COVID-19 at the Border: Lives Hanging in the Balance

The United States–Mexico border remains a site of ongoing public health and humanitarian challenges, drawing attention and action from governmental, charitable, and medical organizations. There are tens of thousands of asylum-seekers currently detained by immigration enforcement along the border, an increasing proportion of which are unaccompanied children. I previously wrote about the role pathologists have in meeting the health needs of these vulnerable populations (1) – but, since that time, the COVID-19 pandemic’s rapid international spread and deadly disease course has changed the priorities and strategies of the anatomic and clinical pathologists who diagnose and treat such patients. Because of their integral role in these ongoing challenges, pathologists’ awareness of – and advocacy for – patients in border detention remains essential.

During a dedicated clinical pathology rotation at my medical school in El Paso, Texas (one of the country’s largest border communities), I spent time in the laboratory with pathologists and other lab personnel, reviewing the changes in priorities that were thrust upon us by the onset of the pandemic. Viral antigen tests and PCR analysis rapidly became a massive new management task for labs across the globe, and validation of these and other clinical tests relevant to the spread of the virus became an urgent need. Since testing began in February 2020, in the El Paso Field Office alone, over 600 detainees in custody have tested positive for the virus number. In fact, El Paso had the largest outbreak of COVID-19 of any detention facility in December 2020, likely contributing to the region’s spike in cases that winter. The unprecedented nature of the pathogen, combined with the cramped physical conditions of border detention, has created a burdensome public health crisis within a greater humanitarian challenge.

In clinical rotations, I’ve also had the chance to experience challenges such as lab safety with infectious disease specimens and managing diagnostic tests from isolated groups like senior care centers, incarcerated populations, and people in US border detention. For communities on or near the US–Mexico border, this latter group represents a significant testing requirement and a major contributor to the hospitalized population, highlighting the heightened need for pathologists’ diagnostic capabilities.

The advent of widespread vaccination has brought generally lower caseloads nationwide but, during the pandemic’s peaks, morgue capacities were overrun, creating severe challenges for forensic pathologists and staff. At the El Paso County medical examiner’s office, temporary morgue units and emergency staffing by prison inmates were needed to meet the vastly increased load of deceased individuals and the accompanying need to determine whether or not their deaths were COVID-19-related. Despite being much younger than the US population average, border detainees’ all-cause mortality has spiked since the onset of the pandemic, largely driven by COVID-19 deaths.

Though it is possible that the worst of the pandemic in the United States is past, ongoing work is needed to address the diagnosis, treatment, and prevention of COVID-19 and similar illnesses, especially in vulnerable populations. Recent immigrants and refugees are an important case study of these needs, and recent increases in unaccompanied migrant children in facilities and worries about overcrowding only increase the need for detainee vaccinations and effective care by all medical providers. Pathologists are at the front lines of these developments, and our work and advocacy on behalf of these vulnerable populations benefits us all.