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Gonsalves Reply Declaration Case 1:20-cv-10617-WGY Document 33-5 Filed 04/02/20 Page 1 of 18 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MASSACHUSETTS Maria Alejandra Celimen Savino, et al., Petitioners-Plaintiffs, Civil Action No. 1:20-cv-10617- WGY v. Steven J. Souza, Respondent-Defendant. REPLY DECLARATION OF GREGG GONSALVES I, Gregg S. Gonsalves, upon my personal knowledge, and in accordance with 28 U.S.C. § 1746, declare as follows: 1. I am an epidemiologist at the Yale School of Medicine and School of Public Health. I have worked at the schools of medicine and public health since 2017. I submit this to respond to the information provided by the Defendant in his opposition to the motion for temporary restraining order and as a supplement to my prior declaration in ths case. See ECF No. 12-2. I understand that my CV was inadvertently not filed with my first declaration and so I attach it here as Exhibit A. 2. I have reviewed the relevant filings in this matter, Savino v. Souza, including the statements and declarations of Plaintiffs, putative Plaintiffs’ class members and their families, lawyers with familiarity with the Bristol County House of Correction and immigration facilities (“BCHOC”), as well as arguments and declarations filed by Defendant. Dkt. Nos. 1-4, 1-5, 12-2, 12-3, 12-4, 12-5, 12-6, 12-7, 12-8, 12-9, 20-3, 20-4, 26, 26-1, 26-2, 26-3. 3. The following represents my expert opinion as to several of Defendant’s claims based on my review of these filings and drawing on my knowledge and experience. 4. Defendant presents the claim that releasing Plaintiffs will “place themselves and their communities at great risk of contracting COVID-19[.]” Dkt. No. 26-1, at 5. 5. On the contrary, allowing ICE facilities to act as “institutional amplifiers” 1 could easily enhance community risk, as outbreaks inside congregate facilities often spill over to 1 Basu, S., Stuckler, D. & McKee, M., Addressing institutional amplifiers in the dynamics and control of tuberculosis epidemics, The American Journal of Tropical Medicine and Hygiene, 84(1), 30-37 (2011). 1 Case 1:20-cv-10617-WGY Document 33-5 Filed 04/02/20 Page 2 of 18 communities through transmission to facility staff and officials, as has been seen with tuberculosis.2 6. Social distancing is meant to reduce the number of people one interacts with on a daily basis. The number of people inside BCHOC and the number of daily contacts between these individuals in detention are far greater than what would be experienced in a host setting. Thus, placing Plaintiffs into homes of family, friends, or sponsors is far safer than leaving them in custody of ICE. 7. Defendant claims that “in conjunction and consultation with the Massachusetts Department of Public Health, the CDC and other public health agencies and correctional institutions, CPS and the BCHOC have instituted strict protocols to keep inmates, detainees, and staff safe, and take all prudent measures to prevent exposure to the COVID-19 virus.” Dkt. No. 26, at 4. 8. Some of these “strict protocols to keep inmates, detainees, and staff safe, and . prevent exposure to the COVID-19 virus” do not cohere with public health guidelines. Specifically, the screening procedures being used by BCHOC are not going to prevent exposure to the virus. The CDC notes that symptoms generally start two to fourteen days after exposure. 3 As such, while checking for symptoms is important, individuals (detainees and employees alike) could easily be infected and spreading the virus to others before showing the symptoms that BCHOC is testing for. 9. Notably, up to 60% of infections may be “covert” and not amenable to the screening measures described in the ICE memo.4 Dkt. No. 26-2, at 4. In fact, other congregate facilities such as state prisons across the United States have similar procedures in place and have not been able to prevent outbreaks of COVID-19, which can be transmitted through asymptomatic or mild infections not detected through syndromic surveillance.5 10. Furthermore, it is not just influenza-like symptoms that BCHOC needs to be screening for. Some studies have shown that the initial symptoms can be gastrointestinal in nature, such as diarrhea or abdominal pain, rather than cough or fever.6 If this is missed, there is the potential for spread of infection before it is recognized as COVID-19. 2 PLoS Medicine Editors, The health crisis of tuberculosis in prisons extends beyond the prison walls, PLoS medicine, 7(12) (2010); Stead, W.W., Undetected tuberculosis in prison: source of infection for community at large, JAMA, 240(23), 2544-2547 (1978). 