COVID-19 Testing and Cases in Immigration Detention Centers, April-August 2020 | Infectious Diseases | JAMA | JAMA Network
[Skip to Navigation]
Sign In
Figure.  Monthly Coronavirus Disease 2019 (COVID-19) Case Rate per 100 000 Persons for Immigration Detention and US Populations (April-August 2020)
Monthly Coronavirus Disease 2019 (COVID-19) Case Rate per 100 000 Persons for Immigration Detention and US Populations (April-August 2020)

ICE indicates Immigration and Customs Enforcement.

Table.  Monthly Rates of COVID-19 Tests and Cases in Immigration Detention Centers Compared With the US General Population (April-August 2020)
Monthly Rates of COVID-19 Tests and Cases in Immigration Detention Centers Compared With the US General Population (April-August 2020)
1.
US Immigration and Customs Enforcement. ICE guidance on COVID-19. Accessed August 31, 2020. https://www.ice.gov/coronavirus
2.
The COVID Tracking Project. US historical data. Accessed August 31, 2020. https://covidtracking.com/data/national
3.
US Census Bureau. US and world population clock. Accessed August 31, 2020. https://www.census.gov/popclock/
4.
US Immigration and Customs Enforcement. Detention management. Accessed August 31, 2020. https://www.ice.gov/detention-management
5.
Office of Inspector General. Early experiences with COVID-19 at ICE detention facilities. Published June 18, 2020. Accessed August 31, 2020. https://www.oig.dhs.gov/sites/default/files/assets/2020-06/OIG-20-42-Jun20.pdf
6.
Hagan  LM, Williams  SP, Spaulding  AC,  et al. Mass testing for SARS-CoV-2 in 16 prisons and jails—six jurisdictions, United States, April-May 2020. Morbidity and Mortality Weekly Report. Published August 21, 2020. Accessed August 31, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a3.htm
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    Research Letter
    October 29, 2020

    COVID-19 Testing and Cases in Immigration Detention Centers, April-August 2020

    Author Affiliations
    • 1Harvard Medical School, Boston, Massachusetts
    • 2Department of Family Medicine, Georgetown University School of Medicine, Washington, DC
    • 3Division of Medical Critical Care, Boston Children’s Hospital, Boston, Massachusetts
    JAMA. 2021;325(2):182-184. doi:10.1001/jama.2020.21473

    Individuals detained by US Immigration and Customs Enforcement (ICE) live in congregate settings and thus have a disproportionately high risk of contracting coronavirus disease 2019 (COVID-19). To reduce spread of COVID-19, ICE published its Pandemic Response Requirements in April 2020. These requirements established social distancing and disinfection protocols, testing guidelines, and expedited detainee release. This analysis examined COVID-19 testing and cases per month among ICE detainees.

    Methods

    Cumulative number of individuals tested for COVID-19 with reverse transcriptase–polymerase chain reaction tests, confirmed cases, and COVID-19–related deaths among all ICE detainees from April 1 to August 31, 2020, were extracted from ICE’s website. These data come from a continually updated database of all facilities housing detainees, including county jails.1 New COVID-19 tests and cases per month were calculated from April to August 2020 by subtracting cumulative counts at each month end. Corresponding data for the US population were obtained from the US Census Bureau.2,3 Mean daily ICE populations per month, retrieved from the ICE Statistics Fiscal-Year 2020 data set, were compared with the prepandemic population in February.4 This cohort study used public, deidentified data and was determined not to constitute human participants research by the Harvard Medical School institutional review board.

    Monthly test and case rates per 100 000 persons were calculated for detainees using the mean daily ICE population per month. Corresponding monthly rates were calculated for the US population on the final day of each month.3 Test positivity rates, defined as reported cases divided by reported tests, were calculated. Rate ratios are reported for ICE detainees vs the US population. Data were analyzed using Microsoft Excel version 16.40.

    Results

    By August 2020, ICE’s mean daily detained population decreased 45% to 21 591 from the prepandemic February population of 39 319. On August 31, ICE reported 5379 cumulative COVID-19 cases and 6 related deaths among its detainees. Cases were reported in 92 of 135 facilities, with 20 facilities accounting for 71% of cases.

