crowded living conditions may also be present in ICE detention facilities, which could make them breeding grounds for the novel coronavirus. The CDC reported last year that there were 898 cases of mumps among people in ICE lockup between September 2018 and August 2019.
According to a statement from ICE last month, detainees were receiving medical screenings for the novel coronavirus, and “[a]s an additional measure of defense, ICE detainees suspected of exposure or infection of certain diseases are medically 'cohorted,' in line with CDC guidelines and ICE detention standards."
Cohorting, or keeping detainees suspected of being infectious in separate groups, is indeed called for by the CDC. But their guidelines also suggest individual infected patients first be kept in their own Airborne Infection Isolation Rooms (AIIRs) if possible. Cohorting is to be carried out when enough AIIRs aren’t available. “It’s a resource issue,” Wynia told me. Cohorting is standard triage during an outbreak, he said, “if you don’t have enough rooms to keep everyone separate.” But, he hastened to add, “you don’t want to put someone in the cohort room who doesn’t already have the illness.”
The Daily Beast reached out to ICE several times for this story, asking if preparations had been made to keep infected detainees isolated, or whether cohorting was the only plan. ICE public affairs officer Britney L. Walker said only the following: “At this time, I can confirm there are currently no detainees in ICE custody with confirmed 2019 novel coronavirus. In addition, ICE takes very seriously the health, safety and welfare of those in our care, and is committed to providing access to necessary and appropriate medical care.”
The good news for the undocumented population is that ICE may not be able to access hospitals in order to make arrests. “Hospitals and clinics are deemed as sensitive locations,” said Magaña Gamero, of CHIRLA. “Enforcement cannot take place inside, and that information is protected through HIPAA and other laws and policies that are in place.” The Daily Beast asked for a comment from ICE about enforcement in hospitals, but as of publication, the agency had not addressed the matter.
Still, Magaña Gamero stressed that seeking care was critical, even in the face of legal threats. “The message we would reiterate to folks is to not hold back out of fear that if they have the coronavirus that that information is going to be disclosed,” she said.
The virus is, after all, a killer—or at least appears to be significantly deadlier than influenza. Deportation isn’t usually as scary as death, Wynia pointed out—although death does sometimes follow soon after. "You can overcome fear of one thing with fear of another,” he said.
This is the exact mental calculus Claudia Lujan performed. A 31-year-old employee of a medical transport company in Phoenix, and an undocumented immigrant, she told The Daily Beast the message that seeking care is critical has sunk in. “The Spanish news has done a great job covering the facts and relaying how serious it is,” she explained.
Lujan, who has no health insurance, said what concerned her most was the financial hardship that comes from any emergency, medical or otherwise. “When my cousin was taken by ICE, his parents were able to pay for his bail and lawyers because we held multiple fundraisers and family sent and loaned pretty hefty chunks of money,” she said. “[The virus] would affect our direct family greatly financially, but our health is more important.”
Among her family, Lujan added, everyone agreed that seeking treatment was the priority no matter what—thanks in part to options back home that many undocumented people don’t have.
“We would deal with the repercussions afterwards,” she said. “Most of our family still lives in Mexico and they're doing OK, so it's not like we wouldn't have somewhere to go.”