ICE Efforts to Address COVID-19 in Detention Facilities (GAO-21-414)
Summary
A GAO report to congressional committees, GAO-21-414, dated June 2021, on immigration detention. It describes the COVID-19 Pandemic Response Requirements that U.S. Immigration and Customs Enforcement (ICE) developed to guide detention facilities, covering intake processing, screening and testing, and social distancing, among other requirements. According to officials from six selected facilities, these requirements were routinely implemented, though some reported that quarantine of detainees was difficult at times due to infrastructure limitations and that detainee compliance with mask wearing was an ongoing challenge. The report examines ICE's efforts to address COVID-19 in detention facilities.
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United States Government Accountability Office
Report to Congressional Committees
IMMIGRATION
June 2021
DETENTION
ICE Efforts to
Address COVID-19
in Detention Facilities
GAO-21-414
June 2021
IMMIGRATION DETENTION
ICE Efforts to Address COVID-19 in Detention
Facilities
Highlights of GAO-21-414, a report to
congressional committees
Why GAO Did This Study What GAO Found
Detention facilities can present a To guide immigration detention facilities’ response to Coronavirus Disease 2019
challenging environment to manage (COVID-19), U.S. Immigration and Customs Enforcement (ICE) developed the
the risk of transmission of infectious COVID-19 Pandemic Response Requirements. These protocols address facility
diseases, including COVID-19. ICE, intake processing, screening and testing, and social distancing, among other
within the Department of Homeland requirements. According to officials from six selected facilities, these
Security, is the lead federal agency requirements were routinely implemented. However, some reported that
responsible for providing safe, secure, quarantine of detainees was difficult at times due to infrastructure limitations, and
and humane confinement for detained detainee compliance with mask wearing was an ongoing challenge. As of March
individuals of foreign nationality while 2021, individual facilities were generally responsible for working directly with
they wait for resolution of their state and local health authorities to administer COVID-19 vaccines to detainees.
immigration cases, or removal from the
United States. As of March 2021, ICE Number of Reported COVID-19 Cases among Detainees in ICE Detention Facilities
confirmed over 10,000 cases of
COVID-19 among detainees within its
detention facilities nationwide and
recorded eight deaths.
This report examines: (1) ICE’s policies
and procedures for responding to
COVID-19 in immigration detention
facilities and how they were
implemented at select facilities; (2)
ICE’s mechanisms for conducting
oversight of COVID-19 related health
and safety measures; and (3) ICE’s
data on COVID-19 cases and identified
high-risk health factors among
detainees. GAO interviewed officials in To oversee detention facilities’ management of COVID-19, ICE administers a
ICE headquarters and from a non- recurring survey to assess their implementation of the Pandemic Response
generalizable sample of six ICE Requirements. According to ICE, field officials review the survey responses and
detention facilities selected on the follow up with facilities on areas requiring attention. Officials told GAO the survey
basis of geographic location, facility helped identify areas of potential noncompliance, but also noted some
type, and average population. GAO challenges, such as a lack of on-site facility monitoring to validate responses. In
reviewed ICE’s Pandemic Response
December 2020, ICE revised the survey to obtain more information on facilities’
Requirements for detention facilities
adherence to requirements and implemented an on-site compliance check. As of
and oversight mechanisms, and
analyzed ICE data on COVID-19 cases
March 2021, officials reported three monthly surveys were completed, plans for
and high-risk detainees in its custody corrective actions were initiated at 11 facilities, and they plan to review survey
between January 2020 and March data more systematically for trends.
2021. ICE identifies and tracks COVID-19 cases among detainees in its custody as well
as those detainees determined to be at high-risk for severe illness due to COVID-
19. In calendar year 2020, ICE tested 80,200 detainees for COVID-19, identified
8,622 positive cases (10.8 percent), and recorded eight deaths. ICE further
identified 14,729 high-risk detainees in its custody nationwide among whom 528
(3.6 percent) tested positive for COVID-19.
View GAO-21-414. For more information,
contact Rebecca Gambler at (202) 512-8777
or gamblerr@gao.gov.
United States Government Accountability Office
Contents
Letter 1
Background 4
ICE Issued Evolving Requirements to Guide COVID-19 Response
Activities, and Selected Facilities Reported Implementing Key
Health and Safety Measures 8
ICE Oversees COVID-19-Related Measures through Facility
Surveys and Renewed On-Site Monitoring 16
ICE Data Identifies Thousands of COVID-19 Cases and High-Risk
Health Conditions among Detainees 22
Agency Comments 25
Appendix I Comments from Department of Homeland Security 28
Appendix II GAO Contact and Staff Acknowledgments 31
Table
Table 1: U.S. Immigration and Customs Enforcement (ICE) Over-
72-Hour Detention Facility Types, Fiscal Year 2020 6
Figures
Figure 1: Number of Reported COVID-19 Cases among
Individuals Detained in Immigration Detention Facilities
and Average Detainee Populations by Month, 2020 7
Figure 2: Positive COVID-19 Cases at Immigration Detention
Facilities in 2020, by U.S. Immigration and Customs
Enforcement (ICE) Field Office 23
Page i GAO-21-414 Immigration Detention
Abbreviations
CDC Centers for Disease Control and Prevention
COVID-19 Coronavirus Disease 2019
DHS Department of Homeland Security
ERO Enforcement and Removal Operations
ICE U.S. Immigration and Customs Enforcement
IGSA Intergovernmental service agreement
IHSC ICE Health Service Corps
PPE personal protective equipment
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Page ii GAO-21-414 Immigration Detention
Letter
441 G St. N.W.
Washington, DC 20548
June 30, 2021
Congressional Committees
As of March 2021, over 10,000 cases of Coronavirus Disease 2019
(COVID-19) were confirmed within immigration detention facilities,
including eight reported deaths among detainees. Within the Department
of Homeland Security (DHS), U.S. Immigration and Customs
Enforcement (ICE) is the lead federal agency responsible for providing
safe, secure, and humane confinement for detained individuals of foreign
nationality while they wait for resolution of their immigration cases, or
removal from the United States.
According to the Centers for Disease Control and Prevention (CDC), the
densely-populated environment of detention facilities may place
detainees, such as those in ICE custody, at higher risk of infection and
transmission. COVID-19 can pose a variety of health risks and some
detainees may be at increased risk due to pre-existing health conditions.
Numerous lawsuits have been filed in federal courts seeking relief on
behalf of detainees based on various allegations related to conditions of
detention during the COVID-19 pandemic.
We were asked to review ICE’s management of COVID-19 within
immigration detention facilities. In addition, the Coronavirus Aid, Relief,
and Economic Security Act (CARES Act) includes a provision for us to
monitor and oversee, offer regular briefings, and publish reports on
activities and funding under the CARES Act or any other act to address
the COVID-19 pandemic and its effects on the health, economy, and
public and private institutions of the United States, including the federal
government’s public health and homeland security efforts. 1 This report
examines (1) ICE’s policies and procedures for responding to COVID-19
in immigration detention facilities and how they were implemented at
select facilities; (2) ICE’s mechanisms for conducting oversight of COVID-
1Pub. L. No. 116-136, div. B, title IX, § 19010, 134 Stat. 281, 579-81 (2020). We regularly
issue government-wide reports on the federal response to COVID-19. For the latest
report, see GAO, COVID-19: Sustained Federal Action Is Crucial as Pandemic Enters Its
Second Year, GAO-21-387 (Washington, D.C.: Mar. 31, 2021). Our next government-wide
report will be issued in July 2021 and will be available on GAO’s website at
https://www.gao.gov/coronavirus.
