Some refugee claimants can now enter Canada

2020/04/24 Leave a comment

Good overview of the limited exceptions:

Some refugee claimants from the United States can once again enter Canada.

The Canada Border Services Agency announced Wednesday that claimants eligible for exemptions under the Safe Third Party Agreement between Canada and the U.S. can enter the country through official land border crossings. Those entering through irregular border crossings will still be returned to the U.S.

“People who arrive irregularly between border crossings are still prohibited from entering Canada to make a refugee claim,” the federal agency said on Twitter, in French.

“As of today, claimants can enter the country at designated land ports of entry only if they are among the few who are eligible for exemptions under the Safe Third Party Agreement.”

Those exempted from the agreement include claimants with family in Canada, unaccompanied minors or people who already have permits, like a student visa. They will also be subject to the mandatory 14-day quarantine for new arrivals.

Last month, in announcing the closure of the Canada’s border with the United States, as part of efforts to contain the spread of the COVID-19 pandemic, the federal government said it would return all refugee claimants coming into the country via irregular crossings back to the U.S. The Americans also said they would do the same for those entering their country from Canada.

At Monday’s sitting of the House of Commons, Public Safety Minister Bill Blair, answering a question from Conservative MP Joël Godin, said that at least 10 people had made irregular crossing since the ban. They were returned to the United States, Blair confirmed.

News of the change to allow some refugee claimants to enter Canada through designated ports of entry first came on Wednesday when Jean-Pierre Fortin, president of the Customs and Immigration Union, gave radio interviews.

Fortin called the change a “surprise” move that was communicated to his members at the end of the day Tuesday.

“We are in a state of crisis,” Fortin said. “We think it is too early to open the border.”

He added that the Canadian Border Services Agency has reserved a nearby hotel, with about 50 rooms, where refugee claimants who take advantage of this new opening would have to go into quarantine for 14 days before the claims could be processed.

Fortin also expressed concerns that Customs officers would need protective equipment and safeguards to deal with people who may have the COVID-19 virus and he said the waiting room for people coming through the border crossing is not large, making social distancing difficult.

In Ottawa, when he was asked about the change at his daily pandemic briefing, Prime Minister Justin Trudeau said as far as he knows the Canada-U.S. Safe Third Country Agreement is still in force. He then referred the question to Minister Blair.

CBSA media relations staff disclosed the Order in Council to reporters seeking more information. The new rules remain in effect until May 21, the date the Canada-U.S. border is set to reopen.

The change was requested by Health Canada, according to a CBSA official, who said the intent is to “minimize the risk of exposure to COVID-19 in Canada.” The official confirmed that foreign nationals are still prohibited from entering Canada from the United States if they have “COVID-19 or have signs and symptoms of COVID-19” or officials have “reasonable grounds to suspect they have such signs and symptoms.”

Refugee rights advocates have called on the government to reopen the border to all asylum seekers.

Janet Dench, the Canadian Council of Refugees, said the ban is “wrong and unnecessary.”

Still, she said changing the rules to allow refugee claimants who have family members already in Canada to enter represents “a step in the right direction.”

“I doesn’t solve the problem, though,” Dench said, calling on the government to respect the rights of asylum seekers to come to Canada.

Source: Some refugee claimants can now enter Canada

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Trump Administration Bars Most International Students From Receiving Coronavirus College Relief

2020/04/24 Leave a comment

Seems similar to the Canadian approach (Canadian citizens and permanent residents studying at Canadian institutions) but to be confirmed when program guidelines confirmed:

The Trump administration is barring most international students and all students who entered the U.S. illegally from receiving emergency college grants approved by Congress as part of a $2.2 trillion coronavirus rescue package.

Education Secretary Betsy DeVos issued the restriction in new guidelines released Tuesday telling colleges how to distribute more than $6 billion in grants meant to help students cover unexpected costs triggered by the pandemic. Earlier guidance from the Education Department suggested universities would have wide flexibility in distributing the grants, but the new guidelines said that only students who qualify for other federal student aid can receive the aid.

More than 400,000 students are estimated to have entered the U.S. illegally. More than 1 million international students are enrolled at U.S. colleges.

University leaders and immigration groups blasted the change, saying DeVos is imposing new limits that were not included in Congress’ legislation. The rescue package did not specify which students are eligible for grants, and many colleges had planned to distribute emergency grants to needy students regardless of their citizenship status.

Some prestigious universities cited the new policy in decisions to reject the funding. Princeton University announced Wednesday that it would refuse its $2.4 million share of coronavirus relief over the policy. Harvard University also cited the change in its decision to reject $8.7 million in aid.

The Education Department said its guidance is aligned with other federal laws. The agency cited the Higher Education Act, a sweeping law that says only U.S. citizens and a narrow set of “eligible noncitizens” are eligible for federal student aid. Angela Morabito, a department spokeswoman, said the rescue package legislation “makes clear that this taxpayer funded relief fund should be targeted to U.S. citizens, which is consistently echoed throughout the law.”

But some higher education advocates challenged that claim. The American Council on Education, an association of college presidents, said the rescue package placed no limits on student eligibility.

“The statute says almost nothing about who is eligible to receive a grant. The Department of Education owns this decision. Period,” said Terry Hartle, the group’s senior vice president. He added that the group is disappointed by DeVos’ policy. “We strongly believed many of these students needed help.”

