As the COVID-19 pandemic upends life across Minnesota, government agencies, community outreach groups and religious leaders are scrambling to distribute information to more than 100,000 state residents who speak little or no English.

They’re also trying to address the reticence of some immigrants to seek medical assistance out of fear that it could jeopardize their pathway to citizenship.

“If we have a part of our population that’s afraid to seek care and not getting access and could end up being more vulnerable and more impacted by COVID-19, that affects everyone’s health,” said Danushka Wanduragala, international health coordinator for the Minnesota Department of Health. “So we need to make sure that no one is being marginalized, no one is being denied care whatever their immigration status is, or their language capability.”

The highest rates of limited English proficiency were found in populations of Lao (25%), Vietnamese (23%), Somali (20%), Mexican (18%), Hmong (17%) and Chinese (17%), according to a state report on the economic status of Minnesotans. The health department’s website features materials on COVID-19 in up to 20 languages. Wanduragala acknowledged concerns that written materials alone are insufficient.

“We definitely want to go well beyond just providing translated materials,” said Wanduragala, who is leading the Health Department’s COVID-19 cultural and faith communities engagement team.

People who need the information may not know to visit the Health Department’s website or have computer access, Wanduragala said. And they may not be literate in their native language, either.

The Health Department has also been posting videos and working closely with ethnic media outlets across the state to run ads and articles along with public service announcements on the radio. For example, the department has worked with the media outlet El Minnesota De Hoy to reach more Spanish speakers.

Founder Gustavo Mancilla said the news is getting through and the Latino community is paying attention.

“There is a lot of concern from the community on social distancing, a lot of confusion in terms of, ‘Am I able to drive for work? Am I able to continue with my life?’ … We are able to provide answers,” Mancilla said of Spanish language media.

It’s not as easy, however, to reach non-English speakers beyond the Twin Cities. The Health Department and the Department of Labor and Economic Development are working out ways to reach people through their workplaces at manufacturing facilities and meat processing plants in rural Minnesota. A spokesman for Austin-based Hormel Foods Corp., one of the nation’s largest meat companies, said it has translated communications on COVID-19 to Spanish, Burmese, French, Karen, Mandarin, Polish, Portuguese, Somali and Vietnamese. A video message from the CEO has subtitles in six languages; posters and TV graphics are in English and Spanish; and a weekly internal publication is translated into Spanish with updates on the pandemic.

For four years now, the city of Minneapolis has been hosting programs on radio stations that are designed to reach out to people who might not get information in other, traditional formats. The shows are offered in English, Spanish, Somali and Hmong. In the past, the programs have focused on helping people navigate city issues, such as learning about snow emergencies or, more recently, educating people about the U.S. census. In mid-March, the city began shifting the focus of those programs to the coronavirus.

One show, for example, might feature an epidemiologist talking in a particular language about ways people can protect themselves. People can call to ask questions. It’s difficult to know how many people tune in to these shows because they run on small stations that don’t have the same kind of ratings metrics as larger stations. The city noted that the radio programs can be particularly helpful for people from cultures that pass information orally rather than in writing.

The city has also started holding online briefings for various cultural groups.

Rosa Tock, executive director of the Minnesota Council on Latino Affairs, said in an e-mail that her organization had been invited to Spanish radio programs to talk about unemployment benefits, the implications of Gov. Tim Walz’s executive order to stay home, and the “public charge” rule that determines whether immigrants seeking green cards or trying to enter the United States are likely to become dependent on the state. The expansion of the rule last year has led many low-income immigrants to drop public benefits and avoid seeking medical care.

Tock noted that a range of resources exist for Spanish speakers, including Facebook Live Events sponsored by the Immigration Law Center of Minnesota and Advocates for Human Rights to explain how the pandemic might affect a person’s immigration status and civil rights.

Tock said she’s heard stories of people who are afraid to access health care, afraid to go out lest they be stopped by police, worried about losing public benefits and possible evictions.

Comunidades Latinas Unidas En Servicio (CLUES) began hearing from people who were concerned about the new public charge rule almost as soon as it was announced, and the economic fallout from the coronavirus has only exacerbated their concerns, said Ruby Azurdia-Lee, the organization’s president and CEO. She said clients canceled mental health appointments “because they said I don’t want to risk the application.”

“Even people that can sometimes will not use any public services because they are afraid to lose their ability to apply for relatives and family members,” Azurdia-Lee said. “There are a lot of members of our community who can be impacted by that kind of language.”

That’s despite the fact that the Trump administration has encouraged everyone — including undocumented immigrants — who have COVID-19 symptoms to seek treatment. Medical care will not negatively affect any immigrant as part of a future public charge analysis, the administration said.

CLUES is collecting donations to establish a relief fund that will give cash payments to help people pay their rent or buy food, medication or other necessities. The nonprofit is also setting up a bilingual hotline to help people learn more about services that might be available during the pandemic.

The Minneapolis City Council passed a resolution last month outlining its priorities during the emergency, including a focus on race equity. On Friday, Minneapolis Mayor Jacob Frey announced an assistance program to help cover rent and utility payments for low-income families and small businesses struggling with financial hits from the coronavirus.

“Households will be eligible regardless of immigration and documentation status,” Frey said. He noted that the program was designed to help people who aren’t getting assistance through other programs.