Page 1 GAO-21-414 Immigration Detention
19 related health and safety measures; and (3) ICE’s data on COVID-19
cases and identified high-risk health factors among detainees.
To describe ICE’s policies and procedures for addressing COVID-19 and
how they were implemented within select immigration detention facilities,
we reviewed ICE documentation and interviewed ICE officials and select
facility operators. Key documents we reviewed included ICE’s COVID-19
Pandemic Response Requirements, which establishes requirements,
protocols, and procedures for managing COVID-19 within immigration
detention facilities. 2 Specifically, this guidance contains detailed
requirements on various health and safety measures, including COVID-19
screening and testing procedures, intake and quarantine protocols, and
recommended social distancing practices, among others. We also
reviewed other guidance from ICE health officials, as well as email
memoranda and recommendations issued by ICE headquarters to field
offices related to managing the pandemic. 3 Lastly, we reviewed ICE’s
COVID-19 Reconstitution Plan, which establishes a phased process for
restoring on-site activities at ICE detention facilities, among other things. 4
At the headquarters level, we interviewed officials from ICE’s
Enforcement Removal Operations (ERO), which oversees the
confinement of ICE detainees across facilities in accordance with
immigration detention standards. Specifically, we met with officials from
ERO’s Custody Management Division, Field Operations Division, and ICE
Health Services Corps (IHSC). For our field interviews, we selected a
non-generalizable sample of six ICE immigration detention facilities that
represent variation among a range of factors including field office location,
facility type, average detainee population, and the number of COVID-19
2ICE, COVID-19 Pandemic Response Requirements, Version 1 (Washington, D.C.: April
10, 2020).
3We reviewed principal guidance and correspondence dated between February 2020 and
April 2020 that describe ICE’s initial steps to manage COVID-19 within immigration
detention facilities.
4ICE, COVID-19 Reconstitution Plan, (Washington, D.C.: July 29, 2020). ICE’s COVID-19
Reconstitution Plan establishes a phased approach to returning to a pre-pandemic
operating posture as health and safety conditions permit.
Page 2 GAO-21-414 Immigration Detention
cases identified at the facility. 5 At each immigration detention facility, we
interviewed ICE field office management, facility operators, facility
medical personnel, and the assigned ICE Detention Service Manager,
among others. 6 During these meetings, we discussed each facility’s
implementation of the Pandemic Response Requirements and other
COVID-19 guidance, as well as any associated challenges.
To describe ICE mechanisms for conducting oversight of COVID-19
related health and safety measures, we reviewed relevant ICE documents
and interviewed ICE headquarters and field officials. Specifically, we
selected and reviewed two sets of responses to the COVID-19 Facility
Checklists for each of the six immigration detention facilities in our non-
generalizable sample. 7 ICE requires all facilities that hold detainees over
72 hours to complete these checklists to assess facility implementation of
the Pandemic Response Requirements. 8 At the headquarters level, we
met with ICE officials to discuss the development and implementation of
the facility checklists, as well as related findings or actions taken to
address potential noncompliance. Within the field, we interviewed the
facility personnel responsible for completing the facility checklists and ICE
5ICE utilizes a variety of detention facility types. These generally include (1) service
processing centers, which ICE owns and primarily operates; (2) contracted detention
facilities, which are generally owned and operated by private companies; (3) dedicated
and non-dedicated intergovernmental service agreement facilities, which are owned and
operated by state, or local governments; and (4) U.S. Marshals Service intergovernmental
agreement or contract facilities, which are generally owned by state or local government
or private entities and are operated under an agreement or contract with the U.S.
Marshals Service. Average detainee population refers to the average number of
detainees in custody on a given day within a specified period, and the number of COVID-
19 cases refers to the number of detainees who tested positive for COVID-19 while in ICE
custody or who were sick with COVID-19 for a period of time that included ICE custody.
Based on these criteria, we selected a non-generalizable sample that included (1) the El
Paso Service Processing Center, (2) the Otay Mesa Detention Center, (3) the Tacoma
ICE Processing Center, (4) the Immigration Centers of America (Farmville), (5) the
BlueBonnet Detention Facility, and (6) the Limestone County Detention Center.
6ICE Detention Service Managers routinely maintain a presence at approximately 57
facilities to conduct ongoing compliance reviews and assist the facility in developing and
monitoring corrective actions to ensure compliance with national detention standards is
achieved and maintained.
7According to officials, ICE issued the initial version of the facility checklist in April 2020
and expanded use of the checklist to all over-72-hour facilities by June 2020. For each of
the six selected facilities, we requested and reviewed survey responses for two different
time periods – one from April/June 2020 and one completed in November/December
2020.
8These facilities house exclusively adult detainees for over 72 hours. ICE also houses
detainees in shorter-term, under-72-hour detention facilities, as well as temporary holding
facilities typically for 12 hours or less.
Page 3 GAO-21-414 Immigration Detention
officials responsible for reviewing the checklist responses for the six
facilities in our non-generalizable sample. During these interviews, we
obtained perspectives on the extent to which the facility checklist is an
effective tool for monitoring facilities’ implementation of the Pandemic
Response Requirements, as well as limitations and related challenges.
To describe ICE data on COVID-19 cases and identified high-risk health
factors among detainees, we analyzed ICE data and interviewed ICE
headquarters and field officials. Specifically, we analyzed calendar year
2020 data from ICE’s Lower Respiratory Illness Tracker, which ICE uses
to document and track COVID-19 cases in immigration detention facilities
nationwide. The tracker is an Excel spreadsheet accessible to authorized
ICE personnel that contains a variety of data on positive cases, including
the date for each positive test, the immigration detention facility in which
the case occurred, and whether exposure to COVID-19 occurred prior to,
during, or overlapping ICE custody. We also analyzed calendar year 2020
data from ICE’s high-risk reporting process. ICE identifies and reports on
detainees determined to be at high-risk for severe illness due to COVID-
19. These data include the reason for high-risk determinations, as well as
each high-risk detainee’s status in the ICE detention life-cycle. To assess
the reliability of these data, we interviewed IHSC headquarters officials;
officials from ERO’s Law Enforcement Systems and Analysis Division,
which collects and analyzes data on ICE operations; and field officials at
the six facilities in our non-generalizable sample to obtain information on
how data are collected. After assessing ICE’s data collection and entry
procedures, as well as the steps ICE takes to ensure data are complete
and accurate, we determined that the data are sufficiently reliable to
report summary statistics on detainees who tested positive for COVID-19
while in ICE custody and on detainees identified as high-risk while in ICE
custody.
We conducted this performance audit from May 2020 to June 2021 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.