The guidelines have created confusion about exactly which students can receive the grants, Hartle said. It’s clear that the department is excluding immigrants who entered the U.S. illegally and international students, he said, but it’s unclear how schools should determine eligibility. Most colleges don’t ask students if they’re U.S. citizens, he said, and officials have no easy way to check.

“A college could give an emergency grant to a Dreamer without realizing the person is a Dreamer,” he said, referring to immigrants who were brought to the U.S. illegally but allowed to stay under the under the Deferred Action for Childhood Arrivals program, or DACA.

At the University of California, Riverside, officials had been planning to award grants to some of the campus’ estimated 600 DACA recipients. Now, officials will turn to fundraising or other revenue sources to help students excluded by the Education Department.

Chancellor Kim Wilcox said he’s grateful for the federal relief but was disheartened by DeVos’ policy.

“I was disappointed for students here at UCR, for students across California, and I was disappointed for the nation,” Wilcox said. “This is a huge economic hit and there are pressing needs everywhere.”

Student advocates see DeVos’ update as a reversal from her previous guidance. When DeVos made the funding available in early April, she said colleges would be given flexibility in deciding how to award grants. She told colleges to focus on helping the neediest students. And in paperwork that colleges sign to receive the funding, the agency says the relief isn’t considered federal financial aid.

That earlier guidance led some schools to believe the grants were exempt from citizenship requirements.

Sara Goldrick-Rab, a professor of higher education policy and sociology at Temple University, said the new requirements are cruel to students who were counting on the grants to cover food, housing and other costs, and to colleges that now have to scramble to revise plans for distributing the funding. Losing access to the grants will likely force some students to drop out, she said, especially those whose families are dealing with unemployment amid the pandemic.

“They’re not going to have the money that they need to stay connected to their college. And people who drop out of college often do not come back,” said Goldrick-Rab, who founded the nonprofit Hope Center for College, Community and Justice.

Critics say the policy is particularly unjust because the same students now barred from receiving grants were counted in the formula used to allocate money for schools. The rescue package provided $14 billion for the nation’s colleges, offering them varying sums based on their student enrollment and the percentage of students they teach from poorer backgrounds.

The United We Dream Network, which advocates for DACA recipients, said it was “callous” of DeVos to block so many students from access to funding. Sanaa Abrar, the group’s advocacy director, urged Congress and colleges to find other ways to help students excluded by DeVos’ directive.

“Every single relief package being discussed in Congress must include both the health care and financial assistance immigrant communities need,” Abrar said, “especially as the Trump administration continues to attack and scapegoat our communities amidst a pandemic.”

Source: Trump Administration Bars Most International Students From Receiving Coronavirus College Relief

Filed under Immigration Tagged with , , ,

Job Losses Higher Among People Of Color During Coronavirus Pandemic as are Nursing Home Deaths

2020/04/24 Leave a comment

Two related articles on racial disparities regarding COVID-19, starting with job losses:

Until a few weeks ago, Melissa St. Hilaire worked the night shift taking care of a 95-year-old woman for a family in Miami.

“I help her to go to the bathroom, use the bathroom, and I watch TV with her, and I comb her hair sometimes in the night,” she said.

But one day in March, the woman’s daughter told her not to come back, saying she wanted to protect her mother during the coronavirus pandemic.

St. Hilaire is black and a Haitian immigrant. And her situation is an example of what early data from this crisis shows: People of color have lost work at greater rates than white workers.

The March jobs data show a number of racial and ethnic disparities in the economic impact of the coronavirus. For example: the share of white people who are employed fell by 1.1% last month. That rate fell by substantially more for black people (a 1.6% drop), Asian Americans (1.7%), and Latinos (2.1%). Economist Christian Weller highlighted this data and more at Forbes earlier this month.

In addition, a survey from the left-leaning Data for Progress found that 45% of black workers have lost jobs or had their hours cut, compared with 31% for white workers. (Samples were not large enough to break out other racial and ethnic groups.)

Losing her job landed St. Hilaire in dire straits. She was able to delay her rent payment after she talked to her landlord.

“​I said to her my situation. She said, ‘OK.’ She understood my situation. She gave me more days,” St. Hilaire said, but she added that shelter isn’t her only concern. “Two weeks before [that], I was out of food. That’s crazy.”

She ended up getting some food supplies from a local aid group. She plans to apply for unemployment and also has a GoFundMe whose proceeds she plans to share with fellow domestic aides.

A big reason for these racial and ethnic gaps has to do with the workplaces that have been hurt most by the economic crisis.

“We know which industries are being hit the hardest,” says Gbenga Ajilore, senior economist at the left-leaning Center for American Progress. “So we look at leisure and hospitality, transportation, utilities, industries that are first ones were hit really hard. We also know service — think hairdressers, salons. We know which ones are getting hit hard, and we know who’s in those occupations.”

People of color — and in the case of domestic workers like St. Hilaire, women of color — are disproportionately in those occupations. Nearly three-quarters of domestic workers were out of work the week of April 6, according to a survey from the National Domestic Workers Alliance.

