A Virus Without Papers: Understanding COVID-19 and the Impact on Immigrant Communities

Abstract

The COVID-19 pandemic has exposed the inequalities facing vulnerable populations: those living in economically precarious situations and lacking adequate health care. In addition, frontline workers deemed essential to meet our basic needs have faced enormous personal risk to keep earning their paychecks and the economy running. Immigrant communities face an intersection of all three vulnerabilities (e.g., economic precarity, health care barriers, essential workforce), making them one of the most vulnerable populations in the United States. We conducted 26 interviews via Zoom with immigrant service providers in Pennsylvania and New York, including lawyers, case workers, religious leaders, advocates, doctors, and educators in order to gain a better understanding of the impact of COVID-19 on immigrant communities. These interviews affirmed that immigrants are concentrated in essential industries, which increases their exposure to the virus. In addition, they lack access to social safety nets when trying to access health care or facing job/income loss. Last, COVID-19 did not adequately slow the detention and deportation machine in the United States, which led to increased transmission of the virus among not only detainees but also others in the detention system, surrounding communities, and the countries to which people were deported, countries that often lacked an adequate infrastructure for dealing with the pandemic.

Based on our interviews, we have a series of specific policy recommendations to diminish the vulnerability of immigrants and create social safety nets that will include them and protect them when the market fails to do so. Immigrants of all types have made indispensable contributions to the US economy during the pandemic and before it. First, Congress and states should pass legislation to provide COVID-19 relief payments to all essential workers, regardless of their status, as compensation for putting their lives on the line to keep the economy running. Second, as a public health imperative, federal and state governments should expand coverage of Medicaid and Children’s Health Insurance Programs (CHIP) to include immigrant essential workers and their children, regardless of their status. Third, DHS should not refer essential workers to removal proceedings, and immigration courts should terminate all removal proceedings for essential workers without criminal records. When it comes to issues of health care affordability and access, Congress must continue to revise the Affordable Healthcare Act to expand coverage for those who do not qualify for Medicaid but earn too little to afford insurance on their own. Finally, there must be a review and rigorous enforcement of workplace health and safety standards, particularly when it comes to farming, meatpacking, food production, and food service industries.

Our final recommendations are specific to DHS and two of the primary agencies they oversee: Immigration and Customs Enforcement (ICE) and the Border Patrol. First, there needs to be a review of ICE policies and practices, leading to a shift in policy that keeps mixed-status families intact and minor children out of detention centers and that streamlines and expands the asylum process. Second, both Congress and the administration must create additional paths to legal status where none now exist, including for recipients of Deferred Action for Childhood Arrivals (DACA) and for children who have arrived since June 2007.

Keywords

immigrant communities vulnerable populations essential workers health care COVID-19

Introduction

The pandemic brought about by COVID-19 has disrupted the lives of people around the world. It has exposed the inequality already facing vulnerable populations: those living in vulnerable and economically insecure situations (DiMaggio et al. 2020; Pager, Bonikowski, and Western 2009; Wright et al. 2020) and lacking adequate health care (Fabi and Saloner 2016; Krouse 2020; Ramgobin et al. 2021). We also know that frontline workers deemed essential to meet our basic reproductive needs have faced enormous personal risk to keep their jobs and the economy running (Kane and Tomer 2021; Ramos et al. 2020; Roberts et al. 2020; Sönmez et al. 2020). When combined with long-existing systemic racism (DiMaggio et al. 2020; Kullar et al. 2020; Van Dorn, Cooney, and Sabin 2020) and the precariousness of immigration status (Asad 2020; Chilton et al. 2009; Hamilton, Patler, and Hale 2019), we argue that immigrant communities are one of the most vulnerable populations in the United States during the pandemic.

In order to understand the full impact of COVID-19 on these communities, we first present a contemporary and comprehensive review of the literature published across disciplines with regard to COVID-19. Next, we discuss the 26 interviews we conducted via Zoom with immigrant service providers in Pennsylvania and New York, including lawyers, case workers, religious leaders, advocates, doctors, and educators. Third, we identify three key themes that emerged from our interviews: the consequences of being an essential worker, the absence of social safety nets, and the insufficient actions of ICE pertaining to immigrant health and safety in detention centers and continuing deportation of immigrants in the face of COVID-19. Finally, we explore the policy implications and recommendations developed from this research.

Literature Review

The term “immigrant” is complicated and often misunderstood. Media narratives play a significant role in creating confusion and criminalizing immigrants (Delia Deckard et al. 2020). In recruiting participants for our study, many jumped to the conclusion that we were focusing on undocumented immigrants. However, our definition of immigrant was inclusive of anyone who was foreign-born, regardless of immigration or citizenship status. We spoke with people who work with refugees, asylum seekers, Deferred Action for Childhood Arrivals (DACA) recipients, Temporary Protected Status (TPS) beneficiaries, undocumented residents, and others. Disentangling one type of immigrant from another or even from native-born citizens is extremely complicated (Brabeck and Xu 2010; Hamilton, Patler, and Hale 2019; Warren and Kerwin 2017). In particular, we seek to draw attention to mixed-status families—that is, those with both undocumented and US citizen or lawful permanent resident (LPR) members. Legal residents in these families face many of the same vulnerabilities as their undocumented family members.

