The impacts of COVID-19 on immigrants and the healthy immigrant effect: Reflections from Canada.

Discussions about potential long-term health consequences of the COVID-19 pandemic on immigrant health and the healthy immigrant effect (HIE) remain unaddressed. Drawing on Canada as a case study, we summarize the primary and secondary impacts of COVID-19 on immigrants. We find that recent and female immigrants as well refugees have fared far worse than either their more established and male counterparts or the Canadian-born population. We then discuss how COVID-19 might influence (or weaken) immigrants' previously documented health advantage. We highlight two structural conditions induced by the pandemic that may alter the health profile of immigrants; namely, immigration policy and delayed medical treatments. Reflections on the requisite data for monitoring and tracking the overall impact of COVID-19 on immigrants' health are included. Finally, we conclude with a discussion of the Canadian patterns and its potential relevance to immigrants and the HIE in the United States.

A Basis to Be Here: Stories from International Graduate Students in the United States.

Recent guidance from the US Immigration and Customs Enforcement drastically altered the lives of international students in America, especially those who are matriculating. This commentary describes how international students still face uncertainty concerning their visa statuses and their place in American society.

SARS-CoV-2 testing and COVID-19-related primary care use among people with citizenship, permanent residency, and temporary immigration status: an analysis of population-based administrative data in British Columbia.

OBJECTIVES: Having temporary immigration status affords limited rights, workplace protections, and access to services. There is not yet research data on impacts of the COVID-19 pandemic for people with temporary immigration status in Canada. METHODS: We use linked administrative data to describe SARS-CoV-2 testing, positive tests, and COVID-19 primary care service use in British Columbia from January 1, 2020 to July 31, 2021, stratified by immigration status (citizen, permanent resident, temporary resident). We plot the rates of people tested and confirmed positive for COVID-19 by week from April 19, 2020 to July 31, 2021 across immigration groups. We use logistic regression to estimate adjusted odds ratios of a positive SARS-CoV-2 test, access to testing, and primary care among people with temporary status or permanent residency, compared with people who hold citizenship. RESULTS: A total of 4,146,593 people with citizenship, 914,089 people with permanent residency, and 212,215 people with temporary status were included. Among people with temporary status, 52.1% had "male" administrative sex and 74.4% were ages 20-39, compared with 50.1% and 24.4% respectively among those with citizenship. Of people with temporary status, 4.9% tested positive for SARS-CoV-2 over this period, compared with 4.0% among people with permanent residency and 2.1% among people with citizenship. Adjusted odds of a positive SARS-CoV-2 test among people with temporary status were almost 50% higher (aOR 1.42, 95% CI 1.39, 1.45), despite having half the odds of access to testing (aOR 0.53, 95% CI 0.53, 0.54) and primary care (aOR 0.50, 95% CI 0.49, 0.52). CONCLUSION: Interwoven immigration, health, and occupational policies place people with temporary status in circumstances of precarity and higher health risk. Reducing precarity accompanying temporary status, including regularization pathways, and decoupling access to health care from immigration status can address health inequities.

RéSUMé: OBJECTIFS: Le statut d'immigration temporaire confère des droits, des mesures de protection au travail et un accès aux services limités. Il n'y a pas encore de données de recherche sur les impacts de la pandémie de COVID-19 chez les personnes ayant un statut d'immigration temporaire au Canada. MéTHODE: Nous utilisons des données administratives maillées pour décrire le dépistage du SRAS-CoV-2, les tests positifs et l'utilisation des services de soins de première ligne liés à la COVID-19 en Colombie-Britannique entre le 1er janvier 2020 et le 31 juillet 2021, stratifiées selon le statut d'immigration (citoyenneté, résidence permanente, résidence temporaire). Nous reportons sur des graphiques les taux hebdomadaires de personnes testées et confirmées positives pour la COVID-19 entre le 19 avril 2020 et le 31 juillet 2021 dans les groupes d'immigration. Nous utilisons la régression logistique pour estimer les rapports de cotes ajustés d'un test positif pour le SRAS-CoV-2, de l'accès au dépistage et de l'accès aux soins primaires chez les personnes ayant le statut de résidents temporaires ou permanents comparativement aux personnes ayant la citoyenneté canadienne. RéSULTATS: En tout, 4 146 593 citoyens, 914 089 résidents permanents et 212 215 résidents temporaires ont été inclus. Chez les personnes ayant le statut de résidents temporaires, 52,1 % étaient de sexe administratif « masculin ¼ et 74,4 % avaient entre 20 et 39 ans, contre 50,1 % et 24,4 % respectivement chez les personnes ayant la citoyenneté. Chez les résidents temporaires, 4,9 % avaient obtenu un test positif pour le SRAS-CoV-2 au cours de la période de l'étude, contre 4 % chez les résidents permanents et 2,1 % chez les citoyens. La probabilité ajustée d'un test positif pour le SRAS-CoV-2 chez les personnes ayant le statut de résidents temporaires était près de 50 % plus élevée (RCa 1,42, IC de 95 % 1,39, 1,45), même si leurs probabilités d'accès au dépistage (RCa 0,53, IC de 95 % 0,53, 0,54) et aux soins primaires (RCa 0,50, IC de 95 % 0,49, 0,52) étaient moitié moindres. CONCLUSION: La conjugaison des politiques d'immigration, de santé et de main-d'œuvre met les personnes ayant le statut de résidents temporaires en situation de précarité et de risques accrus pour la santé. La réduction de la précarité qui accompagne le statut temporaire, dont les voies de régularisation, et le découplage entre l'accès aux soins de santé et le statut d'immigration pourraient répondre aux iniquités en santé.

