Don’t Scapegoat Immigrants for the COVID-19 Pandemic Surge

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This post is a part of our Bioethics in the News series

By Larissa Fluegel, MD, MHS, and Sean A. Valles, PhD

The U.S. COVID-19 pandemic summer surge has inspired a public search for answers as to why wide vaccine availability has not been sufficient to prevent a new wave of infections. Certain answers are plausible, such as blaming the surge on some combination of the more infectious delta variant spread, vaccination rates remaining too low on average and excessively low for some populations, a relaxation of formal disease control restrictions, as well as more nuanced informal social habits such as diminished mask-wearing, more indoor parties, etc. Yet others cast blame onto a much less plausible target: immigrants.

Florida Governor Ron DeSantis blames President Joe Biden for being too lax on the southern U.S. border immigration enforcement, suggesting that Biden has been “helping [to] facilitate” the pandemic. Governor Greg Abbott of Texas took things further, ordering that state law enforcement could “begin pulling over vehicles whose drivers are transporting migrants who pose a risk of carrying COVID-19.” Both of these responses to the pandemic spread are unethical, incoherent, and ineffectual. Accusations against Latin American immigrants are unethical and misguided.

For many reasons, blaming those immigrants crossing the southern U.S. border for negative health outcomes is problematic. Such targeted blame is dehumanizing to immigrants—it promotes negative stereotypes that perpetuate discrimination, mistreatment and health disparities, and by extension, it is detrimental to non-immigrants’ health. Moreover, it is a form of blame shifting that prevents authorities and the public from effectively taking responsibility for community-wide problems.

Image description: a black and white photo of an individual holding a sign that reads “Hamilton was an immigrant. Einstein was a refugee.” They are wearing a long jacket and a tricorne hat. Image source: Victoria Pickering/Flickr.

Blaming immigrants is dehumanizing

There is a long history of dehumanizing immigrants to the U.S., although such dehumanization is generally done selectively. Immigrants such as Charlize Theron and Albert Einstein are treasured, while others are despised for having the “wrong” skin color, accent, occupations, and so on. Dehumanizing and targeting immigrants has been part and parcel of U.S. history, from 19th century church-burning riots that terrorized Irish immigrants, and the overtly racist Chinese Exclusion Act, to current cases of medical abuse and neglect in migrant detention centers. Philosopher David Livingstone Smith traces these sorts of systemic cruelties to a process of dehumanization in which we find ways of convincing ourselves to think of certain groups of people as somehow less than human. To convince ourselves we seek justifications such as depicting immigrants as vermin infecting or invading a country. According to Livingstone Smith, such depictions then give us permission to act aggressively against those groups and to “exclude the target of aggression from the moral community.”

In sum, we find ways to give ourselves permission to dismiss the ethics of how we treat certain groups of people. With such misplaced permission, we decide that certain groups, in this case select immigrants, don’t count as fellow humans worth caring about, and so abuse doesn’t really count as abuse. It’s this sort of misguided logic that also explains Governors Abbott and DeSantis’ school mask requirement bans. Paradoxically, their purported attempt to reign-in government restrictions on individuals simultaneously reveals disregard for the ways in which harsh immigration enforcement strategies negatively impact the lives of immigrants.

Blaming immigrants promotes unrealistic, unhealthy negative stereotypes

Blaming immigrants promotes negative stereotypes that perpetuate discrimination, social mistreatment, and unjust health disparities. Since early in the pandemic, anti-Asian racism and xenophobia mixed in with COVID-19 politics has led to a worldwide phenomenon of hate crimes against anyone appearing to be of Asian descent, and vicious expressions of misguided blame directed at anyone from the same vague region as where the pandemic originated. Historically, and erroneously, people in the U.S. have associated immigrants with human disease and contagion. Immigration authorities have long scrutinized immigrant health when deciding who can enter or remain in the U.S. Additionally, there is a false perception that immigrant illnesses are predominantly acquired before entry to the U.S.; it is instead most often the case that immigrants tend to struggle with worsening health as they spend more time adopting U.S. cultural norms, including unhealthy eating habits.

Stereotypes about “unsanitary” immigrants represent cruel and unjustified blame shifting. For example, consider meat processing plants which have been hot spots for COVID-19 outbreaks. Staffed predominantly by an immigrant workforce, those workers face abusive and unsanitary working conditions (an open secret in the industry for over a century) that foster disease outbreak. Laying blame for this suffering on immigrant workers, or immigration generally, is a horrendous ethical mistake. Statements by public figures like Governors Abbott and DeSantis contribute to morally skewed views about immigrant health.

