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      COVID-19 and immigration detention in the USA: time to act

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      a , b , a , c
      The Lancet. Public Health
      The Author(s). Published by Elsevier Ltd.

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          Abstract

          Over 37 000 immigrants are currently detained by Immigration Customs Enforcement (ICE) in more than 130 facilities across the USA. 1 As understandable fear of the coronavirus disease 2019 (COVID-19) pandemic intensifies in the USA, so too does the imminent danger ICE prisons pose not only to the vulnerable populations detained within their walls but to the nation's public health. Given the urgent need to control the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), ICE should release all detained immigrants posing no threat to public safety. 1 Overcrowding, poor sanitation, inadequate healthcare, and difficulty containing contagious diseases are well documented in ICE's immigration detention system.3, 4, 5 Most facilities are run by private prisons or county jails through lucrative ICE subcontracts. Distancing and other necessary measures to prevent SARS-CoV-2 from spreading are not possible in immigrant prisons. These congregate detention facilities pose a great contagion risk: already, several staff at different immigrant detention centres have tested positive for COVID-19 and detainee infections are being reported as well. 6 Since 2014, the detained immigrant population has skyrocketed. Last year, ICE detained over 500 000 immigrants, more than the rest of the world combined.2, 7 This reflects harsh policies implemented by the US President Administration, including mandatory detention of asylum seekers and a dramatic reduction in parole. ICE detention facilities are often located in small, isolated towns that employ local residents who move each day between facility and community. As SARS-CoV-2 spreads, local health-care systems will be overwhelmed. For example, within 80 miles of the 1000 bed Pine Prairie, Louisiana, detention facility, there are only eight ICU beds. Making matters worse, thousands of inmates are transferred between centres each year. This practice continues as does deporting potentially infected detainees to their home countries. Arguably, it would be difficult to devise a system better suited for spreading SARS-CoV-2. Most immigrant detainees have no criminal record and immigration proceedings are civil, not criminal. 8 Immigrant detainees include asylum seekers who fled their countries because of torture, persecution, and violence. For such traumatised individuals, immigration detention can cause severe psychological distress including depression and post-traumatic stress disorder. 8 Continued imprisonment during this pandemic could result in even more severe harm to the mental health of immigrant detainees. Moreover, the Migration Protection Protocol (MPP) has created an enormous and potentially dangerous SARS-CoV-2 reservoir on the US–Mexican border. Last year under that policy, nearly 60 000 asylum seekers—including women and children—were forced to remain in Mexico during the asylum application process, 9 and live in unsanitary, overcrowded, makeshift encampments with no healthcare system, and violence. ICE has full authority to release detained immigrants. “Unlike the Federal Bureau of Prisons, ICE has complete control over the release of individuals. ICE is not carrying out the sentence imposed by a federal judge,” notes one former ICE Director. 10 As the USA and the rest of the world attempt to stave off the worst pandemic in generations there can be no doubt that continuing to hold immigrant detainees in overcrowded facilities is not only cruel but dangerous. Moral and public health necessity requires immigrant detention to stop. Failure to do so endangers the tens of thousands of civil immigrant detainees and our society.

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          Mental health of detained asylum seekers.

          Asylum seekers arriving in the USA are likely to be held in detention for months or years pending adjudication of their asylum claims. We interviewed 70 asylum seekers detained in New York, New Jersey, and Pennsylvania. We used self-report questionnaires to assess symptoms of anxiety, depression, and post-traumatic stress disorder. At baseline, 54 (77%) participants had clinically significant symptoms of anxiety, 60 (86%) of depression, and 35 (50%) of post-traumatic stress disorder; all symptoms were significantly correlated with length of detention (p=0.004, 0.017, and 0.019, respectively). At follow-up, participants who had been released had marked reductions in all psychological symptoms, but those still detained were more distressed than at baseline. Our findings suggest detention of asylum seekers exacerbates psychological symptoms.
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            Is Open Access

            Notes from the Field: Mumps in Detention Facilities that House Detained Migrants — United States, September 2018–August 2019

