A14 eZ re the washington post.friday, march 13 , 2020
The coronavirus outbreak
such a bad investment.”
Experts say, only 51 percent of
the population is served by such a
comprehensive system.
Levi and public health policy
experts — including Karen DeSal-
vo, who served as acting assistant
secretary for health in the Obama
administration — have been
pushing to secure a Public Health
Infrastructure Fund that would
make permanent basic resources
available to state, territorial, local
and tribal governments.
While some cities such as New
York and Los Angeles have strong
public health departments, many
states, including North Carolina
and Iowa, have around 100 de-
partments, many of them rural.
“There are economies of scale,”
Levi said. “You can’t h ave a robust
system if you have tiny depart-
ments.”
It’s not as if the current crisis
took public health policymakers
by surprise.
The trial runs for covid-19, the
disease caused by the coronavi-
rus, include the post-9/11 anthrax
attacks that disrupted the postal
system, the S ARS outbreak of
2003 and the H1N1 flu pandemic
of 2009-2010.
“We all knew it was coming; we
just didn’t know when or what
microbe it would be,” said Law-
rence Gostin, professor of global
health law at G eorgetown Univer-
sity’s law school, who advocates
for dedicated funding on a na-tional and global level to support
occasional but expected surges in
need.
“Every time we have a crisis, we
always have to go t o Congress,” he
said. “The obvious things is to
have an emergency contingency
fund” that would avoid delays
and political bickering.
Levi said he hopes the current
crisis will hasten change.
“This instance is one where
people are recognizing that had
we been in a stronger position, we
may have saved ourselves some of
the disruption we are now experi-
encing,” he said. “This might be
an important opportunity.”
Still there is a long history to
overcome, experts say, not only of
chronic underfunding but also of
stigma attached to public health
practitioners. They are often re-
garded as “poor docs for poor
people,” Sommer said.
He used to convene meetings
for leaders from local health de-
partments to share knowledge
and strategies and was always
impressed, he said, by the heroic
commitment they showed to
their communities.
“But as a big-picture guy, I left
those meetings depressed,” Som-
mer said, “to see well-meaning
people boxing the air with so few
resources.
[email protected]Katie mettler contributed to this
report.BY FRANCES STEAD SELLERSTo illustrate the gulf between
the nation’s c ostly health care and
its underfunded public health,
Alfred Sommer, former dean of
the Johns Hopkins Bloomberg
School of Public Health, often
tells a story:
When people wake up after
triple bypass surgery at the fa-
mous hospital across the street in
Baltimore, they typically thank
their doctors for the lifesaving
miracles they performed — and
sometimes even make donations
to the institution.
“Nobody wakes up in the
morning and says, ‘Thank God I
don’t have smallpox.’ Or, ‘Thank
God my water is potable,’ ” Som-
mer said.
That in a nutshell, says Som-
mer, is the conundrum facing
public health as it tackles the
coronavirus crisis. Its largely pre-
ventive mission, aimed at pro-
tecting the entire community, h as
been consistently overlooked in a
country that puts a premium —
and spends more money per capi-
ta than any other — on treating
individual sick people. Its victo-
ries are soon taken for granted.
And these days, as the vaccine
debate demonstrates, its science
is increasingly challenged.
“We have an illness-care sys-
tem not a health-care system,”
said Betty Bekemeier, director of
the Northwest Center for Public
Health Practice at the University
of Washington School of Public
Health. “The amount of money
spent on keeping us well is tiny.”
Public health departments are
where disease surveillance starts,
as well as tracking “reportable
diseases,” such as measles, pro-
viding a picture of where and
how infections s pread. But re-
search shows that only about $
per person per year is spent on
public health, in contrast with
about $11,000 per capita spent
annually on treatment, Beke-
meier said. Investing more in
public health, she said, “would
save us a tremendous amount of
dollars on the other end.”
Public health, which competes
for tax dollars like other public
services, has proved to be an easy
target during times of austerity.
And the losses might not be
widely recognized until a disease
outbreak sweeps through a coun-
ty. “The impact of public health... d oesn’t get shown until some-
thing major like this happens”
said Peter Beilenson, director at
the Sacramento County Depart-
ment of Health Services, who said
the department’s budget was
slashed in 2008 and has still not
recovered to its prerecession lev-
els. The county recorded its first
coronavirus death Tuesday.
At a House Oversight Commit-
tee meeting Thursday, Anthony
Fauci, director of the National
Institute of Allergy and Infec-
tious Disease and a member of
the president’s coronavirus task
force, was asked why the United
States has had widespread chal-
lenges providing tests for the
virus.
“We’re not set up for that,” he
said. “Should we be? Yes, but
we’re not.”
“Our public health ‘system’ is
not a ‘system,’ ” said Sommer,
who produced groundbreaking
research on the smallpox vaccine
and later saved the sight — and
lives — of countless children by
demonstrating how they could be
treated with low-cost vitamin A.
Instead, public health is pro-
vided by almost 3,000 agencies in
states, counties, cities and small
towns. Those departments have
responsibilities that extend far
beyond tracking and responding
to epidemics and include moni-
toring food safety, tackling sexu-
ally transmitted diseases and ad-dressing the opioid crisis. All
those functions compete for
stretched resources in the face of
a new disease.
