COVID-19 Is Worsening Immigrant Health Inequities, Especially for Children

By Linda Carroll

June 26, 2020

(Reuters Health) - Existing health inequities faced by immigrants and their children in the United States have worsened during the COVID-19 pandemic, but healthcare workers, especially pediatricians, can help make things better, physicians write in Pediatrics.

"We already know there are baseline health inequities among immigrant families and children with an immigrant parent," said coauthor Dr. Rushina Cholera, a pediatrician and a National Clinician Scholar Fellow at Duke University in Durham, North Carolina. "That's been significantly exacerbated in the time of COVID-19, such that immigrant families are suffering more from access problems and the social drivers of health, which include food insecurity, poverty and housing instability. They've been disproportionately affected by the virus as well."

In a Perspectives piece, Dr. Cholera and her colleagues examine the impact of COVID-19 on children in immigrant families, and list ways for pediatricians, hospitals and health systems to mitigate these risks.

"Healthcare providers can proactively reach out to immigrant families and children in immigrant families and screen for the social determinants of health," Dr. Cholera said. "They can make sure the families are enrolled in programs like WIC and help them to connect with community-based resources."

Many immigrants fear that if they come to the hospital to get tested for COVID-19, they could be apprehended by ICE, Dr. Cholera said. They also fear that if they sign up for government programs, they may have a harder time getting a green card or a path to citizenship because of the public charge rule.

The solution can be to partner with community-based organizations and refer patients to them, Dr. Cholera said. "If I have a fluid partnership with a community organization, I can do a warm handoff for those at high risk of exposure to COVID," she added. "If the person is isolating, you can help them get food delivered by a trusted community member and get them enrolled in WIC."

While many healthcare workers are overwhelmed right now, it's still important to reach out, Dr. Cholera said. "Right now, it's critical to be asking, 'How are you doing with food, with housing, with mental health - and how can we help," she added.

The new paper underscores the increasing vulnerability of immigrants in the time of COVID, said Goleen Samari, an assistant professor of population and family health at the Columbia University Mailman School of Public Health in New York City.

"(The authors) are arguing for the role pediatricians can play in helping patients navigate the healthcare system and connecting patients to legal resources when possible," Samari said. "That can be hard when ICE is sometimes doing raids at hospitals."

Physicians can also refer immigrant patients to be tested for COVID-19 at a place where they will feel comfortable, such as at a community center, Samari said. Another way to help is to make sure there are translated guidelines available, she added.

"Many providers are overwhelmed particularly during the pandemic," Samari said. "But you have to be mindful that the immigrants are additionally marginalized now. These are steps pediatricians can take even if it means a little more work to make sure immigrant patients are served."

SOURCE: Pediatrics, online June 24, 2020.