Past Deaths in Custody Highlight Dire Risks for Immigration Detainees During Coronavirus Outbreak

As the COVID-19 virus spreads in immigration jails, Immigration and Customs Enforcement (ICE) has repeatedly assured the public that detainees’ “health, welfare and safety … is one of the agency’s highest priorities,” and that “comprehensive protocols are in place for the protection of staff and patients” during the pandemic. But previously confidential documents obtained by the Project On Government Oversight (POGO) detailing problems with detention centers’ medical care in recent years cast serious doubt on those assurances.

The documents, obtained through the Freedom of Information Act, are records of government reviews of detainees’ deaths in ICE custody during the first year and a half of the Trump administration and provide new evidence of cases where detainees have died because of the agency’s medical neglect. In some instances, investigators for ICE’s Health Service Corps found that the agency’s care for a detainee was “outside the safe limits of practice” and had contributed to his death. In several other cases, ICE apparently avoided reaching this conclusion, but outside doctors who reviewed the documents for POGO said they provided clear evidence of inadequate care that had contributed to preventable deaths of several detainees.

The investigators’ findings corroborate the disclosures of an ICE Health Service Corps whistleblower, reported by BuzzFeed News last December. According to the whistleblower, the ICE Health Service Corps—which directly provides medical care at many ICE detention centers and oversees care at the rest—systematically failed to provide adequate care to detainees, leading to several preventable deaths. They are also consistent with years of reporting on problems with ICE’s medical care from the Department of Homeland Security’s own watchdog, investigative journalists, and groups including POGO and Human Rights Watch.

The deaths in 2017 and 2018 were not caused by COVID-19, but experts warn that the pandemic could drastically magnify the harms caused by failures in ICE’s medical care. The virus’s spread has provoked increasingly urgent calls for ICE to release people from detention in order to prevent massive outbreaks among detainees, detention center staff, and the surrounding communities.

Recent weeks have seen hunger strikes and protests from detainees, multiple federal lawsuits, and a rapid increase in the number of COVID-19 cases in ICE detention centers. According to ICE’s website, as of Monday, 425 ICE detainees have tested positive for the virus. The true number of cases may be even higher, as ICE has only administered 705 tests to the approximately 30,700 people in ICE detention. ICE did not respond to POGO’s requests for updated testing statistics, or to POGO’s questions on either the pandemic or the death review documents.

Nonetheless, despite limited testing and rising infection counts, ICE has repeatedly dismissed fears that the virus will spread rapidly in crowded immigration jails and overwhelm nearby hospitals as “speculative” and “hypothetical.” Many federal judges have disagreed—notably U.S. District Judge Jesus Bernal, who ruled last week that plaintiffs in a class action lawsuit had demonstrated that ICE was acting with unconstitutional “medical indifference” in the face of the pandemic.

As detailed in the internal reviews POGO obtained, two of the deaths where there was the clearest evidence of medical neglect occurred at immigration jails that are now suffering COVID-19 outbreaks: the Hudson County Correctional Facility in Kearny, New Jersey, a few miles from lower Manhattan, and the LaSalle ICE Processing Center in Jena, Louisiana.

In response to the coronavirus, the Hudson County Correctional Facility has been locking inmates in their cells for almost 24 hours a day since March 22, letting them out only for showers and phone calls. One of the first confirmed COVID-19 cases among ICE detainees occurred at the jail on March 30.

To date, four jail employees have died of the virus, and according to court documentsat least 89 staff members, 27 county prisoners, and 10 ICE detainees have tested positive. (ICE reports only nine of these cases on its website.) As of publication, no Hudson County inmates are known to have died of COVID-19.

Attorneys fear that those statistics understate the spread of COVID-19 among ICE detainees at Hudson. Andrea Sáenz, who heads the immigration defense unit at Brooklyn Defender Services, told POGO in an interview on April 8 that “it’s not entirely clear to me if ICE is testing” detainees in significant numbers. Several of her office’s clients in Hudson County have not been tested or released despite experiencing fevers and respiratory symptoms. ICE only recently began to provide statistics about the number of COVID-19 tests the agency has conducted nationwide, and still does not provide the numbers at individual facilities.

Sáenz said that since the pandemic began, her office had submitted “dozens of release requests” for clients at ICE jails in the New York City area with medical conditions that put them at high risk of death if they contracted COVID-19. But at the time of the interview, clients of hers with chronic conditions including diabetes, hypertension, asthma, and a history of hospitalizations for pneumonia remained inside. The whole facility has become increasingly fearful: “They’re afraid of the correctional officers and the correctional officers are afraid of them,” Saenz said.