A characterization of pre- to post-immigration alcohol use among recent Latino immigrants to the United States before and during the COVID-19 pandemic.

BACKGROUND: Although Latino immigrants to the United States tend to display a gradual increase in alcohol use after immigration, such escalation may not generalize to all Latino/a groups. This study examines patterns of alcohol use shown by recent Latino immigrants (RLIs) to Miami/Dade County (MDC), Florida covering a period from pre-immigration to the first two years after immigration. Differences in alcohol use prior to and during the COVID-19 pandemic were also assessed. METHODS: Data came from an on-going longitudinal study of 540 young adult (50% female) RLIs. Inclusion criteria were age 18 to 34, residing in MDC and having immigrated from a Latin American country within the past year. Respondent-driven sampling was the primary recruitment strategy. RESULTS: Recent Latino immigrants reported a decline in alcohol use from before immigration (18.3 drinks per month, d/m) to the first (13.9 d/m), and second years (10.4 d/m before and 12.9 d/m during the pandemic lockdown) in MDC. The decline, which was moderated by RLIs' sex and legal residency status, was halted by the pandemic lockdown. While "to celebrate" was the most often cited reason for drinking, "to forget" was often cited during the lockdown. CONCLUSIONS: The noted decrease in alcohol use since immigration may reflect the unique array of support and resources available to RLIs in MDC. Nevertheless, some RLIs increased their alcohol use over time, particularly during the COVID-19 pandemic. This disparate impact of the pandemic on alcohol use calls attention to the need to identify the most vulnerable RLIs to MDC and develop targeted interventions for them.

Public Reason, Public Comments, and Public Charge: A Case Study in Moral & Practical Reasoning in Federal Rulemaking.

The "public charge" rule is a long-standing immigration policy that seeks to determine the likelihood that a prospective immigrant will become dependent on the government for subsistence. When the Trump administration sought to expand the criteria that would count against an applicant for permanent residency to include public benefits historically excluded from the calculation, thousands of commenters wrote to oppose or support the proposed changes. This paper explores the moral and practical reasons commenters provided for their position on the public charge rule and considers the value of the public comment process for immigration, health, and social policy.

The Work, Economic, and Remittance Stress and Distress of the COVID-19 Pandemic Containment Policies: The Case of Venezuelan Migrants in Argentina and Chile.

According to the social stress process model, global crises are macro-level stressors that generate physiological stress and psychological distress. However, existing research has not identified immigrants' COVID-19 containment policy stressors or examined the social stress of sending remittances amid crises. Drawing on in-depth longitudinal interviews with 46 Venezuelan immigrants-half before and half during the pandemic-in Chile and Argentina, we identified the COVID-19 containment policies' stressors. We focused on Venezuelan immigrants because they constitute one of the largest internationally displaced populations, with most migrating within South America. We found that the governmental COVID-19 containment measures in both countries generated four stressors: employment loss, income loss, devaluation of employment status, and inability to send needed remittances. Moreover, sending remittances helped some migrants cope with concerns about loved ones in Venezuela. However, sending remittances became a social stressor when immigrants struggled to simultaneously sustain their livelihoods and send financial support to relatives experiencing hardships in Venezuela. For some immigrants, these adversities generated other stressors (e.g., housing instability) and symptoms of anxiety and depression. Broadly, for immigrants, the stressors of global crises transcend international borders and generate high stress, which strains their psychological well-being.

