In normal times, Diana Moreno helped immigrant workers secure work and get paid.
Moreno and the New York City nonprofit New Immigrant Community Empowerment, or NICE, whose Workers Rights Program she directs, advocate on behalf of jornaleros, Latino immigrant day laborers who work for contractors. The center acts as a liaison between workers and employers, ensuring that contractors don't withhold wages and that laborers are paid adequately and are organized according to experience.
But that was before COVID-19 upended life in the heavily immigrant neighborhood of Jackson Heights, Queens, where NICE is based. Now, with no jobs to be had, Moreno's focus has shifted: She's simply helping immigrant families get access to food.
"The first wave was joblessness and unemployment," Moreno said. "And these are people who cannot afford not to go to work."
Across the country, advocates like Moreno are working to provide basic necessities to immigrant families, especially those without legal status who lack a safety net and are too worried or threatened to seek medical treatment or help.
Mobilizing relief efforts
In New York, NICE is one of many groups pivoting from their regular missions. Its "relief brigade" brings groceries to families in the neighborhoods of Jackson Heights and Elmhurst, which have some of the highest numbers of COVID-19 casualties in the city.
"Despite them being part of a high-need population, they are still giving their time and effort to food distribution efforts," Moreno said of the neighborhood members helping deliver the much-needed items.
Moreno, 32, who has been working in New York for the past year after moving there from Gainesville, Florida, said "layer upon layer" of issues have made the pandemic an existential threat in the neighborhoods she serves.
One issue is the high price of medical care, especially for immigrants who don't have access to insurance.
"Cost is at the front of their minds, like any other Americans," Moreno said. "They delay, 100 percent, until they can no longer wait, until it's an emergency."
In addition, families with members who don't have green cards fear using public benefit programs — even if other family members qualify — after the Trump administration expanded a public charge rule. It expands the criteria for denying applications for legal permanent residence based on past or potential use of government benefit programs.
That and fear of Immigration and Customs Enforcement have kept families out of hospitals and medical centers, Moreno said.
"Our members are not going to get tested, because they're afraid," Moreno said. "We have no doubt that that's led to higher rates of infection, especially among families and people living in close quarters, which we know our members do."
'People are afraid to accept anything'
Outside Boston, Erika Perez sees the same trepidation among families.
"People are afraid to accept anything," said Perez, 37, an interpreter and immigrant advocate who has been in the North Shore of Massachusetts since 2002; she's originally from Guatemala. "They think it's going to come back to them."
In March, Perez began helping indigenous Central American immigrant families with their rent payments, writing letters to landlords and serving as an advocate for them. Now, she has organized a group to bring food and supplies to families and tries to persuade worried families to seek medical help.
The initiative, Mayans without Borders, didn't exist before COVID-19. Now, it's working overtime to support 200 indigenous families in the North Shore. Perez, who initially recruited her family members, has raised over $17,000 for the initiative on the website GoFundMe.
"This is just the beginning," said Perez, who had been putting up her own money to fund relief efforts. "I want it to be more sustainable."
The project has taken over her mother-in-law's barn, from which she coordinates her outreach.
In April, Perez was put in touch with Vivian Lopez, 27, a Mayan from Guatemala who lives in Lynn, Massachusetts. Lynn is the third-hardest-hit city in the state, with more than 3,400 confirmed cases in a population of 95,000. The town is also over 40 percent Hispanic.
Lopez was suffering from aches and a fever, but she went to Perez worried about her 6-year-old son, Angel. He was also showing COVID-19 symptoms.
The first thing Perez asked Lopez was to contact Angel's pediatrician.
"I begged her," Perez said. "I said: 'Please, it's for your own good and for your son. Do it for your son.'" But Lopez was too fearful and just wanted to know whether Perez could help her.
Through Perez, who translated, Lopez said she was shocked by the disproportionate number of deaths among Latinos.
"My worst fear was to go into the hospital and not come out of it alive," Lopez said. "My personal opinion is that perhaps [we're] not being provided the proper medical attention. How was it that a lot of Hispanics were dying so quickly in such a short period of time?"
Download the NBC News app for full coverage and alerts about the coronavirus outbreak
Perez said her own cousins didn't want to seek medical help, saying they had experienced discrimination at an urgent care center in the past. Like other families, they're opting to stay home, relying on at-home, traditional remedies.
Some in the community won't even seek out Perez's help, suspecting that her food deliveries might get them tagged under the public charge rule.
Scared of seeking help
Dr. Daniel Correa, a neurologist at Montefiore Medical Center in the Bronx, New York, is part of a network of doctors who have begun to publicly call for repeal of the expanded public charge rule. Latinos have the highest rates of COVID-19 deaths in the city, a trend documented in racial breakdowns by the city health department. A fear of seeking treatment, Correa said, is one of the reasons.
"Public charge was just the latest thing," Correa said, referring to families with immigrant members. "There was already a lot of apprehension in the community before the pandemic. We were seeing concerns regarding public services, and in health care we were already seeing a decrease in public visits."
The U.S. Department of Homeland Security has said emergency medical assistance, such as seeking care for COVID-19, doesn't qualify under the umbrella of public charge. But Correa said there's little trust in the federal government among families.
"They've detained people on the way to health care. We've seen this," Correa said.
In terms of staying healthy, Correa said, orders to stay at home and isolate oneself are tougher for immigrant families who may be living in small spaces with multiple family members.
For some doctors, the coronavirus pandemic has brought a sense of déjà vu. Dr. Ilan Shapiro, a Los Angeles-based pediatrician, said he saw the same fear of seeking medical assistance among immigrant families in 2009, during the outbreak of H1N1.
"People are just waiting, and when they access the system, it's too late," Shapiro said. "That's the U.S. — it's not a different country."