Vulnerable and Economically Insecure Populations

Based on the literature, we know that populations at highest risk from COVID-19 have been those with a high percentage of racial minorities (DiMaggio et al. 2020; Kullar et al. 2020; Van Dorn, Cooney, and Sabin 2020). This is due to a variety of social determinants, such as the type of jobs people hold and the housing available to them (Clark et al. 2020; Rollston and Galea 2020). Those holding part-time, seasonal, and hourly wage jobs may not have the ability to take time off from work to care for themselves or a sick family member. People who have lost their jobs could face eviction and may be more likely to double or triple up with other families, making practices like social distancing impossible. Wright et al. (2020) found that residents in low-income neighborhoods were less likely to comply with shelter-in-place orders due to their employment in essential industries and reliance on public transportation.

Pager, Bonikowski, and Western (2009) suggest that much of the low-wage labor market is still highly racialized and discrimination is prevalent. Such discrimination makes it difficult to find work and to receive equal wages to white counterparts. Low-wage work often lacks additional benefits, including access to paid sick leave or to affordable health care. This means that workers in low-wage labor markets lack the resources necessary to cope when they or a family member becomes sick. This is especially problematic for undocumented immigrants who often must rely on employers that pay them under the table. Some unscrupulous employers threaten to report their undocumented workers to Immigration and Customs Enforcement (ICE) to keep them compliant.

Race is also a risk factor for COVID-19 due to preexisting and underlying comorbidities (Webb Hooper, Nápoles, and Pérez-Stable 2020). These conditions are exacerbated by an unequal distribution of resources, including housing, education, employment, and access to preventative health care (DiMaggio et al. 2020; Kullar et al. 2020; Van Dorn, Cooney, and Sabin 2020). The legal status of immigrants often intersects with race, making them even more vulnerable to increased policing, dense housing options, and low-wage employment without benefits (Rollston and Galea 2020).

Immigrants without legal status or who live with someone without status are vulnerable to immigration enforcement, the fear it generates, and family separation (Asad 2020; Boehm 2017; Golash-Boza 2015). For people living in the shadows, accessing any type of social safety net, visiting a medical facility, or violating a shelter-in-place order to go to work heighten their fears and prevent many from seeking the help they might need, whether food assistance or medical treatment. Economic precarity, dense living situations, lack of access to food and medical resources, and language barriers increase immigrants’ exposure to the pandemic and diminish their chances of surviving it.

We also know that all family members living in mixed-status families face the possibility of family separation and other vulnerabilities (Boehm 2017). Children, in particular, suffer from their parents’ lack of status. For example, they are less likely to have access to the food benefits and health care to which they are entitled because their parents are fearful of drawing attention to themselves or are unaware their children qualify for such resources (Chilton et al. 2009; Hamilton, Patler, and Hale 2019). This means that there are long-term, intergenerational consequences for growing up without status or with a parent without status. Yet the deportation of a significant number of undocumented workers—who constitute roughly 5 percent of the US labor force—could result in devastating losses to the US economy (Edwards and Ortega 2016; Kerwin, Alulema, and Nicholson 2018; Passel and Cohn 2016).

Last, it is important to understand the role of neighborhood contexts on vulnerable populations and immigrants in particular. Research suggests that racialized neighborhoods have been devalued and overlooked, particularly when it comes to environmental concerns and climate change (Liévanos 2020). Neighborhoods composed of Black residents, isolated immigrants, or Asian and Pacific Islanders who are facing economic deprivation are more likely to experience high levels of toxic air pollution (Liévanos 2015). People who live in immigrant communities who are US-born or who are foreign-born and speak English fluently are also highly susceptible to the same vulnerabilities (e.g., discrimination, anti-immigrant ordinances, increased policing) and psychological distress (e.g., depression, anxiety, social isolation) as their immigrant neighbors (Ebert and Ovink 2014; Szkupinski Quiroga, Medina, and Glick 2014). In addition, when anti-immigrant ordnances are passed, the entire community is impacted: reports of discrimination and anti-immigrant sentiment increase, legal status becomes more salient for police officers making arrests, and minor infractions lead to an increase in deportations (Donato and Rodríguez 2014; Ebert and Ovink 2014; Flores 2014). In short, policies and practices that negatively impact immigrants also affect their families, neighborhoods, and broader communities, including LPRs and native-born citizens.

Access to Health Insurance and Health Care

Access to health care during a pandemic has been a privilege only some have been able to obtain. The US health care system remains highly fragmented, and affordability and accessibility are tied closely to employment (Ramgobin et al. 2021). At a time when many people have lost their jobs, they have also lost their health insurance and the wages needed to pay medical bills. Many workers in essential industries lack access to employer-sponsored health care benefits. Racial minorities and immigrant communities who disproportionately hold these jobs have the least access to health care and the most exposure to the pandemic (Krouse 2020; Ramgobin et al. 2021).

