Economic and social impacts of the COVID-19 pandemic on South Asians in the U.S.

Economic and social impacts of the current pandemic that are based on immigration status, employment opportunities, and healthcare access are major issues for South Asians in the U.S. There is wide income inequality with nearly 10% of South Asians in the U.S. living in poverty. Many have low paid and temporary jobs, including in the informal sector, and little to no savings. The pandemic disproportionately impacts these communities but there has been little media coverage. To highlight this gap, we present selected research from our forthcoming manuscript to be published later this month, which are complemented by community-based findings from the recent SAALT report on the disparate impact of COVID-19 across South Asian communities.

>11% of South Asians in the U.S.¹ and >23% in NYC2 are undocumented and excluded from COVID-19 services and support. Many undocumented South Asians work in essential services like grocery stores and restaurants; as taxi and rideshare drivers; in salons, retail and hospitality; and in allied health professions. Many have also experienced job loss and revenue loss as these industries closed or slowed down. More than 686,000 undocumented South Asians, as well as mixed-status families, are excluded from support during the pandemic including benefits like unemployment support and other financial relief programs, and inadequate healthcare provisions such as inaccessible testing and treatment. Undocumented workers including South Asians are at higher risk for COVID-related consequences due to inadequate or overcrowded housing, precarious employment and lack of access to financing, and ineligibility for health insurance, amongst other things.^3-7

Foreign-born South Asians in the U.S. are a substantial portion of the frontline healthcare workforce during this pandemic.^8-10 One in four doctors are international medical graduates,¹¹ and one in 20 doctors are of Indian origin.¹² South Asian international medical graduates report mainly practicing in primary care specialties and underserved rural areas. While there are some visa protections for temporary impacts to work, suspension of H1-B visa programs threatens the renewal of visa status for current doctors and for new doctors in the coming years. Doctors with H1B visa status are concerned about their visa status being tied to their employment. Working on the frontlines risks their health and an inability to return to work due to extended disability, incapacitation, or death could result in the deportation of family members.^13-15

Nearly 20% of South Asians in the U.S. lack health insurance,¹ delaying diagnosis & treatment of COVID-19.^16-17 Although more than half of South Asians in the U.S. report access to healthcare, about two in five under age 65 report no regular source of care.¹ Recent job losses and small business closures have only increased the number of uninsured across the U.S. Linguistic and cultural barriers to healthcare also exist. Despite federal regulations, translation services commonly exclude South Asian languages.^18-20 Local community organizations report an increased need for support and are overwhelmed trying to aid communities with limited resources.²¹ Emerging “public charge” legislation that limits non-citizens from using government programs has heightened wariness in seeking services.^22-23 Although paused for COVID-19, immigrants including South Asians remain hesitant to access healthcare due to misinformation and fear of deportation.^24-25

Rapid changes to deliver healthcare virtually do not meet needs equally, including South Asians in the U.S.^26-27 The sudden reliance on telehealth may be a burden for South Asians in the U.S., especially those who are taking precautions to social distance away from family members who would be capable of providing translation services and technological support. Low-income and undocumented South Asians who are more likely to lack insurance or primary care and typically rely on public hospitals and emergency rooms for affordable care have found themselves facing even more limited healthcare options, particularly in high-risk cities. South Asian clinicians are expected to learn how to maintain and enhance interpersonal skills that establish effective in-person consultation while they learn new skills as the curators (administrators), creators (architects), and moderators (mediators) in the digital space.^28-30

In response to the COVID-19 pandemic, South Asians in the U.S.  need equitable policies and protections regardless of immigration status. For South Asians, particularly immigrants who are essential and frontline workers,  there is an urgent need for services and support to promote economic recovery and ensure healthcare access. We recommend (1) More robust data disaggregation; (2) Linguistically accessible health information and care; (3) Legislation for economic recovery available to all; and (4) Immigation protections for health and safety. Partnering with and funding community organizations already doing the groundwork to provide services in South Asian communities are key steps to achieve these recommendations. For a list of organizations, see the SAALT National Coalition of South Asian Organizations (NCSO) list.