W ashington state, the epicen-
ter of the novel coronavirus in the
United States, has been wrestling
with an outbreak of hepatitis A
among the homeless and an in-
crease in measles cases, as well as
a rise in maternal deaths, accord-
ing to Bekemeier.
When a crisis hits, “these
things end up going on the back
burner,” s he said.
Jeffrey Levi, a professor o f
health management and policy at
the Milken Institute School of
Public Health at G eorge Washing-
ton University, said an expert
panel concluded recently that the
country needs about $32 per
person annually — or an injection
of $4.5 billion — to supply basic
public health services that pro-
vide prevention and health pro-
motion in much the same way
people expect a functioning fire
department, library and police
force.
“It seemed like a lot a year or
two ago,” Bekemeier said. “But
now, when we have to turn
around and spend more than
$8 billion [on the coronavirus
response], it doesn’t seem likeExperts: Public health is underfunded
BY ABIGAIL HAUSLOHNER,
NICK MIROFF
AND MATT ZAPOTOSKYImmigrants held in U.S. deten-
tion centers have been particular-
ly vulnerable to the spread of com-
municable diseases — including
thousands who were put under
quarantine last spring for mumps,
measles, flu and other illnesses —
and it is unclear whether the coro-
navirus could pose a serious con-
cern for U.S. authorities and the
tens of thousands of foreigners in
their c ustody.
Immigration and Customs En-
forcement detains nearly 38,
people in more than 130 private
and state-run jails and prisons
across the country, m any of which
sit in rural areas and operate with
minimal public oversight.
Jenny Burke, an ICE spokes-
woman, said Thursday that as-
pects of the agency’s pandemic
workforce protection plan, devel-
oped in 2014, have been in effect
since January to prevent and miti-
gate the spread of the novel coro-
navirus among the detainee popu-
lation and staff.
She said that since r eports of
covid-19 began, ICE epidemiolo-
gists “have been tracking the out-
break, regularly updating infec-
tion prevention and control pro-
tocols, and issuing guidance to
ICE Health Service Corps staff for
the screening and m anagement of
potential e xposure among detain-
ees.”
ICE officials said that as of
March 3, four detainees had met
the criteria for coronavirus test-
ing, but none has tested positive.
The number of confirmed cases
across the United States has
jumped from a few dozen to more
than a thousand since then, but
the agency declined to say wheth-
er any more detainees have been
tested as infection numbers
climbed nationwide.
Immigration advocates say
they are concerned about the po-
tentially d evastating impact a cor-
onavirus outbreak could have in-
side the U.S. government’s crowd-
ed immigration jails.
The American Civil Liberties
Union of Southern California and
Human Rights Watch this week
called on the Trump administra-
tion to develop a strategy to pre-
vent and mitigate such an out-
break at facilities that have long
been plagued by allegations of
detainee abuse and inadequate
medical care.
“People in detention are highly
vulnerable to outbreaks of conta-
gious i llnesses. T hey are housed in
close quarters and are often in
poor health,” t he groups wrote in a
letter to ICE officials overseeing
an ICE processing center in Ad-
elanto, Calif. “Without the active
engagement of the detention cen-
ter’s a dministration, they have lit-
tle ability to inform themselves
about preventive measures, or to
take such measures if they do
manage to learn of them. We are
particularly concerned about the
health and safety of the people
detained at Adelanto, given the
facility’s demonstrated failure to
provide adequate medical care in
the past.”
The groups sent similar letters
to other ICE detention facilities,
calling on ICE to educate detain-
ees and staff about proper hygiene
measures to reduce the spread of
coronavirus in ICE facilities; pro-
vide sufficient supplies for hand-
washing and cleaning; develop
plans to screen and test for the
virus, as well as contain and treat
the infected; and develop staffing
contingency plans for the possi-
bility that significant numbers of
ICE detention staff will fall ill
from the virus.
ICE officials s aid the agency has
20 detention facilities run by its
Health Service Corps, including
16 that are equipped with air-
borne infection isolation rooms,
where officials said they plan to
house detainees deemed at risk
for covid-19 or displaying symp-
toms. Officials said ICE detention
staff also have received guidance
on the use of protective equip-
ment.
During a surge of border appre-
hensions last spring, ICE placed
between 4,000 and 6,000 detain-
ees in quarantine as a result of
mumps, measles, flu and other
communicable disease outbreaks,
ICE’s acting director, Matthew Al-
bence, told lawmakers during a
congressional hearing Wednes-
day.
“We have extensive experience
with regard to keeping them iso-
lated so that doesn’t spread, and
we also have extensive medical
experience,” Albence said, citing
the agency’s medical staff and
Public Health Service Corps per-
sonnel.
Government investigators and
attorneys have previously report-
ed serious patterns of neglect at
several ICE facilities across the
country, including denied or ig-
nored requests for medical care,
limited dissemination of vaccina-
tions for the flu and other infec-
tious diseases, poorly enforced or
mismanaged quarantines, andovercrowding.