Similar patterns turn up in other industries hurt most by the coronavirus slowdown. The latest jobs report showed more than 450,000 job losses in leisure and hospitality — a category that includes hotels and restaurants. Black, Asian and Latino workers are all disproportionately represented in the hotel industry, and Latino workers have heavy representation in restaurants.

That includes Erick Velasquez, who is Mexican American and who until recently was head bartender at a Greek restaurant in Houston.

“Everything just happened so quick. We’re watching the news, and they talk about COVID-19, and nobody really thought much about it,” he said. “And then a few days after then that’s when they — the city or the county — closed down dining rooms for restaurants everywhere.”

Velasquez has managed to find a temporary job — helping his fellow laid-off workers. He’s a case worker now at the Southern Smoke Foundation, a nonprofit that supports people in the restaurant industry. And he sees racial and ethnic gaps among the people he’s helping.

“​Everybody in the restaurant industry is hurting, but more so, it’s the people that you don’t really see when you go into a restaurant,” Velasquez said. “It’s like the back of the house workers, the immigrant community, the people of color.”

There’s also evidence of disparities in who is able to work from home during this crisis: 30% of white people and 37% of Asian Americans could work from home in 2017 and 2018, according to the Labor Department. Meanwhile, only 20% of black people could. In addition, only 16% of Latinos could work from home, compared to nearly twice as many non-Latinos.

The March jobs report that much of this analysis is based on only captured the start of the economic crisis created by COVID-19. The April report, which will be released May 8, will show if racial gaps have persisted.

If those gaps do continue, it could make existing inequalities worse. The unemployment rates for blacks and Latinos, for example, are always higher than the broader national unemployment rate. Wages for blacks and Latinos are also lower than for other groups.

Ajilore thinks it was easier to ignore these types of gaps when the economy was humming along with record-low unemployment. Now, the economic crisis brought about by the pandemic is holding a magnifying glass to those gaps.

​”Once this pandemic hit, then it’s like you see the cracks in the structure,” he said.

Source: Job Losses Higher Among People Of Color During Coronavirus Pandemic

And nursing home deaths in NYC:

There’s one thing that distinguishes the nursing homes in New York that have reported patient deaths from COVID-19. According to an NPR analysis, they are far more likely to be made up of people of color.

NPR looked at 78 nursing homes in New York in which six or more residents have died of COVID-19. In one facility, 55 people have died as of April 20. Ten others report 30 or more deaths.

Seven of the 11 nursing homes with the highest number of deaths report that 46 percent or more of their residents are “non-white.” Most of these “non-white” residents are black and latinx. At one facility, the Franklin Center for Rehabilitation and Nursing in Queens, which reported 45 deaths, 80 percent of the residents are minority, including 47 percent who are Asian.

NPR filed a public records request with the Centers for Medicare and Medicaid Services and collected data on every nursing home in the United States. We focused our analysis on New York because that state has the most deaths of COVID-19, by far.

Fifty-eight percent of the deaths in the state happened in nursing homes in New York City. Those nursing homes, the NPR numbers show, are notable for their high percentages of residents of color.

But even most of the residents who died in facilities in other parts of the state were living in nursing homes that had a high percentage of residents of color. The population in those facilities tend to reflect the demographics of the counties where they were located.

The racial imbalance in the deaths in New York nursing homes reflects another national trend: That among all fatalities, across the country, from COVID-19, black and Hispanic people make up a disproportionate share of the dying.

NPR analyzed other data too, including the federal government’s system for rating nursing homes that gives each facility a star rating from one to five.

In New York state, nursing homes that recorded deaths actually had better quality scores than other nursing homes. Half of the facilities that report deaths get four or five star ratings from Medicare’s Nursing Home Compare website, indications of “above average” or “much above average” quality.

On other indicators, there was little difference between nursing homes with deaths reported and other facilities in the state. Staffing levels were about the same. Their reliance on Medicaid patients — who bring lower reimbursements — was similar, too. Their occupancy rates — which can indicate problems at a facility if low — also were roughly the same.

But the nursing homes with outbreaks were often larger facilities. Three of those facilities have 700 or more residents. Almost half — 38 out of the 78, including some of the largest in the state — are in New York City.

Nationwide, people living in nursing homes and other long-term care facilities make up close to one out of five deaths nationwide from COVID-19, according to The New York Times.

“It is not surprising that this is exaggerated,” Dr. Clyde Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine, said of NPR’s findings of the racial imbalance in deaths at nursing homes. He wrote in the Journal of the American Medical Association about the long history of racial disparities in health care and how it plays out now in this pandemic.

For “someone living in a nursing home who has suffered more extensive complications to a disease process because of already embedded health disparities,” says Yancy, “one can only imagine what happens when that individual now is facing coronavirus infection, potential COVID-19 complications.”

Years of inequality can lead to less access to health care, to hard lives and jobs, to a greater likelihood of developing diabetes, asthma and other conditions that now put people in those nursing homes at greater risk.

Nursing homes are now being recognized as one of the front lines of the pandemic. The residents are often frail, they have underlying health problems.

Nurse aides — who work for low wages — do the hands-on care. They get people out of bed, bathe them and take them to the toilet. They and other staffers were some of the last to get masks, gloves and other personal protective equipment. That made it easier for the virus to spread, notes Dr. Dora Hughes, of the Milken Institute School of Public Health at George Washington University.