Unhealthy negative stereotypes hurt people and cost all Americans a lot of money

Another pragmatic consideration is how those immigrants who do fall ill interface with the U.S. health care system. Negative stereotypes about immigrants among health care providers lead to substandard and/or improper care. In fact, the anticipation of being mistreated coupled with fear among those with an undocumented immigration status serve to dissuade immigrants from seeking needed care. Such fears might even discourage some from getting the COVID-19 vaccine. In this way, blaming immigrants contributes to worsening the pandemic. (A related irony is that nearly 1 in 3 doctors are themselves immigrants.)

There is a public health concern to this sequence. Delaying or avoiding care harms immigrants as well as those around them. To avert transmission, contagious diseases need to be treated in a timely manner. Not doing so leads to an underestimation of actual disease distribution and burden. A correct estimation is necessary to determine the right amount of resources and timely measures necessary to contain them. It is a waste of public resources to have those in need use emergency rooms for care that, if identified and delivered in a timely manner, could have been averted before the situation worsened. Part of the motivation for the Affordable Care Act was to  increase access to regular necessary care, yet undocumented immigrants were excluded from benefitting from the Act, despite the fact that providing coverage would have improved public health and probably saved the public money as well. For example, consider strep throat, a condition that is easily treatable with inexpensive antibiotics. Left untreated, strep throat can get complicated and potentially cause serious long-term heart problems. Untreated strep throat might drive a person to seek care in an emergency department. Yet another example is an untreated dental cavity that might lead to a dental abscess or a deep skin infection of the mouth and neck, again possibly resulting in an emergency room visit. Once there, correct diagnosis would require fluid cultures and expensive MRI or CT imaging. The cost of delayed care is borne by all of us. Some combination of insurance companies, hospitals, or government pay those excess fees, passing along costs to everyone else.

Speaking out

It is unfortunately fashionable across the U.S. and Europe to blame immigrants for social problems. Economic and social problems are quickly blamed on immigrants. Conversely, the available evidence points to immigrants being economically and socially beneficial to their respective new country.

We, the authors, come to this issue as people who have committed their professional lives to making healthcare and health policy more humane—seeking to help our future physicians and our colleagues treat patients as complex human beings deserving of care, rather than revenue streams to be maximized. Similarly, we see immigration discussions falling prey to the same mistake so common in healthcare, wherein powerful decision-makers, such as politicians, lose sight of their shared humanity with the people whose lives depend on them. We need to demand better from our political leaders and importantly, we need to speak out when politicians dehumanize immigrants.

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Sean A. Valles photo

Larissa Fluegel, MD, MHS, is an Assistant Professor with the Center for Bioethics and Social Justice and the College of Human Medicine at Michigan State University where she teaches social context of clinical decisions.

Sean A. Valles, PhD, is Associate Professor and Director of the Michigan State University Center for Bioethics and Social Justice. He is author of the 2018 book Philosophy of Population Health: Philosophy for a New Public Health Era (Routledge Press).

Join the discussion! Your comments and responses to this commentary are welcomed. The authors will respond to all comments made by Thursday, September 2, 2021. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

Continue reading “Don’t Scapegoat Immigrants for the COVID-19 Pandemic Surge”

A Reasonable and Virtuous Response to a Pandemic

Bioethics in the News logoThis post is a part of our Bioethics in the News series

By Larissa Fluegel, MD, MHS

Within five days of the first two registered cases here in Michigan, social media traffic about COVID-19 visibly ramped up, with a significant amount of COVID-19-related posts on my news feeds. This was the same for my friends. People were posting photos of entire local store aisles almost empty. I went to the store and to my astonishment, checkout lanes had long lines of individuals with carts filled with toilet paper, water, and hand sanitizer. Every single cart looked the same. I thought, what is happening? The apocalypse? Where have the virtues of altruism and selflessness gone? Anyway, this blog is not about toilet paper or human responses to fear, but about the question of what is safe, appropriate, and virtuous to do at the individual level, all things considered.

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Image description: Empty shelves that normally contain toilet paper in a Walgreens store, shared on March 13, 2020. Image source: Raed Mansour/Flickr Creative Commons.

What we know.

  • This is a new virus. The fact that it is new means that humans lack the immunity to mount a quick and sufficiently strong response to clear the virus before it causes disease.
  • Based on all 72,314 cases in the Chinese population, most (80.9%) are ‘mild’ respiratory flu-like (but also gastrointestinal); 4.7% turn critical and 2% are fatal.
  • Severity and risk of death increase with age and with pre-existing conditions.
  • There is a two to fourteen-day incubation time (this is the period of time from when the virus first enters one’s body and the time one shows symptoms).
  • Mild soap and water used as recommended are highly effective in eliminating the virus.
  • There is no effective treatment or vaccine against the virus yet.
  • Michigan’s Governor declared a state of emergency on March 10 and mandated all Michiganders to stay home as of March 23. This state of emergency declaration is not intended to cause panic, but instead is to allow the State to quickly deploy resources to support local responses in combatting the spread. This also is done to avoid overwhelming the healthcare system, where patients are being treated in hospital hallways, cared for by exhausted healthcare workers who might be pressed to decide which patients warrant oxygen assistance and which die.

