Scott A. Allen, MD, FACP
Professor Emeritus, Clinical Medicine
University of California Riverside School of Medicine
Medical Education Building
900 University Avenue
Riverside, CA 92521
Josiah “Jody” Rich, MD, MPH
Professor of Medicine and Epidemiology, Brown University
Director of the Center for Prisoner Health and Human Rights
Attending Physician, The Miriam Hospital,
164 Summit Ave.
Providence, RI 02906
March 19, 2020
The Honorable Bennie Thompson
Chairman
House Committee on Homeland Security
310 Cannon House Office Building
Washington, D.C. 20515

The Honorable Ron Johnson
Chairman
Senate Committee on Homeland Security
and Governmental Affairs
340 Dirksen Senate Office Building
Washington, D.C. 20510

The Honorable Mike Rogers
Ranking Member
House Committee on Homeland Security
310 Cannon House Office Building
Washington, D.C. 20515

The Honorable Gary Peters
Ranking Member
Senate Committee on Homeland Security
and Governmental Affairs
340 Dirksen Senate Office Building
Washington, D.C. 20510

The Honorable Carolyn Maloney
Chairwoman
House Committee on Oversight and Reform
2157 Rayburn House Office Building
Washington, D.C. 20515

The Honorable Jim Jordan
Ranking Member
House Committee on Oversight and Reform
2157 Rayburn House Office Building
Washington, D.C. 20515

