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Coronavirus Disease 2019 Burden Among Unaccompanied Minors in US Custody
Carlo Foppiano Palacios1, Elizabeth W Tucker2, Mark A Travassos3
1Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
COVID-19 spread rapidly in Office of Refugee Resettlement (ORR) facilities, with a 13.4% positivity rate among unaccompanied minors. Higher infection rates were linked to age, sex, testing dates, and for-profit facilities, indicating a need for improved public health measures.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Control
Background:
- US detention centers are prone to infectious disease outbreaks due to crowded and unsanitary conditions.
- The COVID-19 pandemic exacerbated these risks, with significant outbreaks in Immigration and Customs Enforcement (ICE) custody.
- The disease burden among unaccompanied minors in Office of Refugee Resettlement (ORR) facilities remained largely undocumented.
Purpose of the Study:
- To evaluate the prevalence and burden of COVID-19 infections among unaccompanied minors housed in ORR facilities.
- To identify risk factors associated with SARS-CoV-2 positivity in this vulnerable population.
Main Methods:
- Analysis of SARS-CoV-2 testing data from ORR-associated facilities.
- Data collected from February 1, 2020, to November 18, 2020, via a Freedom of Information Act request.
- Inclusion of testing results for refugees and asylum seekers.
Main Results:
- Over 7,132 SARS-CoV-2 tests were conducted, with an overall positivity rate of 13.4%.
- Higher positivity rates were observed in older adolescents (16-17 years), males, and during specific months (April, August, September).
- For-profit facilities and certain detention locations showed increased infection rates; over 10% of positive cases involved long-term detainees.
Conclusions:
- The high SARS-CoV-2 positivity rate highlights challenges in controlling viral spread within ORR facilities.
- For-profit facilities housing unaccompanied migrant children are of particular concern.
- Mandatory social distancing and vaccination for detainees and staff are crucial to mitigate further outbreaks.
Background:
Before the coronavirus disease 2019 (COVID-19) pandemic, crowded and unsanitary living conditions lacking medical expertise made US detention centers hotbeds for infectious disease outbreaks. There have been 30 000 COVID-19 cases, positivity rates exceeding 50%, and 9 deaths in Immigration and Customs Enforcement custody, but the extent of disease among children under the care of the Office of Refugee Resettlement (ORR) has not been well-documented. We sought to evaluate the burden of COVID-19 among unaccompanied minors under the ORR's responsibility.
Methods:
We analyzed SARS-CoV-2 testing results of refugees and asylum seekers in facilities associated with the ORR from February 1, 2020, to November 18, 2020, courtesy of a Freedom of Information Act request.
Results:
ORR facilities performed 7132 SARS-CoV-2 tests from March 13, 2020, to November 18, 2020. Overall, the SARS-CoV-2 positivity rate was 13.4%. Factors associated with higher positivity rates were age group (16-17 years old); identifying as male; undergoing testing in April, August, or September; staying in a for-profit versus a nonprofit facility; and detention in certain facilities. The mean detention time with a positive test was 14.8 ± 3.2 days. Greater than 10% of positive tests were in long-term detainees.
Conclusions:
The high SARS-CoV-2 test positivity rate raises concerns about an inability to limit the spread of SARS-CoV-2 within detention facilities housing unaccompanied migrant children, particularly those run by for-profit companies. Mandated measures for social distancing and vaccination among detainees and detention facility employees are needed to limit the spread of the virus.
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