Vulnerable Immigrant Populations in the New York Metropolitan Area and COVID-19: Lessons Learned in the Epicenter of the Crisis

COVID-19, migrants, and world large urban areas: a thematic policy brief

Migrants living in large urban areas are disproportionately impacted by health crises such as pandemics. This policy brief explores how urban areas mitigate and/or exacerbate the impact of COVID-19 on migrant groups and provides policy recommendations. We conducted a policy review to focus on the effects of COVID-19 on migrants living in cities with > 500,000 residents. We found that structural inequity, lack of migrants' inclusion in as relief programs, and residential segregation exacerbated COVID-19 impacts. Engagement of Civil Society Organizations (CSOs) and e-governance showed promising effects mitigating the impact of COVID-19 on these groups; yet the use of technology introduced additional barriers such as access to devices and internet connection. We recommend increasing policy attention to systemic social inequities faced by migrant groups in urban areas and supporting innovative and inclusive implementation of public health policies, urban design, and greater engagement of CSOs in the delivery of services to migrants.

Supporting organizations to improve migrants' access to health services in New York City

Purpose

To survey community-based migrant-serving organizations (MSOs) in New York City (NYC) regarding their early experiences during the COVID-19 pandemic and perspectives on academic collaborations.

Methods

We developed and emailed a survey via Qualtrics (12/2020-1/2021) to 122 MSOs in NYC collecting data about the organizations; challenges posed by COVID-19; and interest in potential intersectoral collaboration. Descriptive analysis focused on the pandemic's impact on service provision, type of MSO, and organizational capacity.

Results

Thirty-eight MSOs participated (RR=31%). COVID-19-related challenges included limited staff capacity, organizational funding, and technological and resource limitations of communities served. Organizational capacity correlated with types of services offered: smaller organizations offered health and social services, while larger organizations focused on education and employment. MSOs indicated interest in collaboration on migrant policy advocacy and communications, access to interns, and resources regarding best practices and policies.

Conclusions

MSOs in NYC have struggled with funding, staffing, and service provision. They specified fruitful areas for collaboration with academic research institutions.

Implications

Development of an academic-based migrant health resource hub will serve an identified need among MSOs in NYC.

"The perfect storm": community worker perspectives on the impact of COVID-19 on New York City immigrants and migrant-serving organizations

Background

Immigrants in New York City (NYC) have higher COVID-19 mortality than the general population. While migrant-serving organizations (MSOs) provide access to a breadth of services, they are disproportionately impacted by the COVID-19 pandemic due to staffing limitations, funding cuts, and resource limitations of communities served.

Methods

Six focus-group discussions were conducted to explore the experiences of MSOs in NYC during the COVID-19 pandemic from November 2021 to March 2022. Study participants csomprised a subsample of survey respondents from a larger study identified via lists of MSOs.

Results

Twenty-seven organizational representatives from 11 MSOs across NYC participated in the discussions. In addition to providing information on communities served, services offered, and organizational characteristics, the following themes emerged from the convenings: mental health challenges and resources needed for immigrants; immigration-related challenges; factors exacerbating hardships for immigrants during COVID-19; interorganizational collaborations and partnerships; policy change; and needs/requests of MSOs. MSOs provide a wide range of services as non-profit organizations and use interorganizational collaboration to improve service delivery. The proximity of MSOs to immigrant communities helps providers understand the needs of immigrants relating to the COVID-19 pandemic and factors that shape telehealth services.

Conclusion

MSOs are important providers and advocates for immigration policy in the US given their relationship with the populations they serve. These findings have implications for how to support MSOs that serve immigrants in NYC. Strategies to achieve this include timelier availability and exchange of information, policies, and research as well as strengthening the experience-based advocacy of these groups.

Access to COVID-19 testing by individuals with housing insecurity during the early days of the COVID-19 pandemic in the United States: a scoping review

Introduction

The COVID-19 pandemic focused attention on healthcare disparities and inequities faced by individuals within marginalized and structurally disadvantaged groups in the United States. These individuals bore the heaviest burden across this pandemic as they faced increased risk of infection and difficulty in accessing testing and medical care. Individuals experiencing housing insecurity are a particularly vulnerable population given the additional barriers they face. In this scoping review, we identify some of the barriers this high-risk group experienced during the early days of the pandemic and assess novel solutions to overcome these barriers.