Why do we want to stop the spread?

What we really hope to achieve is to flatten the curve of the spread. The goal is to decrease the rate of infection so that too many people don’t get sick at the same time, going beyond our current health care system’s capacity to safely and effectively treat. By doing so, we protect our fellow citizens. How? By preserving access to necessary medical resources.

What do these things mean to us?

We should understand that eventually we might all get sick. We must not make decisions based on fear. We instead should make decisions based on what we know about the virus and its spread, i.e., the facts and recommendations from reputable health authorities like the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) who are carefully monitoring and studying the situation, while avoiding unsupported advice appearing on social media. This is ethical, responsible, and virtuous behavior.

When public health officials strongly recommend that we stay home, we follow their recommendations to the best of our ability because this helps save lives. Remember the issue is no longer about us individually but about us as a community and a nation:

“…[T]o prevent the state’s health care system from being overwhelmed, to allow time for the production of critical test kits, ventilators, and personal protective equipment, and to avoid needless deaths, it is reasonable and necessary to direct residents to remain at home or in their place of residence to the maximum extent feasible.” -The Office of Governor Gretchen Whitmer, Executive Order 2020-21 (COVID-19)

When public health officials strongly recommend that we immediately practice appropriate social distancing, we do that. What this means is that whenever we are able to do so, we should anticipate and avoid places where we cannot be at least 6 feet from another person—except, of course, family members who we live with. If you work in an industry that requires you to show up, do not fret. If the rest of us altruistically do what we can, you should also be okay. If you have a friend or relative who may be at increased risk because of a prior condition, stay away from them—again, let us take care of each other.

But be mindful that social distancing does not mean social isolation. We can and should stay connected through technology that enables us to reach out and connect. This is also good for our emotional and mental health.

Of course, we must not forget to practice respiratory and hand washing etiquette, washing our hands the right way, with soap and running water, when:

  1. You arrive at your location (if leaving home is necessary) and when you return home.
  2. Before and after handling food.
  3. After toileting.

None of these cautions and behavioral virtues suggest that it is necessary to freak out and purchase all the available toilet paper or hand sanitizer. All indications are that food and basic necessities will continue to be available. It does not mean to be obsessively and compulsively spraying disinfectant on every surface of your home multiple times a day, every day. If we practice social distancing or stay home where mandated and practice appropriate hand washing and respiratory etiquette, this is not necessary.

Times like this call for bolstering virtuous behavior. Do what we are told for the sake of all. Do what we can to reconnect with our families and our local community. Do remember those in need. We can go out for a walk or a run or a hike. With appropriate distance these are all okay.

The bottom line is that it is appropriate and virtuous to calmly and sensibly take measures to slow the spread, following guidelines from valid sources while taking care of each other… keeping our distance but keeping in touch.

fluegel-larissa-blogLarissa Fluegel, MD, MHS, is an Adjunct Assistant Professor with the Center for Ethics and Humanities in the Life Sciences and the College of Human Medicine at Michigan State University where she teaches bioethics and the social context of clinical decisions. Her academic interests include the integration of bioethics, social determinants of health, shared decision-making, and health policy into medical education.

Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Thursday, April 9, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.

You must provide your name and email address to leave a comment. Your email address will not be made public.

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Listen: Why I Left the U.S. for My Surgical Procedure

No Easy Answers in Bioethics logoNo Easy Answers in Bioethics Episode 21

What would you do if you needed surgery, but seeking care would mean $25,000 or more in medical debt? Would you consider traveling to another country to receive the same surgery at a fraction of that cost? Would you put off seeking care entirely, until it became an emergency situation?

These questions related to access to care, health insurance, and medical tourism are explored in this episode, which features Center for Ethics and Humanities in the Life Sciences faculty members Len Fleck and Larissa Fluegel. Dr. Fluegel, a clinician born and raised in the Dominican Republic, shares her personal experience of needing gallbladder surgery, and the reasons why she traveled from Michigan to the Dominican Republic to receive that surgery. It may not be surprising that the main reason was cost. Discussing the healthcare systems in both countries, Drs. Fleck and Fluegel explore the challenges that under- and uninsured individuals in the U.S. face when seeking care.

Ways to Listen

This episode was produced and edited by Liz McDaniel in the Center for Ethics. Music: “While We Walk (2004)” by Antony Raijekov via Free Music Archive, licensed under a Attribution-NonCommercial-ShareAlike License. Full episode transcript available.

About: No Easy Answers in Bioethics is a podcast series from the Center for Ethics and Humanities in the Life Sciences in the Michigan State University College of Human Medicine. Each month Center for Ethics faculty and their collaborators discuss their ongoing work and research across many areas of bioethics. Episodes are hosted by H-Net: Humanities and Social Sciences Online.