3 Centers for Disease Control and Prevention, Coronavirus Disease 2019 (COVID-19): Watch for symptoms, https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (last accessed Apr. 1, 2020). 4 Jane Qiu, Covert coronavirus infections could be seeding new outbreaks, Nature (Mar. 20, 2020), https://www.nature.com/articles/d41586-020-00822-x 5 Emma Grey Ellis, Covid-19 Poses a Heightened Threat in Jails and Prisons, Wired (Mar. 24, 2020), https://www.wired.com/story/coronavirus-covid-19-jails-prisons/ 6 Xu, XW et al., Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series., BMJ, 368(606) (2020); Wong, SH et al., Covid-19 and the Digestive System., Journal of Gastroenterology and Hepatology (2020); Jin, X et al., Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms., BMJ (2020). 2 Case 1:20-cv-10617-WGY Document 33-5 Filed 04/02/20 Page 3 of 18 11. BCHOC’s cleaning and logistics protocols are also inadequate to prevent the spread of the virus. Dkt. No. 26-2, at 2. Dkt. No. 26-1, at 2-4. 12. Those protocols are inadequate to prevent transmission of COVID-19 unless all detainees and staff have universal access to Personal Protective Equipment, including N-95 respirators, face shields, and gloves. The mere availability of hand sanitizer and daily cleaning of high-touch surfaces are unlikely to reduce the droplet-borne transmission of 2019-nCoV, as high-traffic areas are constantly exposed to new contamination. While instructing individuals to use sanitizer and refrain from touching their eyes, nose, or mouth is helpful for those only occasionally exposing themselves to infection (such as an individual who only leaves home to go to the grocery store), these prevention techniques are less effective when there is constant exposure, as in BCHOC. 13. BCHOC claims that it is preventing potential spread of the virus by having meals “inside the housing or cells” so that “inmates do not congregate for meals in the main dining hall.” Dkt. No. 26-1, at 2. For male ICE detainees, who are held in one large room (as opposed to cells), holding meals in these large rooms are not any better for social distancing than holding meals in dining halls. 14. Defendant claims that detainees are best kept at BCHOC because “at present no inmate, detainee or staff member has tested positive for COVID-19.” Dkt. No. 26, at 1. 15. Yet this assertion says nothing about whether BCHOC has been exposed to the virus unless every individual who enters the facility has tested negative. Moreover, for this claim be meaningful, those who have exited and re-entered the facility would need to be re-tested and confirmed to be negative after each exit. 16. Defendant claims that the health of Plaintiffs are adequately and continually monitored by experienced administration by Correctional Psychicatric Services, Inc. (“CPS”). Dkt. No. 26, at 3. 17. However, investigative reporting has revealed that CPS has a track record of failing to maintain the health of individiuals in its care at BCHOC, as it has presided over 31 deaths as the facility’s medical provider in the last decade—the same number of deaths as at the larger Suffolk County jail and more than that at any other jail in the state.7 18. Defendant argues that, “Plaintiffs do not explain how release from BCHOC, a facility without a single confirmed case of COVID-19, into the greater Boston area, one of the ‘hot spots’ of America’s COVID-19 crisis, will reduce their risk of injury or death.” Dkt. No. 26, at 25. 19. In fact, release of detainees is an appropriate intervention to prevent COVID-19. A key way to reduce incidence, prevalence, and mortality in a community is to limit the number 7 Chrstine Willmsen & Beth Healy, Pain And Profits: Sheriffs Hand Off Inmate Care To Private Health Companies, WBUR (Mar. 24, 2020), https://www.wbur.org/investigations/2020/03/24/jail-health-companies-profit-sheriffs- watch 3 Case 1:20-cv-10617-WGY Document 33-5 Filed 04/02/20 Page 4 of 18 of persons that enter institutional amplifiers, such as detention centers. Social distancing is the foundation of COVID-19 transmission control, which is impossible in a congregate facility like BCHOC. 20. Vast, uncontrolled COVID-19 outbreaks have been reported at congregate settings like jails across the country, reflecting the “institutional amplifier” effect in action. Cook County Jail in Illinois has 134 cases, just one week after its first two cases were announced on March 23.8 The Riker’s Island Complex in New York reports at least 139 cases.9 21. There is strong, recent evidence regarding the presence of the “institutional amplifier” effect at Customs and Border Patrol and ICE facilities.
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