Drivers and barriers of international migration of doctors to and from the United Kingdom: a scoping review.

BACKGROUND: Many high-income countries are heavily dependent on internationally trained doctors to staff their healthcare workforce. Over one-third of doctors practising in the UK received their primary medical qualification abroad. Simultaneously, an average of around 2.1% of doctors leave the UK medical workforce annually to go overseas. The aim of this study was to identify the drivers and barriers of international migration of doctors to and from the UK. METHODS: A scoping review was conducted. We searched EMBASE, MEDLINE, CINAHL, ERIC and BEI in January 2020 (updated October 2021). Grey literature and citation searching were also carried out. Empirical studies reporting on the drivers and barriers to the international migration of doctors to and from the UK published in the English language from 2009 to present were included. The drivers and barriers were coded in NVivo 12 building on an existing framework. RESULTS: 40 studies were included. 62% were quantitative, 18% were qualitative, 15% were mixed-methods and 5% were literature reviews. Migration into and out of the UK is determined by a variety of macro- (global and national factors), meso- (profession led factors) and micro-level (personal factors). Interestingly, many of the key drivers of migration to the UK were also factors driving migration from the UK, including: poor working conditions, employment opportunities, better training and development opportunities, better quality of life, desire for a life change and financial reasons. The barriers included stricter immigration policies, the registration process and short-term job contracts. CONCLUSIONS: Our research contributes to the literature by providing a comprehensive up-to-date review of the drivers and barriers of migration to and from the UK. The decision for a doctor to migrate is multi-layered and is a complex balance between push/pull at macro-/meso-/micro-levels. To sustain the UK's supply of overseas doctors, it is vital that migration policies take account of the drivers of migration particularly working conditions and active recruitment while addressing any potential barriers. Immigration policies to address the impact of Brexit and the COVID-19 pandemic on the migration of doctors to and from the UK will be particularly important in the immediate future. Trial registration PROSPERO CRD42020165748.

Evaluation of the risk of SARS-CoV-2 infection and hospitalization in vaccinated and previously infected subjects based on real world data.

The objective of our study was to determine the joint protective effect of a previous SARS-CoV-2 infection and vaccination on the risk of a new infection and hospitalization. Two case-control studies nested in a cohort of COVID-19 patients cared for by the Local Health Unit (LHU) of Vercelli, Italy, were performed, one to estimate the risk of infection and the second to estimate the risk of hospitalization. Each new infection and hospitalization was matched with up to 4 disease-free subjects who were the same age, sex and index date (i.e., controls). Study subjects were followed up from cohort entry date to disease outcome, end of follow-up or emigration. Vaccination was associated with a 36% (OR 0.64; 95%CI 0.62-0.66) and 90% (OR 0.10; 95%CI 0.07-0.14) reduction in the risk of infection and hospitalization, respectively. Prior infection was associated with a 65% (OR 0.35; 95%CI 0.30-0.40) and 90% (OR 0.10; 95%CI 0.07-0.14) reduction in the risk of infection and hospitalization, respectively. Vaccinated and recovered subjects showed a 63% (OR 0.37; 95%CI 0.34-0.14) and 98% (OR 0.02; 95%CI 0-0.13) reduction in the risk of infection and hospitalization, respectively. Vaccination remains an essential public health tool for preventing severe forms of COVID-19. Our study shows that vaccination or previous infection has a strong protective effect against Sars-CoV-2 hospitalization. The protective role against infection appears to be present although with a lower efficacy rate than that presented in the RCTs.

Quantifying the impact of COVID-19 on immigration in receiving high-income countries.