Problems with medical care at the Hudson County jail predate the COVID-19 pandemic. Since 2013 there have been at least 17 deaths at the jail, most among county inmates. Six of those deaths occurred over just nine months.

The first to die in that nine-month span was ICE detainee Carlos Mejia-Bonilla. Bonilla was 43 years old and had lived in the U.S. for 25 years before his death on June 10, 2017, from complications of liver cirrhosis. According to a legal complaint filed by his family, the Hudson County jail knew about Bonilla’s cirrhosis but failed to treat it:

Instead of evaluating the progression of Mr. Bonilla’s cirrhosis, coming up with a treatment plan, considering Mr. Bonilla’s medical history, referring Mr. Bonilla to a specialist, or simply prescribing the medication he had already been prescribed, Defendants left him to languish, suffer, and eventually die horrifically and unnecessarily.

An internal investigation into Bonilla’s death by ICE’s Health Service Corps concluded that the jail had failed to provide required medical care. Investigators found that the health care he did receive was “outside the safe limits of practice, which either directly or indirectly contributed to his death.”

The documents show that the day he arrived at the jail, Bonilla told the provider administering his medical intake exam that he had been diagnosed with type 2 diabetes, high blood pressure, anemia, and cirrhosis of the liver, and was taking medications. During the entire time he was at Hudson County, though, he was only treated for diabetes, despite repeatedly asking for medical care for his other conditions.

That first day, Bonilla told the nurse who examined him that aside from his diabetes medication, he didn’t remember the names of the medications he was on, and he did not have any of them with him. He did know the name of his pharmacy, so the detention center contacted the pharmacy for information about his prescriptions. The pharmacy’s list of Bonilla’s prescriptions came in five days later, showing he had prescriptions for each of his chronic conditions, but a doctor never reviewed the list or provided him with medications other than the diabetes drug. Providers also failed to set up an adequate plan to treat all of his conditions or to order any diagnostic testing, ICE investigators found.

The facility’s medical staff never corrected these errors in the two months leading up to Bonilla’s death despite his “repeated requests and worsening symptoms,” ICE Health Service Corps investigators found.

Investigators also found that the medical staff did not consistently communicate with him in a language he understood, even in documents he was required to sign. Although it was clear to ICE investigators that Bonilla had limited English proficiency, staff generally did not use an interpreter or the facility’s approved tools for translation. “Multiple nurses reported using ‘Google’ translation during encounters” instead of the approved translation service available at the facility, according to ICE Health Service Corps.

Ten weeks after arriving at the detention center—having made numerous requests to resume his other medications that went unheeded—Bonilla, “feeling weak and dizzy,” was taken to the facility’s clinic. Not long after, as an advanced practice provider helped him stand up so he could go to the bathroom, Bonilla “became incontinent of urine, followed by a large amount of dark colored clotted blood from the rectum.”

Later, at a nearby hospital, Bonilla was diagnosed with an upper gastrointestinal bleed of the sort that can result from advanced liver disease. He died two days later at the hospital of a gastrointestinal hemorrhage.

Dr. Marc Stern, a public health expert at the University of Washington who has previously advised the Department of Homeland Security on health care in ICE detention, told POGO his read of the ICE investigations into Bonilla’s death is that “over a period of 2 months, a person with serious underlying health conditions is essentially brushed off.”

Stern wrote to POGO, “Given his underlying condition he had a high risk of dying, even in the best hands. But having been sent to this facility, he didn’t stand a chance.” Stern cautioned, though, that these conclusions were based on “incomplete information,” since the ICE documents he reviewed contained redactions and were not a complete medical record.

Dr. Parveen Parmar, a specialist in emergency medicine who has studied ICE detention and who reviewed Bonilla’s and other death reports for POGO, wrote in an email to POGO that, “Had he received appropriate treatment, his death might have been avoided.” Parmar said the ICE reviews show that Bonilla “suffered symptoms that might have been a warning of his impending death,” and that “he placed multiple sick calls complaining of symptoms that should have been more thoroughly evaluated.”

As detention centers contend with COVID-19, Parmar told POGO, “given a pattern, nationwide, of substandard care [by ICE], I am concerned that the nuanced ways in which COVID-19 presents will be missed—just like subtle signs of anemia and GI bleeding were missed” in Bonilla’s case. She added, “I fear many sick individuals in ICE detention will not be transported to hospitals or emergency departments fast enough to save their lives.”

