Local immigrant-rights activists protest by auto Thursday outside Hartford ICE facility. Unidad Latina en Accion photo

With COVID-19 spreading rapidly throughout the nation, we need to work together to save as many lives as possible. This includes asylum seekers who are detained for entry-related offenses.

Asylum seekers are among the most vulnerable groups globally. They are mothers, husbands, and children fleeing violence, poverty, and persecution. With few options, they arrive to the U.S. under a human and legal right to seek asylum. As an internal medicine physician, I provide care to asylum seekers and refugees in Connecticut.

Historically, asylum seekers who were deemed not to be a security risk and demonstrated “credible fear of persecution” were released to live with their families in the community while awaiting legal decisions on their status. They are now instead detained indefinitely in detention facilities run by Immigration and Customs Enforcement (ICE) while awaiting court dates or deportation.

ICE facilities consist of close quarters, common spaces for meals, shared lavatories, and poor access to products needed for personal hygiene. They are described by the Department of Homeland Security’s Inspector General as overcrowded, unsanitary, and unsafe. Scientific evidence shows that SARS CoV-2, the virus that causes COVID-19 infection, can survive for days on common surfaces, and that transmission is highest among close contacts. Public health experts name physical distancing and home quarantine as the primary measures to limit COVID-19 spread. Detention facilities lack the capacity to implement these measures to uphold the public health guidelines to mitigate COVID-19 spread, and are fertile ground for aggressive spread of this highly contagious illness.

ICE has failed to manage prior large outbreaks of contagious illnesses, including vaccine preventable influenza, chicken pox, and mumps outbreaks in multiple facilities across our nation. They have demonstrated an appalling inability to provide adequate medical care to individuals detained.

Alarms have been raised about subpar human rights standards at ICE detention facilities around the United States. Their negligence has been chronicled in a Human Rights Watch report: dangerous delays in care for a man who couldn’t breathe due to a severe lung infection, and lack of safe monitoring of a youth in isolation who died by suicide. An outbreak at an ICE facility of a highly communicable illness like COVID-19, which lacks a vaccine and proven therapeutic treatments, would be devastating to detainees, the community at large, and the hospitals that will care for them.

The detention of asylum seekers in confined facilities during this pandemic will result in spread of COVID-19 not only to detainees and staff, but also to the larger public. Requests to ICE to share their plan for management of COVID-19 within their facilities resulted in a vague statement that ICE “incorporates CDC guidance.” We have already witnessed the harmful effects of rapid COVID-19 spread in residential facilities, including a Kirkland, Washington nursing home in which 81 residents were infected, and 34 died. We should not tolerate the same outcome in any other facility with people whose care we are responsible for.

ICE is also concerned about COVID-19 transmission within its facilities, with the first documented case last week. It has requested 45,000 N95 surgical masks for their field offices. These masks are personal protective equipment (PPE) that frontline physicians, including myself, desperately need to be able to care for critically ill patients. They are already in dire short supply and highly difficult for hospitals to procure nationwide.

Medical professionals and human rights advocates have called on ICE to release detainees and cease their enforcement operations. Instead, ICE has locked down some facilities, and decreased access to their family and legal counsel. While ICE has agreed to stop operations “at or near health facilities” so as not to discourage individuals from seeking healthcare, they have not reduced other routine day-to-day enforcement operations.

There is a community-based alternative to detention. As a matter of public health, and as a moral and legal obligation to the most vulnerable among us, asylum seekers should be released to their families and communities. ICE facilities cannot maintain Centers for Disease Control (CDC) recommended physical distancing principles or provide adequate medical care to those who become ill. Furthermore, ICE’s unconscionable request for our nation’s dwindling supply of PPE, urgently needed by my fellow healthcare workers, is a glaring example of how valuable resources are being drained by practices of ICE.

As a physician and advocate for human rights, I strongly urge our federal administration to continue to uphold international and U.S. asylum laws in the midst of the COVID-19 pandemic. Release asylum seekers detained for entry-related offenses with a community-based alternative, and suspend “as usual” ICE procedures.

Faiza Yasin MD is an Internal Medicine physician and Clinical Instructor of Medicine at Yale in the Department of Infectious Disease, with a Masters in Infectious Disease Epidemiology from Johns Hopkins Bloomberg School of Public Health. She is also a Chief Resident in the HIV Training Track at Yale, provides care for refugees at the Yale Refugee Clinic, and was trained with the Yale Center for Asylum Medicine to provide medical forensic evaluations for asylum seekers.

This commentary also appears in Medpage today’s KevinMD blog.

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