As I write this essay, New York City (NYC) has had a momentary reprieve, going from being the undisputed epicenter of COVID-19 to becoming a global hub of public demonstrations against racial oppression. Just a few weeks ago, while we were all busy insulating ourselves against the virus, another enemy—rooted in centuries of pervasive systemic racism—reared its ugly head in its most recurrent expression: police brutality. Decades of unpunished killings of African Americans at the hands of the police eventually found a catalyst in the video images that captured the final minutes of George Floyd’s life. On May 25, 2020, Minneapolis police choked Mr. Floyd to death after arresting him for the alleged use of a counterfeit $20 dollar bill at a nearby grocery shop. The visual account of his horrific death—one that suggests a twenty-first century lynching—was crowned by him beseeching his murderers: “I can’t breathe.” These words quickly became a battle cry that led to massive public demonstrations in America and many other parts of the world.
While COVID infection (or rather, the threat of it) had kept many of us at home for months, within days of Mr. Floyd’s death, “getting out to protest” became the right thing to do. In the midst of this pandemic two opposite stands (i.e., staying at home versus going out) became paradoxically complementary as victims of poverty, environmental racism, and social inequality simultaneously turned into targets of both a viroid pathogen and police brutality. About three months after the United States declared a state of emergency for COVID-19, the virus has been the great divider among us. It is clear now that infectious diseases do discriminate and minority populations in this county (mostly African-Americans and Latinos) get sicker and die in larger numbers than their white counterparts.
This article examines the impact of COVID-19 on the foreign born in the U.S., particularly the undocumented population, which has also been the object of systematic violence at the hands of the police and has suffered from COVID-19 the most. Latino immigrants, the healthiest among Latinos in the U.S., are experiencing the highest rates of COVID infection, particularly impacting those who are incarcerated. Undocumented Latinos, in particular, tend to be poorer, lack health insurance, and work in essential and frontline jobs—everything from farming to health care—that prevent physical distancing. Contextual sources of vulnerability to COVID-19 are also the result of environmental racism, as ethnic minorities usually live and work in polluted and distressed areas. In NYC, for instance, those residing in immigrant neighborhoods are less likely to be tested for COVID-19 despite the fact that positive cases are more often found in these areas.
Two main questions are addressed in this essay: What has kept undocumented immigrants from receiving the health benefits and services they are entitled to during the COVID-19 pandemic? And, to what extent do fear and concerns about being persecuted and labeled a COVID-19 case lead vulnerable immigrants to avoid seeking needed health care? In order to answer these questions, this essay briefly examines the impact of structural vulnerability and cumulative stigma on immigrants’ ability to receive the health services they need and deserve. In the conclusions, this piece highlights the relevance of a human rights paradigm towards comprehensively embracing the health needs of vulnerable families and their children during the COVID-19 crisis and beyond.
Immigrants’ Responses to Collective Threat
The term “chilling effect” is frequently used in the public health literature to refer to the combination of fear, apprehension, and confusion that keeps at-risk individuals from seeking the health care services and social benefits they are entitled to. I argue that such a term does not fully capture or do justice to the complex of structural conditions that deters immigrants from accessing available health services and governmental benefits. The term “in situ effect” (in situ from the Latin expression meaning “remaining in place”) is coined here to encompass immigrants’ self-protective agency, which shields them from the unintended consequences of seeking government-sponsored health care and social benefits.
In situ effect involves the social harm endured by disenfranchised immigrants for whom remaining in the shadows becomes a means of survival against coercive migration policing, state surveillance, and institutional abuse at the hands of medical and government institutions. For those who are fearful of being detained by Immigration and Customs Enforcements (ICE), or who worry about being able to put enough food on the table, seeking health care when sick is often a last resort. This is compounded by the fact that ICE and CBP (Customs and Border Protection) continue to detain immigrants at doctors’ offices and emergency rooms around the country.
In situ effect is at stake when undocumented workers decide not to see a doctor when experiencing COVID-19 symptoms for fear that releasing their personal information will lead to deportation proceedings by the U.S. Department of Homeland Security. In situ effect also explains why the uninsured population (mostly Latino and African-American) will mostly avoid COVID testing and treatment—even when symptomatic—given their inability to pay any medical bills. It also explains why unemployed Latina mothers may not apply for food aid (through the Snap Assistance programs) as they may be deemed a “public charge,” a designation that may jeopardize their chances of regularizing their families’ legal status in the future.
