Latest news with #DenisNash
Newsweek
02-05-2025
- Health
- Newsweek
ICE Detainee Dies After HIV Undiagnosed for Months During Custody
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. A man who died in ICE custody earlier this year from complications related to untreated HIV could have been saved with the help of routine blood tests, medical experts have told Newsweek, raising concerns about health screening in detention facilities. The 45-year-old Ethiopian man died on January 29, 2025, from "Complications of multiple infections in the setting of human immunodeficiency virus," according to a medical examiner's report filed two days later. His condition went unaddressed during his nearly 4-month detention at Eloy Detention Center in Arizona, a death report from immigration officials said. Modern HIV treatments allow near-average life spans. Three leading infectious disease epidemiologists told Newsweek opportunities to save the man's life were missed. Perry Halkitis, professor of public health at Rutgers University, said "routine blood work" tests would have "immediately" shown that he had HIV. Denis Nash, professor of epidemiology at the CUNY School of Public Health, said the death appeared "entirely preventable" if diagnosed and treated at the time of his initial medical exam, and "still possible" after he started to develop symptoms of advanced HIV. Dr. Monica Gandhi, director of the UCSF Gladstone Center for AIDS Research, also said that antiretroviral therapy during custody "could have prevented" the man's death. When contacted by Newsweek about the concerns, Immigration and Customs Enforcement (ICE) said its 1,600-strong ICE Health Service Corps employees "uphold the highest standards" and follow the latest Performance-Based National Detention Standards to provide "comprehensive medical care," including a full health assessment for detainees within 14 days. Photo-illustration by Newsweek/Getty Detainees do not need to be routinely screened for HIV, those standards show, but "may request HIV testing at any time during detention" and an HIV diagnosis "may be made only by a licensed health care provider, based on a medical history, current clinical evaluation of signs and symptoms and laboratory studies." Nurses twice recorded the man denied having any prior medical history, the death report said. "At no time during detention is a detained individual denied emergent care," ICE added. The detention center's operator, CoreCivic, told Newsweek its staff would not have made medical decisions and are trained to refer all detainee health concerns to medical staff, and that safety, health, and well-being "is our top priority." The documents detailing the man's death were first obtained by the nonprofit watchdog Project On Government Oversight. The man has not been named due to uncertainty about whether his family was aware of his HIV condition. Why It Matters The death raises serious questions over medical care for those in ICE custody. It also raises concerns about the lack of routine HIV screening in ICE facilities, which experts say could have prevented this tragedy. Between fiscal years 2018 and 2025, there were 65 reported deaths in ICE detention facilities. Immigration arrests and detention have risen sharply under President Donald Trump's second term, leaving stretched detention centers at maximum capacity. What to Know The man was arrested by the U.S. Border Patrol near Lukeville, Arizona, on August 19 last year after entering the country illegally. He was placed into expedited removal proceedings and transferred to ICE custody at Eloy Detention Center. No HIV treatment was provided during his time in custody, even though his condition would have required specialized medical attention. After an initial medical screening, which included a chest X-ray, on August 21 and 22, the detainee was cleared to be housed in the general population of the facility, ICE's death report said. The man was evaluated for back pain four times between November 3 and December 16, the death report shows. On December 20, the man informed a detention staff member he had fainted in the recreation yard the day before. A medical doctor assessed him and noted the man showed normal vital signs but also signs of dehydration, an elevated pulse reading of 130 bpm, was feeling weak and fatigued and had lost about 20 percent of his body weight. He was referred to Banner Casa Grande Hospital. Between Christmas Eve and New Year's Ever, doctors at the hospital diagnosed acute respiratory distress, pneumonia, possible lymphoma, and a pericardial effusion, and provided treatment. He was taken by air ambulance to an intensive care unit at Banner University Medical Center Phoenix's (BUMCP) on December 31. Between New Year's Day and January 2, BUMCP medical staff identified his immunocompromised status—HIV can leave the body unable to produce an adequate immune response — and diagnosed him with acute respiratory distress, pneumonia, possible lymphoma with metastases in the lungs, life-threatening sepsis, supraventricular tachycardia, and ischemic stroke. As a result, BUMCP medical staff ordered oncology and palliative care consultations. On January 3, BUMCP medical staff performed a biopsy of his neck lymph node, diagnosed him with tuberculosis, and placed him on a ventilator for airway protection As his condition continued to deteriorate, his next of kin made the decision to withdraw life support. The man was pronounced dead at approximately 1:21 p.m. on January 29. Medical experts told Newsweek that better treatment could have prevented the