Coincidentally, one of the nurses who treated Bonilla at the Hudson County jail, Daisy Doronila, recently died of COVID-19.

New Jersey Governor Phil Murphy tweeted after Doronila’s death that she “served as a nurse at the Hudson County Correctional Center for more than 20 years.” Murphy added that Doronila “gave tirelessly to her family and community.”

Marinda van Dalen, an attorney for New York Lawyers for the Public Interest who represents Bonilla’s family in their civil case, said in an interview with POGO that she could not comment specifically on his death while the case proceeds toward trial. But she fears that COVID-19, when combined with the systemic failures of health care in ICE detention, will lead to more unnecessary deaths unless ICE drastically reduces the number of people it detains. “We’re calling for the release of everyone in ICE custody,” van Dalen said.

Two medical doctors who work with van Dalen, Drs. Nathaniel Kratz and Chanelle Diaz, agreed that releasing detainees is a necessary step now. Kratz and Diaz were two of the organizers of an open letter to ICE signed by over 3,000 physicians warning that an outbreak of COVID-19 in detention centers was “only a matter of time.”

The letter, sent to ICE in March, called on the agency to release as many detainees as possible to mitigate risks to detainees, detention center staff, and the community at large. The physicians’ letter described a recent outbreak of mumps in ICE detention, when “5 cases of mumps ballooned to nearly 900 cases among staff and individuals detained in 57 facilities across 19 states,” a large share of total cases in the United States. Given the lack of a vaccine for COVID-19 and its high death rate, an outbreak in ICE jails would be “devastating,” the doctors warned.

ICE’s response was a form email directing the doctors to its website for updates on COVID-19. Kratz told POGO in an interview on April 10 that “so far what we’ve seen from ICE has really been window dressing,” with “very piecemeal” releases of a few hundred detainees. (According to a court declaration filed by ICE, as of April 10 the total number of releases of medically vulnerable detainees was 693.) Kratz told POGO he does not believe that ICE could adequately control the spread of infection inside detention centers, which are spaces “built for control” rather than hygiene or access to medical treatment.

Diaz said that the real number of COVID-19 cases in ICE detention was likely “exponentially higher” than the number of cases reported, and would continue to grow. She noted that, based on accounts from detainees and their attorneys, “transfers are still occurring” between ICE detention facilities, increasing the likelihood that COVID-19 would spread from one jail to another. Detainees have described continuing “inadequate access to soap, hand sanitizer, cleaning products, and disinfectants,” as well as “people presenting with symptoms that are being ignored, and even worse access than before to timely medical attention,” she said.

Other medical experts have been equally critical of ICE’s response. Two medical subject matter experts for the Department of Homeland Security’s Office of Civil Rights and Civil Liberties, Drs. Scott Allen and Josiah Rich, wrote to Congress in March warning that failing to release ICE detainees in sufficient numbers could lead to a situation where local hospitals become overwhelmed and “many people from the detention center and the community die unnecessarily for want of a ventilator.” (Emphasis in original)

Parmar also emphasized the risk to the community. She told POGO, “I fear we will see a large burden of cases of COVID-19 among individuals in ICE detention,” noting that this “places an unnecessary and avoidable burden on receiving hospitals in often rural areas, with limited hospital capacity.”

Representatives Carolyn Maloney (D-NY) and Jamie Raskin (D-MD), who chair the House Oversight and Reform Committee and its subcommittee on civil rights, respectively, alleged in an April 7 letter that “ICE officials conceded” during a recent briefing “that they have no contingency plans for coronavirus treatment if local hospitals become overwhelmed and cannot treat detainees.”

ICE Health Service Corps staff have filed a number of affidavits in lawsuits describing the measures they are taking to control the virus. But Dr. Homer Venters, the former chief medical officer for New York City’s jails, wrote in a court declaration that ICE’s policies are contrary to the Centers for Disease Control and Prevention’s guidance for facilities “in a manner that threatens the health and survival of ICE detainees.”

In a separate declaration, Venters criticized ICE’s initial guidance for handling COVID-19 outbreaks as “grossly deficient,” and criticized the agency’s reliance on isolation and locking detainees in their cells as a means of controlling infection. He pointed out that isolation increases the risk of self-harm and suicide, reduces the level of monitoring of detainees’ health, and can actually increase physical interaction between detainees and staff because detention facilities frequently handcuff and escort detainees whenever they leave their cells.