Dear Committee Chairpersons and Ranking Members:
We are physicians—an internist and an infectious disease specialist—with unique expertise in
medical care in detention settings.1 We currently serve as medical subject matter experts for the
I, Dr. Scott Allen, MD, FACP, am a Professor Emeritus of Medicine, a former Associate Dean of Academic
Affairs and former Chair of the Department of Internal Medicine at the University of California Riverside School of
Medicine. From 1997 to 2004, I was a full-time correctional physician for the Rhode Island Department of
Corrections; for the final three years, I served as the State Medical Program. I have published over 25 peer-reviewed
papers in academic journals related to prison health care and am a former Associate Editor of the International
Journal of Prisoner Health Care. I am the court appointed monitor for the consent decree in litigation involving
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 Department of Homeland Security’s Office of Civil Rights and Civil Liberties (CRCL). One of
us (Dr. Allen) has conducted numerous investigations of immigration detention facilities on
CRCL’s behalf over the past five years. We both are clinicians and continue to see patients, with
one of us (Dr. Rich) currently providing care to coronavirus infected patients in an ICU setting.
As experts in the field of detention health, infectious disease, and public health, we are gravely
concerned about the need to implement immediate and effective mitigation strategies to slow the
spread of the coronavirus and resulting infections of COVID-19. In recent weeks, attention has
rightly turned to the public health response in congregate settings such as nursing homes, college
campuses, jails, prisons and immigration detention facilities (clusters have already been
identified in Chinese and Iranian prisons according to news reports2 and an inmate and an officer
have reportedly just tested positive at New York’s Rikers Island).3 Reporting in recent days
reveals that immigrant detainees at ICE’s Aurora facility are in isolation for possible exposure to
coronavirus.4 And a member of ICE’s medical staff at a private detention center in New Jersey
has now been reported to have tested positive for coronavirus.5
We have shared our concerns about the serious medical risks from specific public health and
safety threats associated with immigration detention with CRCL’s Officer Cameron Quinn in an
initial letter dated February 25, 2020, and a subsequent letter of March 13, 2020. We offered to
medical care at Riverside County Jails. I have consulted on detention health issues both domestically and
internationally for the Open Society Institute and the International Committee of the Red Cross, among others. I
have worked with the Institute of Medicine on several workshops related to detainee healthcare and serve as a
medical advisor to Physicians for Human Rights. I am the co-founder and co-director of the Center for Prisoner
Health and Human Rights at Brown University (www.prisonerhealth.org), and a former Co-Investigator of the
University of California Criminal Justice and Health Consortium. I am also the founder and medical director of the
Access Clinic, a primary care medical home to adults with developmental disabilities.
I, Dr. Josiah (Jody) Rich, MD, MPH, am a Professor of Medicine and Epidemiology at The Warren Alpert Medical
School of Brown University, and a practicing Infectious Disease Specialist since 1994 at The Miriam Hospital
Immunology Center providing clinical care for over 22 years, and at the Rhode Island Department of Corrections
caring for prisoners with HIV infection and working in the correctional setting doing research. I have published
close to 190 peer-reviewed publications, predominantly in the overlap between infectious diseases, addictions and
incarceration. I am the Director and Co-founder of The Center for Prisoner Health and Human Rights at The Miriam
Hospital (www.prisonerhealth.org), and a Co-Founder of the nationwide Centers for AIDS Research (CFAR)
collaboration in HIV in corrections (CFAR/CHIC) initiative. I am Principal Investigator of three R01 grants and a
K24 grant all focused on incarcerated populations. My primary field and area of specialization and expertise is in the
overlap between infectious diseases and illicit substance use, the treatment and prevention of HIV infection, and the
care and prevention of disease in addicted and incarcerated individuals. I have served as an expert for the National
Academy of Sciences, the Institute of Medicine and others.
2 Erin Mendel, “Coronavirus Outbreaks at China Prisons Spark Worries About Unknown Clusters,” Wall Street
Journal, February 21, 2020, available at: https://www.wsj.com/articles/coronavirus-outbreaks-at-china-prisonsspark-worries-about-unknown-clusters-11582286150; Center for Human Rights in Iran, “Grave Concerns for
Prisoners in Iran Amid Coronavirus Outbreak,” February 28, 2020, available at
https://iranhumanrights.org/2020/02/grave-concerns-for-prisoners-in-iran-amid-coronavirus-outbreak/.
3 Joseph Konig and Ben Feuerherd, “First Rikers Inmate Tests Positive for Coronavirus” New York Post. March
18, 2020, available at: https://nypost.com/2020/03/18/first-rikers-island-inmate-tests-positive-for-coronavirus/
4 Sam Tabachnik, “Ten detainees at Aurora’s ICE detention facility isolated for possible exposure to coronavirus,”
The Denver Post, March 17, 2020, available at https://www.denverpost.com/2020/03/17/coronavirus-ice-detentiongeo-group-aurora-colorado/.
5 Emily Kassie, “First ICE Employees Test Positive for Coronavirus,” The Marshall Project, March 19, 2020,
available at https://www.themarshallproject.org/2020/03/19/first-ice-employees-test-positive-for-coronavirus
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 work with DHS in light of our shared obligation to protect the health, safety, and civil rights of
detainees under DHS’s care. Additionally, on March 17, 2020 we published an opinion piece in
the Washington Post warning of the need to act immediately to stem the spread of the
coronavirus in jails and prisons in order to protect not only the health of prisoners and
corrections workers, but the public at large.6
In the piece we noted the parallel risks in immigration detention. We are writing now to formally