COVID-19 is a communicable disease caused by a novel coronavirus,
Background SARS-CoV-2. The virus is thought to transfer primarily by person-to-
person contact through respiratory droplets produced when an infected
person coughs or sneezes, and it may transfer through contact with
Page 4 GAO-21-414 Immigration Detention
surfaces or objects contaminated with these droplets. There is also
evidence of asymptomatic or presymptomatic transmission, in which an
individual infected with COVID-19 is capable of spreading the virus to
others without or before exhibiting symptoms. Symptoms include fever,
cough, and shortness of breath, and typically appear 2 to 14 days after
exposure. Older adults and people who have chronic medical conditions
like heart, lung, or kidney disease are also at higher risk for more severe
COVID-19 illness.
ICE owns and operates some of its detention facilities. Others are owned
and operated by private companies through contracts with ICE or are
owned by state or local governments or private entities and operated
under agreements with ICE. Additionally, some facilities exclusively
house ICE detainees, and others house ICE detainees and other confined
populations, either together or separately. Table 1 describes the types of
detention facilities and the number of each type during fiscal year 2020.
Page 5 GAO-21-414 Immigration Detention
Table 1: U.S. Immigration and Customs Enforcement (ICE) Over-72-Hour Detention Facility Types, Fiscal Year 2020
Facility Type Description Number of Facilities
Service Processing Center Facility owned and primarily operated by ICE; exclusively houses 5
ICE detainees.
Contract Detention Facility Facility owned and operated by private company under direct ICE 14
contract; exclusively houses ICE detainees.
Dedicated intergovernmental service Facility owned by state or local government or private entity, 22
agreement facility operated under an agreement with ICE; exclusively houses ICE
detainees.
Nondedicated intergovernmental service Facility owned by state or local government or private entity, 66
agreement facility operated under an agreement with ICE; houses ICE detainees
and other confined populations, either together or separately.
U.S. Marshals Service intergovernmental Facility owned by state or local government or private entity, 50
agreement or contract facility operated under an agreement or contract with U.S. Marshals
Service; houses ICE detainees and other populations, either
together or separately.
Total 157
Source: GAO analysis of ICE information | GAO-21-414
Note: This table presents information on authorized facilities that house exclusively adult detainees
for over 72 hours.
Within ICE, ERO has primary responsibility for overseeing the compliance
of ICE detention facilities with applicable immigration detention standards.
ICE has developed standards for immigration detention that specify how
facilities should operate to ensure safe, secure, and humane confinement
for immigration detainees. 9 Within ERO, the Custody Management
Division oversees the routine monitoring and inspection of facilities; the
Field Operations Division oversees 24 field offices that manage local
detention operations; and IHSC serves as the medical authority for
detainee health care issues and oversees administration and costs of
medical care at all detention facilities. As of February 2021, IHSC
provided direct medical care to adult detainees in 14 facilities and
oversees medical care administered by non-IHSC providers in other
facilities.
Detention facilities can present a challenging environment to manage the
risk of transmission of infectious diseases, including COVID-19. For
example, detained persons routinely live, work, eat, and recreate within
shared environments, and detainees in a particular facility may arrive
from a variety of different geographic areas. ICE’s standards applicable to
9ICE detention facilities are generally required to adhere to one of four sets of detention
standards, which vary depending on the contract or agreement.
Page 6 GAO-21-414 Immigration Detention
all facilities housing ICE detainees require each facility to have written
plans that address the management of infections and communicable
diseases, including, but not limited to, testing, isolation, prevention, and
education. These requirements include reporting to and collaborating with
local or state health departments in accordance with state and local laws
and recommendations. 10 See figure 1 for information on the number of
reported COVID-19 cases and average daily populations within
immigration detention facilities for 2020.
Figure 1: Number of Reported COVID-19 Cases among Individuals Detained in Immigration Detention Facilities and Average
Detainee Populations by Month, 2020
Note: This figure represents average daily detainee populations at all over-72 hour immigration
detention facilities. According to U.S. Immigration and Customs Enforcement (ICE), the average daily
population is calculated by summing the total number of detainees at midnight each day in each
facility and dividing by the number of days being measured. ICE reported 8,622 positive COVID-19
cases among detainees in ICE custody in calendar year 2020. ICE data did not identify the month for
19 of these 8,622 cases, so this information is omitted from the figure.
10For example, the Performance-Based National Detention Standards 2008 and 2011
both require facilities to “comply with current and future plans implemented by federal,
state or local authorities addressing specific public health issues.”
Page 7 GAO-21-414 Immigration Detention
ICE’s ERO issued a broad range of requirements and guidance materials
ICE Issued Evolving to address pandemic response activities at detention facilities. Beginning
Requirements to in late January 2020, ERO began providing initial COVID-19
communications, including preliminary medical guidance from IHSC. By
Guide COVID-19 mid-March, ICE began issuing regular updates of applicable information
Response Activities, from the CDC and implemented a broad range of specific policies and
procedures to guide pandemic response activities and help reduce the
and Selected risk of COVID-19 transmission within detention facilities. ERO issued the
Facilities Reported first version of its consolidated COVID-19 Pandemic Response
Requirements in April 2020. This document, issued to all detention
Implementing Key facilities, continues to serve as the primary guidance for all detention
Health and Safety facilities housing ICE detainees to follow during the COVID-19 pandemic.
The following represents additional details regarding the evolving
Measures guidance issued by ERO to support COVID-19 preparation and response
efforts.
• Initial ERO communications. IHSC disseminated the first of a series
of COVID-19-related medical reference documents in late January
2020 to provide awareness of the unfolding outbreak in China and
provide preliminary recommendations related to detainee intake
medical screening, symptom monitoring, and reporting. On February
1, 2020, ERO issued a communication to all of its personnel with
further information on the virus, such as known signs and symptoms,
as well as initial recommendations for staff protective measures.
• Interim guidance and policy documents. Targeted guidance and
policy documents to address the COVID-19 pandemic were
distributed beginning in mid-March 2020. For example, during this
time, ERO announced a suspension of social visitation for detainees
within all facilities, reduced enforcement operations, disseminated
applicable CDC guidance targeted to correctional and detention
facilities, as well as an “Action Plan” consisting of a collection of
COVID-related policies and procedures issued to all field offices to
help ensure a unified response. 11 Among other elements, the Action
Plan included requirements for maintaining detainee access to legal
representation and communications with facility staff and ERO field
office staff, as well as suggested screening practices for facility staff
and detainees.
11Centers for Disease Control and Prevention (CDC), Interim Guidance on Management
of Coronavirus Disease 2019 (COVID-19) in Correctional/Detention Facilities,
https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-corr
ectional-detention.html.
Page 8 GAO-21-414 Immigration Detention
• COVID-19 Pandemic Response Requirements. Originally issued
April 10, 2020, the Pandemic Response Requirements document built
upon previously issued guidance and established specific mandatory
requirements for all detention facilities, as well as recommended best
practices. Specific requirements included are detainee screening and
quarantine procedures; identification of detainees who may be at
higher risk for severe illness due to COVID-19; facility cleaning and
disinfection; and use of personal protective equipment, among others.