Diaz also expressed concern about the “misuse of solitary and isolation,” particularly if staff shortages lead to even more inadequate checks on detainees in their cells.

As POGO reported last year, government data shows increased reports of use of solitary confinement in ICE detention centers during the last year of the Obama administration through early May 2018, including numerous reports of prolonged confinement of detainees diagnosed with mental illness.

Documents POGO obtained about the March 13, 2017, death of an ICE detainee named Roger Rayson demonstrate that the fears that detainees are being neglected in solitary are well founded. Rayson, a 47-year-old Jamaican citizen who was detained at the LaSalle detention facility in Jena, Louisiana, was the first person to die in ICE detention during the Trump administration. During his time in ICE custody, although he was suffering from an aggressive form of cancer, he was locked in solitary confinement rather than receiving medical treatment.

The documents show that Rayson was diagnosed with Burkitt’s lymphoma in August or September 2016 while serving a sentence for a drug conviction in a federal prison in Georgia. Rayson was also HIV-positive, and had type 2 diabetes and a number of other serious conditions.

Burkitt’s lymphoma can be treated, but quickly causes death if left unchecked. According to the documents, the recommended treatment for Rayson was “eight cycles of chemotherapy every 21 days.”

Rayson was transferred to a federal prison medical facility to begin receiving treatment in the fall of 2016, but he received just one course of chemotherapy before his sentence ended and he was transferred to immigration detention on January 28, 2017. It is unclear from the documents exactly when and why he stopped receiving treatment from the Bureau of Prisons. ICE Health Service Corps’ investigation stated that Rayson “did not receive appropriate care for his cancer while in BOP [Bureau of Prisons] custody.” The Bureau of Prisons declined to comment in response to POGO’s emailed questions.

Rayson would receive even less care in ICE detention at LaSalle, documents show. The ICE Health Service Corps physician in charge of health care at LaSalle told ICE that the facility could care for him, without ever reviewing or requesting information about what cancer treatment Rayson had received or would need, and without informing the health care providers at LaSalle that a very sick detainee would be arriving.

Soon after Rayson arrived, the medical staff at LaSalle said they realized that they could not, in fact, adequately treat him. His second day there, he was taken to the emergency room, but was treated for dehydration and released instead of being admitted into the hospital. Health care administrators later told investigators that “local hospitals did not want to care for detainees and usually returned them after brief evaluation and treatment in the ER, rather than admit the detainees to the hospital.”

“He has serious medical conditions and we have already sent him to ER,” wrote a health care administrator in a January 30 email to ICE’s assistant field office director for LaSalle. “We need to look at moving him out as soon as possible.”

Instead of hospitalizing him, guards placed Rayson in a solitary confinement cell on February 2, where he remained for nine days, with the approval of LaSalle’s medical leadership. Hours before he was placed in solitary, he had complained of “constant, knife-like” pain, and an entry in a facility log book that afternoon stated, “He’s afraid he’s going to die.”

An ICE policy dating back to 2013 directs detention centers to avoid placing detainees with “special vulnerability,” such as a serious illness, in solitary confinement except “as a last resort.” But when Rayson was admitted to LaSalle, the facility did not document that he had a special vulnerability. (Five days after his arrival, however, medical leadership added him to their list of detainees with serious illnesses, sent to the regional ICE Health Service Corps office.)

At LaSalle, detainees in solitary are locked in their cells for up to 22 hours a day. During his nine days in solitary, Rayson was never seen by a doctor, and, as nurse practitioners reported to the facility’s medical leadership, his condition worsened steadily. But the doctor acting as clinical director of the facility repeatedly failed to heed recommendations to take Rayson to the hospital—while also failing to examine him.

On February 5, the third full day Rayson spent in segregation (the official name for solitary confinement), an officer called a nurse to see Rayson, saying “You have to get down here. He is wailing.” Rayson was taken to the medical unit, where, according to a note from a nurse whose name is redacted, he “described the pain as electric, frequent, knife like, persistent, and progressive.” He was “severely ill appearing,” but was later returned to his cell.

At a medical staff meeting the next day, a psychologist told LaSalle’s medical leadership and a visiting ICE Health Service Corps official that Rayson “was looking bad and should not be” in solitary. A nurse suggested hospitalization, but the clinical director overrode this recommendation.