Previous studies have examined the impact of COVID-19 on mortality and fertility. However, little is known about the effect of the pandemic on constraining international migration. We use Eurostat and national statistics data on immigration and ARIMA time-series models to quantify the impact of COVID-19 on immigration flows in 15 high-income countries by forecasting their counterfactual levels in 2020, assuming no pandemic, and comparing these estimates with observed immigration counts. We then explore potential driving forces, such as stringency measures and increases in unemployment moderating the extent of immigration change. Our results show that immigration declined in all countries, except in Finland. Yet, significant cross-national variations exist. Australia (60%), Spain (45%) and Sweden (36%) display the largest declines, while immigration decreased by between 15% and 30% in seven countries, and by less than 15% in four nations where results were not statistically significant. International travel restrictions, mobility restrictions and stay-at-home requirements exhibit a relatively strong relationship with declines in immigration, although countries with similar levels of stringency witnessed varying levels of immigration decline. Work and school closings and unemployment show no relationship with changes in immigration.

Emergence of Vaccine-Preventable Diseases: The Perfect Storm of Hesitancy, Refusal, a Pandemic, and War.

The landscape of pediatric vaccination has changed dramatically due to changing attitudes toward immunizations and recent world events. The rise of vaccine hesitancy and refusal related to the concurrent rise of social media and anti-vaccination messages with misinformation campaigns have led to populations of children being unimmunized or under-immunized. These populations have been left vulnerable to the rapid spread of vaccine-preventable infection. Additionally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the clinical syndrome known as coronavirus disease 2019 (COVID-19) resulted in the emergence of a worldwide pandemic. Control measures to mitigate the spread of COVID-19 resulted in numerous reports of children missing routine vaccines along with the stopping of many public health immunization programs. Finally, armed conflicts and war have led to large family migrations from their homelands to various countries and regions leading to increased risk for missed maternal and child immunization as well as difficulty in keeping vaccination records. [Pediatr Ann. 2022;51(11):e426-e430.].

Little To No Correlation Found Between Immigrant Entry And COVID-19 Infection Rates In The United States.

The relationship between immigrant entry and COVID-19 spread in the United States has driven much political discussion and policy, including the implementation of Title 42 by the Centers for Disease Control and Prevention. To examine the relationship between COVID-19 spread and immigrant entry, we compared 2020-21 immigrant flows with local COVID-19 rates, using estimates of border crossings from the Border Patrol and visas issued through the Department of Labor's seasonal guest worker program. Our analysis capturing seasonal guest worker entry at the national level showed no statistically significant relationship with COVID-19 rates. Our analyses of Southwest border crossings showed a small, statistically significant relationship between immigrant flows and COVID-19 rates in border counties (0.14 percent increase in local cases per 100,000 residents for each additional 100 immigrants). However, this estimate is modest compared with the fact that half of all month-to-month changes in case rates were greater than 59 percent. Furthermore, the modest increase became nonsignificant with increasing local vaccination rates. Estimates also did not maintain their statistical significance when analyzed with some alternative approaches. Our findings support existing evidence that the short-term impacts of immigrant flow on local COVID-19 rates were minimal.

COVID-19 case counts and COVID-19 related Emergency Department visits: differences by immigration status, March-December 2020.

BACKGROUND: Undocumented immigrants face barriers to health care access, which may have been exacerbated during the early days of the COVID-19 pandemic. We test whether undocumented immigrants in Los Angeles County accessed COVID-19 related medical care by examining their Emergency Department (ED) patterns through high and low periods of COVID-19 infection. If undocumented immigrants were underutilizing or foregoing health care, we expect null or weaker associations between COVID-19 cases and COVID-19 related ED visits relative to Medi-Cal patients. METHODS: We analyzed all ED visits to the Los Angeles County + University of Southern California (LAC + USC) Medical Center between March - December 2020 (n = 85,387). We conducted logistic regressions with Los Angeles County weekly COVID-19 case counts as our main independent variable and an interaction between case counts and immigration status, stratified by age (over and under 65 years). RESULTS: We found that undocumented immigrants under 65 years old had a higher odds for a COVID-19 related ED visit compared to Medi-Cal patients and that both undocumented and Medi-Cal patients had higher odds of a COVID-19 related ED visit as COVID-19 cases in Los Angeles County increased. For patients over 65 years, Medi-Cal patients actually had a weaker association between ED visits and county COVID-19 counts; as COVID-19 case counts rose, the odds of a COVID-19 related ED visit increased for the undocumented patients. CONCLUSION: While the overall likelihood of undocumented patients having a COVID-19 related ED visit varies compared to Medi-Cal patients - for younger patients, the odds is higher; for older patients, the odds is lower - it does not appear that undocumented patients underutilized the ED during the early COVID-19 pandemic relative to Medi-Cal patients. The ED may be a viable source of contact for this high-risk population for future outreach.

