Why some people can’t avoid mass gathering — detention

As an emergency medicine physician, I am on the front lines of our health care system evaluating and treating patients with COVID-19 daily. Things are bad and it is going to get worse for all of us — some more than others.  Those in detention facilities and jails are among our most vulnerable patient populations. 

Many physicians and legal advocates have urged for the release of individuals who are detained. This is not only the moral and compassionate thing to do, it is a medical necessity for three reasons. 

First, by design, detention facilities present the optimal environment for the transmission of diseases. Physicians have highlighted concerns about COVID-19 outbreaks in detention centers; the spread of diseases in detention facilities and jails is highly likely due to unsanitary conditions and multiple individuals living in close proximity. These conditions have been documented in my home state — Georgia. 

Detained immigrants in Georgia detention facilities have experienced countless violations and consistent inhumane treatment including confiscation of medications, inadequate sources of nutrition and forced unnecessary solitary confinement. Stewart Detention Center in Georgia was identified as one of the worst detention centers in terms of substandard care and violation of human rights. Both Georgia detention centers, Stewart and Irwin, have documented cases of medical neglect and death of detained immigrants over the past ten years. 

Similar deplorable conditions have been documented in countless other detention facilities throughout the United States including Texas, Louisiana and Florida. Further, Georgia ranks fourth in the nation with the number of immigrants detained with neighboring Louisiana right behind. States with the highest number of detained immigrants include Texas, Arizona and California. The conditions in these detention centers and record numbers of detained immigrants will only exacerbate the spread of disease.  

When COVID-19 disease spread occurs — and it will — detention centers have little options in terms of reprieve. Many detained immigrants with medical conditions are placed in medical isolation, which is equivalent to solitary confinement. Not only is this inhumane, it is shockingly unsafe. Placing an individual with significant medical needs in isolation exacerbates underlying medical conditions and places them at additional risk of being unable to call for help. This is an unacceptable and potentially deadly form of quarantine given the expedient progression and severity of disease in those with COVID-19. 

In many detention facilities, including Georgia and Louisiana, detained immigrants have died in solitary confinement — and that was before COVID-19. This deplorable practice still occurs in many detention centers. Individuals with concerning or confirmed symptoms must be watched closely, with adequate access to medical care that is simply not possible in detention facilities.

Finally, many detention centers are geographically isolated from appropriate levels of medical care. Individuals with severe disease require an intensive care unit with appropriate medical equipment and staff. For example, Stewart detention center in Georgia is at least one hour away from a facility where this level of care could be provided. Hospitals located in rural regions are meant to provide critical access for patients in need; those with severe illness require transfer to tertiary hospitals. By the time an individual who is detained is able to be transferred appropriately, it may be too late. 

As an emergency medicine physician, I have a growing list of challenges ahead of me in caring for COVID-19 patients including limitations on staffing, equipment and space. My job — and those of medical professionals working with detained populations — should not be made any harder. We must do all we can to limit the spread of COVID-19 and protect our most vulnerable individuals and communities. Particularly important is the release of asylum seekers in detention, the cessation of ICE facilities transfers, provision of appropriate hygienic supplies and the discontinuance of enforcement activities around medical facilities.

Amy Zeidan is an Assistant Professor of Emergency Medicine at Emory University. She works as an ER physician at Grady Memorial Hospital and co-directors The Human Rights Clinic.