In early April, when Esmeralda*, a 24-year-old woman living in Chelsea, started feeling sick, she was too scared to be tested for COVID-19.

Her temperature spiked. She felt dizzy and was unable to breathe. But Esmeralda, whose mother sent her from El Salvador to escape gang violence seven years ago, was afraid to seek medical treatment because she worried it would derail her asylum application.

“There have been many times when I have been scared to get medical care,” said Esmeralda through a translator. “I’m afraid I won’t be able to pay for the medical care and this will lead me to being flagged for not being able to pay bills. I’m always afraid I will get put on a list many times when it comes to medical care.”

But after 10 days of pain, Esmeralda — who lives with her husband and two children — was rushed to Cambridge Health Alliance Hospital in Everett when, in bed one night, she started having trouble breathing. She was tested, and a few days later, her results came back positive for COVID-19. Her doctors told her she also had pneumonia.

It has taken her weeks to fully recover, but she has returned to studying for her GED and her poetry, which she writes daily, to help deal with the trauma.

Many immigrants in Chelsea and across the state, both with and without documentation, are not seeking medical care or testing for the coronavirus due to deep fear and distrust of government entities. Undocumented immigrants fear questioning and detention by Immigration and Customs Enforcement (ICE) officials at medical facilities, while those with documentation avoid treatment because they believe relying on public programs, like MassHealth, will endanger their immigration status.

“People are very afraid of the virus. Everybody here knows people who have had it, who have been very ill with it, so there’s a lot of fear,” said Dr. Audrey Provenzano, a physician at Massachusetts General Hospital’s Chelsea HealthCare Center. “But there’s also fear about accessing care among the patients in the community, particularly immigrant patients.”

Chelsea — a largely working class, immigrant community — has one of the highest rates of coronavirus infection in the state, city officials say. As of June 12, there have been 2,845 confirmed cases and 148 deaths within the city’s two-and-a-half square miles.

Sunindiya Bhalla, who runs the young mothers program at the Chelsea nonprofit Roca, said Esmeralda’s experience is not unique. She described the plight of a 17-year-old mother from El Salvador who contracted the coronavirus and resisted testing out of fear of endangering herself and her family.

The teenager, who lives in Chelsea with her 19-year-old partner, their newborn baby and 11 other family members, faced weeks of harassment at home from her family to make rent contributions. With little food to feed herself, let alone to support breastfeeding, she went back to work and became sick in late April.

It took Roca members a week to convince her to get tested, Bhalla said.

“This family is scared of ICE. … She didn’t want to get tested for fear her name would be put on a list,” Bhalla said. "If she was the one who got tested, she was afraid she’d get kicked out of the house.”

“It’s not anything the city [of Chelsea] or the health centers have done,” Bhalla added. “They’ve made it as clear as possible that there will be no impact.”

The All-Encompassing Fear Of ICE

Those working in Chelsea say many in the community are facing similar situations.

“For many people who are undocumented — unauthorized immigrants — there is a huge fear of being reported to ICE somehow when being in [a] public place like a clinic,” Provenzano said.

Previous reports of ICE officers detaining undocumented immigrants in courthouses and hospitals have frightened many potential patients, Provenzano said.

“There’s just a lack of trust because the agency, at least by reputation, is hostile,” she said.

ICE officials released a statement that said, “During the COVID-19 crisis, ICE will not carry out enforcement operations at or near health care facilities, such as hospitals, doctors' offices, accredited health clinics, and emergent or urgent care facilities, except in the most extraordinary of circumstances. Individuals should not avoid seeking medical care because they fear civil immigration enforcement.”

Yet misconceptions about the intentions of ICE and U.S. Citizenship and Immigration Services persist. Experts in Chelsea pointed to barriers with language translation and technology access in relaying the message that testing will not threaten immigrants.

Medical professionals are also trying to ease apprehension toward seeking care.

Dr. Audrey Provenzano, M.D. M.P.H., poses for a portrait outside of Massachusetts General Hospital Chelsea in Chelsea, Mass. on June 12, 2020.
Meredith Nierman WGBH News

Dr. Jose Abrego, medical director at the Beth Israel Deaconess Chelsea clinic and walk-in testing site, said he tells his patients, “We really are not interested in immigration status or insurance. This is a free test.” The only information he requires is a name, phone number and a postal address to mail results to.

“There is no reason why someone should not come to get tested,” Abrego said.

During almost every shift, Provenzano repeatedly reassures her patients that their care will not jeopardize their legal status.

“For our patients who are already so vulnerable, it’s really hard to trust in the system when it traditionally has thrown up so many barriers to them being able to access services,” she said. “There’s just a lot of fear, and that’s hard to recover from.”

The Safe Communities Act

A bill pending on Beacon Hill aims to heal the rift between authorities and immigrant communities and encourage more undocumented immigrants to come forward for testing and treatment.

The Safe Communities Act, first introduced in 2015 and previously known as the Trust Act, would prevent law enforcement and court officials from asking immigrants about their status and informing ICE, unless legally required. It would also prohibit local law agencies from acting on behalf of federal ICE agents.

