ICE indicates Immigration and Customs Enforcement.
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Erfani P, Uppal N, Lee CH, Mishori R, Peeler KR. COVID-19 Testing and Cases in Immigration Detention Centers, April-August 2020. 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.
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.
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.
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.
Corresponding Author: Katherine R. Peeler, MD, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 (email@example.com).
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.
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.
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