Tony Dejak/AP Photo
Caregivers wait for patients at a coronavirus testing center outside at University Hospitals, March 16, 2020, in Mayfield Heights, Ohio.
On Tuesday, the Ohio Immigrant Alliance called on county and state leaders to reduce the number of people held in immigration detention facilities and jails in the state. The move came after more than 3,000 medical professionals signed a letter demanding detainees held in immigration facilities by ICE be released.
Already, the ability of the virus to spread in conditions like in detention centers and jails is clear. On Rikers Island, cases jumped from 38 confirmed cases of COVID-19 on March 21 to 60 just two days later. New York Mayor Bill de Blasio said he would release a number of detainees, and New Jersey announced that the state would release up to 1,000 inmates.
Those held in immigration detention facilities often are only held there because of ICE policy, not for any criminal offense—making advocates all the more outraged so many are still in detention.
To understand what the spread of the coronavirus might look like in jails and detention facilities, I spoke with family medicine physician Laura Chambers-Kersh in Dayton, Ohio. She has spent time in Liberia during the tail end of the Ebola epidemic, has worked with asylum seekers and immigrants in Texas, and has been a staff physician at Planned Parenthood.
This interview has been edited for brevity and clarity.
The American Prospect: You’re from Dayton. Can you tell me a little bit about your practice there?
Laura Chambers-Kersh: I work with the Soin Family Medicine Residency here in Dayton, Ohio. We do full-spectrum family medicine. I still am able to take care of pregnant patients and do deliveries and I still do inpatient medicine. I [also] have six weeks a year where I am basically a hospitalist with the residency team. And I do one day a week at a rural site in Jamestown, Ohio, working with a rural population and supervising residents in the clinic and in the hospital.
TAP: What has the preparation and the coverage been like in rural areas in your experience in preparing for this pandemic?
LCK: As of two weeks ago, there had really been no talk about this at the level of family medicine clinic. We weren’t talking about this, not on the scale that we should have been. I think that [the rural] population has the potential to sometimes be less trustful of the medical system. A higher number of patients there are not getting their flu shots than other places. There also tends to be a higher number of smokers in rural areas. And we know that’s going to be a risk factor with people having COPD and lung problems that could make them more vulnerable to the virus, too.
TAP: You have experience with Ebola in Liberia and experience in global public health. What was your work like in Liberia?
LCK: I went to Liberia at the end of the epidemic, in February 2015, with Partners in Health. I went for six weeks as an Ebola health worker. We spent the first week in the country learning how to run an Ebola treatment unit, and how to don and doff, and all the things you need to know to work in and run an Ebola treatment unit. Then we were transported out about eight hours away from the capital city to a pretty remote part of the country to staff their Ebola treatment unit. One of the things that impressed me is how the people of Liberia and Sierra Leone and Guinea changed their behavior. That really was one of the biggest things that allowed them to get that outbreak under control. And I see a lot of parallels between that and what’s going on all over the world right now.
TAP: Give me some examples of what kinds of behavior people had to change.
LCK: With Ebola, the corpse continues to be infected after [death] and there were a lot of burial and funeral practices where many people would come to the funeral and there would actually be a laying on of hands on the body. They had to completely cut that out. And people just washing their hands. When you were around in Liberia, there were buckets of chlorinated water everywhere so that you could wash your hands with that before going into restaurants, hospitals, really anything other than personal homes. And even some personal homes would have those buckets of chlorinated water out.
When you are leaving an Ebola treatment unit, every time you take off a piece of your personal protective equipment, you have to wash your hands. You have gloves on when you’re washing them. But probably 10 or 15 times as you’re taking each piece off. There’s a person watching you to make sure you’re doing it correctly. They just go, “Wash your hands, wash your hands, wash your hands.” So that’s kind of been repeating in my head since this all started.
I think changing our behavior is key. I think testing more people is also pretty key.
TAP: How big of a deal is it do you think that Ohio is limiting testing just to those who are medical personnel or already hospitalized? Is this changing how doctors are treating patients?