    The monthly case rate per 100 000 detainees increased from 1527 in April to 6683 in August (Figure). The monthly test rate per 100 000 detainees increased from 3224 in April to 46 874 in July but decreased to 36 140 in August (Table). The test positivity rate among detainees decreased from 47% in April to 11% in July but increased to 18% in August. Detainee testing rates in July increased 1354% from April, while case rates increased 247%. In August, the testing rate decreased 23% from July, while the case rate and test positivity rate increased by 26% and 64%, respectively.

    From April to August 2020, the mean monthly case rate ratio for detainees, compared with the US population, was 13.4 (95% CI, 8.0-18.9), ranging from 5.7 to 21.8 per month. The mean monthly test rate ratio for detainees, compared with the US population, was 4.6 (95% CI, 2.5-6.7), ranging from 2.0 to 6.9 per month.

    Discussion

    Despite ICE’s mitigation efforts, COVID-19 case rates among detainees increased every month from April to August. An increase in testing appears to only partially explain the increasing monthly case rates. COVID-19 testing expanded more rapidly among detainees than in the US population. However, a consistently higher monthly case rate and test positivity rate among detainees suggest that COVID-19 is escalating more rapidly inside detention centers compared with the US population.

    COVID-19 spread within facilities may be partially due to challenges faced implementing the Pandemic Response Requirements.5 An independent assessment of facilities’ mitigation strategies is necessary to identify and address existing gaps in these efforts. Strategies that have proven effective in other congregate facilities, such as mass asymptomatic testing and changes in dormitory-style housing, should be considered.6

    Limitations of the study include relying on ICE’s publicly available data, which may be subject to reporting delays and missing components. Given limited asymptomatic detainee testing, monthly case rates may be underestimates.6 Comparison of rates between detainees and the US population is limited by differences in testing and reporting methods. ICE also provides limited data for facility staff; thus, this analysis represents an incomplete picture of COVID-19 epidemiology inside facilities.

    Section Editor: Jody W. Zylke, MD, Deputy Editor.
    Back to top
    Article Information

    Corresponding Author: Katherine R. Peeler, MD, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (katherine.peeler@childrens.harvard.edu).

    Accepted for Publication: October 13, 2020.

    Published Online: October 29, 2020. doi:10.1001/jama.2020.21473

    Author Contributions: Mr Erfani and Dr Peeler had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Erfani, Uppal, Lee, Peeler.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Erfani, Uppal, Lee, Peeler.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Erfani, Uppal.

    Administrative, technical, or material support: Erfani, Uppal, Lee, Mishori.

    Supervision: Peeler.

    Conflict of Interest Disclosures: Dr Mishori reported being a senior medical advisor to Physicians for Human Rights. Dr Peeler reported being an unpaid medical expert for Physicians for Human Rights. No other disclosures were reported.

    References
    1.
    US Immigration and Customs Enforcement. ICE guidance on COVID-19. Accessed August 31, 2020. https://www.ice.gov/coronavirus
    2.
    The COVID Tracking Project. US historical data. Accessed August 31, 2020. https://covidtracking.com/data/national
    3.
    US Census Bureau. US and world population clock. Accessed August 31, 2020. https://www.census.gov/popclock/
    4.
    US Immigration and Customs Enforcement. Detention management. Accessed August 31, 2020. https://www.ice.gov/detention-management
    5.
    Office of Inspector General. Early experiences with COVID-19 at ICE detention facilities. Published June 18, 2020. Accessed August 31, 2020. https://www.oig.dhs.gov/sites/default/files/assets/2020-06/OIG-20-42-Jun20.pdf
    6.
    Hagan  LM, Williams  SP, Spaulding  AC,  et al. Mass testing for SARS-CoV-2 in 16 prisons and jails—six jurisdictions, United States, April-May 2020. Morbidity and Mortality Weekly Report. Published August 21, 2020. Accessed August 31, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a3.htm
    ×