“No puedo respirar!” is the first thing I hear as I enter the room, watching a patient gasp for air. He has the sturdy and weathered frame of a migrant farmworker, but today his lungs are about to give out, having battled pneumonia for over a week. Hours later I watch as he is wheeled, comatose on a ventilator, to the ICU. In the midst of the COVID-19 pandemic, I now see many patients who come to the hospital with shortness of breath. However, this case was more severe — more tragic, even — because he delayed seeking medical care. This man’s case is not unique — he shares his immigration status with about 10.5 million people in the United States. Due to fears of crippling medical bills or of deportation, many undocumented immigrants in our country avoid obtaining necessary medical care.

The COVID-19 pandemic has upended the lives of all Americans, but not in equal measure. Undocumented immigrants do not have the privilege of social distancing or working remotely. Holding essential jobs such as day laborers, farmers, janitors, nannies and construction workers, many undocumented immigrants must continue working during this pandemic regardless of stay-at-home orders. Undocumented immigrants also are not afforded assistance from the CARE act and do not possess the resources to go without pay. While most undocumented immigrants pay federal, state, and local taxes, they are ineligible for the financial relief of the recent stimulus packages. Without the financial assistance that most Americans are receiving, undocumented immigrants must continue to work to provide for their families, risking their welfare and others in doing so.

Undocumented immigrants have poor health literacy and are often overlooked by public health information campaigns. As they also lack access to preventive healthcare, undocumented immigrants disproportionately accumulate poorly-managed chronic diseases such as hypertension, increasing their risk of death or morbidity from COVID-19. Many undocumented immigrants live with relatives in close quarters, further increasing the likelihood of contracting and spreading the disease.

Undocumented immigrants contribute to the backbone of our economy, and we rely on this valuable yet vulnerable population for a variety of tasks. To mitigate the spread of COVID-19 among these and other at-risk communities, we need to reverse the structural inequalities of our society. We must engage and teach local immigrant communities about the prevention of the disease and we must provide them with sustainable financial support. A stimulus package that includes vulnerable populations in our society is imperative in reducing the spread of the COVID-19 pandemic. While the patient I saw risked his life by moving to the United States in hope of a better life and future for his family, our failed system continues to put him and all of us at increased risk of this disease.

Reem Hanna, MD, is an assistant professor in the Division of Hospital Medicine at CU School of Medicine. Opinions expressed in this column are hers and are not a position of the University.  The name of the patient was withheld in the interest of patient privacy concerns. 

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