“For all of our pandemic response, much of our attention has focused, appropriately, on hospitals. But I think for what we’ve seen with the nursing home is a fairly stark reminder that we need to really expand our thinking in terms of essential workers,” says Hughes. “The direct care staff, should have been a greater priority.”

Source: In New York Nursing Homes, Death Comes To Facilities With More People Of Color

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‘Will my child ever be a Malaysian?’ — Malaysian Campaign for Equal Citizenship

2020/04/23 Leave a comment

Of note how the impact of gender discrimination in citizenship policy has a greater impact under COVID-19:

Malaysian women currently do not have equal rights to confer citizenship on their children born overseas on an equal basis as Malaysian men. Women must utilise an application process under Article 15(2) that is fraught with delays and frequent rejections without reasons given, and sadly, no guarantee of ultimately securing citizenship.

The Malaysian Campaign for Equal Citizenship would like to highlight that the impact of discriminatory citizenship laws on women are even worse during the Covid-19 pandemic.

As the Malaysian movement control order (MCO) mandates a 14-day quarantine for anyone entering the country, this would be a challenge for pregnant women, especially those who may be travelling with their other children.

Additionally, the MCO only allows foreign spouses to enter Malaysia during the MCO provided they have a long term social visit pass (LTSVP). Hence spouses who do not hold one will not be able to accompany their wives and these mothers either have to return on their own or make the decision to give birth overseas while risking the chances of their children securing a Malaysian citizenship.

With countries’ borders closing and a limited number of flights during the Covid-19 pandemic, these women live with a tremendous dilemma.

That is, expose themselves to the health risks of traveling home (leading to the understandable quarantine) so that the child can be Malaysian; or deliver overseas, and live with the excruciating uncertainty if their child will ever be a Malaysian and then undergo the long tedious process of application.

“I was planning to give birth in Malaysia but because of the coronavirus, travels are restricted. I might not have a choice to give birth in Malaysia which is a pity for my baby as Malaysian women are not able to obtain automatic Malaysian citizenship (upon registration) for their own children, this is just getting more and more impossible.” – Malaysian woman living in Germany

Another Malaysian mother in Singapore felt it was not an ideal solution to travel to Malaysia to deliver her child as her husband could not enter Malaysia without an LTSVP, and she was not comfortable to undergo delivery by herself considering she experienced anxiety throughout her pregnancy.

She has since given birth in Singapore which cost her almost double in medical fees due to such changes in her delivery plans.

Women are often expected to accommodate their pregnancy according to existing Malaysian citizenship provisions by delivering in Malaysia for their children to be Malaysian.

Such inequality in citizenship laws discriminate against women and contribute to the unequal status of women in the family and society. Laws as such make women vulnerable, especially during times of crisis as they are left with limited choices influenced by constraints.

While the Malaysian Government has been swift in addressing the ongoing pandemic, a fair and just solution is needed to ensure that all Malaysian women enjoy equal rights and are not put in unnecessary vulnerable situations.

Therefore, we call on the Government of Malaysia and every Member of Parliament to amend Article 14 of the Federal Constitution so as to grant Malaysian women equal rights to confer citizenship on their children on an equal basis as Malaysian men.

In addressing the urgent needs of the Covid-19 situation on pregnant Malaysian women overseas, we urge the Government of Malaysia, specifically the Ministry of Home Affairs and Immigration Department of Malaysia to especially grant citizenship to children born overseas to Malaysians during the Covid-19 situation as a temporary measure until full equality is enshrined in Malaysian citizenship laws.

Source: ‘Will my child ever be a Malaysian?’ — Malaysian Campaign for Equal Citizenship

Filed under Citizenship, gender Tagged with ,

Canada needs to start taxing Canadians who live abroad

2020/04/23 Leave a comment

Working on a piece analyzing the issue of citizenship-based versus residency-based taxation, given this opinion piece by Chandra Arya, Liberal MP for Nepean.

His arguments are largely based on anecdote rather than available evidence, he fails to question by the USA is an outlier on citizenship-based taxation compared to other OECD countries, and understates the policy and administrative complexities involved in making such a change.

As always, people cite the Asia Pacific Foundation number of three million expatriates without controlling for age and citizenship. Doing so results in about two million expatriates:

It is time for Canada to adopt citizenship-based taxation (CBT).

While we don’t have complete information on where Canadians have taken up long-term residence abroad, there are reports of about 300,000 Canadian citizens in Hong Kong and tens of thousands in each of several countries in the Middle East. From Asia to Africa, from Europe to the Caribbean and South America and, of course, the US, significant numbers of Canadians have made their permanent home away from Canada. There were about 3 million Canadians abroad, including tourists, at the start of the COVID-19 crisis, according to the Prime Minister.

Currently, Canadian income tax obligations are based on residency status and not on citizenship or immigration status, so non-resident Canadians do not pay taxes. However, expatriate Canadians enjoy the same rights as Canadians who are resident here. They should face the same obligations as resident Canadians, including paying taxes, so that they share the responsibility of contributing, at least financially, to our country.

The United States is the only developed country that taxes its citizens on their global income irrespective of where they live or how long they have lived outside of the US. The constitutional validity of CBT has not been tested in Canada, but the 1924 US Supreme Court decision in the case of Cook v. Tait offers cogent reasoning about CBT that shows its validity under the US constitution. The decision relied on the inherent benefits received by US citizens and their property from the US government, regardless of where the citizens made their home or where their property was located.