Fabi and Saloner (2016) examined California as a case study for extending health care to both undocumented children and adults. Even though the state was able to pass legislation to cover both groups, mixed-status families faced significant barriers to utilizing such programs due to misinformation and distrust of government agencies. In addition, providing adults access to the health care exchange is only symbolic if they do not receive subsidies to help cover the costs of coverage.

Many researchers have also noted the broad mental health impact of the pandemic (Torales et al. 2020). This is especially true for people living in poor socioeconomic conditions and those with preexisting mental health issues. These issues are also aggravated from living in hostile political environments (Golash-Boza 2015). Aragona et al. (2020) found that the pandemic led to reduced care for immigrants seeking mental health treatment. This was due, in part, to fear of violating strict lockdown measures as well as digital literacy and access barriers to telehealth options. In addition, the mental health of immigrants also diminished due to food insecurity and other unmet essential needs including rent and health care (Serafini et al. 2021). These findings suggest that those who have most needed services during this time have been the least able to access them, leaving them even more vulnerable.

Essential Frontline Workers

While there has been an increased awareness about the number of essential occupations filled by immigrants during the pandemic, there has been little recognition of the indispensable role that immigrants play in keeping these industries operating. This is not just a US but a global issue. As Reid, Rhonda-Perez, and Schenker (2021, 73) note, essential migrant workers could “be a Bulgarian worker at a meat processing plant in Germany, a Central American farmworker in the fields of California, or a Filipino worker at an aged-care facility in Australia.” COVID-19 has highlighted the precarious working conditions of many essential workers, even before the pandemic struck.

According to the Department of Homeland Security (DHS), 90 million workers are employed in these essential industries (Kane and Tomer 2021). Kerwin and Warren (2020) find that 69 percent of all immigrants in the US labor force and 74 percent of undocumented workers are essential workers compared to 65 percent of the native born labor force. In addition, in the 15 states with the largest labor force, “undocumented essential workers exceeds that of native born essential workers by nine percentage points.” More broadly, immigrants are essential to the US labor force and economy.

Ramos et al. (2020) focus specifically on the industries deemed essential to keep people fed: farming, meatpacking, and food production. They found that the poor treatment of workers in these industries that are dominated by immigrants was exacerbated by COVID-19 and increased health risks to those keeping our food supply chain operating. Several other essential industries, including construction, extraction, installation, maintenance, repair, building, and grounds cleaning and maintenance are also predominantly filled by Hispanic workers (Rogers et al. 2020). As such, Hispanic communities find themselves at the most risk of exposure to COVID-19. Food service, hospitality, and tourism occupations have been hard hit due to stay-at-home measures both in the United States and in tourism-dependent locations (Sönmez et al. 2020).

Some studies have already confirmed that the risk of exposure to COVID-19 is most prevalent in essential worker families and immigrant communities. Hibel et al. (2021) found that 72 percent of their Hispanic families contained at least one employed adult, of whom 91.7 percent were essential workers. Roberts et al. (2020) discovered that essential workers were more likely than nonessential workers to be Black or Hispanic. Essential workers were also substantially more likely to report working outside the home and less likely to report social distancing and wearing masks indoors, as compared to their nonessential counterparts. In their study of Bhutanese and Burmese refugees in the United States, Zhang et al. (2021) noted that the three largest risk factors for contracting COVID-19 were being an essential worker, having an infected family member, and being female. Hibel et al. (2021) also found that Latina mothers were particularly at risk due to their role in caring for children and family members in essential occupations.

Last, immigrants of all types have played a critical role in the battle against COVID-19, filling roughly 16 percent of all US health care jobs (Batalova and Fix 2020; Kerwin and Warren 2020). Nurses in particular have been on the front lines of patient care (Shaffer et al. 2021). Balch (2020) notes that 29,000 frontline health care workers are DACA recipients, susceptible to being deported if DACA is rescinded or paperwork renewal lapses. Yet by 2032 “the United States will have an estimated 46,900 to 121,900 fewer physicians than it needs as the country’s population ages and older doctors retire—a shortfall that disproportionately impacts poor, underserved, and rural areas, according to the brief” (Balch 2020, 2).

Data and Method

In order to understand the impact COVID-19 on immigrant communities, we conducted 26 semistructured interviews via Zoom between June 2020 and February 2021. We recruited interviewees using a snowball sample, which involved recruiting participants using connections to people working within immigrant communities. We interviewed attorneys, advocates, clergy/religious leaders, case managers, and educators. Respondents were from Pennsylvania and New York. There were three male and 23 female respondents. Eight respondents were immigrants (see Table 1). We use Anglo pseudonyms in order to maintain confidentiality of our respondents and the people they serve.