Methods

A scoping review was performed following PRISMA-Sc guidelines looking for studies focusing on COVID-19 testing among individuals experiencing housing insecurity. Barriers as well as solutions to barriers were identified as applicable and summarized using qualitative methods, highlighting particular ways that proved effective in facilitating access to testing access and delivery.

Results

Ultimately, 42 studies were included in the scoping review, with 143 barriers grouped into four categories: lack of cultural understanding, systemic racism, and stigma; medical care cost, insurance, and logistics; immigration policies, language, and fear of deportation; and other. Out of these 42 studies, 30 of these studies also suggested solutions to address them.

Conclusion

A paucity of studies have analyzed COVID-19 testing barriers among those experiencing housing insecurity, and this is even more pronounced in terms of solutions to address those barriers. Expanding resources and supporting investigators within this space is necessary to ensure equitable healthcare delivery.

Preliminary Data on the Impacts of COVID-19 on Filipino Immigrants in Hawai'i

Racial and ethnic minorities experience high rates of disease morbidity and mortality. Filipinos in Hawai'i have the second-highest coronavirus disease 2019 (COVID-19) cases and deaths. This exploratory study examined barriers to compliance with COVID-19 prevention practices for Filipino immigrants residing in O'ahu and Maui. Cross-sectional data were collected using mixed methods involving surveys and key informant interviews with Filipino community members. Survey responses (n=50) were collected identifying crucial factors to be addressed and preferences for receiving information related to COVID-19. Some Filipino customs and practices were a barrier to complying with COVID-19 prevention practices; nevertheless, cultural sensitivity was stressed for education messaging. In addition, family and community navigators should be equipped with the training and resources to disseminate COVID-19 information within their communities. Attitudinal, cultural, and linguistic barriers to promote health persist for Filipinos in Hawai'i. The COVID-19 pandemic has exacerbated these barriers due to the circulation of misinformation and lack of information among the Filipino communities of O'ahu and Maui regarding COVID-19 and local policies. Culturally appropriate support including providing tailored and linguistically appropriate COVID-19 information is recommended. Equipping or training a household member to help navigate COVID-19 policies as they change aligns with this community's emphasis on familial and social relationships.

The vulnerability to COVID-19 of migrants in large urban areas: structural exacerbators and community-level mitigators

BACKGROUND

Despite research on large urban areas in the context of COVID-19, evidence on how these settings impact migrants is still limited.

OBJECTIVE

To explore exacerbating and mitigating factors of large urban areas on migrants' vulnerabilities during the COVID-19 pandemic.

METHODS

We conducted a systematic review of peer-reviewed studies published between 2020 and 2022, focused on migrants (foreign-born individuals who have not been naturalized in the host country, regardless of legal immigration status) in urban areas with a population >500 000. After screening 880 studies, 29 studies were included and categorized within the following thematic framework: (i) pre-existing inequities, (ii) governance strategies, (iii) urban design and (iv) engagement of civil society organizations (CSOs).

RESULTS

Exacerbating factors include pre-existing inequities (e.g. unemployment, financial instability and barriers to healthcare access), exclusionary government responses (e.g. ineligibility for relief funds or unemployment benefits) and residential segregation. Mitigating community-level factors include the engagement of CSOs to fill institutional and governmental gaps through service provision and use of technology.

CONCLUSIONS

We recommend increased attention to pre-existing structural inequities faced by migrants, more inclusive governance strategies and partnerships between government and CSOs to improve the design and delivery of services to migrants in large urban areas. More research is needed on how urban design can be utilized to mitigate COVID-19 impacts on migrant communities. The factors identified in this systematic review should be considered as part of migrant-inclusive emergency preparedness strategies to address the disproportionate impact of health crises on migrant communities.

