Hard to Reach
June 11, 2020
Photo via Houston Emergency Operations Center
The Basics: COVID-19 Disparities
New data from the University of Chicago Poverty Lab suggest that another metric — the test positivity rate — provides further evidence of these disparities. The greater the test positivity rate, the more likely an area is only testing the sickest people and missing others who could be spreading the virus undetected.
A Poverty Lab analysis found that zip codes in Illinois with the most undocumented and uninsured residents also had the highest positive test rates on average, suggesting that not enough people are being tested. The analysis did not establish why these groups were likely to be undertested, although they determined it was not because of a lack of testing sites.
The Barriers: Money, Stigma and Fear
We interviewed more than a dozen advocates and service providers around the country. While many said a lot of the undocumented immigrants they have heard from want to get tested and do their part to prevent the virus from spreading, they all reported common barriers that are making that difficult.
The reason most commonly cited by advocates as to why people are not getting tested was having to miss work and potentially losing a job.
Undocumented immigrants were not included in the federal stimulus package, are not eligible for unemployment benefits and are generally not in a good position to advocate for benefits like paid time off.
Many also fear not being able to afford a test or the resulting treatment if they got sick.
Several advocates and service providers said the undocumented immigrants they knew were worried about being judged for testing positive and feeding existing anti-immigrant sentiment.
“People don’t want to be associated with COVID. People are afraid to talk about COVID,” said Elena Fernandez, the chief program officer at St. John’s Well Child and Family Center, a federally qualified health center in South Los Angeles.
“Nobody wants to be on a government list,” said Katy Atkiss of the Houston Immigration Legal Services Collaborative.
People are nervous that their information could be shared with immigration authorities. Many are also concerned about the Trump administration’s new public charge rule, which allows the government to deny permanent residency to immigrants who are deemed reliant on government services, including Medicaid.
U.S. Citizenship and Immigration Services says COVID-related care will not count toward a public charge determination, but many immigrants don’t trust the government to keep its word, according to advocates.
Reaching the Hard-to-Reach: Translation, Community and Money
With around 11 million undocumented immigrants in the United States, ensuring that this population receives adequate testing and care is critical to preventing the spread of the virus in this vulnerable community and throughout the country. Below are three of the key tactics that experts say are needed to make that happen.
Translating important information about COVID-19 and testing is critical to reaching people who do not speak or read English.
Many cities, states and public health departments are translating key information into additional languages, hiring multilingual outreach workers and contact tracers, and doing interviews with non-English media.
However, some immigrants may not be able to access translations online, or they might speak indigenous or more obscure languages that may not be included in government translations.
People and organizations that already have relationships with undocumented immigrants are more likely to be trusted messengers than government or health officials.
Federally qualified health centers, which serve many of the country’s undocumented immigrants, have stood up testing, done outreach to their patients and even set up their own contact tracing systems.
Many cities, states and health departments are working with community-based organizations to share and amplify their messages around testing.
Several nonprofit organizations have set up relief funds to help support people who lose their jobs or need to take time off to isolate but aren’t eligible for state or federal assistance.
Denver and Boston have pledged $750,000 and $650,000 respectively to support funds in their cities. Oregon is spending $10 million to support farmworkers who need to quarantine, and California is giving out $75 million in one-time $500 payments to undocumented immigrants.
While this money should help, these efforts do not cover most of the undocumented people in the country and provide little protection for workers who fear they will lose their job entirely if they have to miss work.
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Select Research and Reporting:
The Key To Coronavirus Testing Is Community (Maddie Sofia and Rebecca Ramirez, NPR, 6/2/2020)
What Do Coronavirus Racial Disparities Look Like State By State? (Maria Godoy and Daniel Wood, NPR, 5/30/2020)
Where COVID-19 Testing Lags Community Need in Illinois (Isaac Ahuvia, Alex Bartik, Marianne Bertrand, Joshua Gottlieb, Kelly Hallberg, Matt Notowidigdo, Harold Pollack and Winnie van Dijk; University of Chicago Poverty Lab; 5/26/2020)
Vulnerable to COVID-19 and in Frontline Jobs, Immigrants Are Mostly Shut Out of U.S. Relief (Muzaffar Chishti and Jessica Bolter, Migration Policy Institute, 4/24/2020)
Serious Challenges And Potential Solutions For Immigrant Health During COVID-19 (Whitney Duncan and Sarah Horton, Health Affairs, 4/18/2020)
Crowded housing and essential jobs: Why so many Latinos are getting coronavirus (Antonio Olivo, Marissa J. Lang and John D. Harden; Washington Post; 5/26/2020)
Matt Notowidigdo, PhD, University of Chicago Poverty Lab
Samantha Artiga, Director, Disparities Policy Project, Kaiser Family Foundation
Dawn Mautner, MD, MS, Medical Director, Oregon State Medicaid; Senior Health Advisor, Oregon Health Authority
Monica Juarez, MPH, Regional Outreach Coordinator, Oregon Health Authority
Special thanks to medical anthropologist Whitney Duncan who provided translation services and whose research on immigrant health connected us with Ana.
Music composed by Ty Citerman, with additional music from Blue Dot Sessions.
This episode was reported, produced and mixed by Ryan Levi.
Additional thanks to:
Roxanne Kerani, Tair Kiphibane, Randy Capps, Nawar Naseer, Chris Aldridge, Jonathan Ross, Kelly Osmundson, David Malebranche, Isaac Ahuvia, Amy Simmons, Janice Tufte, Lindsay Farrell, Andrea Ruggiero, Sarah Horton, Basim Khan, David Malebranche, Minal Giri, Sarah McAfee, Amanda Benitez, Paola Guzman, Jorge Ramallo, Yesenia Beascochea, Cristian Solano-Córdova, Marcie Mir, Elena Fernandez, Kelly Hallberg, Katy Atkiss, Ricardo Castillo, Tómas Aramburu, the Tradeoffs Advisory Board…
…and our stellar staff!