Table 1.

List of Respondents, Classification, Immigrant Status, and Gender.

Pseudonym	Category	Immigrant	Gender
Kate	Attorney	No	Female
Susan	Advocate	Yes	Female
Anne	Attorney	Yes	Female
Ashley	Case worker	No	Female
Jane	Attorney	No	Female
Tina	Advocate	No	Female
Emma	Advocate	No	Female
Karen	Advocate	No	Female
Mary	Advocate	No	Female
Shelly	Religious	Yes	Female
Amy	Advocate	No	Female
Jessica	Religious	Yes	Female
Emily	Religious	No	Female
Martha	Advocate	No	Female
John	Attorney	Yes	Male
Kristen	Case worker	No	Female
Amber	Immigrant	No	Female
Alex	Case worker	No	Female
Amanda	Case worker	Yes	Female
Tom	Medical	No	Male
Betty	Attorney	No	Female
Cindy	Medical	No	Female
Kathy	Medical	No	Female
William	Attorney	Yes	Male
Caroline	Advocate	Yes	Female
Tammy	Education	No	Female

Our first questions focused on understanding the effect of immigration status on immigrants, their families, and their communities. In particular, we asked about the effect of precarious status on mixed-status families. We then asked a few basic questions regarding the impact of COVID-19 on immigrant communities. Next, we inquired about access to a variety of resources to help navigate the pandemic. Last, we queried whether respondents had any information pertaining to the effect of COVID-19 on the immigration system (e.g., detention centers, raids, deportations).

Upon completing the transcription of the interviews, we independently coded them using the method of narrative analysis (Berg 2009). We did so individually before sharing our thoughts with each other, which helped to ensure interrater reliability and the minimization of personal bias in interpreting the data. Our first observation was that respondents confirmed the preexisting vulnerability of immigrant communities to COVID-19. Upon synthesizing our own interpretations of the interview data, three key themes emerged: the consequences of being an essential worker, the absence of social safety nets, and the persistence of the detention and deportation systems during the pandemic.

Findings

Many respondents identified the vulnerabilities of immigrant communities before the pandemic hit. Many of their clients were working in minimum-wage jobs without any financial security, upward mobility, or benefits including health insurance or paid time off. This means they were living paycheck to paycheck before the economy was shuttered by shelter-in-place government orders. Immigrants who were working under the table due to their lack of status were seen as easily expendable anytime the economy stalled. Emma, an advocate, told us, “I’ve also received a whole bunch of claims about people that were working under the table being taken advantage of and not paid, and they’re typically immigrants of any nature.” Any reduction in income made these families more susceptible to losing their housing, which led to homelessness or doubling up in housing with friends or family members. Emma added, “If we don’t get our community stabilized, we are going to have potentially hundreds of families, which of course includes children, on our streets, and we don’t have anywhere for them to go.” The primary concern for many respondents was to help their clients stay in their homes, paying their utility bills, and finding food.

Additionally, immigrants often face language and cultural barriers in the United States. This can make navigating complex and confusing institutions, including the legal and health care systems, virtually impossible. Several respondents noted that immigrants are set up to fail in these systems. Examples included not understanding how to navigate the security at court buildings when trying to attend their own hearings or signing medical paperwork without understanding the financial repercussions. Martha, an advocate, provided an example: “If you’re undocumented and you ended up with COVID-19, you would probably end up with a very hefty bill, because the Department of Human Services does not help undocumented. You just don’t qualify.” Those with clients that did go to an emergency room or urgent care facility for testing or treatment for COVID-19 ended up with large bills and little means to pay them.

These problems were amplified for undocumented immigrants due to their lack of legal status. William, an attorney, frequently spoke about legal status and citizenship as a privilege: “I think it comes down to privilege. And legal status being one of those privileges…. I think citizenship is socially constructed, like many things…. I don’t know if you’re a citizen. I don’t know if you’re undocumented either. But that shouldn’t change how we treat you as a human.”

Because of this lack of privilege, when COVID-19 struck, immigrant communities were hit the hardest due to their preexisting vulnerabilities. Emily, a religious leader, noted that the immigrant communities she served were already at the lowest levels of socioeconomic status and had the fewest resources to help them cope with a loss of income: “Because they lost whatever source of income they had at the time, we provided some emergency funding for them…they’re just hanging on by a thread…and so the further along the line you were, the harder it hit you.”

Tom, a medical professional, found his health care organization overwhelmed with clients seeking nonmedical services: “Now during COVID-19 has been absolutely horrible, because they call for everything. They don’t have something to eat, they don’t have a diaper, they are going to be evicted, domestic violence, and all that.” His organization responded the best they could by networking and pulling resources together. This networking of community level resources was the primary way our respondents and their organizations tried to assist their clients in meeting their basic needs.