Health behaviours and COVID-19 prevention among immigrants in the United States

Recent studies indicate that the COVID-19 pandemic has had negative implications for the welfare of immigrant communities. However, few studies have examined the behavioural responses used by immigrants to respond to the spread of the virus. This study uses data from the U.S.-based COVID-19 in American Communities study to examine whether there are disparities in the use of COVID-19 prevention behaviours between first-generation immigrants (i.e., foreign-born persons), second-generation immigrants (i.e., U.S.-born persons with at least one immigrant parent), and third-generation individuals (i.e., U.S.-born persons with only U.S.-born parents). The results indicate that recent first-generation immigrants and second-generation immigrants use the behaviours recommended to prevent the spread of COVID-19 less intensively compared to third-generation individuals. Furthermore, increased exposure to U.S. society is found to have a non-linear relationship with the intense use of these behaviours. Results from the analysis of each preventive behaviour show that there are larger gaps between immigrants and U.S. natives in the use of frequent hand washing and comparatively smaller gaps in the practice of avoiding large crowds. However, the most consistent pattern of low use of COVID-19 prevention behaviours was found among recently arrived first-generation immigrants.

"Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States

This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'.

Introduction

Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap.

Methods

This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods.

Results

Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic.

Conclusion

Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.

COVID-19 on Pregnancy Outcomes, Mental Health and Placenta: Focus in Latin America

The COVID-19 pandemic has impacted many aspects of health and society worldwide. One vulnerable group that faced SARS-CoV-2 infection is pregnant women, who were considered to have potentiated risk factors. In physiological pregnancy, maternal systems have several changes and adaptations to support fetal development. These changes involve regulations of cardiovascular, respiratory, and immunologic systems, among others, which SARS-CoV-2 could severely alter. Furthermore, the systemic effects of viral infection could be associated with placental dysfunction and adverse pregnancy outcomes, which have been studied from the start of the pandemic to date. Additionally, pregnancy is a condition of more significant mental health vulnerability, especially when faced with highly stressful situations. In this chapter, we have collected information on the effect of COVID-19 on maternal mortality, the SARS-CoV-2 infection rate in pregnancy, and the impact on pregnancy outcomes, maternal mental health, and placental function, with a particular focus on studies that consider the Latin American population.

Influence of social responsibility and pandemic awareness of nursing students on COVID-19 preventive behaviours: a cross-sectional online survey in South Korea

OBJECTIVES

Factors influencing COVID-19 preventive behaviour require exploration to strengthen the response competencies of prehealthcare professionals and reduce the pandemic's impact. This study aimed to identify the level of COVID-19 preventive behaviour among Korean nursing students and to determine the influence of social responsibility and pandemic awareness to present educational strategies for reducing disaster impact.

METHODS AND ANALYSIS

As a cross-sectional descriptive survey study using an online questionnaire, the participants were convenience sampled from one online community for nursing students and three nursing colleges located in Seoul, South Korea. The data from 590 participants were analysed by t-test, analysis of variance, Pearson's correlation and linear multiple regression using SPSS.

RESULTS

The factors influencing COVID-19 preventive behaviour were identified to be social responsibility (linear regression coefficient 0.354, 95% CI 0.243 to 0.464), pandemic awareness (linear regression coefficient 0.131, 95% CI 0.025 to 0.237), impact of COVID-19 on daily life (linear regression coefficient 0.085, 95% CI 0.019 to 0.152) and living in Daegu/Gyeong-buk area (linear regression coefficient 0.134, 95% CI 0.024 to 0.244).

CONCLUSION

Based on the findings that social responsibility and pandemic awareness are key predictors of COVID-19 preventive behaviour, customised educational programmes and additional studies are recommended for raising social responsibility and pandemic awareness among prehealthcare professionals as a part of disaster response.

Use of social media platforms by migrant and ethnic minority populations during the COVID-19 pandemic: a systematic review

OBJECTIVE

Migrants and ethnic minority groups have been disproportionately impacted by COVID-19 and have lower levels of vaccine uptake in some contexts. We aimed to determine the extent and nature of social media use in migrant and ethnic minority communities for COVID-19 information, and implications for preventative health measures including vaccination intent and uptake.

DESIGN

A systematic review of published and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched databases including Embase, Web of Science, PubMed NIH, CINAHL, facilitated through the WHO Global Research on COVID-19 database from 31 December 2019 to 9 June 2021.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Research reporting the use of social media by migrants and/or ethnic minority groups in relation to COVID-19.

