Monday, August 25, 2014
Will immigrants make you sick?
The current immigration “problem” has got people fired up. Protesters are yelling at buses full of American kids, accusing undocumented child immigrants of every imaginable ill deed, from stealing jobs to using scarce resources to spreading disease.
The first 2 can be argued, the last not so much. Travelers from abroad can bring in some unpleasant illnesses whether or not they are immigrants. The actual risk is has been mendaciously bantered about by some politicians.
Two factors have already lowered borders that once held back the spread of some infections: rapid global travel and trade, and climate change. Global travel helped spread the HIV virus, and trade brought West Nile virus to the U.S. Trade can also spread food-borne illnesses like infectious diarrhea, but so can domestic foods. Few would argue that travel and trade should be eliminated as a method of disease control, although we can certainly develop precautions based on experience. Climate change is helping nasty diseases such as Dengue fever and chikungunya make their way into the U.S., and other than closing the borders completely it’s not clear to me how halting immigrant children at the border helps mitigate the danger.
Screening immigrants for vaccine-preventable diseases is a good policy and allows for vaccination for susceptible people, however many recent outbreaks of diseases like measles and mumps have been imported by Americans traveling abroad and returning to communities with poor vaccination rates. Vaccination of Americans is a priority for both domestic and imported risks.
Dr. Marc Siegel’s piece on the Fox News website is typical of the hyperbolic and frankly incorrect, ignorant, and inflammatory rhetoric from the right. He harkens back to the early 20th century when immigrants were excluded from the country for medical reasons. No doubt many of these were good choices, but disease was an excuse often used by nativists and eugenicists to exclude ethnic groups they disliked. The Johnson Immigration Act of 1924 leveled fines against steamship lines that allowed in “any alien afflicted with idiocy, insanity, imbecility, feeble-mindedness, epilepsy, constitutional psychopathic inferiority, chronic alcoholism, tuberculosis in any form, or a loathsome or dangerous contagious disease.”
That’s pretty broad and open to a lot of subjective judgment.
Siegel calls out some specific diseases he thinks Central American immigrant children are importing. Scabies is an unpleasant skin disease caused by small mites that burrow into the skin. It’s relatively common in the U.S., especially among people living in crowded and un-hygienic conditions, but it is not confined to any particular socio-economic class. It requires prolonged skin-to-skin contact for transmission, but can also be transmitted from inanimate objects. The mites can only live for a few days off the body, so object-to-person transmission (“fomites”) is not very efficient.
He also calls out drug-resistant tuberculosis. This dangerous disease is thankfully still relatively rare in the U.S. Imported cases are a concern, but Central America is not a hotbed of TB.
Scabies and TB are most efficiently spread in crowded conditions, like those immigrants are held in if not sent out into the general population. Keeping immigrants confined increases the risk of these diseases.
Siegal also mentions a few vanishingly rare diseases such as Hansen’s Disease (leprosy), another not-easily spread infection.
Ignorant and/or mendacious accusations like these inflame fears and hatred but do little to help prevent the spread of infectious diseases. Most of these diseases are social, not individual problems and require social solutions. One of these is to completely close our borders to immigration, travel and trade. Since this is insane, a better policy is to screen recent immigrants for important contagious diseases and see that they get vaccinations and proper treatment, including, if needed, isolation from crowded centers. Educating and vaccinating our own people is also essential.
Disease is a lousy excuse for excluding whole classes of people entering the U.S. and fanning those flames simply incites fear and hatred.
Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog at Forbes. His blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.
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