Rayson’s condition continued to worsen over the next few days “as evidenced by uncontrollable pain, vomiting, and progressing weakness,” investigators found. This deterioration was not recorded in segregation logs, where providers inaccurately wrote on six days that Rayson “had no medical complaints, was in no acute distress” and “did not appear to have any acute or unresolved medical conditions that may worsen in segregation.” Nurses told investigators that they’d been instructed not to wake him if he was sleeping when they went to check on him, so records stating that Rayson reported no pain “should not be construed to mean the detainee stated he was experiencing no pain.” The nurses conduct rounds once daily for detainees in solitary, they told investigators, and, unless they’ve received special instructions are not required to assess detainees or take their vital signs.

Rayson didn’t leave solitary until February 11. On that day, a nurse found him in severe pain, too weak to get into a wheelchair, with vomit on the floor and his cell smelling of urine. He was taken to the hospital that evening.

A little over a month later—after two surgeries and several transfers between hospitals—Rayson went into cardiac arrest and died at Lafayette General Hospital. Rayson’s death certificate lists his cause of death as “remote subdural hemorrhage,” bleeding outside the brain usually caused by a traumatic brain injury. According to Rayson’s autopsy, the pathologist could not determine what had caused the bleeding, noting that the level of platelets in Rayson’s blood “is not low enough for spontaneous hemorrhage as a cause. ... Since it is not known what caused the subdural hemorrhage, the manner of death is best considered undetermined.”

ICE Health Service Corps’ review of the circumstances leading to Rayson’s death concluded that “it cannot be determined whether the health care services provided at [LaSalle] contributed to Mr. Rayson’s death, because the medical examiner could not determine his manner of death (i.e., whether an accident, natural causes, or homicide caused the subdural hematoma).”

However, the mortality review details numerous fundamental problems in LaSalle’s care for Rayson. The ICE Health Service Corps physician who served as the facility’s clinical director “did not assume primary responsibility for Mr. Rayson’s medical management,” according to the review. Instead, reviewers found, it “appears as if the CD [clinical director] deliberated Mr. Rayson’s care from afar without examining the patient when indicated and as requested” by the advanced practice providers caring for Rayson. They “repeatedly recommended” moving Rayson to a hospital, but the clinical director “persisted in recommending caring for Mr. Rayson” at LaSalle, the review found.

“Nursing staff regularly reported about Mr. Rayson’s deteriorating health status,” the mortality review states. “In response to those reports,” medical leadership at LaSalle “focused their efforts on communicating to ERO [ICE’s Enforcement and Removal Operations division] the need to deport Mr. Rayson as soon as possible.” But LaSalle’s medical leadership “did not ensure Mr. Rayson received an appropriate level of care while detained.”

Parmar said that based on the available records, the government’s failure to treat Rayson’s cancer “directly” caused Rayson’s death. She was particularly critical of the physician who acted as LaSalle’s clinical director during Rayson’s detention, who, she wrote, “never examined the patient, and prevented appropriate transfer to a hospital when Rayson was clearly critically ill. Rayson had a treatable condition, the way in which he suffered in ICE custody and died in such pain is beyond belief.”

Stern wrote in an email to POGO that, “The patient’s care, overall, was highly mismanaged. In summary, a patient with a potentially treatable tumor did not receive treatment and died.” Stern noted in a follow-up interview that the delay in Rayson’s chemotherapy treatment in Bureau of Prisons custody likely meant that “by the time he got to LaSalle, there wasn’t enough time” to prevent his death.

Stern said that the analysis of Rayson’s likely cause of death, in both the autopsy and the ICE reports, appeared to be “incomplete.” He noted that the medical examiner who conducted the autopsy did not appear to realize that Rayson “had gotten platelet transfusions, so it’s likely his platelet count was at some point, low enough to cause spontaneous bleeding. ... And the low platelet count (along with other abnormalities) were likely the result of untreated tumor or tumor complications.”

Parmar said that if Rayson’s hemorrhage did result from a head injury, it may have been a result of a fall he suffered in ICE detention. The documents say that by February 7—his fifth full day in solitary—he “had difficulty standing up and was too weak to walk.”

Stern noted that the mortality review was not completed for a year and a half after Rayson’s death, a delay he found “despicable, sad, and dangerous. The whole idea of a review is to identify any system problems and fix them before the next person is injured.” Implementing necessary changes, through a document that ICE calls a “corrective action plan,” would take even longer.

As reported last year by BuzzFeed News, an ICE Health Services Corps whistleblower alleged that Rayson had received “deplorable” health care in ICE custody, and that the health service ignored multiple internal requests for a “corrective action plan” to correct those failings.

