SOUTH PORTLAND — In mid-June 2019, 437 asylum-seekers from the Democratic Republic of Congo and Angola arrived in Portland. The Expo became an emergency shelter for two months while community organizations worked around the clock to place families in permanent housing. What then gave me pride – that my community stepped up to protect these people coming to America for a better life – now gives me anxiety in the age of social distancing. At first glance, it may seem lucky that the need for emergency shelter did not strike this year in the midst of a pandemic. But for many of Maine’s most marginalized groups, the situation may not be much better now.

Around the country, minorities are unequally affected by coronavirus. Currently available data show that minorities make up an alarmingly high number of COVID-19-related deaths and cases across the United States. In New York City, the risk of contracting COVID-19 is highest in the Latinx and African American populations, and age-adjusted mortality among the black population is double that of white and Asian residents. Though Maine’s racial and ethnic makeup differs from that of New York City, the same pattern is observed here. The latest Maine Center for Disease Control and Prevention data show a disproportionate number of positive cases have been observed in black or African American populations – a significant percentage of whom includes Maine’s immigrant and refugee population.

A health care disparity is an unequal difference attributable to variables other than access to care. Illnesses such as high blood pressure, diabetes, heart disease or chronic kidney disease may be influencing results, but health care disparities extend beyond co-morbid chronic illnesses. Those living in urban poverty are largely minorities. The privilege of social distancing is out of reach for many: It requires private transportation, paid work leave or the ability to work from home. Densely populated urban areas, multigenerational households, residential segregation and overrepresentation in homeless shelters and prisons further limit social distancing. In addition, minorities are disproportionately essential workers and risk daily exposure on the front lines. Thus, the impact of adverse health care disparities cannot be ignored.

Health care access and health literacy may also be a barrier to successfully limiting the spread of coronavirus in these communities. Public health outreach for the immigrant and refugee populations requires extra effort, given limited English proficiency, health literacy and cultural differences. As the Portland Press Herald has reported, immigrant community leaders have taken on the formidable task of creating and distributing translated materials on hand hygiene and social distancing.

Moreover, recent policy changes may have made this an uphill battle. The public charge rule – which took effect Feb. 24 – may be a further barrier to health care for immigrant communities. This new rule negatively weighs the use of public assistance – such as nutrition assistance, non-emergency Medicaid and housing benefits – against any applicant for permanent U.S. residence (and their dependents). Widespread fear and confusion regarding this rule have already resulted in nationwide disenrollment from health insurance and other services, even though many may qualify. Though U.S. Citizenship and Immigration Services announced that “the Public Charge Rule does not restrict access to testing, screening, or treatment of communicable diseases, including COVID-19,” fear of the consequences of the public charge rule in immigrant communities will likely lead to fewer seeking care, which could cause increased community spread of COVID-19.

There may seem to be few strategies to address health care disparities such as chronic illness, inability to socially distance and lack of language proficiency. However, several approaches may be employed to limit coronavirus’ spread in these populations. First, continued public health awareness and outreach programming tailored to immigrant communities will be crucial. Differences in cultural understanding of these practices may require cultural brokers and ongoing involvement from community leaders. Further, implementation of contact tracing in these communities will be critical to success. Lastly, persistent advocacy to dismantle the public charge rule, coupled with clear communication with our immigrant communities, will be necessary to avoid the devastating costs of delays in health care access and diagnosis.

Now more than ever, our community in Maine is only as healthy as the most vulnerable among us. We must advocate for and protect these communities for the health of our state.

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