Detention facilities cannot respond adequately to this pandemic

In the world of pediatrics, my colleagues and I remain vigilant about the threat of coronavirus to children. Every week, we learn more information about new presentations of COVID-19, such as novel inflammatory syndromes. Still, I am hopeful that with supportive home care, good infection control practices, and access to high-quality health care when needed, we can keep children in our communities healthy and safe. However, there is a group of children who lack all these protective factors, and who I feel powerless to help. Nearly 7,000 detained immigrant children are at risk of contracting COVID-19, and they are more susceptible to becoming seriously ill. Furthermore, COVID-19 could quickly move from detention centers into surrounding communities, putting us all at greater risk.

Well before the pandemic, children were dying in Immigration and Customs Enforcement (ICE) custody, often of respiratory illnesses. Children in detention have disproportionally higher rates of conditions like asthma, malnutrition, and immunosuppression, placing them at increased risk of serious illness or death in a system that is simply not set up to provide health care. Despite three children having died in custody of the flu or flu-related complications, the flu vaccine was not offered to many children in custody. The government recognizes that there are not enough clinicians or specialized care services in shelters holding migrant children.

Now, we are starting to see a crisis of COVID-19 spreading via detained children. The Office of Refugee Resettlement (ORR) first confirmed positive cases in children and staff last month. Then there were confirmed reports of spread among children in a facility in Chicago, and this month, ICE reported 943 cases in detainees. Moreover, a high proportion of children infected with COVID-19 show no symptoms, and testing remains limited. Asymptomatic children can spread the infection to each other, staff, visitors, vendors, and contractors, who may further spread the virus in their community, especially as lockdowns end. These “tinderbox scenarios” of geographic spread from detention sites across the country threaten to prolong the intensity and length of the crisis we are already mired in.

Knowing how COVID-19 is straining resources even at highly specialized pediatric centers, it’s hard to imagine detention facilities responding adequately to this pandemic. ICE claims that their facilities “continue to incorporate CDC’s Covid-19 guidance”. However, attorneys report seeing large groups of children crowded in a room for legal screenings, no evidence of these rooms being sanitized, and diluted soap in bathroomsSocial distancing is nonexistent. Any parent or sibling can attest to the futility of asking young children to maintain strict hygiene or physical distance in crowded settings. ICE says it is testing detainees with symptoms and wants to increase quarantine capacity, but neither of these strategies addresses the issue of asymptomatic children. Even if it were feasible, keeping young children who are already forcibly separated from parents, in isolation, for weeks, would be shockingly cruel and detrimental to their well-being.

The only effective way to protect these children and prevent the spread of infection is an immediate release from detention. Last month, a federal judge urged the same, calling on the Trump administration to release children to waiting sponsors. Judge Gee cited both the potential harm to children and the public’s interest in preventing outbreaks that can “spread to others in geographic proximity, and likely overwhelm local health care systems.” ICE has demonstrated a pattern of not following court agreements regarding releasing children, and despite an unprecedented pandemic, continues to do so. This week, the New York Times reported that the administration is instead clandestinely deporting children, despite the presence of sponsors who are ready to care for children at home while they go through the immigration court process. Often, deportation means sending children to crowded tent camps or overrun shelters, where they will continue to remain at high risk for the devastating effects of COVID-19, as well as other diseases.

As we collectively combat this pandemic, I’ve witnessed amazing ways in which providers and community members have come together to advocate for evidence-based measures to keep children and communities healthy and safe. We must extend this advocacy to every child in need. Ask your local, state, or national representatives to exercise their jurisdiction over ICE and ORR. Demand policies in the best interest of children, including release from immigration detention facilities and an end to unsanctioned deportation. As we look out for one another, we must not forget the most vulnerable children amongst us. Providing them the care and protection they deserve would protect our health – and our humanity.

Priya Pathak is a pediatrician.

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