DATA EXTRACTION

We extracted data on key outcomes, study design, country, population under study and sample size.

RESULTS

1849 unique records were screened, and 21 data sources were included, including populations in the UK, USA, China, Jordan, Qatar and Turkey. We found evidence of consistent use of a range of social media platforms for COVID-19 information in some migrant and ethnic minority populations (including WeChat, Facebook, WhatsApp, Instagram, Twitter, YouTube), which may stem from difficulty in accessing COVID-19 information in their native languages or from trusted sources. Some evidence suggested circulating misinformation and social media use may be associated with lower participation in preventative health measures, including vaccine intent and uptake, findings which are likely relevant to multiple population groups.

CONCLUSIONS

Social media platforms are an important source of information about COVID-19 for some migrant and ethnic minority populations. Urgent actions and further research are now needed to better understand effective approaches to tackling circulating misinformation, and to seize on opportunities to better use social media platforms to support public health communication and improve vaccine uptake.

REGISTRATION

This study has been registered with PROSPERO (CRD42021259190).

Mental health disparities in Latinx immigrant communities residing in the United States during COVID-19: Implications for policy and practice

Objectives

Studies have demonstrated that Latinx populations face significant health disparities in access to mental health care. The objective of this study was to describe the impact of the COVID-19 pandemic on the mental health needs of Latinx families, from the perspectives of direct service providers working with Latinx communities.

Methods

Twenty-one semi-structured interviews were conducted virtually with direct service providers to the Latinx community from August to October 2020. Interviews were transcribed verbatim and analyzed using thematic analysis.

Results

Two-thirds of providers were female, with a median age of 33 years, and provided direct services to Latinx clients and had extensive experience working with immigrant families, particularly in Massachusetts. Key themes identified describing the impact of COVID-19 on the mental health needs of Latinx families included: (1) exacerbation of mental health symptoms, (2) financial stressors, (3) preoccupation regarding transnational lives, (4) secondary needs becoming more salient, and (5) immigration status as a main driver of inequality.

Conclusions

Our findings highlight the importance of focusing on the mental health needs of Latinx immigrants and ensuring their access to mental health services. Telehealth seems to be a potential tool that promotes mental health access among Latinx clients. Future research needs to continue investigating the role of telehealth in decreasing mental health access disparities.

Tackling Ethnic Health Disparities Through Community Health Worker Programs: A Scoping Review on Their Utilization During the COVID-19 Outbreak

The coronavirus disease (COVID-19) outbreak has magnified existing health inequities linked to social determinants of health, with racial and ethnic minorities being disproportionately affected by the pandemic. A proposed strategy to address these inequities is based on the implementation of community health worker (CHW) programs able to bridge the gaps between marginalized communities and the formal health care systems. A scoping review was conducted through searching 4 databases: PubMed, Scopus, Web of Science, and Science Direct. Inclusion criteria focused on studies defining any kind of adopted CHW intervention to address inequities related to racial/ethnic groups during the COVID-19 crisis, published from December 31, 2019, to October 31, 2021. Narrative synthesis was undertaken to summarize the findings. In total, 23 studies met the inclusion out of the 107 search results. Data converged on the relevant potential of CHWs on engaging with community leaders, addressing social determinants of health, and issues related to structural racism, promoting culturally tailored health information, and encouraging institutions to policy change in favor of people left behind. Although vulnerability of racial and ethnic minorities was already present before the COVID-19 outbreak, the pandemic has represented a wakeup call to address it more efficiently. In recent years, CHWs have increasingly been acknowledged as valuable members of the health care workforce. As health disparities may increase after our multicultural societies begin to recover from COVID-19, CHWs may play a crucial role in addressing system-level changes to have broad and lasting effects on health outcomes.

