key: cord-1011382-kwdlqdmf
authors: Openshaw, John James; Travassos, Mark A
title: COVID-19 outbreaks in U.S. immigrant detention centers: the urgent need to adopt CDC guidelines for prevention and evaluation
date: 2020-05-31
journal: Clin Infect Dis
DOI: 10.1093/cid/ciaa692
sha: fa62ea902ffb1bcea8d41841958205137cf0ca9f
doc_id: 1011382
cord_uid: kwdlqdmf

There have been several significant outbreaks of COVID-19 in federal immigrant detention centers, which lack clear and consistent guidelines across Department of Homeland Security (DHS) agencies to limit the spread of COVID-19. The Centers for Disease Control and Prevention (CDC) has issued detailed guidelines for the control, prevention, and evaluation of COVID-19 in detention facilities. While the DHS’s Immigration and Customs Enforcement agency has stated that it complies with CDC recommendations, its policies significantly differ from these CDC guidelines, placing detainees at risk for contracting COVID-19. This submission urges the adoption of CDC guidelines across DHS-associated facilities. Such a policy change has the potential to protect and save the lives of the most vulnerable populations under the auspices of the federal government.

A c c e p t e d M a n u s c r i p t 4 The Department of Homeland Security (DHS) has proven itself ill-equipped to manage the spread of COVID-19 in its detention facilities. There have been over 1, 200 confirmed COVID-19 cases across 52 facilities run by the DHS's Immigration and Customs Enforcement (ICE) agency [1] . Of those tested, more than 50% of ICE detainees have been positive for COVID-19, including 155 COVID-19-positive detainees at the Otay Mesa Detention Center in San Diego, where one detainee has died from the illness [1, 2] . Children have not been spared. In one Chicago facility where the DHS's Office of Refugee Resettlement (ORR) places unaccompanied migrant minors, 42 children have tested positive for COVID-19 [3] .

United States detention centers pose significant medical risks to migrants and asylum seekers, particularly given inadequate medical monitoring and expertise and delays in bringing detainees to medical attention [4] . Detention centers house children and adults in crowded conditions stretched beyond maximum carrying capacity, without adequate sanitation or medical care [5, 6] . In 2019, thousands of detained migrants and asylum seekers were quarantined for influenza, mumps, and chicken pox outbreaks [7] . Before September 2018, no child had died in the care of the DHS's United States Customs and Border Patrol (CBP) in a decade [7] . Since then, at least three children have died from influenza-related complications [7] . Two recent adult deaths have raised questions of significant medical mismanagement [8] . DHS has declined opportunities to support migrant detainee health, refusing to provide influenza vaccinations to CBP detainees per Centers for Disease Control and Prevention (CDC) recommendation [9] .

The COVID-19 pandemic places further stress on a system teetering on the verge of disaster. ICE has stated that its COVID-19 evaluation and prevention procedures comply with CDC guidance [1] . The CDC has issued extensive guidelines for the prevention, evaluation, and care of potential COVID-19 cases in detention facilities [10] . However, in several critical A c c e p t e d M a n u s c r i p t 5 areas of infection control and prevention, ICE guidelines differ from CDC recommendations, putting detainees at risk for infection. ICE policy is to cohort potential COVID-19 cases with respiratory symptoms together in a single room [1] . As ICE cohorts detainees based on symptoms without knowing testing results, such a policy risks exposing those who have non-COVID-19 respiratory illnesses to infection. CDC guidelines for detention facilities explicitly state the need to individually isolate suspected and confirmed COVID-19 cases, providing each individual their own housing and bathroom space [10] . These guidelines include an explicit rejoinder: "Only individuals who are laboratory confirmed COVID-19 cases should be placed under medical isolation as a cohort" [10] . CDC guidelines also recommend that when processing new detainees that are close contacts of known COVID-19 cases, they should be quarantined for 14 days. ICE only "monitors" such new ICE detainees at risk for COVID-19, with no provision for quarantine [1] .

CDC detention facility guidelines emphasize the need for social distancing: sleeping quarters should be rearranged to allow for six feet between detainees in all directions, permitting each detainee to socially distance from others [10] . ICE guidelines make no such provision. In fact, there are no federally mandated rules to guarantee that a detainee can socially isolate from others within an immigration detention center. The inability to safely social distance, combined with the lack of appropriate quarantines, serve to increase the risk of spread of COVID-19 in overcrowded DHS facilities.

What has DHS done to reduce the risk of COVID-19 at its facilities? ICE has released 900 detainees at high risk for severe disease [1] . It has stated that it will reduce "the population of all detention facilities to 70 percent or less to increase social distancing" [1] .

With an overall detainee population of 15,000 [11] , ICE has not made significant progress towards this goal. ICE claims to stagger meal and recreation times, and all community service projects and social visitation have been suspended. Otherwise, there remain no explicit A c c e p t e d M a n u s c r i p t 6 guarantees of social distancing. Safeguards at ORR facilities, which shelter families and unaccompanied minors, remain unclear, as ORR has not released any COVID-19 prevention or evaluation guidelines for its facilities.

What can be done to protect against the spread of COVID-19 within immigrant detention facilities? The federal government should mandate CDC COVID-19 detention facility guidelines across DHS-associated detention facilities. These interventions are lowtech and effective. All detention centers should take the necessary steps to achieve safe social distancing, including providing enough space to allow each detainee to separate from others by at least six feet, reducing detainee populations, and staggered use of communal facilities.

DHS-associated facilities should also eliminate practices of cohorting detainees with respiratory illness before cases have been identified.

Furthermore, CDC guidelines must extend beyond federal DHS detention facilities to include the many non-governmental detainee facilities across the country. This includes the Chicago facility with an outbreak among unaccompanied minors and the Otay Mesa Detention Center, the site of the largest detainee outbreak. It is unclear how much oversight of infection control and prevention occurs within private facilities, which are run by contractorssome for profitor state or regional facilities. Implementing CDC guidelines for COVID-19 infection control and prevention within these facilities is critical to limiting the spread of disease.

Finally, adoption of CDC guidelines will protect detention facility employees and their families. Forty-four ICE employees at detention centers in nine states have been diagnosed with COVID-19 [1] . At least 39 COVID-19 cases have been reported among staff for shelters for unaccompanied children [3] . CDC guidelines protect employees, outlining the need for staff specifically dedicated to detainees with COVID-19 infection and for sufficient A c c e p t e d M a n u s c r i p t 7 supplies of personal protective equipment for them [10] . Adoption of CDC guidelines protects employees and limits the spread of COVID-19 to the surrounding community.

The responsibility for the health and protection of detainees and asylum seekers lies with the federal government. Past failings when it comes to infectious disease prevention do not bode well for DHS's ability to control the spread of COVID-19, with the data already suggesting widespread transmission within DHS facilities. We call on professional societies including the Infectious Diseases Society of America, American Academy of Pediatrics, and the American Medical Association to urge DHS to accept CDC guidelines as the standard of care for COVID-19 infection prevention and evaluation for immigrant detention facilities.

This will be an important first step towards limiting disease spread and protecting the lives of the most vulnerable in federal custody.

ICE Guidance on COVID-19

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In the freezer: abusive conditions for women and children in US immigration holding cells

Detained migrant children got no toothbrush, no soap, no sleep

A natural death: the political battlefield of infections and migrant children's bodies

Internal ICE Reviews Of Two Immigrant Deaths Stoke Fears About

Influenza in U.S. Detention Centers -The Desperate Need for Immunization

Interim Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities

Detention management: ICE currently detained population