As of publication, there were 7 cases of COVID-19 at LaSalle. ICE has declined to answer questions from POGO about how many people at the facility have been tested. According to a declaration from an ICE official, as of April 3 there were 1,094 people detained at LaSalle, which can hold 1,335 people. Detainees say they fear that an even larger outbreak is inevitable.

On April 14, immigrants detained in Louisiana with serious health conditions filed suit seeking release. Nine of the 16 are detained at LaSalle. The oldest, 78-year-old Matilde Flores de Saavedra, suffers from hypertension and diabetes. The other LaSalle plaintiffs also suffer from serious medical conditions that place them at greater risk of complications from COVID-19, including asthma, an autoimmune condition called Graves’ disease, complications from prolonged hunger strikes, and diabetes and heart disease.

The LaSalle plaintiffs allege in their complaint that they are housed together in an 80-person dorm, where they spend all but a few hours a day. They sleep in bunk beds only a short distance apart from one another, and share at most six toilets, three showers, one microwave, and eight sinks. Detainees report they have no masks and have insufficient cleaning or disinfecting supplies, and guards rarely wear masks or gloves. The dorm is almost completely full, and new people are frequently transferred in, some of them with respiratory symptoms. Little if any medical care is available, according to the complaint. Protests against these conditions were met with pepper spray.

A Cameroonian asylum seeker identified as “T.M.F.” described similar conditions at LaSalle in a declaration filed in a separate court case. T.M.F., who remains in detention despite having been granted asylum by an immigration judge, wrote, “After all we have suffered and endured to seek safe haven in the US, we cannot believe we may be left to die here in these detention centers.”

Another asylum seeker from Cameroon, “B.A.E.,” wrote that medical staff at LaSalle had refused to test him for coronavirus despite the fact that he had a fever and was coughing up blood: “The doctors told me that everything was fine and did not perform any tests. They gave me syrup and salt and ibuprofen. It hasn’t helped. Despite my symptoms, I was sent back to my crowded dorm.”

Detention staff likely have reasons to be fearful, too. In addition to the reportedly inadequate protective measures for staff and detainees at detention centers, ICE’s continued practice of transferring detainees between facilities has put detainees and staff alike at increased risk of exposure to the virus. ProPublica reported late last month that flights to transfer detainees “continued even as many of the areas where detainees are held have gone into lockdown.” The agency transferred one detainee with a history of respiratory diseases on at least nine ICE flights with other immigrant detainees over about two weeks. The detainee, Sirous Asgari, told ProPublica, “They are endangering the lives of all these people, including myself, and nobody cares. Why?” According to his attorneys, he recently tested positive for COVID-19.

A registered nurse at an ICE detention center in rural Louisiana, who did not provide his name or the name of the jail for fear of losing his job, told Voice of America, “we’re not getting much information on why ICE continues to move detainees in large numbers from one facility to the other in the midst of a global pandemic.” The nurse continued, “we’re not equipped for critical care here. A patient would have to be sent to a hospital if they had severe respiratory symptoms, and the hospitals are already overloaded.”

ICE should drastically reduce the detained population, beginning but not ending with detainees with medical vulnerabilities. ICE may impose appropriate alternatives to detention, and should not oppose the implementation of these alternatives unless an individual can be shown to pose a danger to the community that outweighs the public health risk of the spread of COVID-19 in detention. Very few individuals in ICE detention would meet this standard.

ICE should update its screening and testing guidance for the coronavirus to reflect the fact of widespread community transmission in the United States.

ICE should increase access to testing among detention facility staff and detainees, and avoid “cohorting” that locks asymptomatic and symptomatic detainees in close quarters for extended periods.

ICE should require prompt public reporting from detention facilities on

• the number of positive, negative, and pending COVID-19 tests among ICE detainees, ICE staff, and other detention facility staff who had contact with ICE detainees;
• the number of detainees discharged or hospitalized with confirmed or suspected cases of COVID-19;
• any deaths due to confirmed or suspected COVID-19 complications among ICE detainees, ICE staff, and other detention facility staff, including such deaths that occur after individuals are discharged from ICE custody;
• individuals in detention identified as being particularly vulnerable to severe complications or death from COVID-19; and
• the number of transfers or deportations from facilities with confirmed cases of COVID-19.

The Department of Homeland Security should appoint credible, independent subject matter experts in correctional health care and infectious disease to make recommendations to ICE regarding controlling the spread of COVID-19. The department should allow those experts to conduct on-site reviews at detention centers, including confidential interviews with staff and detainees, and should make the experts’ reports available to Congress and the public.