REFERENCES

1. SAALT.  2019. “Demographic Snapshot of South Asians in the United States: April 2019.” https://saalt.org/wp-content/uploads/2019/04/SAALT-Demographic-Snapshot-2019.pdf
2. DRUM. 2012. “Worker Rights are Human Rights: South Asian Immigrant Workers in New York City.” https://www.drumnyc.org/wp-content/themes/wpaid/images/wc-report.pdf
3. Chowdhury, Rebecca. 2020. “Many undocumented immigrants are frontline workers, but their families can’t get government aid.” Th Appeal. https://theappeal.org/coronavirus-essential-workers-undocumented-immigrants-government-aid/
4. Naveed, Hina. 2020. “I’m a nurse battling against COVID-19, but DACA fight could end in my deportation.” USA Today. https://www.usatoday.com/story/opinion/policing/2020/04/17/coronavirus-im-front-line-nurse-but-daca-fight-could-mean-deportation/2963866001
5. New York City Comptroller, 2020. “New York City’s Frontline Workers.” https://comptroller.nyc.gov/reports/new-york-citys-frontline-workers/
6. Mozumder, Suman G. 2020. “Low-wage South Asian workers in the U.S. hard hit by coronavirus business downturn.” India Abroad. https://www.indiaabroad.com/indian-americans/low-wage-south-asian-workers-in-the-u-s-hard-hit-by-coronavirus-business-downturn/article_ce0aad00-6c9e-11ea-993b-e7075f5469df.html
7. Liao, Shannon. 2020. “Unemployment claims from Asian Americans have spiked 6,900% in New York. Here’s why.” CNN. https://www.cnn.com/2020/05/01/economy/unemployment-benefits-new-york-asian-americans/index.html
8. Raymer, Steve. 2004. “Indian doctors help fill U.S. health care needs.” Yale. https://yaleglobal.yale.edu/content/indian-doctors-help-fill-us-health-care-needs
9. Rao, Meghna. 2020. “The South Asian Frontliners of New York.” The Juggernaut. https://www.thejuggernaut.com/south-asian-frontliners-new-york
10. Park, Jewel, and Hye Chang Rhim. 2020. “Consequences of COVID-19 on international medical graduates and students applying to residencies in the United States.” Korean Journal of Medical Education 32(2): 91.
11. Educational Commission for Foreign Medical Graduates. “IMGs in the United States.” https://www.ecfmg.org/certification/imgs-united-states.html
12. Raymer, Steve. 2004. YaleGlobal Online. “Indian Doctors Help Fill US Health Care Needs.” https://yaleglobal.yale.edu/content/indian-doctors-help-fill-us-health-care-needs
13. Ordoñez, Franco. 2020. National Public Radio. “Trump Freezes Green Cards, Many Work Visas Until End Of Year.” https://www.npr.org/2020/06/20/881245867/trump-expected-to-suspend-h-1b-other-visas-until-end-of-year
14. Constate, Agnes. 2020. “Fear of deportation heightened for immigrant doctors on H-1B visas amid pandemic.” NBC News. https://www.nbcnews.com/news/asian-america/fear-deportation-heightened-immigrant-doctors-h-1b-visas-amid-pandemic-n1204791
15. Malhotra, Ashish. 2020. “Foreign doctors on front lines of COVID-19 fear deportation from U.S.” Los Angeles Times. https://www.latimes.com/world-nation/story/2020-04-06/foreign-doctors-on-u-s-frontlines-of-covid-19-fear-deportation
16. Ramakrishnan, Karthik and Farah Z. Ahmad. 2014. “Health Care and Health Outcomes”. Center for American Progress. https://aapidata.com/wp-content/uploads/2017/09/AAPI-Health3-3.pdf