Another respondent, Jessica, a religious leader, also mentioned the rise of domestic violence during the pandemic. She called the pandemic a “great opportunity for the domestic violence that is not being reported, because they are afraid…. They have to stay home, so the kids are suffering a lot. So many traumatic moments between husband and wife, so I will say that is part—we don’t know yet how to deal with that. We are working, we know it is not a great solution, but we are trying to see if we can have some therapies, working with the children over the phone, especially if they report. The problem is they don’t report and that’s a huge part of the deal, because they are all home killing each other, in another word.”

Immigrant families often face elevated levels of unreported domestic violence when one or more family member is undocumented due to the fear of reporting crime to an authority for fear it might lead to deportation.

Consequences of Being an Essential Worker

As noted above, preexisting vulnerabilities were tied closely to financial insecurity. This was because many of the immigrants served by our respondents were minimum-wage, essential workers. Being an essential worker during a pandemic came with significant consequences not only to the individual worker but to their family and communities. Exposure was the main of most of our respondents.

I think that the immigrant community has probably been impacted more than many, many other Americans or other populations in terms of the pandemic. First to lose jobs, first to be on the front lines of exposure. For example, I met a number of people who work in the warehousing industry who are immigrants—and remember everything is still being delivered. Amazon must be making gazillions of dollars because people are getting stuff shipped to them. Somebody has to pack that stuff and ship it out and deliver it. And generally, it’s a lower wage employee, lower skilled, and that’s often who the immigrant community is. So, I think they face more significant challenges. (Mary, Advocate)

When [essential workers] have to go to work during pandemic it means they are being exposed—to be infected—more than other people. When they get exposed, they don’t have any insurance to go to the hospital, so they infect other families because they don’t know that they are infected. That disease is much [more] lethal to the immigrant community because they don’t have the legal protection and benefits compared to the other people. (Susan, Advocate)

So there’s been a huge economic impact. A lot of refugees in our community either work in essential jobs where they don’t necessarily feel they have appropriate PPE [personal protective equipment] or feel safe. Or they work in like sort of low-wage jobs where they maybe are considered expendable by their employers, so they’ve been let go because of the pandemic, and again like a double whammy of economic hardship for the community. So that’s a big one. (Kathy, Medical)

This frontline exposure affected all essential workers, but those living in immigrant communities had the least resources to cope with the consequences. This was even more true for those immigrants who were undocumented or living in a household with undocumented family members.

In terms of how it’s decimated the community both economically and health wise is—you guys are studying it and people are going to be studying this for years to come. It’s been devastating really for undocumented clients. They were the first ones to lose their jobs because obviously they’re the first in line to get cut as business slowed down, so there was that. Many of our clients have gotten sick being on the front lines and those continuing to work, and lack of access to medical care, and housing situations where they’re unable to socially distance because there’s lot of family members in a single household. All of those things that you hear are impacting, are rippling across our client base. (John, Attorney)

Especially during the pandemic, I mean as you know, so many undocumented people are doing the frontline jobs that are essential and that are putting them at greater risk and then of course they lack health care if they get sick. (Betty, Attorney)

Many nonessential and professional workers have been able to weather the pandemic from the comfort of their own homes and the utilization of technology. William, an attorney, applied his theory about immigration status or citizenship as privilege when it came to employment during the pandemic.

If you work at the mushroom factory here, you don’t have the privilege to have an autoimmune disorder. You don’t have the privilege to be elderly. You don’t have the privilege to say I don’t have childcare…. When I think of somebody who was an immigrant, it’s like, I have to leave my 12-year-old child at home, and they gotta take care of the three-year-old and a six-year-old. And I have to go work, you know, and expose myself to COVID-19. And nobody’s giving me unemployment, nobody’s giving me childcare, and my autoimmune disorder is nonexistent. And I’m sure that there’s immigrants that have health reasons or health situations and that they’re sacrificing their health and their livelihood, because they have no other option. So what COVID-19 did was, I think it’s separated people’s privileges from these essential workers.

As he notes, many people with preexisting conditions that have been shown to amplify the fatality of COVID-19 have also been allowed to work remotely so as to decrease their risk of exposure. When a worker is already vulnerable due to their immigration status, they are not afforded the privilege of having preexisting conditions.

Many essential workers were also fearful that if they did contract COVID-19 and showed symptoms, they might be sent home or lose their job. Respondents reported that their clients were unwilling to stay home or get tested because of this fear. Cindy, a medical professional, noted, “There was a lot of hesitancy to get tested, because people knew that if they had a positive test result, they couldn’t go to work for two weeks. So even convincing people to get tested was tough.” The loss of a job or a reduced paycheck due to missed work was something that these families could not afford to face.

Last, even though these essential workers knew they faced higher levels of exposure to COVID-19, there was also a fear of testing or seeking health treatment due to the fear of being reported as undocumented or exposing an undocumented family member to possible deportation. “Yes, sometimes I have fever, but I will lose my job and, if I go, they are going to deport me. So, there is no trust. The health department said for the COVID-19, no one will be targeted, but there is a lack of trust because again, just recently, what happened in this hospital. A hospital called in ICE, so it’s a big impact” (Amanda, Case Worker).

