Yes, There’s a Public-Health Crisis at the Border

Migrants, en route to the United States, make their way to San Pedro Tapanatepec from Mexico, October 27, 2018. (Ueslei Marcelino/Reuters)
Setting the policy debate aside, it’s clear that the migrant crisis poses a public-health threat.

The humanitarian crisis at our southern border continues. Earlier this week, a 16-year-old Guatemalan boy, Carlos Gregorio Hernandez Vasquez, who was reportedly sick with the flu, died in border-patrol custody. Other detainees at the Border Patrol’s Centralized Processing Center in McAllen, Texas, have shown high fevers and flu-like symptoms. Medical staff at the facility have stopped taking in new migrants to help avoid the spread of illness. Three dozen migrants have been quarantined and 32 more cases of the flu have been confirmed.

The flu can kill, either by initially overwhelming your immune system or because of associated complications, including pneumonia. It may spread fairly rapidly, especially at a detention center, where the conditions are far from ideal and detainees are close together. It is not as wildly contagious as measles, for example, but it tends to infect one out of four people who are exposed to it. It is no longer flu season, but sporadic cases are still appearing, and may spread more easily among a population that is largely unvaccinated.

But Carlos’s tragic death brings up larger questions about the handling of infectious diseases among the surge of migrants coming here from Central America and how these problems can be better addressed. Reports of recent outbreaks include not only influenza, but mumps and chicken pox as well.

Carlos reportedly said he wasn’t feeling well last Sunday morning, and saw a nurse practitioner at the center who recommended Tamiflu, an effective antiviral drug against influenza. When administered in a timely manner, Tamiflu can decrease the severity and the duration of symptoms and limit their spread. This would appear to have been a correct and timely intervention.

But instead of being sent to a hospital or a more medically sophisticated Health and Human Services supervised facility, Carlos was sent to another Border Patrol station 20 miles away to be isolated. Isolation makes sense to help contain the disease, though the flu can be transmitted several days before the onset of symptoms (typically fever, fatigue, muscle aches, headache, sore throat), and no border station is equipped to properly handle a patient very sick with the flu. Carlos was later found dead there.

It’s clear that the Border Patrol is struggling to handle the influx of migrants. It is building tent cities in the area, where infectious diseases including flu can continue to spread. Given the scale of the border crisis, it is not their fault that illness is occurring and spreading, though they do have a role in identification, treatment, and containment of disease. The temperatures inside the detention centers are reportedly quite cold, and respiratory viruses including flu typically travel farther in cold low humidity temperatures.

Unfortunately, politics rather than public health has been predominating. The White House has asked for $3 billion to help the Department of Health and Human Services provide care for unaccompanied minors such as Carlos as part of a $4.5 billion request for emergency services at the border. Detained migrant children are supposed to be placed into shelters managed by HHS within three days. But HHS approval is needed, and there was a delay in Carlos’s case — and in many other cases.

Democrats in Congress have expressed concern that emergency funds would be used to detain more migrants, rather than to provide food and humanitarian assistance. The $4.5 billion has been deleted from a $19 billion disaster-aid bill that has just passed the Senate.

This concern may or may not be justified, but as a physician I would like to see the focus shift from the current policy-oriented debate to one that takes public-health concerns seriously. Carlos didn’t show symptoms when he was originally detained. If he had simply been released into the community, he could still have spread the flu, missed timely medical intervention, and ending up dying tragically.

What would work best for the undocumented children coming into this country and for the rest of us would be to show our most humane face. Detaining for the purpose of illness control alone makes sense, but then we must provide the health care needed to control disease and save lives. The Centers for Disease Control and Prevention must become more heavily involved. They already have quarantine stations and are overseeing the situation but must have more boots on the ground. It’s time for the country to realize that there is a legitimate public-health emergency at the border.


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