Epidemiology of Coronavirus Disease 2019 in US Immigration and Customs Enforcement Detention Facilities

The US is facing a humanitarian crisis as tens of thousands of people are held in detention centers under Immigration and Customs Enforcement (ICE). Practices undertaken by ICE, such as detainment, deportation, and searches, adversely affect the physical and mental health of those who are undocumented.¹ Immigration and Customs Enforcement facilities have been characterized as unsanitary, unsafe, and inhumane by a recent whistleblower.² Home to moldy, uncleaned bathrooms and limited personal hygiene supplies and medical services, facilities pose health risks to people even beyond the context of a global pandemic.³ Human rights advocates have called for the release of people detained and the suspension of deportation flights.⁴ Thus far, ongoing deportation flights have led to documented spread of coronavirus disease 2019 (COVID-19) in more than 11 countries.⁵ Herein, we describe the COVID-19 burden among people detained by ICE compared with the US population.

Data concerning ICE and COVID-19 for this cohort study were obtained from the COVID Prison Project from May 5 to September 15, 2020, with the ICE mean daily population (MDP) serving as the denominator. General population COVID-19 data were obtained from The New York Times, with denominator data from the American Community Survey (eMethods in the Supplement). We used publicly available data and were exempted from institutional review board approval and informed consent by University of North Carolina at Chapel Hill. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

We used baseline facility MDP to calculate cumulative case rates per 1000 persons detained by ICE over time and compared this with cumulative case rates in the general population. We also used ICE testing and case data to calculate the percentage tested and test positivity rate (percentage of tests returned with positive results). For county-level comparisons, we used year-to-date MDP from September 12, 2020, to calculate cumulative and current case rates for ICE designated facilities. County cumulative case rates in the general population were also calculated. Risk ratios compared cumulative case rates in facilities and the corresponding county. Analysis was performed using STATA, version 15 (StataCorp LLC) and Excel (Microsoft Corporation).

One hundred sixty-seven facilities housed people detained by ICE, most of which were facilities that primarily housed non-ICE detainees (eg, county jails). Immigration and Customs Enforcement reported at least 1 COVID-19 case in 96 facilities. Using baseline MDP, the overall September 15 cumulative case rate was 214 per 1000 people (5810 cases among 27 189 people); ICE reported 6 deaths. There were 28 designated ICE facilities that exclusively housed people detained by ICE, including 4 family residential centers.

As testing rates reported by ICE increased, case rates increased, and test positivity rates decreased (Figure). However, the increase in case rates among people detained by ICE has outpaced the growth in the US population. The cumulative case rate in the 28 ICE-designated facilities varied from 0 per 1000 to 1050 per 1000 at Webb County Detention Center in Texas (Table). The risk ratio was greater than 1 in 20 of 28 facilities.

Cumulative case rates among people detained by ICE are higher than those of the US population and dwarf those of surrounding communities. However, this study has limitations. This analysis depends on ICE reporting; thus, cases may actually be higher.⁶ With a mean stay of 38 days, it is difficult to assess mortality and testing rates given high population churn. We report crude rates because age data for ICE detainees are not available. It is likely that the age structure is younger than that of the general population. Facility staff were excluded. There are potential differences in facility responses to COVID-19 (https://www.freedomforimmigrants.org/map). Ultimately, it is imperative that expeditious action is taken to protect people housed in ICE detention facilities from COVID-19 by reducing the number of people detained and terminating raids, transfers, and deportation flights.

Accepted for Publication: December 1, 2020.

Published: January 19, 2021. doi:10.1001/jamanetworkopen.2020.34409

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Casanova FO et al. JAMA Network Open.

Corresponding Author: Kathryn M. Nowotny, PhD, Department of Sociology, University of Miami, 5202 University Dr, Merrick Bldg Rm 120, Coral Gables, FL 33146 (kathryn.nowotny@miami.edu).

Author Contributions: Mss Casanova and Hamblett contributed equally as authors. Drs Brinkley-Rubinstein and Nowotny had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

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

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Casanova, Brinkley-Rubinstein, Nowotny.

Statistical analysis: Nowotny.

Obtained funding: Brinkley-Rubinstein.

Administrative, technical, or material support: Casanova, Brinkley-Rubinstein.

Supervision: Brinkley-Rubinstein.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by a grant from the Langeloth Foundation (the COVID Prison Project) and grant R25DA037190 from the National Institute on Drug Abuse–funded Criminal Justice Research Training Program (Drs Nowotny and Brinkley-Rubinstein).

Role of the Funder/Sponsor: The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Langeloth Foundation or National Institutes of Health.

Additional Contributions: Chris Corsi, BA, Department of Social Medicine, University of North Carolina, Chapel Hill, served as project coordinator and was compensated for his contributions to this work. The COVID Prison Project team provided ongoing support with data collection and management.