share our concerns about the imminent risk to the health and safety of immigrant detainees, as
well as to the public at large, that is a direct consequence of detaining populations in congregate
settings. We also offer to Congress, as we have to CRCL, our support and assistance in
addressing the public health challenges that must be confronted as proactively as possible to
mitigate the spread of the coronavirus both in, and through, immigration detention and
congregate settings.
Nature of the Risk in Immigration Detention and Congregate Settings
One of the risks of detention of immigrants in congregant settings is the rapid spread of
infectious diseases. Although much is still unknown, the case-fatality rate (number of infected
patients who will die from the disease) and rate of spread for COVID-19 appears to be as high or
higher than that for influenza or varicella (chicken pox).
In addition to spread within detention facilities, the extensive transfer of individuals (who are
often without symptoms) throughout the detention system, which occurs with great frequency in
the immigration context, could rapidly disseminate the virus throughout the entire system with
devastating consequences to public health. 7
Anyone can get a coronavirus infection. While healthy children appear to suffer mildly if they
contract COVID-19, they still pose risk as carriers of infection, particularly so because they may
not display symptoms of illness.8 Family detention continues to struggle with managing
outbreaks of influenza and varicella. 9 Notably, seven children who have died in and around
Josiah Rich, Scott Allen, and Mavis Nimoh, “We must release prisoners to lessen the spread of coronavirus,”
Washington Post, March 17, 2020, available at https://www.washingtonpost.com/opinions/2020/03/17/we-mustrelease-prisoners-lessen-spread-coronavirus/.
7 See Hamed Aleaziz, “A Local Sheriff Said No To More Immigrant Detainees Because of Coronavirus Fears. So
ICE Transferred Them All To New Facilities,” BuzzFeed News, March 18, 2020 (ICE recently transferred170
immigrant detainees from Wisconsin to facilities in Texas and Illinois. “’In order to accommodate various
operational demands, ICE routinely transfers detainees within its detention network based on available resources and
the needs of the agency…’ an ICE official said in a statement.”),
available at https://www.buzzfeednews.com/article/hamedaleaziz/wisconsin-sheriff-ice-detainees-coronavirus
8 Interview with Jay C. Butler, MD, Deputy Director for Infectious Diseases, Centers for Disease Control and
Prevention, “Coronovirus (COVID-19) Testing,” JAMA Network, March 16, 2020, available at
https://youtu.be/oGiOi7eV05g (min 19:00).
9 Indeed, I (Dr. Allen) raised concerns to CRCL, the DHS Office of Inspector General, and to Congress in July 2018,
along with my colleague Dr. Pamela McPherson, about the risks if harm to immigrant children in family detention
centers because of specific systemic weaknesses at those facilities in their ability to provide for the medical and
mental health needs of children in detention. See, e.g., July 17, 2018 Letter to Senate Whistleblower Caucus Chairs
from Drs. Scott Allen and Pamela McPherson, available at
https://www.wyden.senate.gov/imo/media/doc/Doctors%20Congressional%20Disclosure%20SWC.pdf. Those
concerns, including but not limited to inadequate medical staffing, a lack of translation services, and the risk of
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 immigration detention, according to press reports, six died of infectious disease, including three
deaths from influenza. 10 Containing the spread of an infection in a congregate facility housing
families creates the conditions where many of those infected children who do not manifest
symptoms will unavoidably spread the virus to older family members who may be a higher risk
of serious illness.
Finally, as you well know, social distancing is essential to slow the spread of the coronavirus to
minimize the risk of infection and to try to reduce the number of those needing medical treatment
from the already-overwhelmed and inadequately prepared health care providers and facilities.
However, social distancing is an oxymoron in congregate settings, which because of the
concentration of people in a close area with limited options for creating distance between
detainees, are at very high risk for an outbreak of infectious disease. This then creates an
enormous public health risk, not only because disease can spread so quickly, but because those
who contract COVID-19 with symptoms that require medical intervention will need to be treated
at local hospitals, thus increasing the risk of infection to the public at large and overwhelming
treatment facilities.
As local hospital systems become overwhelmed by the patient flow from detention center
outbreaks, precious health resources will be less available for people in the community.To be
more explicit, a detention center with a rapid outbreak could result in multiple detainees—five,
ten or more—being sent to the local community hospital where there may only be six or eight
ventilators over a very short period. As they fill up and overwhelm the ventilator resources,
those ventilators are unavailable when the infection inevitably is carried by staff to the
community and are also unavailable for all the usual critical illnesses (heart attacks, trauma,
etc). In the alternate scenario where detainees are released from high risk congregate settings,
the tinderbox scenario of a large cohort of people getting sick all at once is less likely to occur,
and the peak volume of patients hitting the community hospital would level out. In the first
scenario, many people from the detention center and the community die unnecessarily for want
of a ventilator. In the latter, survival is maximized as the local mass outbreak scenario is averted.
It is additionally concerning that dozens of immigration detention centers are in remote areas
with limited access to health care facilities. Many facilities, because of the rural locations, have
only one on-site medical provider. If that provider gets sick and requires being quarantined for at
least fourteen days, the entire facility could be without any medical providers at all during a
foreseeable outbreak of a rapidly infectious disease. We simply can’t afford a drain on
resources/medical personnel from any preventable cases.

