In this Opinion Feature, Dr. Luz Maria Garcini, Cristina Abraham, Ciciya Abraham, and Vyas Sarabu outline the risks and unique challenges faced by people living with undocumented status in the United States during the COVID-19 pandemic.

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An immigration activist participates in a rally near the White House on October 7, 2021, in Washington, DC. The group demonstrated for immigration reform and urged President Biden to authorize a pathway to citizenship for undocumented immigrants. Image credit: Kevin Dietsch/Getty Images

Dr. Luz M. Garcini is affiliated with the Department of Medicine at the University of Texas Health Science Center at San Antonio, and with the Baker Institute for Public Policy, Center for Mexico and the U.S. at Rice University. Cristina Abraham and Ciciya Abraham are based at the University of Texas at San Antonio, and Vyas Sarabu is based in the Department of Medicine at the University of Texas Health Science Center at San Antonio.

Since the onset of the COVID-19 pandemic, millions of Americans have experienced significant social, economic, and personal hardship, as well as uncertainties in medical coverage.

Yet, the consequences of the pandemic have impacted vulnerable communities disproportionately — these groups include families with undocumented immigration legal status. The toll of COVID-19 among undocumented immigrants is multifaceted and compounded by health, economic, and social stressors.

Risk factors, such as limited access to healthcare, increased exposure to the virus due to frontline jobs, and restricted access to information and technology needed to keep people informed have increased the risk of COVID-19 infection among undocumented communities.

As a result, the risk of disability, hospitalization, and even death is high in this marginalized population.

Compounded with the difficulties mentioned above, undocumented immigrants often face legal and financial obstacles, which prevent them from seeking timely medical attention, receiving quality healthcare, or both.

Many undocumented immigrants lack health insurance, given that they are excluded from coverage through the Affordable Care Act, Medicare, and in many instances, Medicaid.

“In addition, undocumented immigrants lack access to financial aid provided by the federal government and live in constant fear of deportation, detention, separation from family and loved ones and victimization, discrimination, [or both]. These realities deter them from seeking necessary health services even when paying out of pocket.”

While immigration legal status is not a gatekeeper for having access to the COVID-19 vaccine — available to all despite citizenship — many undocumented immigrants fear and mistrust the government, its institutions, and its services due to the sharp increase of anti-immigrant actions and vitriol over the past years.

Indeed, mistrust and fear are significant barriers to COVID-19 diagnostic testing and vaccination among undocumented families, according to our recent research, currently under peer review.

In addition to the aforementioned health-related challenges, the COVID-19 pandemic has created economic reverberations for undocumented immigrants, affecting employment, education, housing, caregiving, and economic security.

For many undocumented immigrants, the economic effects of COVID-19 have added to an already sizeable mental toll by hampering the ability of immigrants to provide monetary support for their families in their countries of origin.

In 2020, an estimated 75% of remittances received in Latin America and the Caribbean originated in the U.S. Further estimates found that the loss in remittances to the locations mentioned above reduced by at least $10 billion in 2020 compared to 2019.

In the face of job losses, many undocumented immigrants have had to develop new skills in a short time and take up new occupations, especially those deemed “essential” during the pandemic, in order to maintain income streams.

“In addition to causing a tremendous amount of stress, the need to undertake any jobs available without adequate training or precautionary measures has forced many undocumented immigrants to work under hazardous conditions without health protections, benefits, or guarantees.”

Socially, the COVID-19 pandemic has also affected undocumented families in several ways. For instance, family separation due to restriction in border closings, an inability to be with family due to shelter-in-place ordinances, and isolation from loved ones due to COVID-19 exposure have been highlighted as salient stressors affecting the mental health and well-being of undocumented families.

Other prevalent social stressors among undocumented immigrants have been stigmatization and discrimination, given that these immigrants have often been portrayed as dangerous, a threat to economic stability, a drain to society, and as disease-carrying public health hazards during the COVID-19 pandemic.

Limited knowledge about immigrants and a poor understanding of the immigration experience have perpetuated these stereotypes resulting in detrimental social and health consequences, including avoidance when seeking necessary health services.

Despite the disproportionate impact of the COVID-19 pandemic on the health and well-being of undocumented communities, these immigrants are incredibly resilient. Undocumented immigrants are resourceful and tend to view life with optimism.

Their fortitude, tenacity, and reliance on spirituality and religion keep them strong in the face of loss and uncertainty. They tend to look at adversities as temporary and keep hoping that a brighter future lies ahead, which is a palliative remedy for the numerous complex stressors they face.

Undocumented immigrants also have an impressive capacity to adapt to changing and uncertain situations, even in the face of limited resources and opportunities. Within the context of the pandemic, their ability to cope with loss, resource shortages, unstable income, and changing social restrictions are only a few examples of their tremendous resilience.

Yet, despite their resilience, the chronic and salient stressors that continue to impact undocumented families can seriously compromise their health and well-being, which is concerning given their limited access to healthcare.

The detrimental effects of chronic stress on health, including reducing the ability of the immune system to fight illness effectively, are well documented.

As rates of SARS-CoV-2 infections continue to fluctuate, it is essential to acknowledge that chronic stress — and resulting impaired immunity — may have serious implications for undocumented families, including increased risk for more severe disease, serious disease complications, and even death.

Undocumented immigrants comprise a considerable proportion of the U.S. population, including a significant portion of essential workers who made, and continue to make, vital contributions to overcome the economic toll of the COVID-19 pandemic.

Their contribution on the front lines deserves recognition and should be a call to revise immigration policy.

In the context of exclusionary policies, anti-immigrant rhetoric and actions, and uncertain socioeconomic conditions, it is clear that the existing immigration policies are in need of dire reform. As a nation, we have benefited tremendously from the economic, social, and cultural contributions of undocumented communities.

As a nation, we have a responsibility to uphold the humanity of undocumented families and recognize their essential contributions to this country during a public health crisis characterized by anxiety, confusion, and deep mistrust.

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