Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families.

Abstract

* Abbreviations: CIF — : children in immigrant families COVID-19 — : coronavirus disease DACA — : Deferred Action for Childhood Arrivals ICE — : Immigration and Customs Enforcement LEP — : limited English proficiency SDH — : social determinant of health TPS — : temporary protected status WIC — : Women, Infants, and Children Program Like many health conditions that disproportionately impact vulnerable populations of color, we expect that the coronavirus disease (COVID-19) pandemic will inequitably affect the health and livelihoods of immigrant families. One in 4 children (>18 million) in the United States lives in an immigrant family, in which the child or ≥1 parent was born outside the United States.1 Among children in immigrant families (CIF), >7 million live in “mixed-status” families, meaning ≥1 parent is not a US citizen.2 Before the COVID-19 pandemic, immigrant families faced increasingly restrictive policies and discrimination. Regardless of legal status, CIF experience increased health and social risks compared with peers in nonimmigrant families, including lower rates of health insurance coverage and higher poverty levels.3 The COVID-19 pandemic amplifies existing inequities and introduces new ones as immigrant families navigate school closures, lack of health insurance and paid leave, and decisions to seek medical care or public services amid ongoing immigration enforcement. Additionally, immigrant families are more likely to live in multigenerational households,4 heightening the risk of COVID-19 for multiple family members. Families with limited English proficiency (LEP) must decipher rapidly evolving public health directives, such as “shelter-in-place” orders and recommendations for mask-wearing, without multilingual and culturally relevant messaging. Underlying these challenges is the implicit presumption of a safe place in shelter-in-place and social distancing directives. For immigrant families seeking safe haven in the United States, “place” may include violence and abject poverty, both in home countries and at the US border. For CIF in US communities coping with persistent fears of immigration enforcement and family separation, … Address correspondence to Rushina Cholera, Duke University School of Medicine, 200 Morris St, 3rd Floor, Durham, NC 27701. E-mail: rushina.cholera{at}duke.edu