Michael S. Kirsch of  the University of Notre Dame, in his seminal 2007 article “Taxing Citizens in a Global Economy,” argues for the same principle. Kirsch suggests that recent globalization trends strengthen, rather than weaken, the case for taxing US citizens living abroad. He concludes that modern advances in transportation and communication weaken the case for giving preferential treatment to income earned by citizens working abroad, in that these developments afford the expatriate US citizen virtually the same rights as that of a resident US citizen, such as personal protection, property protection, the right to vote and the right to enter.

The same can be said of expatriate Canadians. They are assured of guaranteed access to a safe, secure and stable society, virtually free world-class health care and education systems and, depending on income levels, affordable housing, irrespective of their length of stay (or lack thereof) in Canada. In addition, depending on the time spent in Canada, financial supports like Old Age Security and the Guaranteed Income Supplement are available to them. Anecdotal evidence suggests citizens are returning to Canada to enjoy these benefits after spending their productive lives elsewhere. This is a significant contingent liability for Canada, because citizenship — not contribution (or lack thereof) to our society — is the criterion for benefits and support.

Kirsch also discusses the need to maintain the cohesion of a society. In the absence of citizenship-based taxation, there is a strong tax-driven incentive for a not insignificant number of high-income and high-net-worth individuals to establish tax residence abroad in order to avoid income taxes. The creation of a separate class of citizens could have corrosive effects on broader society, just as it has done in other countries that rely only on residence-based taxation.

A Canadian passport facilitates visa-free travel and increased international mobility — and serves as a plan B, allowing these global citizens to return here when things get rough elsewhere.

There was a time when most immigrants to Canada came here to become citizens and settle permanently. Now, for a small but growing number, the objective is to acquire citizenship and leave again. A Canadian passport facilitates visa-free travel and increased international mobility — and serves as a plan B, allowing these global citizens to return here when things get rough elsewhere. But without CBT, they don’t help to finance the society they are counting on as a safe harbour.

There are also budgetary considerations underlying the adoption of a CBT system. Before the COVID-19 crisis, our economy was in great shape and able to generate sufficient government revenues to maintain a comfortable federal debt-to-GDP ratio of about 30 percent. Now we are in another world altogether. We are going to have the biggest budget deficit in the history of Canada, thanks to the biggest bailout packages ever for millions of Canadians and businesses. The public debt may exceed all previous peaks. While it is always optimal for a country to have an expanding tax base that is able to fund social programs and services or investments in infrastructure, defence and economic development, it has now become a necessity. With CBT, the tax base would include many more new taxpayers.

Changes to demographics, particularly the greying of our society, will only accentuate the need for higher government revenues, as these changes will result in substantial growth in demand for social services. Volatile global situations will increase the number of Canadians returning to safety (financial, health and/or physical) in Canada, also boosting the demand for government services.

One revenue option to meet these demands is to increase direct or indirect tax rates. The alternative is to shrink spending. Canadians seem to have no appetite for either of these options, especially in the current crisis. The Liberals in the recent past have raised taxes on the wealthy. But there is a limit to this approach.

The only viable alternative for enlarging the revenue stream in order to maintain adequate service delivery to citizens is to expand the taxpayer base. This is why the idea of CBT is so appealing. The government should examine CBT’s feasibility, including the potential contingent liability and revenue, plus enforcement and international tax agreement issues. The financial burden and responsibility of meeting the needs of all Canadians should be shared by all citizens. It is the equitable thing to do.

Source: Canada needs to start taxing Canadians who live abroad

Andrew Caddell, in his overview Opinion: The post-COVID Canada faces many challenges The post-COVID Canada faces many challenge includes a throwaway line which is completely silent on these complexities:

Governments will have to get out of debt without crushing the economy, or Canadians. This will require creative ways of raising taxes. One possibility would be a two per cent increase in the GST to seven per cent: that would generate $90-billion over five years. Second, the three million Canadians abroad should contribute, through a 10 per cent tax on income; that could bring in at least $30-billion per year. Third, tax havens for Canada’s wealthiest have to be closed, and that money taxed.

Filed under Citizenship Tagged with , , , ,

Opinion: U.S. Must Avoid Building Racial Bias Into COVID-19 Emergency Guidance

2020/04/23 Leave a comment

Another angle and concern regarding racial disparities in healthcare:

Across the United States, we are seeing alarming statistics about the disproportionate toll of COVID-19 on Latino and black people. In New York City, the New York Times tells us, coronavirus is twice as deadly for these minorities as for their white counterparts. In both Chicago and Louisiana, black patients account for 70% of coronavirus deaths, even though they make up roughly a third of the population.

At Massachusetts General Hospital, where we practice, an estimated 35% to 40% of patients admitted to the hospital with the coronavirus are Latino — that’s a 400% increase over the percentage of patients admitted before the outbreak who were Latino.

In the emergency room, conversations about a patient’s end-of-life wishes are taking place in broken Spanish, seconds before they get intubated. In the intensive care unit, doctors barely have time to update family members, because they’re too bogged down by patient-care tasks to call an interpreter. For patients healthy enough to go home, our usual script around social distancing falls short, as many of our black and Latino patients are unable to self-isolate within large multigenerational households. In addition, many of these patients either are essential workers or live with one — they cannot simply “stay home”.