This document is subject to ongoing revisions and is currently on
version 6, issued March 16, 2021. 12
ICE officials and representatives we spoke with from six facilities
generally stated that the guidance and information provided by ICE were
sufficient, and several reported that additional opportunities to clarify new
requirements or discuss specific facility conditions were available through
regular conference calls and communication with ERO headquarters. Two
officials also noted that the volume and frequency of the updates to these
materials presented some challenges to review and implement under
short time frames. All five of the private facility operators we spoke with
reported that they also independently monitored CDC guidance as the
pandemic unfolded, and they each developed their own policies to help
direct pandemic response activities.
The Pandemic Response Requirements address a broad range of
COVID-19 health and safety measures. Specifically, it calls for measures
in the areas of detainee intake screening and testing, identification of
“high-risk” detainees, quarantine and isolation, hygiene and personal
protective equipment (PPE) supplies, cleaning and disinfection, social
distancing and education efforts, and visitation procedures.
• Detainee intake screening and testing. The Pandemic Response
Requirements calls for pre-intake COVID-19 screening for all staff and
new entrants at all facilities. For new admissions, the screening
should occur before beginning intake procedures and consists of a
temperature screening as well as a verbal screening for symptoms
12In January 2021, IHSC also began disseminating protocols related to administering the
COVID-19 vaccine to detainees within IHSC-staffed facilities, including establishing a
vaccine priority schedule based on detainee age and identified health conditions.
According to ICE officials, as of March 2021, individual facilities were generally
responsible for working with state and local health authorities to obtain and administer a
COVID-19 vaccine based on the specific eligibility requirements in their states.
Page 9 GAO-21-414 Immigration Detention
and known contacts with infected persons. 13 Beginning in September
2020, the Pandemic Response Requirements also requires testing for
all new intakes within 12 hours of arrival. 14 Consistent with CDC
guidelines, prior versions generally recommended limiting testing to
symptomatic individuals or those with recent or known exposure to
persons with COVID-19 infection.
According to officials we spoke with at six immigration detention
facilities, medical staff routinely conduct COVID-19 screening for
detainees during intake using a standard symptom questionnaire. 15
Officials at each of the six facilities reported testing symptomatic
individuals since spring 2020 and three of the six facilities had begun
implementing testing of all detainees during intake by July 2020. 16 At
IHSC-staffed detention facilities, medical staff enter any reported
symptoms and associated COVID-19 testing results into IHSC’s
Lower Respiratory Illness Tracker (COVID-19 Tracker). 17 According to
officials, ICE utilizes the COVID-19 Tracker to monitor cases across
ICE detention facilities, inform medical decisions, and update ICE’s
public website listing COVID-19 cases across immigration detention
facilities. 18 At contracted and IGSA detention facilities, medical
providers track symptom and test result information locally and send
13This screening is to take place before entrance to the facility or just inside the facility,
where practical, and should include questions based on the CDC Interim Guidance for
Management of Coronavirus Disease (COVID-19) in Correctional and Detention Facilities.
As an additional resource to medical providers, IHSC has developed a document
identifying key steps in the intake process.
14Collection timeframe may extend to 24 hours if facility collection logistics require
additional time. Any confirmed or suspected COVID-19 cases are to be reported to
applicable ICE offices and the local health department.
15Officials at five of the six facilities told us their facility was accepting new detainees
during our interviews in fall 2020. Among these five facilities, most reported receiving
transfers or new entrants in singles or small groups but one facility reported sometimes
receiving up to 10 new intakes on a single day. The sixth facility we interviewed
experienced an outbreak of COVID-19 in mid-2020, and as a result was placed under a
court injunction restricting the intake of new detainees to the facility.
16Facility operators generally reported sending tests to an off-site laboratory for analysis
and results. According to these officials, medical staff generally receive test results within
2 to 3 days, but noted that delays of 5 to 7 days were common early in the pandemic.
17IHSC’s Lower Respiratory Illness Tracker is a spreadsheet available to authorized ICE
staff. According to officials, ICE uses the spreadsheet to record and track positive COVID-
19 cases, symptomatic cases, and test results, among other data.
18ICE maintains a cumulative total of COVID-19 cases by facility, among other
information, at ice.gov/coronavirus.
Page 10 GAO-21-414 Immigration Detention
these data to IHSC officials via email. IHSC officials then enter the
data provided into the COVID-19 Tracker.
• Identification of “high-risk” detainees. According to the Pandemic
Response Requirements, all facilities are to evaluate new admissions
within 5 days of entering ICE custody to identify the presence of
factors that may place a detainee at higher risk for severe illness due
to COVID-19. 19 Select factors include those aged 55 or older,
pregnancy status, chronic health conditions, physical or mental
impairments, and severe psychiatric illness. 20 Applicable notifications
of detainees that fall into these categories should be made to the local
ERO Field Office Director (or designee) and the Field Medical
Coordinator within twelve hours of determining whether the detainee
meets the criteria, according to ICE policy. The October 2020 version
of the Pandemic Response Requirements also introduced some
additional procedures applicable for detainees identified as “high-risk”,
such as twice-daily temperature and verbal screening, enhanced
monitoring or care if infected with COVID-19, and “significant weight”
given to risk factors when making a custody determination.
Operators from each of the facilities we interviewed reported
implementing procedures for identifying detainees that fall into
specified categories associated with potentially higher-risk from
COVID-19. At IHSC-staffed facilities, medical staff routinely collect
detainee medical information during intake and enter data directly into
ICE’s Electronic Health Record System—ICE’s system of record for
all detainee health information—including existing health conditions
that may put them at high-risk for severe illness due to COVID-19. If
medical staff at a facility not staffed by IHSC determine that a
detainee falls into one or more high-risk category, medical staff track
19This requirement is due, in part, to a court order that ICE identify and track detainees
falling into two designated subclasses associated with COVID-19-related risk factors and
disabilities, Fraihat v. ICE, 445 F. Supp. 3d 709, 750-1 2020 WL 1932570 (C.D. Cal. Apr.
20, 2020) (Order granting Plaintiffs’ Emergency Motion to Certify Subclass and Motion for
Preliminary Injunction, inter alia); Fraihat v. ICE, 220 WL 1932393 (C.D. Cal. Apr. 20,
2020) (Order on Plaintiffs’ Emergency Motion for Provisional Class Certification). See also
Fraihat v. ICE, 2020 WL 6541994 (C.D. Cal. Oct. 7, 2020) (Order granting in part and
denying in part Plaintiffs’ Motion to Enforce Apr. 20, 2020 Preliminary Injunction).
20Based on the Fraihat ruling and related CDC guidance, the Pandemic Response
Requirements identifies the following chronic health conditions: cancer, chronic kidney
disease, chronic obstructive pulmonary disease, Down syndrome, weakened immune
system, overweight and obesity, serious heart conditions, including heart failure, coronary
artery disease and cardiomyopathies, sickle cell disease, type one and type two diabetes
mellitus, asthma, cerebrovascular disease, cystic fibrosis, hypertension or high blood
pressure, neurologic conditions, including dementia, liver disease, pulmonary fibrosis,
smoking, and thalassemia.