Medical respondents particularly noted that this fear, when combined with cultural distrust, would also make the vaccination process equally difficult.

And we saw a lot of people who did have COVID-19 and were probably very sick with it and should have gone to the hospital, but wouldn’t because of the same issues; afraid of immigration status, showing up to the hospital. But also there was a sense that people were telling us that if you go to the hospital, you don’t leave, and you’ll die. So people just didn’t want to go, because they were afraid of COVID-19 at the hospital (Cindy, Medical).

I’ve been working with health navigators in the Congolese [refugee] community who are concerned because the clients that they work with aren’t taking COVID-19 seriously or believe that COVID-19 was created by the US government to kill them. And so it’s not an issue of access; it’s an issue of sort of cultural difference and potentially health literacy. (Kathy, Medical)

Overall, these workers were putting themselves as well as their families and communities at risk of increased exposure to the virus. Their higher rates of contracting the disease, combined with their inability or unwillingness to seek treatment, meant that they spread the virus to those around them.

Absence of Social Safety Nets

For many people who hold essential, frontline jobs, they not only face increased exposure by going to work every day while earning low wages but also lack access to social safety nets. Kate, an attorney, said, “They just are much more easily exploited and much more vulnerable to things like disasters, things like changes in the economy, because they don’t have the kind of safety—they are not able to rely on any kind of social safety nets that other people are.” As noted, they lack access to employer-sponsored health insurance. In addition, their immigration status may make them ineligible or fearful of applying for health-related benefits for themselves or their children, even when their children are US citizens. In addition, people who lost jobs also lost their health insurance. Tina, an advocate, said, “If they lost their employment then they lost also their health care. Of course, they can apply for DHS. Now COVID-19 was supposed to be covered. Anything COVID-19 related was supposed to be covered, but as far as health, people were very afraid to go to the doctor for any reason if they thought they would be with anyone with the virus itself. As far as health wise, it’s now relearning how to use medicine and calling a doctor. Now it’s through a Teladoc virtual.”

With regard to the switch to receiving medical care through online, telehealth systems, Kristen, a case worker, described additional barriers to receiving health care: “A lot of them require like a telehealth appointment prior to getting a test which is a really big barrier which requires some kind of digital access and digital literacy related barriers to accessing health care right now.”

For Cindy, a medical professional, the hardest decision was to close her health care organization during the pandemic due to a lack of PPE and other resources necessary to keep staff and patients safe.

So it felt wrong to close, but on the other hand, you have to take an oath to do no harm, and we felt like we couldn’t guarantee a safe place for our patients and the staff members, many of whom were from the community. So we felt like, how can we be open if we’re a dangerous place because we don’t have the right stuff? So we were closed for all in-person visits for a couple of months and had to do everything by telephone, which just meant that we had very limited ability to care for all the people that would normally come in for their blood pressure medicine or their diabetes medicine or whatever.

She and her team recognized they were closing at a time when their patients needed them the most and lacked alternative sources of support.

In addition to a loss of access to medical care, respondents described the lack of resources available to immigrant communities, particularly their undocumented members.

Especially right now during COVID-19, when a lot of these families, they’re struggling a lot but it’s a real gap and a real disparity between the folks who our government considers worthy of these social services and those who are not considered” (Kristen, Case Worker).

It is daily that I get calls or messages from people daily telling me that this situation has affected them in some way. The most common way being that they lost their job and that now they are facing eviction. It is always made harder by the fact that a lot of immigrant communities, well most undocumented people, don’t have access to the kinds of social support that are available to other people. For example, unemployment benefits, certain access to certain forms of health care. Like the stimulus check, for example, that they are not going to get. Things like that. I think it has certainly devastated—disproportionately devastated—the undocumented community. (Susan, Advocate)

I think the biggest impact for those folks who are undocumented…is probably the worst because they didn’t get unemployment. They don’t have access to welfare, they don’t have access to that stimulus, they didn’t have access to anything so the best that they can do is figure out how they are going to survive with those agencies that are providing supportive services specifically for the immigrant population. And the food of course, the food banks they are helping regardless so I think that is the biggest impact. (Tina, Advocate)

The absence of unemployment benefits and ineligibility to receive government stimulus payments were seen as two of the biggest barriers for immigrant families to weather the economic downturn of the pandemic. However, it was not solely undocumented immigrants that faced this lack of resources. Mixed-status families were also unable to access safety nets:

The federal government excluded mixed-status families as well, not only undocumented families…. So if families had a US-born and an undocumented [family member]…their kids were also excluded from COVID-19 relief. And so obviously, we have so many US-born children that were excluded from COVID-19 relief, and I’m so worried and also can picture the impact that this has in our communities. (Caroline, Advocate)

Some of the kids get access to health insurance from the state—the CHIP plan here in Pennsylvania—where other kids don’t and so potentially two kids get sick with the same thing, and have different access to care. And so the one kid gets free medicine from their pediatrician, the other kid doesn’t have a pediatrician, so the family will sort of ration that medicine in between the kids or something like that. (Cindy, Medical)

The stimulus checks didn’t go to the mixed-status families, didn’t go to the undocumented families. And these people just didn’t stop working. They had to, they had to go work. So what COVID-19 did was basically threaten the livelihood of a lot of immigrant families. And again, they had to push through without, with very little safety net (William, Attorney).

