Clinicians must maintain a high index of suspicion , asking about travel history and immigration history . With tuberculosis we may forget that individuals may have been exposed to the bacterium many years back and then may reactivate among those who are foreign-born . We must maintain that high index of suspicion when they have signs and symptoms of tuberculosis .”
— Trini Mathew , MD , MPH , FACP , FIDSA ,
that newcomers are part of our communities , and that we cannot for both normative and pragmatic reasons ignore their healthcare needs . At other times , we seek to deny their participation in our healthcare system , often based on the false belief that including them will draw them to our borders .”
They say that “ pain , passion , and complexity that arise when immigration and health policy collide ,” and assert further , “ On their own , both immigration and health are increasingly salient and ever more contentious . Questions of health policy — what care to offer , to whom , and how to reduce its cost , as well as how to prevent the spread of both communicable and noncommunicable diseases — have a unique and personal impact on people ’ s lives . They influence how long we live as well as the quality of our lives . They touch upon our deepest cultural , religious and moral beliefs , as debates about reproductive and sexual health , and the right to die attest . They also have an enormous impact on the economy of persons , nations , and the globe .”
Again , balance must be achieved , and in a 2017 whitepaper , the Federation for American Immigration Reform ( FAIR ) observes , “ Communicable diseases do not stop at international borders . They could be one of the most dangerous – yet rarely considered – consequence of inadequate immigration controls . Nevertheless , the mainstream media , and most policy makers , avoid any discussion of the public health challenges presented by illegal immigration . However , in a world where rapid global travel is both accessible and affordable to large numbers of people , the possibility of an epidemic traceable to migrants is a reality that cannot be ignored . When people live in areas lacking basic sanitation and medical care , diseases will take root and spread rapidly . This is neither an expression of xenophobia , nor an excuse to exclude migrants as ‘ carriers of disease .’ The need to control infectious disease is a simple fact of human biology .”
According to the Migration Policy Institute , as of early September , nearly 34,000 U . S . -bound Afghans were being housed at U . S . and NATO bases in the Middle East and Europe ; another nearly 26,000 evacuees were at eight military facilities in the United States . Many more are coming from Haiti , individuals who have questionable vaccine status overall and who are not being vaccinated for COVID-19 . There are thousands more undocumented individuals attempting to cross or crossing U . S . borders , a situation that potentially can exacerbate a healthcare system still trying to recover from the COVID-19 pandemic and bracing for a potentially brutal cold and flu season ( see related coverage in this issue on page XX ). The Pew Research Center reported in 2015 that approximately half of undocumented immigrants are from areas such as Asia , the Middle East , the Caribbean , and Central America , as well as from Mexico .
As Gushulak , et al . ( 2010 ) observe , “ In terms of public health , migration has implications for recognition of threats , as well as for surveillance and response capacity . Migration also influences broader aspects of the health of the public , including the background burden of chronic or latent diseases ( both infectious and noninfectious ) and patterns of preexisting immunity ; it also influences the use and uptake of disease prevention and health promotion interventions , and healthcare service utilization in general .”
Trini Mathew , MD , MPH , FACP , FIDSA , chair of the Public Policy and Government Affairs Committee for the Society for Healthcare Epidemiology of America ( SHEA ), reminds us to “ think back to the early 1900s at Ellis Island , so we have some historical perspective on how the country handled immigrants coming to the U . S .” She adds , “ That helps us understand how the U . S . has welcomed refugees , immigrants , and asylum seekers and how they became naturalized . History has shown us that the U . S . has always addressed the medical conditions as well as physical and mental wellbeing of people coming to this country to establish better lives for themselves . I ’ m very confident that the CDC and its partners have a good process in place for those coming to our country now .”
Mathew continues , “ The one potential downfall would be if frontline healthcare staff fail to keep up with the information that the CDC provides . CDC sent a great summary of what clinicians should be looking for in case they provide care for or interface with refugees , including evacuees from Afghanistan and returning U . S . citizens from abroad . So , we need to continue to confirm what we in infectious disease have always inquired about , and that is travel history , which is more crucial than ever before . With the COVID-19 pandemic right now , there is a great deal of focus on travel and the people with whom we interact .”
Mathew addresses timing , a key consideration . “ Clinicians must maintain a high index of suspicion , asking about travel history and immigration history . With tuberculosis we may forget that individuals may have been exposed to the bacterium many years back and then may reactivate among those who are foreign-born . We must maintain that high index of suspicion when they have signs and symptoms of tuberculosis , a task falling to primary physicians or those who are on the frontline of providing care , such as at an urgent care center primary care clinic , or the hospital emergency department . Taking detailed travel history is a critical