Page 11 GAO-21-414 Immigration Detention
this information locally using a variety of tools and inform IHSC staff
via email. When IHSC is notified that a detainee at such a facility falls
into one or more high-risk categories, staff enter this information in
ICE’s Electronic Health Record System and use this information to
inform medical and release decisions. According to ICE field office
officials we spoke with, custody determinations are conducted on a
case-by-case basis generally incorporating a wide range of factors,
including potential risks to community safety or failure to attend
required hearings, as well as associated COVID-19 risk factors.
• Quarantine and isolation. The Pandemic Response Requirements
state that detainees awaiting test results who are asymptomatic are to
be placed in an intake quarantine for 14 days prior to release to the
general detainee population. The requirements suggest that facilities
should consider grouping these detainees into “cohorts” (arriving on
the same day or within a few days) in designated areas based on the
specific capabilities and most effective methods available for each
individual facility. Any suspected or confirmed COVID-19 cases are to
be isolated separately from other individuals. If single isolation rooms
are unavailable, individuals with laboratory-confirmed COVID-19
should be isolated together as a cohort separate from other
detainees, including those with pending tests. 21 During these
quarantine and isolation periods, medical providers are to conduct
periodic screening and symptom monitoring, as well as supplemental
procedures for detainees identified as high-risk or testing positive for
COVID-19. 22
ICE officials and facility operators from each of the six facilities we
interviewed reported that all new admissions completed the minimum
14-day quarantine before being introduced to the general
population. 23 Consistent with the Pandemic Response Requirements,
officials reported that they group symptom-free detainees into cohorts
of individuals with similar risk classifications where necessary. Two
21COVID-19 positive detainees generally complete a 10-day isolation period, but may
require up to 20 days due to severe illness or other health conditions. The Pandemic
Response Requirements includes additional references to applicable CDC guidance for
medically isolating COVID-19 cases and specify an order of preference for types of
isolation housing based on facility capabilities.
22Examples of supplemental procedures include twice-daily temperature and verbal
symptom screening for high-risk individuals and regular monitoring of vitals and medical
assessment of COVID-19 positive detainees.
23Officials we spoke with from one facility chose to independently implement a 21-day
quarantine for new entrants to the facility after the contracted facility operators observed
detainees developing symptoms after the 14-day quarantine period.
Page 12 GAO-21-414 Immigration Detention
facility operators cited that limited infrastructure made quarantine of
cohorts difficult at times, whereas three facilities reported there was
generally sufficient space for quarantine due to reduced detainee
populations. Symptomatic or positive COVID-19 cases are routinely
placed in isolation units where available, or in some cases, may be
housed as a small group. 24
• Hygiene and PPE supplies. According to the Pandemic Response
Requirements, all facilities are required to maintain sufficient stocks of
hygiene supplies (soap, hand sanitizer, tissues) and personal
protective equipment including facemasks, N95 respirators, eye
protection, disposable medical gloves, and disposable gowns/one-
piece coveralls. 25 Staff and detainees are to be trained on proper use
and disposal of soiled items.
Officials at each of the six facilities we interviewed reported they were
able to maintain sufficient supply of PPE for detainees or staff during
the course of the COVID-19 pandemic. Four of the facilities reported
stock of PPE running low at times, but none reported running out at
any point. Officials at the other two facilities we spoke with reported
having ample supplies throughout the pandemic. The sudden
increase in usage among facilities required some detention facility
officials to identify alternative sources to procure PPE, such as
coordination with other facilities or local public health departments to
share supplies. In addition, officials reported maintaining detainee
access to personal hygiene supplies such as hand sanitizer and soap.
• Cleaning and disinfection. The Pandemic Response Requirements
note that facilities are to adhere to CDC recommendations for
cleaning and disinfection during the COVID-19 response. 26 Among
other requirements, surfaces and objects that are frequently touched
24Officials we interviewed reported that any detainees that are cohorted with a detainee
who subsequently tests positive for COVID-19 will restart their 14-day quarantine and will
continue to be monitored for symptoms.
25The Pandemic Response Requirements permits the use of cloth face masks for
detainees and staff and notes that some PPE, such as N95 respirators may face
shortages during the pandemic.
26Centers for Disease Control and Prevention, Cleaning and Disinfection for Community
Facilities,
https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection
.html.
Page 13 GAO-21-414 Immigration Detention
should be cleaned and disinfected several times per day, and shared
equipment is to be cleaned after each use. 27
Each of the facility operators that we interviewed generally reported
having a sufficient supply of cleaning supplies in the facility. Officials
from four of the six facilities specifically noted that “high-touch” items,
such as doorknobs and telephones, are sanitized frequently
throughout the day in addition to regular facility cleaning by janitorial
staff. Officials at four facilities also reported that detainees maintain
regular access to cleaning supplies to sanitize their personal living
spaces and items. Supplemental cleaning identified at one facility
included removal of detainees from the housing units on a weekly
basis to spray the areas with a bleach solution.
• Social distancing and education efforts. To facilitate social
distancing among detainees, the Pandemic Response Requirements
state that facilities are to make efforts to reduce the detainee
population to 75 percent of capacity. Other recommendations include
taking steps to limit the number of interactions between detainees
from other housing units, such as staggering access to shared spaces
and extending recreation and meal hours. To encourage social
distancing and effective hygiene for detainees, facilities are to post
educational signage and reinforce recommended practices. 28
Officials we interviewed at each of the six facilities told us they
reduced detainee populations below 75 percent capacity, with four
facilities reporting the number of detainees at or below 25 percent
total capacity. 29 Three of the six facilities reported serving detainees
meals within their housing units and three of the six reported
staggering recreation time outside of housing units to prevent
contamination between cohorts. Officials at each facility also reported
widespread use of signage throughout the facility in multiple
languages addressing items such as hygiene practices, COVID-19-
related symptoms, use of PPE, and recommended social distancing
practices. Officials at three of the facilities we spoke with also reported
placing tape or stickers on the floor to mark the appropriate space, 6
27Facilities are also required to ensure there is adequate oversight and supervision of all
individuals responsible for cleaning and disinfection, and to report any confirmed or
suspected cases of detainees suffering adverse reactions to cleaning supplies or
chemicals to designated ICE officials for further investigation.
28Signage must be in English and Spanish, as well as any other common languages for
detainees at the facility.
29ICE field officials identified that these reductions were largely due to reduced
enforcement activities in their area of responsibility.
Page 14 GAO-21-414 Immigration Detention
feet apart, to reduce possible exposure to COVID-19 among
detainees and staff. Officials from two of the facilities also identified
additional education efforts, such as presentation of COVID-19
educational videos and holding regular ‘town hall’ meetings to allow
communication between detainees and staff for any concerns,
questions, and discussion of COVID-19 policies.
Officials we spoke with from three of the facilities stated that detainee
compliance with mask wearing and social distancing was an ongoing
challenge, but noted that enforcement options must be balanced with
the need to reduce the overall tension level within the facility during a
stressful time.
• Visitation procedures. Facilities are to provide access to virtual
visitation programs to address COVID-19 related impacts on social
and legal visitation, according to the Pandemic Response
Requirements. These may include revised processes for detainee-
attorney calls or meetings, leveraging available technologies, and
providing detainees with some number of free calls per week.
