On behalf of the Pediatric Residency Immigrant Health Task Force (IHTF), please see our second Immigration Health Tip of the Month in 2021, focusing on COVID updates and immigrant communities.
“One of our members said, “If I do not die from COVID, I will die from not having a job."
- Gabriela Galicia, Executive Director of Street Level Health Project in Oakland
Who can get vaccinated now?
- 1A: Healthcare workers and long-term care residents
- 1B: Individuals >65 and those who work in the following sectors: agriculture and food, education and childcare, emergency services
- For details about what jobs are included in the agriculture/food and emergency services sectors, refer to the lists here: https://covid19.ca.gov/essential-workforce/
- For details about what jobs are included under education and childcare, refer here: https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/VaccineAllocationGuidelines.aspx
What is the next phase of the COVID vaccine rollout for the general public?
- As of March 15th, “healthcare providers may use their clinical judgement to vaccinate individuals aged 16-64 who are deemed at very high risk:”
- Includes: Cancer, CKD, Down Syndrome, Chronic Pulmonary Disease (Oxygen Dependent), Solid Organ Transplant, Pregnancy, Sickle Cell Disease, Heart Conditions, Severe Obesity, T2DM (Hgb A1C > 7.5)
- OR as a result of a developmental or other severe high-risk disability if:
- Likely to develop severe/life threatening illness from COVID
- COVID would limit the individual’s ability to receive ongoing care or services
- Adequate and timely COVID care would be particularly challenging as a result of the individual’s disability
- Reference: https://covid19.ca.gov/vaccines/
How does immigration impact COVID vaccination?
- Released Feb 1, 2021 from the Department of Homeland Security (DHS):
- “DHS and its Federal government partners fully support equal access to the COVID-19 vaccines and vaccine distribution sites for undocumented immigrants. It is a moral and public health imperative to ensure that all individuals residing in the United States have access to the vaccine. DHS encourages all individuals, regardless of immigration status, to receive the COVID-19 vaccine once eligible under local distribution guidelines.” https://www.dhs.gov/news/2021/02/01/dhs-statement-equal-access-covid-19-vaccines-and-vaccine-distribution-sites
- Of note, there have been news reports in other states that have described undocumented immigrants being turned away from vaccine sites, ultimately with vaccine appointments being rescheduled. (i.e. https://www.washingtonpost.com/nation/2021/02/26/undocumented-texas-denied-vaccine/)
- Provider counseling recommended on vaccine access
- CDC COVID vaccine flyer available in 8 languages: https://www.cdc.gov/coronavirus/2019-ncov/communication/print-resources.html?Sort=Date%3A%3Adesc&Search=Facts&Audience=General%20Public&Topics=Vaccines. Note: no specific mention of availability to undocumented population in this flyer
Points for consideration when counseling on the COVID vaccine:
1) Ensure vaccine site accessibility, counsel on ‘no cost’: “The federal government has provided resources to make the COVID-19 vaccine available at no cost for people who are uninsured regardless of immigration status.”
- In SF: "Starting on Tuesday, February 23, Muni and Paratransit will be free for those traveling to get vaccinated for COVID-19. This includes trips in both directions. The SFMTA is also providing additional access to taxi service for those who use the Essential Trip Card." https://www.sfmta.com/blog/free-muni-and-paratransit-covid-19-vaccine-appointments
2) Opportunity to provide education on vaccine side effects: “Noncitizen immigrants may have heightened concerns about potential side effects.”
3) Opportunity to provide information on vaccine eligibility: “Noncitizen immigrants may not know if they are eligible to receive the vaccine and/or worry that obtaining it may have negative immigration-related consequences”
4) Concerns about data collection: “Data collection and sharing related to COVID-19 vaccinations may further raise fears among immigrants.”
- “Minimizing the collection of personally identifiable information, clearly explaining how it will be used, and clarifying that it cannot be used for immigration-related purposes can help reduce fears about accessing the vaccine.”
- Reference: https://www.kff.org/racial-equity-and-health-policy/issue-brief/immigrant-access-to-covid-19-vaccines-key-issues-to-consider/
- More resources from "Boosting Vaccine Confidence in Multicultural Patient Communities” by Vincent Iannelli, MD: https://vaxopedia.org/2021/02/03/boosting-vaccine-confidence-in-multicultural-patient-communities/
- Unclear what will happen in California ICE detention centers –discrepancy about if state or federal government will decide
- California advocacy ongoing for equity in vaccine distribution: https://www.latimes.com/opinion/story/2021-02-15/coronavirus-vaccination-immigration-ice-detention-center-otay-mesa
COVID and Technological challenges
- Telehealth via phone and video can be difficult for many reasons (e.g. interpreter connection, timing, technology)
- Utilization of interpreter when needed:
- Consider calling the interpreter ahead of the visit or booking an interpreter for the clinic appointment prior to the appointment time
- Update: At UCSF Health sites, on demand video interpreting is available (i.e. connect an interpreter directly to a Zoom video call in the moment)
- Full instructions here: https://ucsf.app.box.com/v/OnDemandVideoInterpreting
- Bottom line: Participants > Invite > Room System > Call Out > Drop-down Menu to select VMI-language
- Interpreter will appear as SIP xxxxxxxx
- Interpreter will request Access Code (The UCSF access code is “1234”), Patient MRN, calling from BCH Oakland? Y/N, and Provider First/last name
- https://ucsf.app.box.com/v/OnDemandVideo (2-3-minute video with instructions)
Considerations:
- Patient’s access to video-capable device if pursuing a video visit (e.g. iPad, computer, smart phone), consider if telephone visit would be appropriate based upon the particular situation.
- Many family members may be working jobs that require in-person presence during clinic hours. Therefore, it may be difficult for patients to have a fully charged device after a day of work or to have a quiet or private space for the call if they are still at work or commuting.
In solidarity,
Ali Lai & Greta Peng OBO the Immigrant Health Task Force (IHTF)