An Ellis Island lesson for the coronavirus era

Since the end of the Korean War, American policymakers have become less and less concerned about the public health effects associated with mass migration. To a certain extent, that makes sense. In the post-war period, significant parts of the world gained access to clean water, quality health care and medications. With modern tools and techniques keeping the majority of us relatively healthy, one can easily forget that dangerous microbes often accompany people and goods moving across national borders.

Nevertheless, there are thousands of dangerous viruses, bacteria, protozoa and other germs hiding out all over the world. Most of them are spread by contact with infected people, livestock or agricultural produce. And despite modern medicine’s Herculean efforts to control them, the best that science can hope for is to keep them at bay. Pandemic outbreaks historically have been a national security and public safety concern — and they should remain so. However, the infrequency with which dreaded disease affects the industrialized nations of the West has caused us to turn a blind eye to the 500-pound gorilla lurking on the periphery. 

It wasn’t always that way. Throughout the great waves of immigration in the 19th and 20th centuries, public health surveillance was an integral part of the immigration inspections process. Even in the absence of ongoing disease outbreaks, personnel from the U.S. Public Health Service (and its precursor, the Marine Hospital Service) were billeted at Ellis Island, Angel Island and East Boston Immigration Stations.

Now derided by most immigration historians as a manifestation of “xenophobia,” immigrant health inspections actually were aimed at protecting both migrating foreigners and the American public. Sick aliens arriving in New York City were admitted, at taxpayer expense, to the state-of-the art Ward’s Island Emigrant Hospital, which was designed according to the hygiene-maximizing layout advocated by Florence Nightingale in her “Notes on Hospitals.” That facility later was replaced with the Ellis Island Immigrant Hospital, which employed novel techniques such as using autoclaves to sterilize medical instruments, employing radiation to disinfect mattresses and bed linens, and setting up an isolation ward to quarantine anyone with a communicable disease. These facilities furnished many new arrivals with the first modern health care they ever received.

But it has been at least 50 years since any U.S. Public Health Service personnel were regularly stationed at ports of entry or transportation hubs. And we have come to see outbreaks as temporary crises that crop up and disappear. However, our ability to respond to these crises is markedly improved if we remain vigilant, even during those times when there is no specific threat on the horizon.

Among the lessons that the United States should be taking from the COVID-19 pandemic is that we must return to an Ellis Island mindset when it comes to immigration and public health surveillance. How much more quickly and effectively could we have responded to this pandemic if we had acknowledged the inescapable connection between global migration and disease — and if closing the borders to halt the spread of contagion were a natural, uncontroversial response  to pandemics?

The novel coronavirus hitched a ride to the United States via a human being. And regular health screening at ports of entry could have given public health officials a leg up in determining who might run the risk of transmitting a highly contagious disease. While it’s impossible to conclusively screen every traveler who comes to the United States for every communicable disease of public health significance, we can assess the majority of travelers for the symptoms of infections known to present the most significant threat. And when appropriate, we can and should close our borders — as President Trump did last month — to combat biological threats emanating from abroad.

In response to the COVID-19 pandemic, Mongolia rapidly closed its borders with China. And, despite a health care system that can only generously be described as “modernizing,” it managed to avoid widespread transmission of the SARS-CoV2 virus. By contrast, Switzerland, which is at the cutting edge of high-tech health care, refused to close its border with Italy and rapidly found itself with one of the world’s highest infection rates for COVID-19.

Most of the recent U.S. debate on immigration and border security has focused on protecting the American public from terrorism and transnational crime. However, lax immigration enforcement also exposes the American public to the threat of infectious disease outbreaks. Our policymakers should take cues from their Ellis Island forebears and take appropriate action to make public health surveillance a regular part of immigration inspection and vetting procedures. The health of both the American public and immigrants depends upon it. Public health security is national security.

Matt O’Brien is director of research at the Federation for American Immigration Reform (FAIR), a nonprofit group advocating for legal immigration.