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Children are at high risk for COVID-19 infection in border detention facilities

April 16, 2020
by Alexa Tomassi

Marietta Vázquez, MD wears many hats: pediatrics professor, infectious diseases specialist, program director, and vice chair. In her free time and embedded deeply in her work on behalf of underserved children, she advocates for policies that protect and safeguard children’s health. Most recently, Dr. Vázquez served as a medical and public health expert on a legal proceeding that aims to expedite the release of migrant children being held in detention facilities in response to the rampant coronavirus outbreak. Detention facilities face a threat like nursing homes, long-term facilities, and prisons are facing: multiple individuals in close quarters which increases risk for person-to-person transmission of the deadly infection. When it comes to influenza, we vaccinate to mitigate the risk of an outbreak, but when a vaccine doesn’t yet exist, what can we do?

The plaintiff’s petition asked that the children — at least 3,600 in shelters around the United States— be released within seven days to outside sponsors unless they’ve been deemed a flight risk. Judge Dolly M. Gee of the United States District Court denied the request for immediate release but set strict timelines for the government to make concerted and continuing efforts to release the children quickly and safely, considering current travel restrictions due to the pandemic. For the plaintiffs, this is seen as a big win and a huge step forward in advocating for the rights of children – something supported by many other human rights groups and The American Academy of Pediatrics (AAP).

The ruling from Judge Gee requested that the Office of Refugee Resettlement (ORR) and Immigration and Customs Enforcement (ICE) provide an accounting of their efforts to release those in custody by April 6, including data on any minors who have not been released and why. By April 9, court-approved Juvenile Coordinators should have “provided the Court and the Special Monitor with a report regarding whether their facilities are at, above, or below capacity levels (with specific numbers) and the status of implementation of CDC-compliant guidance. The Juvenile Coordinators shall also videotape living conditions at any facility chosen by the Special Monitor and/or her expert consultant for review, as well as provide any requested information on what guidance protocols are being followed there.”

While the ruling doesn't grant exactly what the plaintiff’s asked for — to allow all detained children to be immediately released — it gave deadlines for ORR and border patrol to have a plan in place and is seen as a significant step in the right direction. Besides the looming threat of coronavirus, the overall harm detention and family separation does to a child is vast and long-lasting.

Doctors and members of the AAP have been sounding the alarm for many months about the effects on detained children, often describing the facilities as overcrowded, unhygienic, and unsafe. Dr. Vázquez said unequivocally, “No detention is safe or good for children, these children should not be detained, they are not criminals. Data shows the adverse, irreparable effects of detention on children. Detaining children, separating children from their families, leads to irreparable damage, emotionally and mentally. On top of that, it's very important that, in the case that children are detained, that we safeguard their mental health and well-being. There should be great detail placed on what’s safe and sanitary. We should make sure that all communications are culturally competent, and that children aren't detained for a long time or separated from their families.”

Steven Marans, MSW, PhD., Harris Professor of Child Psychiatry and Professor of Psychiatry at the Child Study Center and Department of Psychiatry at Yale School of Medicine, agrees. "Parents are the first and most important source in protecting children in dangerous or challenging circumstances. It's well-established that unanticipated separation from parents is one of the most preventable sources of traumatic distress and suffering that has profound impacts on the child’s immediate well-being and longer-term, subsequent development,” Dr. Marans said.

“This kind of unanticipated separation alters a child's developmental potential, subsequent feelings about themselves and relationships, as well as learning potential and productivity. In addition to the already high risk for traumatic impact of parental separation, the coronavirus pandemic creates additional burdens and distress, exacerbated by fears about their own health and safety and that of parents and family members they have little or no contact with."

Cities nationwide are also starting to see how institutional and environmental racism, poverty, and systemic inequality are affecting who gets sick with COVID-19 and access to care. Dr. Vazquez shared, “This pandemic is having its worst effects on the underserved, those without financial means, internet access, health insurance, transportation, or no legal rights as citizens.” Yale School of Medicine physicians, including Dr. Vázquez and Julia Rosenberg, MD sent a letter from a group of 185 doctors to Connecticut Governor Ned Lamont asking that he allow undocumented immigrants to enroll in HUSKY, the state’s Medicaid system, so they can receive free COVID-19 testing and treatment if necessary.

During this time of uncertainty for so many, something we can all do is reach out to our elected representatives at every level of government. Dr. Vázquez said, “The message should be that children and families in detention centers are at high risk,” of getting and transmitting coronavirus. Releasing them from detention sooner than later helps mitigate that risk and prevent more widespread infections.

On Monday, April 13, Sen. Cory Booker and Rep. Pramila Jayapal introduced the Federal Immigrant Release for Safety and Security Together Act (FIRST Act) that would require ICE to release detained immigrants who don’t pose any public safety risk, namely, those older than 50 or younger than 21, and anyone with a health condition that may make them more vulnerable to contracting coronavirus. The FIRST Act would also require all detention centers to provide immigrants with access to soap and other hygiene products, as well as free phone calls and video calls to their families and legal representation. Finally, it would limit ICE raids in immigrant communities and in places such as hospitals during the outbreak so undocumented people can access necessary health care.

You can reach your member of Congress and urge them to support the FIRST Act by using this lookup tool to send an email via their office’s website, or by calling their Washington D.C. or state office.

Dr. Marietta Vazquez is a professor of Pediatrics in the Division of Infectious Diseases & General Pediatrics at the Yale School of Medicine; Vice Chair of Diversity, Equity, and Inclusion; Director Yale Children’s Hispanic Clinic (Y-CHiC); and Diversity Officer for the Yale Center for Clinical Investigation (YCCI).

Submitted by Alexa Tomassi on April 16, 2020