It particularly upset respondents that their clients were either ineligible for or too fearful to seek out the resources available to them, even though they paid into the tax pool that funded these programs and services. Anne, an attorney, said,

I’ve never encountered an undocumented family or client that never have paid taxes. All of my clients have been paying taxes, billions of dollars, and the IRS [Internal Revenue Service] knows about it. The IRS actually gives undocumented clients a specific ITIN [individual taxpayer identification number]; basically an identification number, similar to SSN which is social security number. IRS can track easily who is giving this money to the government and they are aware of it, but because it is a financial benefit to them, they are not saying anything. At the same time…undocumented immigrants, without legal status do not get any benefits from these taxes that they pay. They do not get Medicaid, they do not get food stamps, they do not get Rule 9 federal housing situation.

When we asked our respondents what type of resources were available to their clients regardless of status, they most frequently identified food banks and church pantries. Tammy, an education advocate, described one way her organization was helping families keep their children in school during the switch to online learning: “We do help them with making sure that they are going into the schools to pick up the computers to make sure that they signing into Class Dojo, because the school district uses Class Dojo, we make sure that the family is eligible for Xfinity Essential for Wi-Fi and is getting that information in their language. So we provide all that support to the families in their native language.”

However, respondents often felt helpless. There were so few resources available to help their clients who were vulnerable before the pandemic hit and who faced increased exposure to COVID-19 due to their jobs as essential workers, with no social safety net to support them or their families. Often, networking with small, community-based organizations that were offering food boxes and, in a few cases, small amounts of cash assistance to help pay rent was the most they could provide. Several respondents noted that they were helping fewer people, but not because there was less need. Rather, more people were falling through the cracks: they lacked the means or knowledge to seek assistance.

Continuation of the Detention and Deportation Machine

Attorney respondents were concerned with the inability to slow down the removal and detention process during the health crises. Many of them spent time trying to free clients due to the high rates of COVID-19 spread in detention centers. Susan, an advocate, noted, “We are also filing federal court cases to basically help them to not die in prison or detention centers as they call it.” Kate, an attorney, told us, “If ICE detainees were in their own country, they would have the highest rate of COVID-19 in the world.” These concerns point to the need to release healthy detainees before they became sick or to quarantine the sick population away from the healthy population. Our respondents were not confident that either of these practices were happening. Several studies have confirmed their suspicions (Kerwin 2020; Niu and Rhyne 2021; Tosh, Berg, and Leon 2021). Instead, they indicated that DHS moved prisoners around between detention centers, spreading the virus. John, an attorney, explained:

We just had a client who was detained and sent down in the middle of the pandemic—early onset of the pandemic in April—down to Dallas. I mean he said that they shipped the entire 60 or 80 immigrant detainees out there in [detention center], you know they basically shipped them all out to different facilities down south. And kind of hearing his story of the harrowing experience of what it was and kind of what they went through, and what sort of measures the ICE agents did take and did not take in terms of protecting detainees, in terms of infection rates among detainees, I think there is a lot there to study and to investigate.

Many of the transferred detainees could no longer bear the conditions of being detained and signed away their rights to an immigration hearing. While international travel during the pandemic has been limited, respondents spoke of deportation “death flights,” with planes full of COVID-19 positive deportees:

There are a lot of cases where ICE was deporting people who were either, they just didn’t test them, but I mean who were COVID-19 positive. These deportation flights, a whole bunch of people had COVID-19 and now you’re sending them back to Guatemala. You’re sending them back to Haiti. You’re sending them back to wherever, and a lot of spread in countries that have no real medical infrastructure; their governments not very strong to begin with. They’re not financially stable, and because we just can’t stop deporting people, we—the United States—were actually furthering the spread of COVID-19 into those countries. (Jane, Attorney)

So, I mean basically they’re intentionally giving people COVID-19. It’s certainly criminal; you could say it’s genocidal. It borders on that because you’re taking people of color from immigrant communities and you’re intentionally giving them a disease. (Betty, Attorney)

Discussion and Conclusion

The pandemic disrupted countless lives. People across industries lost jobs. Essential workers endured the worst of the disease, while professional occupations moved online from the comfort of home. Depending on pre-COVID-19 circumstances, some have had access to social safety nets, including unemployment, food stamps, paid sick leave, health insurance and health care, and federal stimulus payments. Immigrants, especially those with a precarious status or no legal status, and their families have served on the front lines at increased risk of exposure and financial precarity, with no social safety nets when they became sick or lost their jobs.