LCK: If you look at the example of South Korea, a big reason why they have been able to really slow down the virus is through testing widely, [based on] that whole idea of asymptomatic carriers and people who are contagious before they start to show symptoms. The fact that not everyone is taking this seriously because they don’t realize just because Ohio has only x number of cases that have tested positive is not reflective at all of how many cases we actually have. It’s critical to impress upon the population at large just how widespread this actually is.
Last Tuesday, it was announced that they were setting a testing unit up in Dayton for COVID-19. Great—but then the rumor was that they only had 150 tests. If you have the whole city of Dayton, and every single primary care office is wanting to send people to get tested, you’re going to blow through 150 tests pretty quickly. We’re basically telling everyone to just assume that they had [the virus] if they had symptoms that were consistent with it and then isolate themselves.
The University of Washington has posted a lot of their resources so that everyone is not reinventing the wheel. The sharing among medical providers across the country has been really cool to watch. There’s a Google document of mental-health resources that people have put together that’s open-access to help support your doctors and medical staff during this epidemic. Those are worldwide resources online that anyone can access.
The University of Washington basically said if you’re coming into the clinic or even the emergency room and you have mild symptoms, you’re not going to get tested [for the virus]. You need to assume that you have it and go home and isolate. But I think telling someone you’ve been around prior to [developing symptoms of the virus] that you think you have it—versus you tested positive for it—we may respond very differently to maybes, as opposed to “Oh my gosh, I was around Sue last week and she tested positive to coronavirus.”
Is it changing how we treat patients? Not really, because how we treat them if they have mild symptoms is just how we would treat them if they had the cold or the flu. But the implications for controlling the spread of the epidemic without testing are great.
TAP: Ohio Governor Mike DeWine has been one of the more proactive governors taking steps to shut things down and change behavior. Do you think that’s been effective? Or is it too soon to tell?
LCK: I think it’s commendable that he has been so proactive. He seems to really be listening to the Department of Health and the public-health people in the state and basing his policy directives based on what people are telling him.
When he first announced that he was closing the schools, to be honest, I had not been following this much. I think I have a little PTSD from Ebola and I think I followed that outbreak so zealously that when other outbreaks have come up, I’ve been like, “I can’t follow that. I’ve just got to let that go.” So I remember when he issued that, I was like, “Really?” But within a day or two I was like, “Yes! We did need to do that. How often [is it] that Ohio is one of the states taking the lead?” I was very proud. That’s coming from a pretty liberal person here.
TAP: Is there anything that pregnant mothers should know about the virus?
LCK: That’s one of those areas we don’t know much about. There was some data that came out of China mostly looking at women in the third trimester that didn’t show that they were at greater risk for virus complications than anyone else simply by being pregnant. But there is not a lot of data looking at women in the first or second trimester. The first trimester is often when the fetus is most susceptible. The American College of Obstetricians and Gynecologists [ACOG], had issued a statement saying that there is no evidence that women who are pregnant are at increased risk. But also that there just wasn’t a lot of evidence for that group.
I do think it’s important for pregnant women to protect themselves as much as possible. ACOG is still saying that currently available data is not showing that pregnant women are at increased risk. But pregnant women are known to be at greater risk for other respiratory infections like influenza and SARS, so they’re saying that pregnant women should be considered an at-risk population. There have been some cases of preterm birth for infants born to mothers who tested positive for COVID-19 during pregnancy. But this is limited data and it’s not clear if outcomes such as preterm birth were caused by the virus. They don’t know yet if [the virus] can cross the placenta and in the limited data that we have, infants born to mothers that had COVID-19, none of the infants had tested positive for the virus in the reports published in peer-reviewed literature. I think the key thing is that we really don’t know.
TAP: Have you seen any cases in Dayton in your practice?
LCK: We have not in my practice that we know of.
TAP: Because you haven’t been able to test enough?
LCK: Yes. Which is crazy—right?!
TAP: Is there anything that jails, prisons, and detention centers can do to prevent the spread of the virus—if you were not to release people?