In a pandemic that has stretched U.S. health care resources thin, it’s not surprising to see a worsening of already existent health care disparities. Several states and organizations have started to release Crisis Standards of Care guidelines in recent weeks — these are meant to help hospitals ration critical resources like ventilators and intensive care unit beds, if and when the need is dire.

The overall aim of such guidelines, which can vary in their specifics from state to state and hospital to hospital, is to allocate limited resources to the people who are most likely to benefit from them.

To determine which patients get priority in treatment, several of the CSCs published so far, such as guidelines from Colorado and Massachusetts, recommend that the hospital use frameworks that include the patient’s age and “SOFA” score (a measure of how critically ill the patient is at arrival, based on objective laboratory values). Importantly, they also include what we doctors call “comorbidities” — other, underlying medical conditions that can put patients who are infected with this virus at a higher risk for worse outcomes.

We know that historically disadvantaged populations — including black and Latino patients — have a higher burden of the comorbidities traditionally used by hospitals to stratify patients by risk. This is largely because of structural and socioeconomic factors. Studies and statistics suggest that, compared to their white counterparts, black patients are 40% more likely to have high blood pressure, twice as likely to have heart failure, three times as likely to die from asthma-related complications, three times more likely to have chronic kidney disease, twice as likely to be diagnosed with colon and prostate cancer, and represent 44% of the HIV positive population. Similarly, Latino patients are twice as likely to both have and die from diabetes, and twice as likely to have chronic liver disease than non-Hispanic whites.

Although the foundational principle of Crisis Standards of Care guidelines are utilitarian and aim to benefit the greatest number of people while treating “individual cases fairly,” a system that penalizes on the basis of comorbidities will undoubtedly and unfairly penalize the populations that are already more vulnerable to those conditions.

Furthermore, given the novelty of COVID-19, we still don’t have a complete picture of which factors lead to worse outcomes. While some data suggest that patients with severe COVID-19 are more likely to have hypertension or respiratory or cardiovascular illnesses, there are also findings suggesting that men have more severe disease than women. Yet, the Crisis Standards of Care are not factoring sex into their scoring system. This means that we are arbitrarily choosing metrics to guess which patients will do better, and we’re doing so at the expense of populations that have historically been marginalized by the health care system.

COVID-19 is already affecting and killing a disproportionate number of black and Latino patients across the United States. Using comorbidities as a proxy for disease severity to allocate resources, without taking into account race and ethnicity, will almost certainly mean that racial and ethnic minorities will be placed in the “back of the line” for critical care resources.

In order to do the greatest good for the greatest number of people ethically and fairly, standards of care must be informed by the existing inequalities in our country.

While we’re not suggesting that comorbidities be removed from crisis standards of care altogether, we urge states to reevaluate current guidelines and include only major comorbidities with a known short-term impact on a patient’s prognosis.

States should also track and make publicly available demographic data — including race and ethnicity — for patients hospitalized with COVID-19 in order to ensure that people of color are not being denied resources disproportionately. Lastly, states should ensure that the committees designing crisis standards of care are composed of a racially and ethnically diverse group of individuals in a way that is representative of their population.

It was devastating enough to have to tell my African American patient’s young son that his dad’s illness was so life-threatening we needed to place a breathing tube down his throat and send him to the intensive care unit. I can only imagine how he would feel if, in some unfortunate circumstance, we would have to tell him that his father would need to be taken off the ventilator to conserve resources.

Dr. Jossie Carreras Tartak and Dr. Hazar Khidir are residents in Emergency Medicine at Massachusetts General Hospital in Boston.

Source: Opinion: U.S. Must Avoid Building Racial Bias Into COVID-19 Emergency Guidance

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Ibbitson: Neither the United States nor Canada can afford to ban immigration

2020/04/23 Leave a comment

As some have noted, this is more of a rhetorical argument than substantive, as the debate, at least in Canada, will be more with respect to levels and the mix of programs than a ban (which Trump will continue to talk about for political purposes):

However, Ibbitson is a bit too optimistic that Canada will automatically go back to the current immigration plan and a bit too accepting on the general demographic arguments without considering the expected impact of AI and automation.

Posing options as closing doors or returning the current immigration plan and levels is a false choice as the reality for Canada, I expect, will remain towards open immigration but with some adjustments once the medium-term effects of COVID-19 work through the economy:

The tweet may simply have been a bit of raw meat for his base. But if Donald Trump really does plan to ban all immigration into the United States, that would be the worst act of his presidency, which is saying something.

Banning immigrants would amplify one of the most important demographic trends of our time: declining fertility rates among millennials and Gen Z. Babies who are not being born must be replaced with people brought in from abroad. The inevitable alternative is increased joblessness and economic decline. This is as true for Canada as it is for the United States.

The U.S. President tweeted Monday night that “in light of the attack from the Invisible Enemy, as well as the need to protect the jobs of our GREAT American Citizens, I will be signing an Executive Order to temporarily suspend immigration into the United States!”

On one level, the tweet in nonsensical. Most countries have closed their borders as they grapple with this pandemic. Until the novel coronavirus is brought under control one way or another, both Canada and the United States will be largely closed to immigration.