communication breakdowns and confusion that results from different lines of authority needing to coordinate
between various agencies and partners from different government programs and departments responsible for
detention programs with rapid turnover, all continue to contribute to heightened risks to meeting the medical
challenges posed by the spread of the coronavirus.
10 Nicole Acevedo, “Why are children dying in U.S. custody?,” NBC News, May 29, 2019, available at
https://www.nbcnews.com/news/latino/why-are-migrant-children-dying-u-s-custody-n1010316
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 Proactive Approaches Required
Before coronavirus spreads through immigration detention, proactivity is required in three
primary areas: 1) Processes for screening, testing, isolation and quarantine; 2) Limiting transport
and transfer of immigrant detainees; and 3) Implementing alternatives to detention to facilitate as
much social distancing as possible.
Protocols for early screening, testing, isolation and quarantine exist in detention settings to
address infectious diseases such as influenza, chicken pox and measles. However, the track
record of ICE facilities implementing these protocols historically has been inconsistent. In the
current scenario, with widespread reporting about the lack of available tests for COVID-19 and
challenges for screening given the late-onset display of symptoms for what is now a communityspread illness, detention facilities, like the rest of country, are already behind the curve for this
stage of mitigation.
Detention facilities will need to rapidly identify cases and develop plans to isolate exposed
cohorts to limit the spread, as well as transfer ill patients to appropriate facilities. Screening
should occur as early as possible after apprehension (including at border holding facilities) to
prevent introduction of the virus into detention centers. We strongly recommend ongoing
consultation with CDC and public health officials to forge optimal infection prevention and
control strategies to mitigate the health risks to detained patient populations and correctional
workers. Any outbreak in a facility could rapidly overwhelm the capacity of healthcare
programs. Partnerships with local public health agencies, hospitals and clinics, including joint
planning exercises and preparedness drills, will be necessary.
Transferring detainees between facilities should be kept to an absolute minimum. The transfer
process puts the immigrants being transferred, populations in the new facilities, and personnel all
at increased risk of exposure. The nationwide network of detention centers, where frequent and
routine inter-facility transfers occur, represents a frighteningly efficient mechanism for rapid
spread of the virus to otherwise remote areas of the country where many detention centers are
housed.
Finally, regarding the need to implement immediate social distancing to reduce the likelihood of
exposure to detainees, facility personnel, and the general public, it is essential to consider
releasing all detainees who do not pose an immediate risk to public safety.
Congregant settings have a high risk of rapid spread of infectious diseases, and wherever
possible, public health mitigation efforts involve moving people out of congregate settings (as
we are seeing with colleges and universities and K-12 schools).11 Minimally, DHS should
consider releasing all detainees in high risk medical groups such as older people and those with