LCK: I do think that some of them have started implementing measures that sound like they could have an effect. Disinfection and deep cleaning, limiting visits to just video visits. They’re not letting in anyone to see inmates. Which is kind of a plus and minus if they’re not letting lawyers see their clients. I think DeWine has made this for [all Ohio workers] now, you have to have your temperature tested on-site. That could be helpful [in these facilities].
But the bottom line is, these are facilities [where] we know, the medical service they provide is not optimal. Hygiene and cleanliness are not optimal. That’s at least as true, if not more so, in immigration facilities. When they’ve gone in and done spot checks, the situations are terrible.
There was the mumps outbreak last summer [in Texas immigrant detention facilities]. We know that [detainees] are certainly not able to do social distancing, or even wash their hands a lot. Hand sanitizer is one of the controlled substances in a lot of these places.
TAP: If someone in a detention center or similar facility contracts the virus, what would be a best-practices recommendation for these facilities—if not release? Is it even possible to protect against the spread of the virus? Can you really effect any social-distancing policy?
LCK: I think it would be incredibly difficult. There was a heartbreaking article that was just published about the Italian doctors right now. In the hospital, one doctor said, “The virus is everywhere. It’s contaminated everything.” Even in the hospital, once you get a certain number of people with the virus, it gets everywhere—and that’s in the hospital in Italy, which has an excellent health care system. So what’s that going to look like in a detention center? In a jail? In a prison? In a hospital where you have cleaning crews going through two or three times a day, hand sanitizer everywhere, people with [personal protective equipment], we don’t have enough PPE in the hospitals right now. So they certainly don’t have it in detention centers and jails. I think it would be incredibly difficult to contain it once it starts.
Cleaning all surfaces in an entire facility? To not miss something when [the virus] can live at a minimum for three days on plastic and metal and probably longer? What about cloth? In an immigration facility, detainees often don’t even have a change of clothes. They can be packed in so tightly that they can’t even sit down.
TAP: You have background in the Ebola epidemic and background in family practice. Is that what made you want to speak out about detention centers? Or was it just the knowledge as a medical professional that these facilities can easily spread a virus?
LCK: None of those answers are wrong. I recently was faculty at the University of New Mexico School of Medicine, where we do a lot of work around social determinants of health and I think that really plays into a pandemic like this also. I did some work with Physicians for Human Rights around asylum cases and I did some work with RAICES [Refugee and Immigrant Center for Education and Legal Services] when I practiced in Texas doing some asylum exams and things like that. And my sister is an immigration lawyer with ABLE [Advocates for Basic Legal Equality] in Ohio. I talk with her about this stuff.
There are so many things that we have done [that are] a huge disservice to people who are seeking a safer life in this country. Splitting up families, and the kind of deportations that we do, and this is just sort of one more thing on the pile. There are people living in this country who are afraid to go to the hospital to get tested for COVID because they’re afraid that if they go they’re going to get picked up by ICE. What are the implications for that? And there are people in detention where they have no way of taking any of these basic measures that should be a human right, to distance yourself from people who may be infected and to wash your hands. That’s completely out of their control and that’s unjust.
TAP: Governor DeWine has been proactive thus far, and he’s asked people to begin to shelter in place. Why do you think he’s been reluctant to take the next steps to protect vulnerable detained and incarcerated populations?
LCK: I’m not sure. I think that that is a move that could have pretty serious political ramifications. Many people in this country don’t feel like people who are detained or incarcerated should have the same rights as everyone else.
I think that many people have that bias without even realizing it. DeWine’s got to be day and night focused on [the virus], and I don’t hear people in the medical community talking about [detentions and jails]. And I don’t think that’s any disservice to the medical community. I think that they’re probably so focused on what’s in their wheelhouse and what’s right around them. And if you ask them, “Hey, do you think this should happen?” they would probably reply yes, but it probably never occurred to them to think about it. And I honestly don’t know that it would ever occur to me to think about it if I wasn’t talking about it with my sister.
