US deportation policies in the time of COVID-19: a public health threat to the Americas

A critical concern during the coronavirus disease 2019 (COVID-19) pandemic is the vulnerability of low- and middle-income countries (LMICs) in the face of its consequences.¹ Even before the COVID-19 pandemic, some countries in the Americas were in a permanent state of crisis, with major inadequacies in their health systems and being unable to provide adequate care to their citizens. For example, with less than 1.5 beds per 1000 inhabitants, nearly one-third of the countries in the Americas figure among the 50 countries with the lowest global ranking of hospital bed density (Belize, Bolivia, Costa Rica, El Salvador, Guatemala, Haiti, Honduras, Nicaragua, Paraguay, Saint Lucia, Venezuela).² While better equipped countries such as France, Italy, and the United States (US) have faced shortages of intensive care unit (ICU) beds during the COVID-19 pandemic, some countries in the Americas had fewer than 4 ICU beds per 1 million inhabitants before the crisis.³ In response to the critical lack of resources in the Americas, the Pan American Health Organization (PAHO) has provided training on COVID-19 testing and testing kits to more than 20 countries.^{4 , 5}

Several factors are negatively affecting government actions taken to reduce the risk of spreading COVID-19 in LMICs in the Americas. First, high population density in urban centers and slums, poverty, inadequate housing, high temperatures and electricity rationing, and the inability of governments to provide large-scale assistance to affected populations make confinement and physical distancing measures impossible to apply. Second, the absence or rationing of running water in some countries of the Americas impedes the observance of health standards regarding handwashing to effectively prevent the spread of the COVID-19. Finally, the lack of trust in government authorities hinders local populations' adherence to public health instructions.

However, despite the high vulnerability of the majority of countries in the Americas, countries belonging to the half with the lowest gross domestic product each, except Honduras, had less than 1000 cases of COVID-19 as of May 6, 2020.⁶ However, some countries, such as Guatemala and Haiti, have recently seen a rapid increase in the number of cases owing to a previously overlooked factor: the deportation of individuals by US immigration authorities. On a flight returning deportees from the US to Guatemala, 75% tested positive for COVID-19. On another flight, 12 randomly selected individuals all tested positive.⁷ In Haiti, where, owing to the low number of COVID-19 cases, the government announced measures to restart manufacturing industries, an accelerated increase in the number of cases was observed after several individuals deported by the US tested positive for COVID-19.⁸ In El Salvador, Honduras, Ecuador, and Mexico, several individuals who had been deported also tested positive for COVID-19. Among the countries concerned, Haiti, Guatemala, El Salvador, and Honduras are already facing an acute food crisis that would be aggravated by an increase in COVID-19 cases.⁹

Although deportations decreased from 17,965 in March to 2985 in the first 11 days of April, the US immigration authorities' decision to continue deporting individuals to these vulnerable countries amid the pandemic constitutes a significant threat to the spread of the highly contagious COVID-19. Moreover, deportation cases are poorly managed in these countries, where public health authorities are frequently unable to guarantee deported individuals' quarantine.^{7 , 8} In Guatemala, deportees are sheltered in adverse conditions.⁷ In Haiti, some deportees and their families have not agreed to follow their government's quarantine measures, and as a result, some have been forced to leave the hotel where they were confined without being tested. Others who tested positive have not accepted the test results and left confinement in a climate of violence.⁸

In an open letter to the US government, 164 organizations called for the end of deportations, highlighting the threat they represent. Since then, in less than a week, 62 new deportations have been carried out to Jamaica and 128 to Haiti. By failing to promptly putting an end to deportations, the US Administration risks becoming the most influential factor in the spread of COVID-19 in some vulnerable countries in the Americas. In this time of pandemic, international solidarity, one of the strong pillars of global health, is more than necessary. Its absence may quickly become a threat to both LMICs in the face of COVID-19. In the present situation, it is important that the World Health Organization and the PAHO remain vigilant to LMICs in the Americas' needs and support them in better managing deportations in an effort to contain this new threat.