In May, as the number of people detained by U.S. Immigration and Customs Enforcement began to swell, the number of positive Covid-19 cases shot up dramatically. On May 19, the agency reported over 2,100 cases, a more than sixfold increase from the beginning of March, concentrated in detention facilities in Mississippi and Louisiana.

As immigrant right advocates have pointed out, the increases appear to be connected to ICE’s refusal to systematically provide Covid-19 vaccines to the people in its custody. Even when vaccines are offered by state health departments, The Intercept has found, detained people are not always taking them — sometimes due to skepticism of medical care in ICE custody and sometimes due to detention officials’ lackadaisical effort to inform people about the vaccine’s availability.

In addition, The Intercept has found that the increase in coronavirus cases coincided with ICE’s decision to transfer detainees through a Mississippi facility where cases were exploding, effectively spreading the virus to various other detention centers in the South — despite the fact that the agency has previously acknowledged in internal documents that such transfers cause outbreaks.

“Transfers in and of themselves are high risk. Every time you travel by bus, by public transportation, with other people, there’s a high risk of transmission and a high risk of being infected, especially if you’re not tested and you’re asymptomatically infected,” said Dr. Ranit Mishori, a professor at Georgetown University School of Medicine and senior medical adviser to Physicians for Human Rights. “If I were running the ICE medical operation, getting a vaccination program underway would be my absolute top choice.”

“As is everything with Covid, there is no one solution,” added Mishori, who recently co-authored a blog post with recommendations for vaccination in immigration detention. She pointed to other deficiencies that could be addressed, like the lack of proper testing, the transfers, and the failure to provide for social distancing.

From mid-March to mid-May, as President Joe Biden’s administration began to allow more asylum-seekers into the U.S. the number of people in ICE detention grew from about 14,000 to 20,400, representing about a 45 percent increase. The number of confirmed active Covid-19 cases over the same period went from about 475 to 2,100, about a 340 percent increase. The Biden administration continues to expel most asylum-seekers immediately upon their entry into the U.S. under an obscure public health rule called Title 42; those who make it through are screened for infection. ICE does not report infections among its staff, but there have long been indications that staff bring the virus into detention centers, not the other way around.

The loci of the outbreaks were in Mississippi, Louisiana, and Arizona, where ICE has a robust detention infrastructure. The spread can also be tied to lagging vaccination rates as a whole. Louisiana ranks 48th out of 51 states, including Washington, D.C., while Mississippi is dead last, with about 28 percent of its adult population fully vaccinated.

For months, ICE has refused to take responsibility for vaccinating people in its custody, punting the task to state and local officials — despite the fact that civil immigration detainees are inarguably in federal custody, even when held in local jails and private detention centers. As a result, vaccine offerings have been inconsistent across detention centers, including in the states where there was an outbreak last month. A spokesperson for the Mississippi Department of Health said that the department had provided 1,100 doses of the Johnson & Johnson vaccine and 800 of the two-part Moderna vaccine to the Adams County Detention Center as of late May, but did not respond to questions about whether vaccination remains available at the center or if its staff is directly involved in vaccinating detainees. Ryan Gustin, a spokesperson for the private detention company CoreCivic, said the company is working with ICE and the state Health Department to administer the vaccine, but did not address whether vaccines are currently being made available or how many have been administered so far.

A spokesperson for the Louisiana Department of Health did not respond to questions, though people detained by ICE in the state told The Intercept vaccines had been offered at various centers.

A spokesperson for the GEO Group, a private prison company that operates several centers in Louisiana, referred questions to ICE, and LaSalle Corrections, which runs two Louisiana immigration detention facilities, did not respond to questions. A regional spokesperson for ICE also did not respond to questions.

According to advocates, attorneys, and multiple people who passed through the Adams County Detention Center, the facility in Natchez, Mississippi, has been a stopping point for people brought in from the southern border and bound for other detention centers in the South, mostly Louisiana.

The immigration enforcement agency does not publicly report transfers between its facilities, but there are reasons to believe the Covid-19 spike originated at Adams and spread elsewhere in the region. At the end of April, ICE reported 232 cases at Adams, while the agency’s other facilities in Mississippi and Louisiana were at 50 or less. By May 21, the number of recorded cases at Adams was 415: more than any other ICE facility, and about a fifth of all acknowledged cases in ICE facilities nationwide. The Richwood Correctional Center in Monroe, Louisiana, had shot up to 196 cases, while the Jackson Parish Correctional Center in Monroe reached 86 and the South Louisiana ICE Processing Center hit 61.