But once economic life returns to something approaching normal, then not only will immigration need to return to previous levels – currently 340,000 a year in Canada’s case; traditionally more than one million a year in the case of the United States – they should be increased to make up for the immigrants who should be arriving today but aren’t.

“We desperately need immigration,” said Benjamin Tal, deputy chief economist of the Canadian Imperial Bank of Commerce, in an interview. “We are an aging society that in 10 or 15 years will be totally dependent on immigrants that we are getting now.”

That Canadian fertility rate declined from 1.6 children per woman in 2010 to 1.5 last year, while in the United States it fell to 1.7, far below the 2.1 needed to keep a population stable. Fertility rates have been below the replacement rate in most developed countries for decades, which is why immigration is required for population growth.

But in recent years, a new trend has emerged. The birth rate for millennials and Gen Z is lower than it was for Gen X and the baby boomers. A study by Ron Kneebone, a professor of economics at University of Calgary, showed that fertility levels for Canadian women under 30 declined significantly between 2000 and 2017.

Citing correlations between past economic downturns and fertility, Prof. Kneebone strongly suspects that the current economic crisis will lower Canada’s birth rate even further. “When I’m uncertain whether I’m going to keep my job and be able to pay the mortgage, is this the time to be having another kid? Probably not,” he said in an interview.

And, as he points out, countries with low fertility, little immigration and declining populations struggle to preserve economic growth. Just ask Italy or Japan.

Mr. Trump has played to nativist sentiments throughout his presidency. The fabled wall on the Mexican border, banning visitors from certain Muslim countries, suppressing immigration levels overall – these are policies designed to appeal to Americans who fear their white, Christian culture is being overwhelmed by foreigners.

In that context, Monday’s tweet should be seen not as an update on pandemic border control but as a racist reassurance to his MAGA base.

But restricting immigration would be disastrous for the United States. One-quarter of all health care workers in the U.S. are immigrants. They account for half of all the entrepreneurs whose startups grew to be worth US$1-billion or more. They account for almost 40 per cent of U.S. Nobel Prize winners.

The American health care system and the American economy depend on immigrants. By stoking anti-immigrant sentiments, Mr. Trump is threatening the future of both.

Polls show that most Canadians continue to support the high level of immigration that this country has enjoyed under both Conservative and Liberal governments for three decades. But Quebec Premier François Legault has reduced the number of immigrants coming into the province and has said he may reduce the level even further in the wake of the pandemic.

That’s a policy for economic suicide. When the borders reopen, Canada should increase its immigration target above next year’s goal of 350,000. Every immigrant we don’t bring in this year and next is an opportunity lost for Canada’s future, unless we make it up further on.

Neither the U.S. nor Canada can afford to close its doors.

Source: Opinion: Neither the United States nor Canada can afford to ban immigration

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Toronto public health to start collecting COVID-19 data on race in a bid to track health inequities

2020/04/23 Leave a comment

Other cities and provinces to take note:

Toronto’s public health unit will expand its data collecting capabilities so that it can better assess the pandemic’s impact by race and income, the Star has learned.

The aim is to assess whether there are disparities in how COVID-19 is impacting some communities — an initiative the city is shouldering because “provincial officials suggest this is not a priority concern for them,” according to a letter from Toronto Board of Health chair Joe Cressy to board members, expected to be made public Wednesday.

“We know that the biggest indicator of one’s health status is their postal code — not because of where we live, but because of what it can say about who we are,” the letter says.

“This makes it clear just how important it is that we have access to comprehensive data.”

Ontario has drawn criticism from health advocacy groups for not collecting statistics on race and ethnicity after the province’s chief medical officer, David Williams, said earlier this month this kind of data collection isn’t currently necessary.

A 2016 government report on health inequities — authored by Williams — highlights the role factors like race and income play in determining health, and notes the importance of “data to understand health inequities and inform community development efforts.”

“To create healthy communities, it’s time for the public health sector in Ontario to champion health equity: to bring a wide range of partners together to develop policies and programs that reduce or eliminate social, economic and environmental barriers to good health,” the 2016 report said.

Early evidence from the United States shows Black and Hispanic communities have been disproportionately impacted by the COVID-19 pandemic. Preliminary data released by New York City last weekshows the virus is killing Blacks and Latinos at twice the rate of white people.

In a statement to the Star, a spokesperson for Ontario’s Ministry of Health said existing legislation does not “require or authorize health information custodians to collect race-based data.”

“Health was excluded from the Anti-Racism Act due to Personal Health Information Protection Act considerations,” the statement said.

“The ministry wants to understand issues of inequity, in terms of how the coronavirus pandemic and pandemic response may affect subgroups of the population differentially and is researching using data from other sources to better understand equity issues.”

In an interview with the Star, Cressy called the province’s response to the issue “flabbergasting.”

“This shouldn’t be groundbreaking. Nor should it even be necessary,” he said of the measures now being taken by the City of Toronto.

“It’s absolutely essential, as it has always been, that we have comprehensive data to fully understand and in turn respond to COVID-19. In the absence of appropriate disaggregate race-based data, we cannot properly respond.”

As a result, Cressy said, Toronto Public Health is now exploring ways to expand data fields in its current system — known as the Coronavirus Rapid Entry System — to include race and sociodemographic data.