Madeline Holcombe, “Some schools closed for coronavirus in US are not going back for the rest of the academic
year,” CNN, March 18, 2020, available at https://www.cnn.com/2020/03/18/us/coronavirus-schools-not-going-backyear/index.html; Eric Levenson, Chris Boyette and Janine Mack, “Colleges and universities across the US are
canceling in-person classes due to coronavirus,” CNN, March 12, 2020, available at
https://www.cnn.com/2020/03/09/us/coronavirus-university-college-classes/index.html.
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 chronic diseases. COVID-19 infection among these groups will require many to be transferred to
local hospitals for intensive medical and ventilator care—highly expensive interventions that
may soon be in short supply.
Given the already established risks of adverse health consequences associated with the detention
of children and their families,12 the policy of detention of children and their families in should be
reconsidered in light of these new infectious disease threats so that children would only be
placed in congregate detention settings when lower risk community settings are not available and
then for as brief a time as possible.
In addition, given the low risk of releasing detainees who do not pose a threat to public safety—
i.e., those only charged with immigration violations—releasing all immigration detainees who do
not pose a security risk should be seriously considered in the national effort to stop the spread of
the coronavirus.
Similarly, the practice of forcing asylum seekers to remain in Mexico has created a de facto
congregate setting for immigrants, since large groups of people are concentrated on the US
southern border as a result of the MPP program in the worst of hygienic conditions without any
basic public health infrastructure or access to medical facilities or the ability to engage in social
distancing as they await asylum hearings, which are currently on hold as a consequence of the
government’s response to stop the spread of the coronavirus.13 This is a tinderbox that cannot be
ignored in the national strategy to slow the spread of infection.
ICE recently announced that in response to the coronavirus pandemic, it will delay arresting
immigrants who do not pose public safety threats, and will also stop detaining immigrants who
fall outside of mandatory detention guidelines. 14 But with reporting that immigrant detainees at
ICE facilities are already being isolated for possible exposure to coronavirus, it is not enough to
simply stop adding to the existing population of immigrant detainees. Social distancing through
release is necessary to slow transmission of infection.15
Reassessing the security and public health risks, and acting immediately, will save lives of not
only those detained, but also detention staff and their families, and the community-at-large.
Report of the DHS Advisory Committee on Family Residential Centers, September 30, 2016, available at
https://www.ice.gov/sites/default/files/documents/Report/2016/ACFRC-sc16093.pdf
13 See Rick Jervis, “Migrants waiting at US-Mexico border at risk of coronavirus, health experts warn,” USA Today,
March 17, 2020, available at https://www.usatoday.com/story/news/nation/2020/03/17/us-border-could-hit-hardcoronavirus-migrants-wait-mexico/5062446002/.
14 ICE website, Guidance on COVID-19, Immigration and Enforcement Check-Ins, Updated March 18, 2020, 7:45
pm, available at https://www.ice.gov/covid19.
15 Release of immigrants from detention to control the coronavirus outbreak has been recommended by John
Sandweg, former acting head of ICE during the Obama administration, who further noted, "’The overwhelming
majority of people in ICE detention don't pose a threat to public safety and are not an unmanageable flight
risk.’…’Unlike the Federal Bureau of Prisons, ICE has complete control over the release of individuals. ICE is not
carrying out the sentence imposed by a federal judge….It has 100% discretion.’" See Camilo Montoya-Galvez,
“’Powder kegs’: Calls grow for ICE to release immigrants to avoid coronavirus outbreak, CBS News, March 19,
2020, available at https://www.cbsnews.com/news/coronavirus-ice-release-immigrants-detention-outbreak/.
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 Our legal counsel, Dana Gold of the Government Accountability Project, is supporting and
coordinating our efforts to share our concerns with Congress and other oversight entities about
the substantial and specific threats to public health and safety the coronavirus poses by
congregate settings for immigrants. As we similarly offered to DHS, we stand ready to aid you in
any way to mitigate this crisis and prevent its escalation in light of our unique expertise in
detention health and experience with ICE detention specifically. Please contact our attorney,
Dana Gold, at danag@whistleblower.org, or her colleague, Irvin McCullough, at
irvinm@whistleblower.org, with any questions.
Sincerely,
/s/
Scott A. Allen, MD, FACP
Professor Emeritus, University of California, School of Medicine
Medical Subject Matter Expert, CRCL, DHS
/s/
Josiah D. Rich, MD, MPH
Professor of Medicine and Epidemiology
The Warren Alpert Medical School of Brown University
Medical Subject Matter Expert, CRCL, DHS

Cc:

Dana Gold, Esq. and Irvin McCullough, Government Accountability Project
Senate Committee on the Judiciary
House Committee on the Judiciary
White House Coronavirus Task Force

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