"We're Worse off Now Than During COVID": Community Health Workers' Perspectives on Intensifying Immigration Enforcement as Cascading Crisis.

Scholars have not conventionally examined the COVID-19 pandemic and immigration enforcement together or as having similar dimensions. We use the framework of cascading crisis to assess the impact of the cascading pandemic-immigration enforcement crisis on Latine immigrants' health from the perspectives of community health workers (CHWs) deeply embedded in immigrant communities. This qualitative study was carried out in a large metropolitan region across two phases: December 2024-January 2025 (focused on the pandemic period, January 2020-May 2023) and April-May 2025 (focused after the official end of the public health emergency in May 2023). We conducted 41 semi-structured interviews with CHWs recruited from four local organizations and analyzed data using thematic analysis. We identified three themes highlighting how CHWs described immigration enforcement as an extension of the pandemic: immigrants' lockdown mentality and decreased access to services, elevated distrust of the government, and barriers with information-sharing. Although CHWs effectively forged trust-building strategies during the pandemic that carried forward beyond its official end, this trust is now being undermined. In response, CHWs have had to innovate to adapt to immigrants' new circumstances and reaffirm trust. A multi-faceted approach to addressing the pandemic-immigration enforcement cascading crisis will be necessary, including health care professional advocacy, health care delivery innovation, the passage of inclusionary state-local policies, and alternate models of community care.