Notre Dame Alumnus Julia Iafrate (Class of 2002) at the front lines of the fight against COVID-19 in hard-hit New York City

After more than a decade in the States. Dr. Julia Iafrate’s Green Card was denied even as she treats COVID-19 patients in the Big Apple

May 08, 2020 by Grant LaFlecheThe St. Catharines Standard

The impact of 12 hours in a New York City emergency room treating COVID-19 patients are etched into Dr. Julia Iafrate's face.

The whites of her eyes are laced with red, her mascara smudged. Deep, dark grooves run over her cheeks and the bridge of her nose — the mark of the mask that keeps the novel coronavirus at bay. 

The hours are long at New York Presbyterian Hospital. Twelve hours a shift in the heart of America's COVID-19 epicentre. There is, Iafrate said, a silence that surrounds the dying that is unnerving. 

"Many times patients are intubated as soon as they arrive," said the St. Catharines-born doctor. "These are patients who are often on ventilators and cannot communicate with you. It is very quiet and, honestly, that can be unsettling."

Iafrate has seen many patients die. By Thursday, the death toll in New York City had risen to nearly 19,000. And she has seen many of her colleagues suffering post-traumatic stress brought on by the unending pressure.

But fighting the virus isn't the only battle Iafrate faces. While she toils in the ER, Iafrate's lawyer is fighting to keep her in her adopted country. Last week, the United States government rejected Iafrate's Green Card application on grounds she does not provide a service in the national interest.

"It was pretty shocking. I was blindsided," said Iafrate, who has lived and worked in the U.S. for 13 years with an education that includes a residency at the Mayo Clinic. 

"As you might know, the immigration situation here is not the best. But part of the process is they ask you to be an expert in your field. Which I am. I worked my butt off to get where I am, and to be denied like this … I was flabbergasted."

Iafrate, a sports and dance medicine physician by training, is on the COVID-19 front line by choice. She was working at Columbia University Medical Center, which is affiliated with the hospital, when the pandemic struck.

Her clinic was closed and Iafrate started doing telephone screening of possible COVID-19 patients. But when the hospital asked for doctors to volunteer in the overwhelmed emergency room, she couldn't say no.

"I wanted to help. We're doctors. This is what we are supposed to do," said the 35-year-old. "I thought I was a good fit. Really, I am only two years out of residency, so (emergency medicine) is still fresh for me. I am young. It is better that I do it than someone who is retired and has been out of it for 10 or 15 years."

The grim reality of the ER seems a world away from where Iafrate grew up. When she was two years old, her family moved from Thorold to Fonthill, where her parents Bruno and Jeannie Iafrate still live.

She got a degree in kinesiology from McMaster University in Hamilton and then, as is the wont of many university graduates, Iafrate took some time to travel.

"I just needed a break from studies. So I moved to Kenya and lived there for about six months, and did some medical mission work with a group called Volunteer Kenya," she said. "That kind of solidified the deal for me, so I decided to apply to medical school. So, I actually did my applications for med school from there."

She got her medical degree from Midwestern University in Arizona, followed by the Mayo Clinic residency and sports medicine fellowship at University of Iowa before taking her position at Columbia. A physician with USA Ski Team, she lectures across the U.S regularly and is one of the few women in the U.S. to be at the top of her field. 

New York City's population and density made it the perfect breeding ground for the coronavirus. The city had more than 183,000 confirmed cases as of Thursday. Hospitals are overwhelmed by the sick and dying.

Even those cases that are not COVID-19-related are more dire than they would normally see, Iafrate said.

"Even with heart attacks and strokes, we are finding people aren't calling 911 because they are so afraid of COVID-19. So when we do see them, they are in worse shape than they might otherwise be."

Like many doctors treating COVID-19 patients, Iafrate is isolated when her hospital work is over. Friends drop off groceries. Family in Canada stay in touch digitally. But given the high risk of infection faced by health-care workers, Iafrate said she isn't going to expose anyone.

"If I don't have it, I probably did at some point. I try to do things that have nothing to do with medicine when I go home."

Her work visa, sponsored by Columbia, expired last year and she applied for her Green Card. 

The denial stung. Putting aside her professional expertise, Iafrate answered the call to confront COVID-19 as a volunteer. To be told by the government she is of no use to the nation simply makes no sense to her.

The decision to reject her application is under review, and Iafrate said her lawyer is working on an appeal. If that fails, there is a longer route to the Green Card she could apply for, but it would likely require her to leave the country while the process moves forward.

"That can take up to two years," she said.

If her attempts to stay in the U.S. fails, Iafrate said she would return to Canada, although she admitted she feels more at home in the Big Apple than she ever did in Niagara.

And if she did come home, she would likely have to wait on the sidelines for sometime before being able to rejoin the fight against COVID-19. 

"I would probably have to get my credentials again, get board certified again. It's not like I could just pack up and move home and start right away."

Her case made national news in the U.S. when CNN picked up the story. The selfie of her ER-battered face hit social media, as did another of Iafrate in protective gear holding a sign that said "I am an immigrant and a doctor fighting COVID19 on the front lines."

Whether the media exposure will help her case isn't clear. And while her lawyer fights the government, Iafrate said she will return to the hospital for her next 12 hours on the COVID-19 trenches.

And she'll stay there for as long as she can.

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