With these protections in place, officials hope to decrease the fear of reaching out for help.

“During this public health crisis, it's critical to pass the Safe Communities Act to send a loud message to immigrant communities that they do not have to fear. They can seek healthcare, testing, and services with safety and security,” said Rep. Liz Miranda, co-sponsor of the House bill along with Rep. Ruth Balser. “Action on Safe Communities is more critical than ever now, for the powerful message of safety and security it will send immigrants.”

Sen. Jamie Eldridge, the Senate bill's sponsor, said it will “draw a bright line” between state law enforcement and federal immigration officers.

“Let’s make sure Massachusetts’ values aren’t aiding and abetting the Trump administration,” he said.

Those who oppose the bill say it would hinder the ability of law enforcement to protect citizens and want State Police to continue enforcing federal policy. Gov. Charlie Baker voiced his opposition to the bill in a 2017 statement, saying he feared it would make "the Commonwealth a sanctuary state.”

One in six Massachusetts residents are immigrants, and the number of undocumented immigrants living in the state is estimated to be between 173,000 and 250,000. According to 2018 American Community Survey data, immigrants comprise 20 percent of the state’s workforce, mainly in low-paying jobs that can’t be done remotely in the hospitality, transportation and healthcare sectors.

The House bill is with the Joint Committee on Public Safety and Homeland Security. The reporting date has been extended to July 15 to give committee members more time to consider it before voting. If the committee votes to approve it, it will likely go to the House Ways & Means Committee, said Balser, and from there, if approved, to the House floor.

Balser said she is hopeful that the committee will support it, and that lawmakers will vote on it this session. Eldridge said he is optimistic that this session — the bill’s fourth — will see its passage and the legislation can form a vital part of COVID-19 relief for immigrant communities.

Anxiety Over ‘Public Charges’

While the Safe Communities Act, if passed, may build trust among undocumented immigrant communities, it won’t address “public charge” fears preventing green card applicants and visa holders from seeking treatment and claiming financial aid during the pandemic.

A “public charge” is a non-citizen who uses some form of public assistance funded by the government, typically related to healthcare, housing or food.

On the eve of the pandemic, the Trump administration rolled out new rules that said immigrants who use public benefits — including Section 8 housing assistance and Supplemental Nutritional Assistance Program (SNAP) benefits, also known as food stamps — may be refused permanent legal status. Ken Cuccinelli, the acting deputy secretary of the Department of Homeland Security, said at the time the rule codifies the long-standing principle of self-sufficiency in immigration law.

Healthcare coverage for testing and treatment related to COVID-19 under MassHealth and Medicaid is exempt from the public charge test. But many immigrants have a difficult time trusting this, medical professionals say.

“Even before the coronavirus started happening, we definitely saw a drop-off in patients accessing care because they were very afraid of not being able to move forward with some kind of immigration process in the future if they used the insurance,” Provenzano said. Most of her patients use MassHealth or Medicaid, she said.

In Massachusetts, all residents who are tested and treated for coronavirus are covered, regardless of insurance or immigration status. Unemployment insurance payments are also exempt from the public charge test. Public charge restrictions do not apply to green card holders, people renewing their DACA status or those applying for Temporary Protected Status.

U.S. Citizenship and Immigration Services said in a statement they will not include benefits received for testing, treatment or eventual vaccination for COVID-19 in any green card or visa review process. Instead, they said, USCIS will “take all such evidence into consideration” as they review case files.

But as trust between the community and authorities continues to erode, it’s difficult to convince people that there will be no repercussions to seeking medical care.

“It’s lingering fear from what has been going on for months that is heightened by anxiety, fear of separation from their children and the stigma of being tested positive,” said Bhalla of the Chelsea nonprofit Roca.

The front entrance of the Chelsea, Mass. nonprofit Roca.
Meredith Nierman WGBH News

Esmeralda, the young mother and student who has been working with lawyers for months to gain legal status in the United States after years of sexual abuse and commercial exploitation, has hesitated to claim benefits she is eligible for because she doesn’t want it to hurt her asylum case.

“I have had moments in the past where I have not been comfortable doing things like seeking public benefits because of public charge,” she said.

Reassurances about the government also mean little to Griselda Paiz, 35, from El Salvador, who is living in Chelsea with her two children and husband and pregnant with her third child. She and her husband are undocumented and frightened to leave the house, even to visit a doctor.

“The president only helps people who have status or [are] a citizen,” Paiz said.

She said she believes she and her immediate family have not contracted the virus, but her husband’s uncle died of COVID-19. If she were to get sick, she would get medical help, Paiz said. Her husband says if he got sick, he would refuse medical care.

Paiz said she is afraid to apply for benefits that might protect her and her family from the virus, like food stamps and rent assistance.

“If you apply, you’re always thinking, what will happen?” Paiz said. “You don’t know if it’s going to go against you. We don’t know how things will end up.”

*The name Esmeralda is a pseudonym. WGBH News agreed to not use her real name to protect her identity as she moves through the asylum process.

Catherine McGloin is a freelance journalist, former editor-in-chief of the Scope and Poynter fellow, based in Boston. She can be reached on Twitter @catmcgloin.