During suspended social visitation, officials we interviewed from three
of the facilities provided detainees with tablets to conduct virtual face-
to-face visits. Officials at some facilities also reported providing
detainees with additional free phone call minutes to communicate with
friends and family. Three of the facilities we spoke with suspended in-
person legal visitation in favor of remote access options, such as
tablet, video, or telephone legal visitation for a period of several
months during 2020. At the time of our interviews with these facilities,
all six were allowing in-person legal visitation and each of them
reported providing detainee access to legal counsel through
telephone or virtual meetings. These facilities also reported that
attorneys are subject to routine screening and required to wear PPE
during any in-person visits.
Page 15 GAO-21-414 Immigration Detention
ICE Oversees
COVID-19-Related
Measures through
Facility Surveys and
Renewed On-Site
Monitoring
ICE Conducts Oversight of ICE conducts oversight of detention facilities’ efforts to implement COVID-
COVID-19 Measures 19 health and safety measures primarily through recurring surveys. In
April 2020, ICE began administering its first version of a recurring survey
through Recurring Surveys
to assess facility compliance with COVID-related measures outlined in the
Pandemic Response Requirements. These initial surveys were a 74-item
checklist-style questionnaire, administered to all detention facilities on a
biweekly basis. 30 The surveys consist of primarily yes or no responses
and asks facility staff to respond to questions such as the availability of
PPE and hygiene supplies, implementation of social distancing
guidelines, and reporting protocols for suspected and positive COVID-19
cases. Custody Management officials stated that the survey was
purposefully developed in a binary format to help elicit clear-cut
responses regarding implementation of specified health and safety
measures. According to ICE officials, the surveys were originally
administered strictly to facilities with an assigned Detention Service
Manager and were expanded to include facilities that did not have one
beginning in June 2020. These survey responses were to be completed
by facility representatives and then reviewed and signed off by the
facility’s assigned Detention Service Manager for accuracy. For those
facilities without assigned Detention Service Managers, surveys were
validated by another representative of the Detention Management Unit
that may not be on-site at individual facilities on a regular basis.
Our review of survey responses from the six facilities we interviewed
indicated that the Pandemic Response Requirements were generally
being met, but each contained several ‘no’ responses. 31 Of the surveys
30The survey is administered to over-72-hour facilities, meaning all facilities that house
detainees for over 72 hours are required to complete the survey. Those that house
detainees for less than 72 hours are not required to complete the survey.
31We reviewed two surveys for each of the six facilities in our review. Most of the surveys
we reviewed were completed in April and November 2020.
Page 16 GAO-21-414 Immigration Detention
we reviewed, facility responses ranged from one to six ‘no’ responses out
of the 74 survey questions. 32 Examples of ‘no’ responses we observed
varied from issues such as not sanitizing detainee personal mail to not
coordinating with state and local health authorities upon the release of a
symptomatic or COVID-positive detainee. One facility’s survey also
reported having no policies or procedures to accommodate religious
practices with social distancing or appropriate PPE through November
2020.
As previously noted, detention management staff were to review all
survey responses, and in cases of ‘no’ responses, these staff were
responsible for collecting any additional information necessary to
determine if there was a potential deficiency in the areas covered by the
survey questions, according to Custody Management officials. According
to the Pandemic Response Requirements, ERO is to communicate any
verified cases of non-compliance to facilities—referred to as
deficiencies—through a formal notification. 33 Custody Management
officials reported that the facility responses obtained from the initial
surveys did not result in any formal notifications to facilities of non-
compliance with the Pandemic Response Requirements. Custody
Management officials also told us that throughout 2020, ICE headquarters
staff collected some additional data from facilities to help assess facility
implementation in several specific areas covered in the survey, such as
intake testing, saturation testing, and PPE availability. According to
Detention Service Managers we spoke with, any issues identified with the
survey responses were generally addressed informally through phone
calls and other communications; however, we observed that several of
the ‘no’ responses in the surveys we reviewed remained consistent over
the course of several months. ERO officials noted that there was a
general expectation that repeat “no” responses for survey questions
would be addressed in some manner between April and November
2020—the time periods in which we reviewed survey responses—and
32Not all of the ‘no’ responses would be associated with a potential deficiency. For
example, we observed ‘no’ responses for each of the facilities regarding the allowance of
contact visitation.
33These notifications are termed a Contract Deficiency Report for dedicated facilities and
a Notice of Intent for non-dedicated facilities. Upon notification, a facility is required to
develop a corrective action plan to remedy the deficiency and submit it to ICE for approval
within 7 business days.
Page 17 GAO-21-414 Immigration Detention
lack of corrective action could be grounds for a potential deficiency. 34
However, as discussed below, these specific oversight efforts were
revised in December 2020, when a new version of the survey—and
monthly on-site compliance checks—were introduced.
Further, while some facility operators and ICE field officials we spoke with
considered the survey an effective tool in managing compliance with the
Pandemic Response Requirements among facilities, others stated that
the tool was somewhat burdensome and the results did not change much
over time. For example, officials at one facility considered the checklist
effective in identifying potential shortfalls in the facility’s implementation of
COVID-19 health and safety measures early on and assessing where
additional efforts may be needed. However, officials from one ERO field
office considered the survey to be redundant, due to its biweekly
administration and the policies already implemented within the facilities.
Despite these limitations, these officials noted that some form of oversight
remained necessary. Detention Service Managers from the facilities we
spoke with also generally noted that the responses to the survey
questions showed little variation over time. 35
In addition, limited on-site presence of Detention Service Managers
posed a key challenge for validating initial survey responses. Although
these managers are responsible for conducting the primary review and
validation of the facility surveys, they were generally not on-site at their
34ERO reported that Detention Service Managers and Detention Standard Compliance
Officers are to bring any issues needing attention, or deficiencies, to the Field Office
Director (or designee), as well as the Contracting Officer and the Contracting Officer’s
Representative. It is up to these entities to follow up and ensure that the deficiency or area
of non-compliance is corrected. For more information on this process and our related
recommendations, see GAO, Immigration Detention: Actions Needed to Improve
Planning, Documentation, and Oversight of Detention Facility Contracts, GAO-21-149
(Washington D.C., Jan. 13, 2021).
35Out of the six facilities in our review, the four with Detention Service Managers onsite
reported little to no variation in survey responses. At the other two facilities without
Detention Service Managers onsite, facility operators also stated that their survey
responses had little to no variation over time. Examples of some survey responses that
did change among those we reviewed include (1) suspending or reinstating in-person
legal visitation depending on the local severity of COVID-19 cases and (2) implementation
of sanitizing processes of detainee personal items. According to ERO officials, little to no
variation in findings is expected in facilities that are complying with the requirements of the
Pandemic Response Requirements.
Page 18 GAO-21-414 Immigration Detention
assigned facilities after March 2020. 36 As a result, ICE officials reported
that Detention Service Managers were not available to conduct physical
observations or to validate survey responses from their initial
implementation in April 2020 through late summer 2020, when some
Detention Service Managers were able to return to their facilities.
