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Rivera Perla ’15 MD’22: Naturalization is a COVID-19 public health intervention

My phone vibrated with text after text in my scrubs’ top pocket as I placed a hidden stitch under the surface of my patient’s skin. It was June 18, 2020 and I knew the rush of notifications meant that the Supreme Court had ruled on the Deferred Action for Childhood Arrivals program. I put aside my racing thoughts and continued suturing despite the fact that right then, mid-stitch, mid-pandemic and in my third year of medical school, my ability to be a daughter, sister, partner and physician in the country I call home was in jeopardy once again. To my relief, the Supreme Court ruled to keep DACA, meaning that as a DACA recipient myself, I would be able to continue to pursue my career as a future surgeon, for now. However, in the midst of the COVID-19 pandemic, it is time we recognize documentation status as more than just an immigration issue; it is a key determinant of health that will continue to impact the country for decades to come. France, for example, has already awarded citizenship to hundreds of COVID-19 frontline workers. It’s time the United States follows suit. 

The COVID-19 pandemic in the United States has unmasked many inequities in access to financial relief, testing and primary care, with undocumented individuals among those most disproportionately affected. Since undocumented immigrants are ineligible for unemployment benefits, many have had to continue to work and face a higher risk of exposure to COVID-19. Increasingly prevalent are the fears of seeking medical care due to cost, risk of deportation and  the Public Charge rule, which states some individuals may be denied legal status in the future if they use public services. This should alarm you. The health of undocumented Americans is inextricably intertwined with the health of all Americans. This has always been the case; from farm workers to teachers, housekeepers, scientists, restaurant workers, artists and caregivers, allowing undocumented individuals access to public services to protect them from the coronavirus is integral to the advancement of American public health. Never has this been more apparent than during the current COVID-19 pandemic, where an infection of one means a risk for many more. 

Since the start of the pandemic, health care workers have been at the front lines amid the chaos, ready to do whatever is in their power to protect civilians. This includes about 200 DACAmented medical students, residents and physicians and 30,000 DACAmented health care workers. It is estimated that if physician and physician-trainee DACA recipients were to stay permanently in the United States, they would collectively care for 1.7 to 5.1 million Americans over the course of their careers. This impact is even greater if we include the potential contributions of many more undocumented individuals who are non-DACA recipients. In the midst of a projected 54,100-physician shortage by 2033 compounded by COVID-19-related physician burnout, creating a permanent path to citizenship for all undocumented Americans is a necessary public health intervention. 

Unfortunately, many Americans oppose amnesty, as they believe it will naturalize a group of people who may compete for government services and drain the economy. However, before the pandemic, undocumented workers contributed $11.7 billion a year in taxes. Since the start of the pandemic, one in six undocumented workers has lost their job in New York City; many undocumented individuals work “under the table” or without contracts, thus making them particularly vulnerable to job loss. Naturalization would provide opportunities for professional development that would inevitably augment economic contributions both long term and in the midst of a pandemic. The last U.S. amnesty program, the 1986 Immigration Reform and Control Act under President Ronald Reagan, naturalized approximately 2.7 million people and led to upward mobility for 48 percent of naturalized men by 1992. In another example of note, France’s recent accelerated naturalization program includes not just health care workers, but also business owners, cleaning staff and other essential workers. A similar policy is urgently necessary in the United States, where the COVID-19 pandemic has exposed a dire need for essential workers. Comprehensive immigration reform would stimulate the economy and strengthen this indispensable workforce. 

Undocumented immigrants have dedicated their service to this country even while under the constant threat of deportation. Naturalization will curb the effects of the pandemic and augment their financial contributions to the United States. Since the Supreme Court’s ruling in June, my feelings of relief have made way for hope: a hope that one day, the uncertainty will fade and my future as a surgeon, as well as the future of all undocumented individuals, will become more secure. It’s time for a permanent solution — the health of the country depends on it. 

Krissia Margarita Rivera Perla ’15 MD’22 can be reached at Please send responses to this opinion to and op-eds to



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