Responding to the Disproportionate Impact of COVID-19 Among Latinx Patients in Baltimore: The JHM Latinx Anchor Strategy

Latinx immigrants have been profoundly impacted by COVID-19. As the Johns Hopkins Health System faced a surge in admissions of limited English proficiency patients with COVID-19, it became evident that an institutional strategy to address the needs of this patient population was needed. The Johns Hopkins Medicine (JHM) Latinx Anchor Strategy was established in April 2020 with diverse stakeholder engagement to identify the most urgent community needs and develop timely solutions. The JHM Latinx Anchor Strategy provided a platform for information sharing to promote equitable access to resources for Latinxs with limited English proficiency who were impacted by COVID-19. Leveraging institutional, community, and government resources and expertise, the JHM Latinx Anchor Strategy helped establish interventions to improve access to COVID-19 testing and care for low-income immigrants without a primary care doctor and helped mitigate economic vulnerability through the distribution of food for 2,677 individuals and cash to 446 families and 95 individuals (May to August 2020). Expanded linguistic and culturally competent communication through webinars and livestream events reached more than 10,000 community members and partners. Over 7,500 limited English proficiency patients received linguistically congruent direct patient services through the Esperanza Center bilingual hotline, community testing resulting efforts, and inpatient consultations. The first stage of the JHM Latinx Anchor Strategy relied heavily on volunteer efforts. Funding for a sustainable response will be required to address ongoing COVID-19 needs, including expansion of the bilingual/bicultural healthcare workforce, expanded access to primary care, and investments in population health strategies addressing social determinants of health.

Considering social inequalities in health in large-scale testing for COVID-19 in Montréal: a qualitative case study

BACKGROUND

Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada).

METHODS

Part of the multicountry study HoSPiCOVID, this article reports on a qualitative case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo.

RESULTS

Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population.

CONCLUSIONS

These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.

Lessons Learned From a Qualitative COVID-19 Investigation Among Essential Workers With Limited English Proficiency in Southwest Kansas

In this commentary, we briefly describe our methodology in conducting a remote qualitative investigation with essential workers from southwest Kansas, and then describe some key considerations, challenges, and lessons learned in recruiting and conducting interviews remotely. From August 4, 2020 through August 26, 2020, Centers for Disease Control and Prevention (CDC) staff conducted five phone interviews with culturally and linguistically diverse employees in southwest Kansas to understand COVID-19 knowledge, attitudes, and practices and communication preferences. Our experience details the potential challenges of the federal government in recruiting individuals from these communities and highlights the possibilities for more effectively engaging health department and community partners to support investigation efforts. Optimizing recruitment strategies with additional participation from community partners, developing culturally and linguistically appropriate data collection tools, and providing supportive resources and services may augment participation from refugee, immigrant, and migrant (RIM) communities in similar remote investigations.

COVID-19 pandemic-related change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery hospitalization: a differences-in-differences analysis

OBJECTIVE

Exclusive breastmilk feeding during the delivery hospitalization, a Joint Commission indicator of perinatal care quality, is associated with longer-term breastfeeding success. Marked racial and ethnic disparities in breastfeeding exclusivity and duration existed prior to COVID-19. The pandemic, accompanied by uncertainty regarding intrapartum and postpartum safety practices, may have influenced disparities in infant feeding practices. Our objective was to examine whether the first wave of the COVID-19 pandemic in New York City was associated with a change in racial and ethnic disparities in exclusive breastmilk feeding during the delivery stay.

METHODS

We conducted a cross-sectional study of electronic medical records from 14,964 births in two New York City hospitals. We conducted a difference-in-differences (DID) analysis to compare Black-white, Latina-white, and Asian-white disparities in exclusive breastmilk feeding in a pandemic cohort (April 1-July 31, 2020, n=3122 deliveries) to disparities in a pre-pandemic cohort (January 1, 2019-February 28, 2020, n=11,842). We defined exclusive breastmilk feeding as receipt of only breastmilk during delivery hospitalization, regardless of route of administration. We ascertained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection status from reverse transcription-polymerase chain reaction tests from nasopharyngeal swab at admission. For each DID model (e.g. Black-white disparity), we used covariate-adjusted log binomial regression models to estimate racial and ethnic risk differences, pandemic versus pre-pandemic cohort risk differences, and an interaction term representing the DID estimator.