Ramón, who said he spent about a day at Adams before testing positive for Covid-19 and was transferred immediately to the River Correctional Center in Ferriday, Louisiana, called Adams a “trampoline” from which asylum-seekers were being bounced around. The Intercept is referring to Ramón and all others in ICE custody by pseudonyms due to their fear of retaliation by detention officials.

Several people who passed through Adams reported that they were given Covid-19 tests upon their arrival, but not always upon their exit or arrival at other centers. Ramón claimed that after he and four others were transferred to River with still-active infections, they were put in isolation but left largely untreated.

Even when vaccines are offered by state or local authorities, detained immigrants are sometimes hesitant to take them. A group of close to 40 women detained at the South Louisiana ICE Processing Center in Basile said they had been offered the Johnson & Johnson vaccine, but had refused it out of fear that the facility’s medical staff would be unable or unwilling to treat them if they developed adverse reactions, such as the very rare but known increased risk of blood clots among women in particular. Their fears were exacerbated by a possible case of tuberculosis among the detained population earlier this month. As The Intercept previously reported, the woman who was ill was exhibiting symptoms long before facility staff intervened, according to several people who were in her housing unit.

“We have a person who gets convulsions and the medical attention is always very late,” said Yesenia, a Venezuelan asylum-seeker who turned herself in after crossing the border in mid-February. She passed through a Customs and Border Protection “icebox” facility in San Diego before being turned over to ICE, first at the San Luis Regional Detention Center in San Luis, Arizona, then Adams in Mississippi, and finally South Louisiana. “At nights they don’t even have emergency staff, there’s always just a nurse who tells us we have to wait until the next day to see a doctor or a specialist. … We also had a woman here who passed out from a fever, she had such a high fever and a bad infection and she was evaluated the next day, not even the day she passed out.”

In that context, the women felt that getting vaccinated was more trouble than it was worth, particularly given some of their existing medical vulnerabilities. A Cuban asylum-seeker named Margarita complained of having received inadequate treatment for a tumor in her spine, migraine, and chronic allergies. “At the border, they threw out all my medication, I was carrying all that I managed to bring from my country,” she said. (Border Patrol has been known to summarily confiscate belongings, including medicine.)

Last year, in a case known as Fraihat v. ICE, a federal judge ordered the agency to evaluate for release people who were over 55, pregnant, or presented certain medical vulnerabilities that would leave them particularly susceptible to Covid-19. However, Margarita said that despite her increased risk, which she said is documented in her medical records, she was never asked about her ailments, evaluated for release, or even had a formal credible fear interview — the first step in an asylum process — after having spent over five weeks in detention. A few days after her arrival in South Louisiana, she began to have deep muscle pain and spent three days bedridden before being administered a Covid-19 test, which came back positive. “They tried to give me ibuprofen for it, and I’m allergic to ibuprofen,” she said. She described a recovery plan similar to one outlined by people in ICE custody near the beginning of the pandemic, more than a year ago.

ICE has also taken a haphazard approach to Covid-19 testing prior to releasing people from its custody, according to two women detained at South Louisiana. A Cuban asylum-seeker named Tamara told The Intercept that she’d been given paperwork denoting a negative result without actually having had a test when staff mistakenly believed she was being imminently released. Rosa, another Cuban woman who was released in mid-May, separately told The Intercept that she was given a negative result before her release — even though she had not been tested. She also said she had indicated her interest in being vaccinated, but vaccines were never offered in the month she was there.

Two people recently released from the LaSalle ICE Processing Center in Jena, Louisiana, separately told The Intercept that officials who’d brought vaccines to the detention center spoke only English, and they had been unable to communicate to them what they were there for. “At one point this official came in, he’s standing there holding these papers and he starts speaking in English. I was one of the people who told him to get a translator because we didn’t know what he was talking about,” said Rafael, who was in the center up until early June. David, another asylum-seeker, said he only learned that two people who had come to the center and spoke only English were offering vaccines after the officials had already left. “None of us [in my unit] got injected,” he said. Both men told The Intercept they had passed through Adams before reaching their final detention centers, as did several women at South Louisiana.

Ramón, at River, said he has had Covid-19 and had asked to be vaccinated, yet was not given an opportunity when vaccines were administered at the facility. “Sadly on the day that they came to distribute it, I went to work, I was working in the kitchen and nobody told me anything,” he said. “I’d even been told someone would come to the kitchen to give it to me, but they never arrived.”