Ranit M ishori, a senior m edical
adviser for Physicians for Human
Rights, said she was concerned
about ICE’s capacity to both test
detainees and quarantine them
when necessary.
“I had to turn away patients
yesterday who may have the mild
forms of covid-19,” said Mishori,
who practices family medicine in
Washington, D.C., citing federal
guidelines that restrict the condi-
tions under which coronavirus
testing can be authorized. “If weare not equipped throughout the
country to test the people who
need to be tested, imagine what
happens in these facilities t o these
marginalized populations.”
ICE has reported at least 21
deaths in its facilities over the past
two years — eight of which oc-
curred in the past six months
alone — including, most recently,
a 22-year-old female Guatemalan
asylum seeker who died o f hepati-
tis, septic shock and liver failure,
after being detained at a Texas
facility for more than six months;
and a 63-year-old man held in
Florida who died in January after
weeks of respiratory distress and
other s erious symptoms of illness.
In December, a 40-year-old, also
held in Florida, died after he suc-
cumbed to septic s hock.Advocacy groups and Demo-
cratic lawmakers have urged ICE
to reduce the number of people in
its custody by releasing particu-
larly v ulnerable p eople — many of
ICE’s detainees are asylum seek-
ers with no previous criminal re-
cord — to minimize the crowded
conditions that facilitate the
spread of the disease and ensure
that people with underlying con-
ditions get access to care.
Albence told lawmakers
Wednesday that his agency will
not release vulnerable detaineesas a preventive measure against
coronavirus: “The people that we
have in detention are there be-
cause they are public safety
threats or flight risks.”
On Thursday, the union that
represents immigration judges
across the country called on the
Justice Department to suspend
hearings in a wide swath of cases
out of fear that such proceedings
could help spread the coronavi-
rus.
In a letter to the director of the
Justice Department’s Executive
Office for Immigration Review,
Judge Ashley Ta baddor said that
all of the “non-detained master
calendar dockets” — essentially,
hearings for people not in federal
custody — “must be completely
suspended b ecause they present acontinuing and unacceptable risk
in the current environment.”
Ta baddor, the head of the Na-
tional Association of Immigration
Judges, said the dockets typically
bring 5 0 or more respondents into
each courtroom, many of whom
have recently traveled interna-
tionally, plus attorneys and other
family members. She said that the
union had been informed
Wednesday that one attorney in a
March 10 hearing reported having
flu-like symptoms and was con-
cerned about a coronavirus infec-
tion.
“This is exactly the type of situ-
ation the White House, CDC and
other public health authorities
urge us to avoid, and we trust that
you will agree that it is untenable
and irresponsible in light of the
current spread of COVID-19 infec-
tions across the country,” Tabad-
dor wrote.
The association that Ta baddor
represents also recently publi-
cized orders that judges received
from the Justice Department to
take down courtroom signage on
methods to prevent the spread of
coronavirus. The department
then reversed that order.
The association also has called
repeatedly on the Executive Office
for Immigration Review to pro-
vide its judges more clarity on
how they can manage their court-
rooms to prevent the spread of
covid-19, and as of Thursday, said
they had received no response.
Immigration attorney Matthew
Archambeault said immigration
judges in Newark on Thursday
allowed lawyers to attend court
hearings while their clients wait-
ed outside to minimize close con-
tact. But that, he said, left thewaiting room packed with dozens
of people.
“I’m worried about myself; I’m
worried about my family,” Ar-
chambeault said. “I have my
mother-in-law at home, who is
elderly, and she’s n ot in the best of
health.”
A spokesperson for the Execu-
tive Office of Immigration Review
said the courts’ status “remains
the same, and we do not plan any
mass closure of immigration
courts.”
“A s concerns are raised, we will
address them on a case-by-case
basis as necessary and appropri-
ate,” t he spokesperson said.
U.S. Customs and Border Pro-
tection, which includes Border P a-
trol authorities, also grappled
with allegations of harsh condi-
tions, and inadequate sanitation
and medical care for migrants
detained in CBP facilities along
the U.S.-Mexico border, particu-
larly during last year’s surge in
border crossings, when border in-
frastructure w as overwhelmed.
A CBP spokesperson said bor-
der agents are working to identify
“individuals who have traveled
from or transited through coun-
tries affected by COVID-19.”
“Individuals apprehended by
U.S. Border Patrol between the
ports of entry with symptoms of
illness are referred to the CDC or
local health officials for addition-
al health screening,” the spokes-
person said. “U.S. Border Patrol
takes all necessary precautions to
ensure that no communicable dis-
eases are spread across popula-
tions i n custody.”
[email protected]
[email protected]
[email protected]Immigration advocates fear potential impact on crowded ICE jails, courts
Jovelle tamayo For the Washington Post
Detainees work in the kitchen of an ICE processing center in Tacoma, Wash. ICE detains nearly 38,000 people in more than 130 private and state-run jails and prisons.“People in detention are highly vulnerable to
outbreaks of contagious illnesses. They are housed
in close quarters and are often in poor health.”
ACLU of Southern California and Human Rights Watch, in a letterUPLOADED BY "What's News" vk.com/wsnws TELEGRAM: t.me/whatsnws