RESULTS

Exclusive breastmilk feeding increased from pre-pandemic to pandemic among white (40.8% to 46.6%, p<0.001) and Asian (27.9% to 35.8%, p=0.004) women, but not Black (22.6% to 25.3%, p=0.275) or Latina (20.1% to 21.4%, p=0.515) women overall. There was an increase in the Latina-white exclusive breastmilk feeding disparity associated with the pandemic (DID estimator=6.3 fewer cases per 100 births (95% CI=-10.8, -1.9)). We found decreased breastmilk feeding specifically among SARS-CoV-2 positive Latina women (20.1% pre-pandemic vs. 9.1% pandemic p=0.013), and no change in Black-white or Asian-white disparities.

CONCLUSIONS

We observed a pandemic-related increase in the Latina-white disparity in exclusive breastmilk feeding, urging hospital policies and programs to increase equity in breastmilk feeding and perinatal care quality during and beyond this health emergency.

COVID-19 and Systemic Racism Pandemics Impact Daily Life for Immigrant/Refugees, Minneapolis, USA

Background:

The pandemics of COVID-19 and systemic racism have a deleterious impact on the daily life experiences and health for populations of color. The experiences are compounded for immigrant/refugee communities that may have other barriers such as English language literacy or trauma. Cumulative stress due to everyday racism is harmful for health.

Objectives:

This study describes the impact of day-to-day lived experiences of Karen, Somali, and Latinx communities during the COVID-19 pandemic and aftermath of the police murder of George Floyd in the Minneapolis/St. Paul metro area.

Methods:

In-depth interviews were conducted over three weeks in September and October 2020 to understand the daily life experiences of Karen, Somali and Latinx adults drawn from community contacts during the COVID-19 pandemic and the aftermath of the police murder of George Floyd. Interviewers were bilingual and from the communities they interviewed. Nine questions were asked, ranging from their knowledge of COVID-19, prevention practices, experiences during shelter-in-place, and the perceptions of the police murder of George Floyd. Qualitative analysis included transcript review, coding facilitated by Atlas.ti Cloud software, summaries, and validation by interviewers.

Findings:

Thirty-two adults were interviewed (Latinx = 10, Karen = 10, Somali = 12). One-third were in person per participant request and complying with COVID-19 precautions, and the remainder were remote. The average age recorded was 37 years (range 20–66 years), 43.8% males and 56.3% females. Respondents reported experiences of discrimination and systemic racism while engaging in daily life activities, including accessing foods and common goods, school, work, transportation, and healthcare, all of which were exacerbated by COVID-19 and the police murder of George Floyd.

Conclusions:

Immigrant/refugee communities of color in Minneapolis/St. Paul face daily experiences of racism that were compounded by the events of 2020. Discrimination and systemic racism contribute to the persistent health inequities among populations of color.

Unsettling the American Dream: Mobility, Migration and Precarity among Translocal Himalayan Communities during COVID-19

New York City (NYC) garnered significant national and international attention when it emerged as the coronavirus epicentre in the USA, in spring 2020. As has been widely documented, this crisis has disproportionately impacted minority, immigrant and marginalized communities. Among those affected were people from Mustang, Nepal, a Himalayan region bordering Tibet. This community is often rendered invisible within larger Asian immigrant populations, but the presence of Mustangis in the US has transformed their translocal worlds, lived between Nepal and NYC. Seasonal mobility and life-stage wage labour in cosmopolitan Asia have been common in Mustang for decades. More permanent moves to NYC began in the 1990s. These migrations were based on assumptions about attaining financial stability in the US in ways deemed unattainable in Nepal. An ethnographic focus on one translocal Mustangi family frames this discussion of how COVID-19 has overturned previously held ideas around migration to NYC and uncovered new forms of precarity. The authors build on theories of transnationalism and translocality to position migration as a cyclical process whereby the well-being of Mustangis in Nepal and NYC rests on the reliability of global migratory networks and translocal kinship relations - a basis for security and belonging that COVID-19 has challenged and reconfigured.