Our respondents provided a wide variety of services to immigrant communities and had to shift the way in which they operated during the pandemic. Moving services online was extremely difficult when combined with language barriers, Wi-Fi access, and digital literacy issues. Lawyers were no longer able to accompany clients into court even though cases were continuing to proceed. Health clinics had to shut their doors due to a lack of PPE. Advocates and case workers had to network resources in order to make sure people had food and warm clothing during the winter months. Educational advocates had to try to keep students learning in the switch to virtual classrooms, facing many of the access and digital literacy issues noted above. Some politicians in Pennsylvania attempted to expand the Children’s Healthcare Insurance Program (CHIP) coverage to undocumented children, but with no success.

While the introduction of multiple vaccines has brought hope that the end of the pandemic is near and the economy is gearing up, there is still much work to do. Immigrants, their families, and their communities have been severely damaged. Lives have been lost. Others live with the long-term effects of COVID-19. Distrust of government impedes receipt of services and resources for which immigrants are eligible. As eviction moratoriums are lifted, more families will likely be displaced, which will lead to increased homelessness and the doubling and tripling of families living together.

Limitations

While southeast Pennsylvania is home to one of only three family detention centers in the country, it is a nontraditional state for immigration. Findings may differ for border or port states where immigrant communities are more established, larger, and more diverse. Future research should consider additional geographic locations for a cross-comparative study.

In addition, our sample size is relatively small and may not be generalizable. However, our findings are important for understanding the pandemic. Our respondents were able to offer firsthand accounts of how their work with immigrant communities has been affected and its impact on their clients.

Last, we did not speak directly with members of immigrant communities. While people who directly serve these communities have valuable insights, they do not have the same lived experiences or perspectives as immigrants. Moreover, there is significant variety of experiences among diverse immigrant populations. We acknowledge the ethical dilemmas that arise when one group seeks to speak on behalf of others (Banks et al. 2013; Minkler 2005). Nevertheless, we think that our respondents provided important insight in the way in which COVID-19 negatively impacted the lives of immigrants.

Implications and Recommendations

Immigrants, regardless of their status, are an integral part of our economy and our communities. To pretend they do not exist or to punish them for not having a legal status only hurts our communities as a whole. As Mary, an advocate, put it: “For me, it’s an understanding that this is a community in the Commonwealth…that is making contributions, that is not adequately represented and could be better served, and it would be better for all of us. In terms of public health, in terms of education, to promote just as any other individual. People are people, right? It just doesn’t make sense to me not to pay attention to this community. To act like they don’t exist is not in anyone’s benefit.” Overcoming issues of trust will be extremely important in allowing immigrants to access existing and future social safety nets. Local community organizations that have already established trust within immigrant communities must play a role in creating access to social safety nets, as they are made available. Utilizing these types of organizations including churches, law offices, and health clinics is the best way to spread information and resources to immigrant communities.

Based on our interviews, we have a series of specific policy recommendations to ease the vulnerability of immigrants and create social safety nets that will include them and protect them when the market fails to do so. We know that immigrants of all types have made indispensable contributions to the US economy as essential workers and in other ways. Therefore, we present both short-term and long-term recommendations. In the short term, we propose that COVID-19 relief payments be made to all essential workers, regardless of their status, as compensation for putting their lives on the line to keep the economy running. One example of a successful attempt to accomplish this is in New York State (Young 2021). Second, as a public health imperative, both federal and state governments should expand Medicaid and CHIP programs to include all essential workers and their children, regardless of their status. Finally, DHS should not refer essential workers for removal proceedings and the US immigration courts should terminate removal proceedings for essential workers without a criminal record.

Several of the following legislative recommendations would positively impact the lives of nonimmigrant vulnerable populations as well. First, when it comes to issues of health care affordability and access, Congress must continue to revise the Affordable Healthcare Act to expand coverage for those who do not qualify for Medicaid but earn too little to afford insurance on their own. Doing so would help address preexisting comorbidities for all vulnerable populations as well as providing treatment for COVID-19. Second, there must be a review and rigorous enforcement of workplace health and safety particularly when it comes to farming, meatpacking, food production, and food service. Immigrants of all statuses dominate these industries that all people rely on to eat every day.

Our final recommendations are specific to DHS and two of the primary agencies they oversee: ICE and the Border Patrol. First, there needs to be a review of ICE policies and practices. This could include a funding reduction with resources instead going to legal services to process cases faster. Second, they must deprioritize the arrest and removal of noncriminals. Third, there needs to be a shift in policy that keeps mixed-status families intact. Research indicates that even documented immigrants and US citizens suffer trauma and lack of access to resources by simply living with an undocumented family member. Finally, both Congress and the administration must create additional paths to a legal status for DACA recipients and all essential workers. In particular, we endorse the efforts put forward by the Biden administration in support of the US Citizenship Act of 2021, which includes a broad legalization program.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received an Albright Creative Research Experience grant to financially support the research, authorship, and/or publication of this article.

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