It is also worth mentioning the “micro aggressions” regularly experienced by immigrants and ethnic minorities when reaching out to health and social service agencies. This includes being the object of rude or dismissive treatment as well as the absence of translation and interpretation services. Social disparities around class, race, ethnicity, and legal status are also articulated via subtle or overt discrimination, rejection, and a general lack of empathy and understanding on the part of health care and social service agencies.
Structural racism, as the ultimate driver of social and health inequalities in the United States, and Latin America generally, has found in the coronavirus epidemic its latest expression, particularly among disadvantaged populations. For vulnerable immigrants, this means dealing with a “cumulative stigma” compounded by their precarious legal status and working conditions, both of which place them at risk of contracting COVID-19. Rather than being additive, “cumulative stigma” works intersectionally by intertwining racial, social, and identity markers (including gender and sexual orientation) among other categories. Stigma is therefore conceived not as the result of one singled-out characteristic, but as the combined effect of racial, social, and economic oppression. In this view, internalized cumulative stigma is even more pronounced among certain immigrant populations, as with indigenous groups that only speak their native tongue and are generally ignored, discriminated against, and disrespected. The embodiment of these negative markers will certainly make them more vulnerable to COVID-19 and negatively impact their ability to care for themselves and others. In sum, one of the main lessons of the COVID-19 crisis is that frontiers of race, ethnicity, class, and immigrant status are crucial axes of (in) equality that shape our differential exposure to the virus along with our likelihood of coming out triumphant over it.
Epilogue: Embracing Health as a Human Right
The literature on COVID-19 has been emerging almost as rapidly as the infection rate, with some promising scholarly work recently published in the public health and social sciences. Although well intentioned, many of the conclusions drawn from this fledgling body of research are inspired by individually based epidemiological models that support the “population health frame” and disregard the analysis of immigrants’ structural vulnerability. For instance, COVID-19 prevention targeting immigrants and refugees (indirectly framed as “the other”) is often justified as a necessary step to protect the health of the public (indirectly framed as “us”). Encouraging migrants and refugees to disclose their potential COVID-19 symptoms and seek care is often seen as critical to effectively controlling the spread of disease to the public.
As scholars, people of color, and immigrants, we have a unique opportunity to make our voices heard at a time when the whole world is pointing its critical gaze at us. Such an approach will help strengthen our communities while debunking myths and erroneous information that continue to stigmatize and marginalize those that have been suffering from this pandemic the most. By joining coalitions with other universities, unions, religious groups, and grassroots organizations we will be able to support our communities while advancing legal change, locally and federally, towards extending their social, political and health rights. In a neoliberal world where access to health care and medical coverage are mostly considered commodities, it is essential that we embrace the universal entitlement to adequate and timely medical care, nutritious food, and safe housing to all, regardless of race, ethnicity, class or nationality. In sum, we, New Yorkers, are in an exceptional position to frame health care as a human right. This piece has meant a contribution in this direction.
Anahí Viladrich is a sociologist and medical anthropologist originally from Argentina. Her research and writing intertwines the field of migration studies, culture and health. As a full professor at the City University of New York, she combines her work as a researcher and teacher with her passion for mentoring younger generations of scholars.
She is currently a Full Professor in the Department of Sociology (with a courtesy appointment in Anthropology) of the Queens College of the City University of New York (CUNY). Viladrich is also affiliate with the CUNY Graduate School of Public Health and Health Policy; and with the Department of Sociology, the M. A. in Migration Studies and the Center for Latin American, Caribbean and Latino Studies at the CUNY Graduate Center.
Viladrich holds a degree in Sociology (BA/MA) from the University of Buenos Aires, Argentina. In the U.S. she received a PhD, with Distinction & the Marisa de Castro Benton Award in Sociomedical Sciences (Medical Anthropology), and an MPhil in Sociomedical Sciences, both from Columbia University. She also holds an MA in Sociology (with Honors) from the New School University.