Prevalence and risk factors of food insecurity among Californians during the COVID-19 pandemic: Disparities by immigration status and ethnicity.

The COVID-19 pandemic exacerbated socioeconomic disparities in food insecurity. Non-citizens, who do not qualify for most publicly-funded food assistance programs, may be most vulnerable to food insecurity during the pandemic. However, no study has examined heterogeneity in food insecurity by immigration status and ethnicity in the context of the pandemic. We analyzed the 2020 non-restricted California Health Interview Survey to examine disparities in food insecurity by ethnicity and immigration status (i.e., US-born, naturalized, non-citizen) among Asians and Latinxs (N = 19,514) compared to US-born Whites. Weighted multivariable logistic regression analyses assessed the association of immigration status and ethnicity with food insecurity. Decomposition analyses assessed the extent to which pandemic-related economic stressors, including experiencing reduced work hours or losing a job versus pre-pandemic socioeconomic position (SEP), accounted for disparities in food insecurity by ethnicity and immigration status. Regardless of immigration status, Latinxs were more likely to experience food insecurity than Whites. Based on the adjusted analyses, non-citizen, naturalized, and US-born Latinxs had a predicted probability of 12%, 11.4%, and 11.9% of experiencing food insecurity, respectively. In contrast, non-citizen Asians, but not US-born or naturalized Asians, reported greater food insecurity than Whites (12.5% vs. 8.2%). SEP accounted for 43% to 66% of the relationship between immigration status-ethnicity and food insecurity. The pandemic exacerbated economic hardship, but food insecurity was largely explained by long-standing SEP-related factors among Latinxs, regardless of immigration status, and non-citizen Asians. To address disparities in food insecurity, social assistance programs and COVID-19 economic relief should be extended to non-citizens.

The global polarisation of remote work.

The Covid-19 pandemic has led to the rise of digitally enabled remote work with consequences for the global division of labour. Remote work could connect labour markets, but it might also increase spatial polarisation. However, our understanding of the geographies of remote work is limited. Specifically, in how far could remote work connect employers and workers in different countries? Does it bring jobs to rural areas because of lower living costs, or does it concentrate in large cities? And how do skill requirements affect competition for employment and wages? We use data from a fully remote labour market-an online labour platform-to show that remote platform work is polarised along three dimensions. First, countries are globally divided: North American, European, and South Asian remote platform workers attract most jobs, while many Global South countries participate only marginally. Secondly, remote jobs are pulled to large cities; rural areas fall behind. Thirdly, remote work is polarised along the skill axis: workers with in-demand skills attract profitable jobs, while others face intense competition and obtain low wages. The findings suggest that agglomerative forces linked to the unequal spatial distribution of skills, human capital, and opportunities shape the global geography of remote work. These forces pull remote work to places with institutions that foster specialisation and complex economic activities, i. e. metropolitan areas focused on information and communication technologies. Locations without access to these enabling institutions-in many cases, rural areas-fall behind. To make remote work an effective tool for economic and rural development, it would need to be complemented by local skill-building, infrastructure investment, and labour market programmes.

The polarizing impact of numeracy, economic literacy, and science literacy on the perception of immigration.

Immigrants might be perceived as a threat to a country's jobs, security, and cultural identity. In this study, we aimed to test whether individuals with higher numerical, scientific, and economic literacy were more polarized in their perception of immigration, depending on their cultural worldview orientation. We measured these variables in a representative sample of citizens in a medium-sized city in northern Italy. We found evidence that numerical, scientific, and economic literacy polarize concerns about immigration aligning them to people's worldview orientations. Individuals with higher numerical, economic, and scientific literacy were less concerned about immigration if they held an egalitarian-communitarian worldview, while they were more concerned about immigration if they held a hierarchical-individualistic worldview. On the contrary, individuals with less numerical, economic, and scientific literacy did not show a polarized perception of immigration. Results reveal that citizens with higher knowledge and ability presented a more polarized perception of immigration. Conclusions highlight the central role of cultural worldviews over information theories in shaping concerns about immigration.

Clinical Considerations for Immigrant, Refugee, and Asylee Youth Populations.

This article will explore the psychological sequelae of forced family separation in immigration policy, the effects of the COVID-19 pandemic on the youth migrant population, how youth migrants form an identity in their new country, and finally how politics affect the mental health of youth migrants.