Association Between Age and Ethnicity with Pediatric Clinical Outcomes in COVID-2019

The novel coronavirus SARS-CoV-2 (COVID-19) has infected people across the world, including an increasing number of children in the United States (U.S.). The epidemiology of pediatric infection in the U.S. and how it influences clinical outcomes is still being characterized. In this study, we describe a cohort of 989 children with laboratory-confirmed SARS-CoV-2 infection. Children under age 20 in a statewide health system with SARS-CoV-2 infection, defined by positive PCR testing, between February 1 and August 30, 2020 were included in this observational cohort study. Data extracted from the medical record included age, demographic information, clinical illness severity, hospital stay, and comorbidities. Analysis included descriptive statistics and Chi-square as appropriate. Nine hundred and eighty-children met inclusion criteria for this study, ranging from 1 month to 20 years in age. Most children (62.4%) were asymptomatic at the time of diagnosis and children over the age of 2 were significantly more likely to be asymptomatic at diagnosis than younger children (P < .05). Hispanic children were significantly more likely to be symptomatic at the time of diagnosis (56.3% asymptomatic; P < .05). The high proportion of children with asymptomatic infection emphasizes the importance of understanding the unique role of children in the pandemic. Older children are more likely to be asymptomatic, but also more likely to experience severe or critical illness when symptoms do develop. Hispanic children were more likely to be symptomatic at diagnosis, highlighting the importance of culturally specific outreach to vulnerable communities.

A First Look: Disparities in COVID-19 Mortality Among US-Born and Foreign-Born Minnesota Residents

This research brief provides one of the first examinations of the impact of COVID-19 mortality on immigrant communities in the United States. In the absence of national data, we examine COVID-19 deaths in Minnesota, historically one of the major U.S. refugee destinations, using individual-level death certificates obtained from the Minnesota Department of Health Office of Vital Records. Minnesota’s foreign-born crude COVID-19 death rates were similar to rates for the US-born, but COVID-19 death rates adjusted for age and gender were twice as high among the foreign-born. Among foreign-born Latinos, in particular, COVID-19 mortality was concentrated in relatively younger, prime working age men. Moreover, the place-based and temporal patterns of COVID-19 mortality were quite distinct, with the majority of US-born mortality concentrated in long-term care facilities and late in 2020, and foreign-born mortality occurring outside of residential institutions and earlier in the pandemic. The disparate impacts of COVID-19 for foreign-born Minnesotans demonstrate the need for targeted public health planning and intervention in immigrant communities.

Building trust in American hospital-community development projects: a scoping review

Although it has become increasingly common for hospitals to engage in development projects aimed at improving the social determinants of health in surrounding communities, scholarly literature examining the establishment of trust between hospitals and communities is sparse. Because of an extensive and complex history of abuse suffered by marginalized populations at the hands of medical institutions, trust building is critical to the pursuit of equitable health outcomes in these communities. A scoping review was conducted to assess the current base of knowledge for building trust between hospital systems and community members. The review identified only 13 relevant articles addressing this topic, centered on six key themes: with whom to form partnerships; how to form partnerships; conceptualizing and defining trust; questions about investment and hiring; effective communication with communities; and, understanding communities.

Clinical outcomes and risk factors for COVID-19 among migrant populations in high-income countries: A systematic review

BACKGROUND

Migrants in high-income countries may be at increased risk of COVID-19 due to their health and social circumstances, yet the extent to which they are affected and their predisposing risk factors are not clearly understood. We did a systematic review to assess clinical outcomes of COVID-19 in migrant populations, indirect health and social impacts, and to determine key risk factors.

METHODS

We did a systematic review following PRISMA guidelines (PROSPERO CRD42020222135). We searched multiple databases to 18/11/2020 for peer-reviewed and grey literature on migrants (foreign-born) and COVID-19 in 82 high-income countries. We used our international networks to source national datasets and grey literature. Data were extracted on primary outcomes (cases, hospitalisations, deaths) and we evaluated secondary outcomes on indirect health and social impacts and risk factors using narrative synthesis.

RESULTS

3016 data sources were screened with 158 from 15 countries included in the analysis (35 data sources for primary outcomes: cases [21], hospitalisations [4]; deaths [15]; 123 for secondary outcomes). We found that migrants are at increased risk of infection and are disproportionately represented among COVID-19 cases. Available datasets suggest a similarly disproportionate representation of migrants in reported COVID-19 deaths, as well as increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected. Migrants experience risk factors including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement.