Cressy said an early analysis cross-referencing the geographic location of early positive COVID-19 diagnoses with census data didn’t find concerning trends — but noted that initial cases often involved individuals returning from international travel who tend to have higher incomes.

“There are two stories to this pandemic. The first was early travel-related cases. And the second is how COVID-19 preys on the most vulnerable,” he said.

Steini Brown, the dean of the Dalla Lana School of Public Health, said low-income Ontarians are “now at a higher risk of infection and cases.”

“If you look into the evidence from the U.S., there are a variety of factors about who people are that are very strongly associated with their likelihood of getting the infection,” he said.

Research has already shown that the workers deemed essential to maintaining the country’s vital supply chain during the pandemic are significantly more likely to be low-wage and racialized compared to the rest of the labour market.

Source: Star ExclusiveToronto public health to start collecting COVID-19 data on race in a bid to track health inequities

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Fewer than 10 asylum seekers sent back to U.S. since Canadian border shutdown: Blair

2020/04/22 Leave a comment

As expected. Full April stats, when available in about a month, will show a dramatic decline in overall numbers:

The federal public safety minister says fewer than 10 asylum seekers have been turned back to the U.S. since the historic shutdown of the border.

Bill Blair provided the figure to the House of Commons today, noting it has been almost a month since the Canada-U.S. border closed to all but non-essential travel to help curb the spread of COVID-19.

The deal struck by the two countries included a provision that those crossing between formal border points in order to seek asylum would also be turned back.

Figures published today by the Immigration Department suggest, however, that the flow of people prior to that remained relatively steady.

The RCMP intercepted 930 people crossing irregularly in Canada in March, down from 1,002 the same month last year.

So far this year, 3,035 people have been intercepted crossing between formal border points, up from 2,698 in the first three months of 2019.

Source:  Less than 10 asylum seekers sent back to U.S. since Canadian border shutdown: Blair – National

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Trump says he will suspend all immigration into U.S. over coronavirus

2020/04/22 Leave a comment

Not terribly surprising given that has always been his intent and that of his senior policy advisor and anti-immigration hawk, Stephen Miller. Details yet to come:

President Donald Trump said on Monday he will suspend all immigration into the United States temporarily through an executive order in response to the coronavirus outbreak and to protect American jobs.

The move, which the Republican president announced on Twitter, effectively achieves a long-term Trump policy goal to curb immigration, making use of the health and economic crisis that has swept the country as a result of the pandemic to do so.

The decision drew swift condemnation from some Democrats, who accused the president of creating a distraction from what they view as a slow and faulty response to the coronavirus.

Trump said he was taking the action to protect the U.S. workforce. Millions of Americans are suffering unemployment after companies shed employees amid nationwide lockdowns to stop the contagion.

“In light of the attack from the Invisible Enemy, as well as the need to protect the jobs of our GREAT American Citizens, I will be signing an Executive Order to temporarily suspend immigration into the United States,” Trump said in a tweet.

The White House declined to offer further details about the reasoning behind the decision, its timing, or its legal basis.

“As our country battles the pandemic, as workers put their lives on the line, the President attacks immigrants & blames others for his own failures”, former Democratic presidential candidate Amy Klobuchar said in a tweet.

Immigration is largely halted into the United States anyway thanks to border restrictions and flight bans put in place as the virus spread across the globe.

But the issue remains an effective rallying cry for Trump’s supporters.

Trump won the White House in 2016 in part on a promise to curb immigration by building a wall on the U.S. border with Mexico. He and his advisers have spent the first three years of his tenure cracking down on both legal and illegal entries into the country. Crowds regularly chant “Build the Wall!” at Trump’s political rallies, which are now idled because of the virus.

Trump has lamented the economic fallout of the outbreak; his stewardship of the U.S. economy was set to be his key argument for re-election in November.

The U.S. death toll from the virus topped 42,000 on Monday, according to a Reuters tally.

The U.S. economy has come to a near standstill because of the pandemic; more than 22 million people applied for unemployment benefits in the last month.

“You cut off immigration, you crater our nation’s already weakened economy,” former Democratic presidential candidate Julian Castro said in a tweet. “What a dumb move.”

The United States has the world’s largest number of confirmed coronavirus cases, with more than 780,000 infections, up 27,000 on Monday.

But the president has made a point of saying the peak had passed and has been encouraging U.S. states to reopen their economies.

“It makes sense to protect opportunities for our workforce while this pandemic plays out,” said Thomas Homan, Trump’s former acting director of U.S. Immigration and Customs Enforcement. “It’s really not about immigration. It’s about the pandemic and keeping our country safer while protecting opportunities for unemployed Americans.”

The United States in mid-March suspended all routine visa services, both immigrant and non-immigrant, in most countries worldwide due to the coronavirus outbreak in a move that has potentially impacted hundreds of thousands of people.

U.S. missions have continued to provide emergency visa services as resources allowed and a senior State Department official in late March said U.S. was ready work with people who were already identified as being eligible for various types of visas, including one for medical professionals.

The administration recently announced an easing of rules to allow in more agricultural workers on temporary H2A visas to help farmers with their crops.

Source: Trump says he will suspend all immigration into U.S. over coronavirus

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