However, Custody Management officials noted that Detention Service
Managers may request supporting documentation or photographic
evidence to help validate implementation of facility measures as
necessary. 37 Overall, Custody Management officials stated that they have
reasonable confidence in the Detention Service Manager’s ability to
validate survey responses and produce accurate results despite their lack
of on-site access in the early months of the pandemic due to the
Detention Service Manager’s extensive knowledge of their assigned
facilities. However, they acknowledged that they have less confidence in
the accuracy of survey responses in facilities without an assigned
Detention Service Manager. As discussed below, ICE updated its
oversight mechanisms in late 2020 to address challenges associated with
the limited on-site presence of Detention Service Managers.
ICE officials from the six facilities we interviewed also identified additional
coordination efforts to help address COVID-19-related impacts that may
help mitigate the effects of limited on-site presence. For example, some
facilities continued to have other ICE officials and medical providers on-
site throughout the pandemic who could help provide ongoing oversight of
pandemic-related health and safety measures. Specifically, IHSC medical
staff and ICE field office officials, including facility officers-in-charge and
assistant officers-in-charge, reported they were on-site regularly at some
facilities after the declaration of the pandemic in March 2020. 38 In one
facility we spoke with, two officers-in-charge split their staff between them
and implemented a rotating 2-week telework and onsite procedure. 39 In
some cases, Detention Service Managers told us they were able to
36On March 21, 2020, ERO issued guidance recommending that staff who were able to
work from home should begin telework to reduce the risk of COVID-19 transmission.
37Two of the three Detention Service Managers we spoke with reported requesting and
reviewing additional photographic evidence to help assess facility compliance as part of
their review of the survey responses.
38Officials we spoke to at ICE-operated Service Processing Centers and Contract
Detention facilities reported a variety of ICE staff with regular on-site presence, including
ICE medical providers and detention officers, among others.
39The 14-day length corresponds to COVID-19’s incubation period, allowing staff to
quarantine and telework for 2 weeks after their last day onsite at the facility before
returning to work again without leaving the facility understaffed.
Page 19 GAO-21-414 Immigration Detention
leverage existing relationships with these individuals if additional
information was needed regarding facility checklist responses. In addition,
several IHSC officials and facility operators with whom we spoke also
identified a regular series of virtual meetings and teleconferences from
March 2020 through the summer of 2020 to discuss COVID-19-related
measures and facility implementation efforts. According to these
individuals, the meetings were open to facility and medical staff, ERO
representatives, and applicable contracted facility staff; and offered an
opportunity to discuss any guidance and requirements issued and identify
related questions or challenges.
ICE Updated Its Facility Beginning in late 2020, ICE revised and updated its oversight
Survey and Revised Its mechanisms, including its facility surveys and onsite monitoring.
According to ICE officials, these revisions helped address challenges,
Requirements for On-site
such as the limited onsite presence of Detention Service Managers.
Monitoring Because these revisions were still being implemented during our review,
it is too soon to assess their effect on ICE’s oversight of detention
facilities’ compliance with the Pandemic Response Requirements.
More specifically, beginning in December 2020, ERO introduced a
revised survey that replaced the prior facility checklist. The new facility
checklist is to be completed monthly—rather than bi-weekly—and
includes multi-part questions that require narrative responses as opposed
to the previous version’s yes or no questions. Comprised of 134
questions, the revised checklist is almost twice as long as the original
version. According to Custody Management officials, many different
entities took part in a 2-week working group to develop the new survey in
accordance with CDC recommendations and the Pandemic Response
Requirements, as well as the Fraihat v. ICE court ruling. 40
A Detention Service Manager from one of the facilities we spoke with
stated that the new survey tool is designed to obtain more specific
information regarding the implementation of the Pandemic Response
Requirements measures in each individual facility. Among the revisions,
the new survey specifically addresses procedures related to the
identification and management of detainees that are considered at higher
40Entities identified that took part in the working group included ICE Domestic Operations,
ICE Office of the Principal Legal Advisor, IHSC, Detention Management officials, and the
Department of Justice, among others. The new survey tool was created in response to an
updated court order issued October 7, 2020 on the Fraihat v. ICE determination, which
referred to the existing facility surveys as ‘deeply flawed’ and ‘exceedingly vague’.
Page 20 GAO-21-414 Immigration Detention
risk of developing severe illness from COVID-19 due to existing health
factors. 41 In addition, the new survey has a section to monitor procedures
for staff exposure to COVID-19, such as sick leave policy, positive
COVID-19 test notifications, exposed but asymptomatic staff, and
identifying non-essential staff for telework. The new survey also has
additional questions addressing the implementation of testing and
quarantine measures and the availability and use of hygiene and cleaning
supplies.
In conjunction with the rollout of the revised survey tool, the October 2020
update of the Pandemic Response Requirements calls for renewed onsite
monitoring by Detention Management staff. Specifically, a Detention
Service Manager or Detention Service Compliance Officer is to conduct
an on-site, in-person “spot check” at all facilities to assess if the facility is
in compliance with the requirements. According to the Pandemic
Response Requirements, as part of these compliance checks, officials
are to review policies, logs and records; observe facility operations; speak
with facility staff and detainees; and complete a standardized form to note
observations and findings. This new monitoring mechanism provides an
opportunity to validate facility survey responses and may help remedy
some of the oversight challenges identified by Detention Service
Managers and field medical coordinators we spoke with regarding lack of
on-site presence. According to Custody Management officials, the
addition of the on-site component is intended to enhance ICE oversight
and help ensure that facilities remain in compliance with COVID-19-
related measures.
According to Custody Management officials, the new survey was
disseminated to facilities beginning in December 2020. As of March 2021,
these officials reported that three monthly surveys were completed and
plans for corrective actions were initiated as a result of the new checklist
and on-site compliance spot checks. For example, the January 2021
monthly spot check identified 43 instances of non-compliance that
resulted in ERO issuing notifications and requests for corrective action to
11 facilities. Among the specific issues identified, five facilities did not
adequately test or evaluate high-risk detainees, and three facilities did not
follow required protocols related to provision of masks or proper disposal
of PPE. Custody management officials at headquarters also stated that
41The criteria to determine if a detainee is considered ‘high-risk’ in the facility survey is
pursuant to a court order issued April 20th, 2020, Fraihat v. ICE, and the CDC Interim
Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and
Detention Facilities.
Page 21 GAO-21-414 Immigration Detention
they plan to begin collecting and reviewing the survey data more
systematically for trends and recurring issues. Such analysis will be
important in helping ICE monitor and assess the impacts of its revised
survey and additional on-site facility checks.
ICE Data Identifies
Thousands of
COVID-19 Cases and
High-Risk Health
Conditions among
Detainees
ICE Data Identifies As described earlier in this report, ICE screens detainees for COVID-19
Positive COVID-19 Cases during intake and collects data on positive cases. Specifically, according
to officials we spoke with at six immigration detention facilities, facility
at Over 100 ICE Detention
medical staff screen detainees using a standard symptom questionnaire
Facilities Nationwide and generally administer a COVID-19 test. After intake screening, IHSC
personnel obtain and enter data on positive detainees into the Lower
Respiratory Illness Tracker, which ICE uses to track COVID-19 cases
across ICE detention facilities, among other things.