17. Lee, Sunmin, Genevieve Martinez, Grace X. Ma, Chiehwen E. Hsu, E. Stephanie Robinson, Julie Bawa, and Hee-Soon Juon. 2010. “Barriers to health care access in 13 Asian American communities.” American Journal of Health Behavior 34(1): 21-30.
18. Kang, Esther Yoon-Ji. 2020. “Asian Americans Feel The Bite Of Prejudice During The COVID-19 Pandemic.” National Public Radio. https://www.npr.org/local/309/2020/03/31/824397216/asian-americans-feel-the-bite-of-prejudice-during-the-c-o-v-i-d-19-pandemic
19. Eldred, Sheila M. 2018. “With Scarce Access to Interpreters, Immigrants Struggle to Understand Doctors’ Orders.” National Public Radio. https://www.npr.org/sections/health-shots/2018/08/15/638913165/with-scarce-access-to-medical-interpreters-immigrant-patients-struggle-to-unders
20. Scarborough, William, Lewis, Amanda E., and Ivan Arenas. 2018. “A Tale of Diversity, Disparity, and Discrimination: The State of Racial Justice for Asian American Chicagoans.” Institute for Research on Race and Public Policy; University of Illinois at Chicago.  https://irrpp.uic.edu/pdf/publications/IRRPP_TheStateOfRacialJusticeForAsianAmericanChicagoansReport.pdf
21. Chung, Christine, Claudia I. Aponte, and Ann Choi. 2020. “NYC South Asian leaders say community COVID toll undercounted.” The City, 26 April. https://www.thecity.nyc/coronavirus/2020/4/26/21247099/nyc-south-asian-leaders-say-community-covid-toll-undercounted
22. Page, Kathleen R., Venkataramani Maya, Beyrer, Chris,and Sarah Polk. 2020. “Undocumented U.S. Immigrants And COVID-19.” New England Journal of Medicine, 382(21): e62.
23. Kaiser Family Foundation. 2019. “Disparities Policy: Changes to “Public Charge” Inadmissibility Rule: Implications for Health and Health Coverage.” https://www.kff.org/disparities-policy/fact-sheet/public-charge-policies-for-immigrants-implications-for-health-coverage/
24. McFarling, Usha Lee. 2020. “Fearing deportation, many immigrants at higher risk of Covid-19 are afraid to seek testing or care.” STAT News. https://www.statnews.com/2020/04/15/fearing-deportation-many-immigrants-at-higher-risk-of-covid-19-are-afraid-to-seek-testing-or-care/
25. Jha, Ritu. 2019. “New Public Charge Rule would be Affecting Many Low-Income, South Asian Families.” IndicaNews. https://indicanews.com/2019/08/28/new-public-charge-rule-would-be-affecting-many-low-income-south-asian-families/
26. Williams, David R., and Lisa A. Cooper. 2020. “COVID-19 and Health Equity—A New Kind of “Herd Immunity”.” JAMA 323(24):2478–2480.
27. Wosik, Jedrek, Fudim, Marat, Cameron, Blake, Gellad, Ziad F., Cho, Alex, Phinney, Donna, Curtis, Simon, Roman, Matthew, Poon, Eric G., Ferranti, Jeffrey, Katz, Jason N., and James Tcheng. 2020. “Telehealth transformation: COVID-19 and the rise of virtual care.” Journal of the American Medical Informatics Association 27(6): 957-962.
28. Mallin M, Schlein S, Doctor S. 2014. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med. 89(4): 598-601.
29. Cabrera D, Vartabedian BS, Spinner RJ, Jordan BL, et al. 2017. More than likes and Tweets: Creating Social Media Portfolios for Academic Promotion and Tenure. J Grad Med Educ 9(4): 421-425.
30. Lurie N, Carr BG. 2018. The role of telehealth in the medical response to disasters. JAMA Intern Med. 178(6): 745-74.