By Judy Stone
Influenza kills. In the last season, 2018-2019, flu was associated with more than 57,000 deaths, including 129 in children. Yet in August, the U.S. Customs and Border Patrol (CBP) announced they would not be providing flu vaccines to migrants in border detention.
Dr. Mark Travassos, of the University of Maryland’s Center for Vaccine Development and Global Health, notes: “Before September 2018, no child had died in United States Border Patrol custody in a decade. Since then, seven detained children have died in the past 10 months.”
In this month’s Clinical Infectious Disease (CID) journal, Travassos has analyzed these deaths. His findings, and those of a strongly worded accompanying editorial, raise many ethical concerns and many more related questions as well.
The first death Travassos describes is, in some ways, the most damning. In December, 2018, Felipe Alonso Gomez, an 8-year-old Guatemalan boy, was captured and detained with his father. When he became ill with flu-like symptoms, the boy was taken to a small county hospital in Alamogordo, N.M. There, despite a diagnosis of a viral infection, he was given an inappropriate prescription for amoxicillin, an antibiotic. Further, although Felipe had a positive test for influenza, he was not given treatment with the antiviral, oseltamivir (Tamiflu). We know that flu has an incubation period of two to four days, so the boy must have contracted the infection while in detention. An autopsy showed that Felipe died of sepsis from Staph aureus, a common complication of influenza. Dr. Travassos asks, “How could a previously healthy boy die under the care of the United States government? Under the present administration, detainment centers have become a black box — what happens in them has not been open for review by…even elected officials.”
Here’s what little we know about the other deaths:
Sixteen-year-old Carlos Hernandez Vásquez died of influenza. Per Travassos’ article, he was “held in a cell alone, with hourly checks by Border Patrol agents, until he was found dead the next morning.” But this begs the question — what did these hourly checks consist of? Seven-year-old Jakelin Caal Maquin also died from sepsis, “raising concerns about the ability of Border Patrol employees to recognize children in need of urgent medical attention,” according to Travassos.
The other deaths are no less disturbing. Travassos concludes, “Acceptance of the conditions facing migrant children is to turn a blind eye to potential human rights violations.”
A Repeat of History?
Many will argue that these deaths are the parents’ fault and that they should not have risked coming here.
People dehumanize the refugees, calling them “illegals” and many have no sympathy for their plight.
What these people seem to be unaware of is that seeking asylum is legal, under the United Nations 1951 Convention and 1967 Protocol. Further, the process requires the asylum seeker to be physically present in the United States.
In 1938, in Evian, France, 32 European country representatives met to discuss the problem of the Jews wishing to escape persecution from Nazi Germany. They did not change their quotas nor allow more Jews to emigrate.
In 1939, the SS St. Louis, carrying 937 Jewish refugees from Germany, was turned away from Havana, then from the United States and then from Canada. The ship was forced to return. Two hundred fifty-four passengers were killed by the Nazis.
My family were Holocaust survivors. When I saw the photos of the kids in cages and the migrants crowded together to standing room only, or sleeping on the ground under a bridge, it triggered the memory of my mother telling me about sleeping packed like sardines on the dirt floor in Auschwitz, with only one piece of coarse bread and a small piece of wurst per day. Infections in those crowded conditions spread, with dysentery, typhoid and typhus killing thousands. Is what we are doing now that different?
Last week, I visited the International Red Cross/Red Crescent Museum in Geneva. It was sobering to see the refugee stories from all over and how little we have learned. It was also striking that the U.S. government recently went to court arguing that children are not entitled to basic sanitation, clean clothes, bathing and toothbrushes. Yet there were displays showing that clean water, soap and materials for basic hygiene are even mandated to prisoners of war under the Geneva Convention. In fact, one of the most striking displays was this artwork carved from soap by a Myanmar prisoner.
More than flu
The deaths from influenza are just a hint of what other problems may be hidden. We know that there are outbreaks of measles, mumps, chickenpox and diarrhea in these detention camps. We don’t know numbers, because officials refuse to provide that information. They have hidden the children from view of Congress and journalists.
We know that in the Arizona measles outbreak in the Eloy Detention Center was fueled by unvaccinated employees and that ICE even refused to give information to the Pinal County health officer.
These deaths raise many other questions, including:
How many kids are being kept in detention camps, where are they and under what conditions are they being held?
How many vaccine preventable illnesses are occurring among ICE/CBP employees? Why aren’t these government employees or contract workers required to have the same sorts of immunizations healthcare workers in hospitals are required to?
What, if any, training does the staff have in recognizing illness and ensuring prompt, appropriate care? Why don’t ill children have access to a pediatrician?
A Way Forward
Dr. Betsy Herold, Professor of Pediatrics, Albert Einstein College of Medicine and Children’s Hospital, co-authored the CID editorial. She stressed to me that “the kinds of conditions that are existing right now at the borders and at other sites are against all guidelines for how to take care of children (and adults as well) — the crowded conditions, poor hygiene, poor sanitation, lack of access to rapid medical care and lack of access to vaccines is all a set up for outbreaks of infectious diseases.”
She reiterated that, based on the timing of acquisition, at least some children are becoming ill with infections such as influenza after arriving here.
“We are exposing the kids to disease because of the inhumane, unsanitary conditions in which we are putting them,” she said.
Herold emphasized that we don’t need to launch new research about caring for detainees.
“What could and should be done are straightforward and simple. We know how to prevent epidemics. We know how to prevent outbreaks. We know what kind of conditions are appropriate and safe and would promote the health of these children.”
The CDC recommends vaccination to prevent influenza for children over six months of age.
Flu vaccination reduced the risk of flu-associated death by nearly two-thirds (65 percent) among healthy children. All of the major infectious disease societies in the U.S. have expressed their serious concerns about the decision to withhold a standard and life-saving treatment from migrant children.
Together, these societies — the Infectious Diseases Society of America (IDSA), Pediatric Infectious Diseases Society (PIDS), American Society of Tropical Medicine and Hygiene, Society for Healthcare Epidemiology of America (SHEA), and HIV Medicine Association (HIVMA) — represent more than 16,000 infectious disease physicians.
The response from the infectious diseases specialty community has been dismay and outrage, noting the conditions migrant children are being held in are not defensible. Why is this response not universal?
This article was published on Forbes.com Nov. 2, 2019 and is republished here with permission.
Judy Stone is an infectious disease specialist living in Cumberland, Md. She is the author of “Conducting Clinical Research” and “Resilience: One Family’s Story of Hope and Triumph over Evil.”