The Trump administration’s crackdown on immigration could scare their communities from seeking out care for coronavirus, potentially hastening the spread of a deadly outbreak that’s growing rapidly in the United States, advocates and public health groups are warning.

Those serving immigrant populations have reported significant drop-offs in immigrants seeking health care during Donald Trump’s presidency over fears of his administration’s tough enforcement measures. Immigration advocates and health care providers in some parts of the country say there are signs the novel coronavirus is already spreading in immigrant communities, intensifying efforts to fortify the populations against the highly contagious disease.

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Marco Trujillo, who handles immigrant outreach for a health care coalition in Cincinnati, says he’s fielded questions on coronavirus from dozens of people in the past few days. At least two of those people told him they had symptoms consistent with the virus but refused his pleas to contact a doctor.

“They didn’t want to go to the hospital because they are afraid, because of their immigration status," said Trujillo, a member of Cincinnati’s Central Community Health Board. “They don't even want to give their information to a doctor.”

Democrats have steadily warned that Trump’s immigration policies could undermine efforts to detect and stamp out the virus that’s effectively shuttered large sections of American life. Joe Biden in Sunday night’s Democratic debate, decrying Trump’s policies, said even “xenophobic folks” should want undocumented immigrants to seek out care for coronavirus without fear of deportation.

“It’s even in their interest that that woman come forward or that man come forward because it deals with keeping the spread from moving more rapidly,” Biden said.

Mary’s Center, a Washington-area health care nonprofit predominately serving Latino immigrants, said it’s starting to see potential cases of coronavirus among its patients, though it’s still awaiting results on the limited number of tests they’ve run. Executive Director Maria Gomez said she’s less concerned the center’s patients will be afraid to access care — the center is known and trusted in the immigrant community — and worried more about economic upheaval that’s already affecting their hourly wage jobs.

She worries pressures to stay employed and avoid scrutiny of immigration officials will push immigrants to keep working even if they’re infected, increasing the chance of spreading coronavirus to others.

“How will they pay the rent?” Gomez said. “They’re afraid to go get any help now because they were just working very hard to make ends meet.”

Some lawmakers have called on Immigration and Customs Enforcement to suspend immigration raids and arrests around hospitals and medical clinics amid the outbreak. The immigration enforcement agency, responding to concerns around coronavirus, said it "does not conduct operations at medical facilities, except under extraordinary circumstances."

Public health experts say fears of seeking out care are very real among immigrants — and theclinicianswho serve them. Jennifer Nuzzo, an epidemiologist who studied a 2018 outbreak of mumps in an immigrant community in Pennsylvania, found the outbreak was exacerbated by dozens of people who were undocumented immigrants and legal immigrants without insurance avoiding medical care. Doctors in the area also hesitated to order lab tests or report potential cases out of concern their patients could be reported to immigration authorities.

“The doctors had no intention of collecting immigration status, but they were nonetheless conflated with other government officials who did,” said Nuzzo, an associate professor at John Hopkins University’s Center for Health Security. “That made it difficult for public health workers to learn how many cases there were and who had the disease.”

Democratic officials meanwhile have also pushed the Trump administration to halt a new measure that could make it harder for legal immigrants to get a green card if they’ve used — or are deemed likely to use — safety net programs like Medicaid or food stamps. The revised so-called public charge rule, which the Supreme Court allowed to take effect last month, had a chilling effect on legal immigrants seeking out care before it even took effect, advocates say.

CDC Director Robert Redfield in Capitol Hill testimony last week acknowledged concerns raised by Democratic lawmakers that the public charge rule could discourage immigrants to get care. But other Trump administration officials have tried to tamp down those concerns.

The Department of Homeland Security's immigration agency over the weekend updated its public charge webpage with an alert that "encourages" all immigrants with Covid-19 symptoms to seek medical care and said it won't count against their legal status. Still, the guidance — which was promised to lawmakers by Ken Cuccinelli, an immigration hardliner who heads the United States Citizenship and Immigration Services — notes that immigration officials must continue to look act use of certain public benefits, including "those that may be used to obtain testing or treatment for COVID-19" when they're making a decision about a person's legal status.

An agency spokesperson also said the policy isn't meant to discourage immigrants from seeking necessary care — although immigration advocates and health clinics have long said that’s a clear effect of the rule.

The Trump administration had estimated 77,000 people were likely to forego Medicaid because of the public charge rule, but health experts predicted millions of people may drop public benefits out of fear they fall under stricter guidelines. Nearly half of the nation’s community health centers reported immigrants were refusing to enroll in Medicaid and some even dropped coverage amid confusion about the public charge rule, according to a survey from the Kaiser Family Foundation last fall.

Some immigration advocates say there’s been little outreach from official channels on coronavirus geared toward immigrant communities. Those advocates, along with some states and local public health departments, have been trying to fill the gap.

In the Texas county that includes the progressive-minded Austin, county officials have set up a coronavirus hotline at clinics that provide care to the uninsured and undocumented.

“We are making sure everyone has access to quality care regardless of their citizenship status,” said Ted Burton, vice president of communications at Central Health. “As a community everybody has been really focused on response, prevention and education.”