CONCLUSIONS

Migrants in high-income countries are at high risk of exposure to, and infection with, COVID-19. These data are of immediate relevance to national public health and policy responses to the pandemic. Robust data on testing uptake and clinical outcomes in migrants, and barriers and facilitators to COVID-19 vaccination, are urgently needed, alongside strengthening engagement with diverse migrant groups.

Broken Promises to the People of Newark: A Historical Review of the Newark Uprising, the Newark Agreements, and Rutgers New Jersey Medical School's Commitments to Newark

Many have referred to the coronavirus disease 2019 crisis and intertwined issues of structural racism as “twin pandemics”. As healthcare workers in Newark, New Jersey, a city heavily affected by the twin pandemics, we recognize that health workforce changes must be grounded in our community’s recent history. The objective of this essay is to briefly describe the relationship between organized medicine, state and local leaders, and the people of Newark. We begin with a discussion of Newark in the 1950s and 1960s: its people experienced poor socioeconomic conditions, terrible medical care, and the many sequelae of abhorrent racism. Plans to establish a New Jersey Medical School in Newark’s Central Ward also threatened to displace many residents from their homes. We then describe the Newark Agreements of 1968, which formalized a social contract between the state, business leaders, and people of Newark. In part, the Medical School committed to indefinitely promoting public health in Newark. We share progress towards this goal. Finally, we document key healthcare administrative decisions facing our community today. Stakeholder opinions are shared. We conclude that the Newark Agreements set an important standard for communities across the country. Creative solutions to healthcare policy may be realized through extensive community collaboration.

Mitigating SARS-CoV-2 Transmission in Hispanic and Latino Communities-Prince William Health District, Virginia, June 2020

Objectives

To identify factors contributing to disproportionate rates of COVID-19 among Hispanic or Latino persons in Prince William Health District, Virginia, and to identify measures to better engage Hispanic and Latino communities in COVID-19 mitigation.

Methods

Data collection proceeded via three methods in June 2020: a quantitative survey of Hispanic or Latino residents, key informant interviews with local leaders familiar with this population, and focus group discussions with Hispanic or Latino community members.

Results

Those who worked outside the home, lived in larger households, or lived with someone who had tested positive were more likely to report testing positive for SARS-CoV-2 (unadjusted odds ratios of 2.5, 1.2, and 12.9, respectively). Difficulty implementing COVID-19 prevention practices (reported by 46% of survey respondents), immigration-related fears (repeatedly identified in qualitative data), and limited awareness of local COVID-19 resources (57% of survey respondents spoke little or no English) were identified. Survey respondents also reported declines in their food security (25%) and mental health (25%).

Conclusions

Specific attention to the needs of Hispanic or Latino communities could help reduce the burden of COVID-19. The investigation methods can also be used by other jurisdictions to evaluate the needs of and services provided to diverse underserved populations.

How mental health care should change as a consequence of the COVID-19 pandemic

The unpredictability and uncertainty of the COVID-19 pandemic; the associated lockdowns, physical distancing, and other containment strategies; and the resulting economic breakdown could increase the risk of mental health problems and exacerbate health inequalities. Preliminary findings suggest adverse mental health effects in previously healthy people and especially in people with pre-existing mental health disorders. Despite the heterogeneity of worldwide health systems, efforts have been made to adapt the delivery of mental health care to the demands of COVID-19. Mental health concerns have been addressed via the public mental health response and by adapting mental health services, mostly focusing on infection control, modifying access to diagnosis and treatment, ensuring continuity of care for mental health service users, and paying attention to new cases of mental ill health and populations at high risk of mental health problems. Sustainable adaptations of delivery systems for mental health care should be developed by experts, clinicians, and service users, and should be specifically designed to mitigate disparities in health-care provision. Thorough and continuous assessment of health and service-use outcomes in mental health clinical practice will be crucial for defining which practices should be further developed and which discontinued. For this Position Paper, an international group of clinicians, mental health experts, and users of mental health services has come together to reflect on the challenges for mental health that COVID-19 poses. The interconnectedness of the world made society vulnerable to this infection, but it also provides the infrastructure to address previous system failings by disseminating good practices that can result in sustained, efficient, and equitable delivery of mental health-care delivery. Thus, the COVID-19 pandemic could be an opportunity to improve mental health services.