In calendar year 2020, ICE processed 137,749 intakes at immigration
detention facilities, tested 80,200 detainees for COVID-19, and recorded
8,622 positive cases at over 100 immigration detention facilities
nationwide. Among detainees who tested positive for COVID-19, ICE
determined that approximately 89 percent (7,687) were exposed to the
virus while in ICE custody, whereas 5 percent (435) were exposed prior to
entering into ICE custody, according to ICE data. ICE data did not identify
the point of exposure for approximately 6 percent of detainees (500) who
tested positive for COVID-19. 42 Further, according to ICE data,
approximately 35 percent (3,009) of detainees who tested positive for
COVID-19 exhibited symptoms generally associated with COVID-19. 43
Among these, 209 required hospitalization, whereas the remaining 2,800
42For the purposes of this report, ICE custody refers to detainees in facilities operated by
ICE personnel as well as those in facilities operated by the U.S. Marshals Service, local
jails, or privately owned/operated facilities under contract or agreement with ICE.
43According to the CDC, symptoms of COVID-19 include fever or chills, cough, shortness
of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of
taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.
Page 22 GAO-21-414 Immigration Detention
received care by medical staff at the immigration detention facility.
According to ICE officials, eight detainees died while in ICE custody as a
result of COVID-19—a case fatality rate of approximately 0.09 percent.
According to ICE data, approximately 73 percent (6,329) of COVID-19
cases among detainees occurred at immigration detention facilities within
eight ICE field offices in the southern United States. Figure 2 identifies the
number of COVID-19 cases identified at ICE detention facilities in 2020,
by field office.
Figure 2: Positive COVID-19 Cases at Immigration Detention Facilities in 2020, by U.S. Immigration and Customs Enforcement
(ICE) Field Office
Note: The number of immigration detention facilities and size of detainee populations may vary
considerably between individual field offices. For example, some field offices, such as New Orleans,
oversee more than 15 individual facilities whereas the Seattle field office housed nearly all of the
detainees within its area of responsibility in a single facility.
Page 23 GAO-21-414 Immigration Detention
According to ICE data, approximately 30 percent (2,566) of positive
COVID-19 cases occurred at IHSC-staffed immigration detention
facilities, whereas the remaining 70 percent (6,056) of cases occurred at
facilities operated by contract medical staff or local health authorities. 44
According to officials, 139 medical staff at immigration detention facilities
contracted COVID-19. Among these, 31 were ICE medical personnel
whereas the remaining 108 were contract medical staff.
ICE Data Identifies As described earlier in this report, facility medical staff identify the
Detainees with Medical presence of factors that may place a detainee at high-risk of severe
illness due to COVID-19 within 5 days of intake. IHSC then obtains these
Conditions that Place
data from facilities and enters it into ICE’s Electronic Health Record
Them at Higher Risk of System.
Severe Illness Due to
COVID-19 According to ICE data, facility medical staff determined that 14,728
detainees at ICE immigration detention facilities in calendar year 2020
had one or more conditions that placed them at high risk for severe illness
due to COVID-19. Among these high risk conditions, detainees visited
facility medical units for mental health, hypertension, diabetes, asthma,
and seizure disorder most frequently in calendar year 2020, according to
ICE data. Further, approximately 2,830 detainees in ICE custody in
calendar year 2020 were age 55 or over.
In calendar year 2020, ICE released 5,801 detainees from custody that it
identified as having one or more high-risk conditions, according to ICE
data. 45 ICE removed 5,432 high-risk detainees from the United States
whereas 3,487 remained in ICE custody as of the end of calendar year
2020. 46 According to ICE officials, 528 high-risk detainees tested positive
for COVID-19 as of March 30, 2021.
44As of February 2021, IHSC provided medical care, including COVID-19 screening during
intake, at 14 adult detention facilities nationwide. At non-IHSC-staffed facilities, contract
medical staff or local health authorities are responsible for providing medical care and
screening detainees for COVID-19 during intake.
45ICE’s Field Operations Division is responsible for making release decisions. In general,
ICE release decisions are informed by a variety of considerations, including the presence
of one or more high-risk factors, according to officials.
46ICE data did not identify the status of eight high-risk detainees in ICE custody in
calendar year 2020.
Page 24 GAO-21-414 Immigration Detention
We provided a draft of this report to DHS for review and comment. DHS
Agency Comments provided written comments, which are reproduced in appendix I. DHS
also provided technical comments, which we incorporated as appropriate.
We are sending copies of this report to the appropriate congressional
committees and the Secretary of Homeland Security, as well as other
interested parties. In addition, the report will be available at no charge on
the GAO website at https://www.gao.gov.
If you or your staff have any questions, please contact me at (202) 512-
8777 or gamblerr@gao.gov. Contact points for our Offices of
Congressional Relations and Public Affairs may be found on the last page
of this report. GAO staff who made significant contributions to this report
are listed in appendix II.
Sincerely yours,
Rebecca Gambler
Director, Homeland Security and Justice
Page 25 GAO-21-414 Immigration Detention
List of Committees
The Honorable Patrick Leahy
Chairman
The Honorable Richard Shelby
Vice Chairman
Committee on Appropriations
United States Senate
The Honorable Ron Wyden
Chairman
The Honorable Mike Crapo
Ranking Member
Committee on Finance
United States Senate
The Honorable Patty Murray
Chair
The Honorable Richard Burr
Ranking Member
Committee on Health, Education, Labor, and Pensions
United States Senate
The Honorable Gary C. Peters
Chairman
The Honorable Rob Portman
Ranking Member
Committee on Homeland Security and Governmental Affairs
United States Senate
The Honorable Rosa L. DeLauro
Chairwoman
The Honorable Kay Granger
Ranking Member
Committee on Appropriations
House of Representatives
Page 26 GAO-21-414 Immigration Detention
The Honorable Frank Pallone, Jr.
Chair
The Honorable Cathy McMorris Rodgers
Republican Leader
Committee on Energy and Commerce
House of Representatives
The Honorable Bennie G. Thompson
Chairman
The Honorable John Katko
Ranking Member
Committee on Homeland Security
House of Representatives
The Honorable Carolyn B. Maloney
Chairwoman
The Honorable James Comer
Ranking Member
Committee on Oversight and Reform
House of Representatives
The Honorable Richard E. Neal
Chairman
The Honorable Kevin Brady
Republican Leader
Committee on Ways and Means
House of Representatives
Page 27 GAO-21-414 Immigration Detention
Appendix I: Comments from Department of
Appendix I: Comments from Department of
Homeland Security
Homeland Security
Page 28 GAO-21-414 Immigration Detention
Appendix I: Comments from Department of
Homeland Security
Page 29 GAO-21-414 Immigration Detention
Appendix I: Comments from Department of
Homeland Security
Page 30 GAO-21-414 Immigration Detention
Appendix II: GAO Contact and Staff
Appendix II: GAO Contact and Staff
Acknowledgments
Acknowledgments
Rebecca Gambler, at (202) 512-8777 or gamblerr@gao.gov
GAO Contact
In addition to the contact named above, Kirk Kiester (Assistant Director),
Staff Ryan Lambert (Analyst-in-Charge), Breanne Cave, Bruce Crise, Eric
Acknowledgments Hauswirth, Bridget Jackson, Sasan J. “Jon” Najmi, and Kevin Reeves
made key contributions to this report.
(104300)
Page 31 GAO-21-414 Immigration Detention
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