            On October 12, 2018, five confirmed cases of mumps among migrants who had been transferred between two detention facilities were reported by the facilities to the Texas Department of State Health Services (TDSHS). By December 11, eight Texas detention facilities and six facilities in five other states had reported 67 mumps cases to U.S. Immigration and Customs Enforcement (ICE) Health Service Corps (IHSC) or local health departments. On December 12, TDSHS contacted CDC to discuss mumps control in detention facilities and facilitate communication with IHSC. During January 4–17, 2019, six more state health departments reported new cases in detention facilities, which prompted CDC and IHSC to launch a coordinated national outbreak response. During September 1, 2018–August 22, 2019, a total of 898 confirmed and probable mumps cases ( 1 ) in adult migrants detained in 57 facilities (18% of 315 U.S. facilities that house ICE detainees*) were reported in 19 states (Figure); an additional 33 cases occurred among staff members. Private companies operated 34 facilities, 19 were county jails that house detained migrants, and four were ICE-operated. Forty-four percent (394) of cases were reported from facilities that house ICE detainees in Texas. Median patient age was 25 years (range = 17–67); 846 (94%) were male. Based on detainee custody status during their incubation period (12–25 days before symptom onset), most (758, 84%) patients were exposed while in custody of ICE or another U.S. agency † ; 43 (5%) were exposed before apprehension; and the custody status at the time of exposure of 97 (11%) was unknown. Among those with data on complications, 79 (15%) of 527 male patients reported orchitis, and at least 13 patients were hospitalized. More than half (576, 64%) of cases were confirmed by quantitative reverse transcription–polymerase chain reaction testing or viral culture testing at CDC, state public health laboratories, Association of Public Health Laboratories–CDC Vaccine Preventable Disease Reference Centers, or commercial laboratories. Sequencing of isolates from 70 patients identified genotype G, the most common mumps genotype detected in the United States since 2006 ( 2 ). IHSC provided >25,000 doses of measles-mumps-rubella (MMR) vaccine in response to mumps in 56 facilities. FIGURE Mumps cases among U.S. Immigration and Customs Enforcement (ICE) detainees, by custody status* at time of exposure, by week of onset — United States, September 2018–August 2019 (N = 898) † Abbreviations: CBP = U.S. Customs and Border Protection; USMS = U.S. Marshals Service. * Based on mumps incubation period of 12–25 days before symptom onset. † Data collected as of August 22, 2019. The figure is a histogram showing mumps cases among U.S. Immigration and Customs Enforcement (ICE) detainees, by custody status* at time of exposure, by week of onset, in the United States, during September 2018–August 2019. Since 2015, approximately 150 mumps outbreaks and 16,000 cases have been reported in the United States, typically in close-contact settings such as universities, schools, and athletic events. § This is the first report of mumps outbreaks in detention facilities. MMR vaccination efforts differ among detention facilities; facilities should follow local or state health department recommendations for preventing and responding to mumps ( 3 ) and should report cases and follow disease control guidance from their health department. Detainees and staff members at increased risk for mumps should be offered MMR vaccine per existing recommendations for vaccination during outbreaks ( 4 , 5 ). MMR vaccine has not been shown to be effective at preventing disease in persons already infected with mumps; facilities should be aware that cases might occur among detainees exposed before vaccination. Health departments, CDC, IHSC, and facility health administration can work together to develop appropriate control measures based on local epidemiology and the specific needs of each facility. Identifying and vaccinating close contacts of exposed or symptomatic persons with mumps in detention centers is challenging. IHSC can look up transfer history and facilitate vaccine procurement for detainees in ICE custody upon request from facility health services administrators. CDC is coordinating communication among state and local health departments, IHSC, and other federal partners to mobilize appropriate resources and is providing technical support for implementing appropriate disease control and prevention measures. Effective public health interventions require understanding of facility and custody operations, which often involve frequent transfers of detainees (between facilities and states) and multiple entities with authority for operations and detainee custody. As of August 22, 2019, mumps outbreaks are ongoing in 15 facilities in seven states, and new introductions into detention facilities through detainees who are transferred or exposed before being taken into custody continue to occur.
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              Author and article information

              Contributors
              Journal
              Lancet Public Health
              Lancet Public Health
              The Lancet. Public Health
              The Author(s). Published by Elsevier Ltd.
              2468-2667
              31 March 2020
              May 2020
              31 March 2020
              : 5
              : 5
              : e245-e246
              Affiliations
              [a ]Bellevue Program for Survivors of Torture, New York, NY 10016, USA
              [b ]School of Medicine, New York, NY, USA
              [c ]School of Global Public Health New York University, New York, NY, USA
              Article
              S2468-2667(20)30081-5
              10.1016/S2468-2667(20)30081-5
              7271269
              32243775
              05638b0b-1f0c-45d0-ac20-750fff702a6a
              © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

              Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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