man's death. "This patient died of AIDS and resultant opportunistic infections that result from untreated HIV infection, including central nervous system toxoplasmosis, pneumocystis pneumonia, tuberculosis, and CMV (all infections that occur as a result of advanced immunodeficiency with HIV)," said Dr. Gandhi after reviewing the medical examiner's report. "He was not receiving antiretroviral therapy (which treats HIV) when in ICE detention which could have prevented all of these conditions." Nash, professor of epidemiology at the CUNY School of Public Health, said the death appeared "entirely preventable" if recognized and diagnosed in time. "It is possible that [the detainee] could have survived, had his HIV been diagnosed and treated at the time of his initial medical exam, and also still possible even after he started to develop symptoms of advanced HIV and OIS." He added: "The presence of multiple opportunistic infections—like pneumocystis pneumonia, CMV, toxoplasmosis, and advanced TB—strongly suggests he had untreated HIV for a long time. These are not subtle signs; they are classic indicators of HIV infection that has progressed to full-blown AIDS due to a severely weakened immune system. "And development of new symptoms after detention should receive immediate attention, as both advanced HIV and TB disease can progress rapidly towards a fatal outcome without treatment." It is still common for people to be diagnosed too late to benefit from treatment, Nash said, and clinical management is harder when people have advanced HIV and other complications. "Even when this happens, people can often respond well to treatment of HIV and the OIS. But time is of the essence. And of course clinical management is harder when people have advanced HIV with Oi-related complications like this," he said. This electron microscope image made available by the U.S. National Institutes of Health shows a human T cell, in blue, under attack by HIV, in yellow, the virus that causes AIDS. This electron microscope image made available by the U.S. National Institutes of Health shows a human T cell, in blue, under attack by HIV, in yellow, the virus that causes AIDS. Seth Pincus, Elizabeth Fischer, Austin Athman/National Institute of Allergy and Infectious Diseases/NIH via AP Halkitis, an expert in infectious disease epidemiology and professor of public health at Rutgers University, said in a statement: "If they had run routine blood work they would have seen immediately from his CD4 [a type of white blood cell that plays a crucial role in the immune system] count that he had HIV. Immediately!" Public health experts have repeatedly raised alarms about inadequate infectious disease screening in immigration detention centers. A study published in Health and Human Rights Journal in 2009 concluded "the system of immigration detention in the US fails to adequately screen detainees for HIV and delivers a substandard level of medical care to those with HIV." The study urged ICE to adopt routine HIV testing to all detainees, provide appropriate care to those who require treatment, report HIV statistics to an external agency, and guarantee defined medical care as a matter of law. A 2024 study in the American Journal of Public Health called on ICE to improve access to HIV treatment and begin publishing monthly health care metrics—including data on whether detainees are receiving HIV medications. Immigration arrests and detention have risen sharply since Trump began his second White House term on January 20. U.S. ICE agents made 32,809 migrant arrests between then and March 10, 2025, officials said at a news conference in March, at a rate more than double than under former President Joe Biden. Detention centers are struggling to cope. U.S. immigration detention is filled to capacity at 47,600 detainees, a senior ICE official told reporters that month, and the Trump administration is seeking more bed space. The Elroy facility had the sixth highest daily population on January 6, according to data analyzed by Syracuse University nonprofit TRAC.
Yahoo
20-02-2025
- Health
- Yahoo
The Axe Hanging Over America's Disease Detectives
Americans have plenty to worry about these days when it comes to infectious-disease outbreaks. This is the worst flu season in 15 years, there's a serious measles outbreak roiling Texas, and the threat of bird flu isn't going away. 'The house is on fire,' Denis Nash, an epidemiologist at CUNY School of Public Health, told me. The more America is pummeled by disease, the greater the chance of widespread outbreaks and even another pandemic. As of this week, the federal government may be less equipped to deal with these threats. Elon Musk's efforts to shrink the federal workforce have hit public-health agencies, including the CDC, NIH, and FDA. The Trump administration has not released details on the layoffs, but the cuts appear to be more than trivial. The CDC lost an estimated 700 people, according to the Associated Press. Meanwhile, more than 1,000 NIH staffers reportedly lost their jobs. Perhaps as notable as who was laid off is who wasn't. The Trump administration initially seemed likely to target the CDC's Epidemic Intelligence Service, a cohort of doctors, scientists, nurses, and even veterinarians who investigate and respond to disease outbreaks around the world. Throughout the program's history, EIS officers have been the first line of defense against anthrax, Ebola, smallpox, polio, E. coli, and, yes, bird flu. Four recent CDC directors have been part of the program. The layoffs were mostly based on workers' probationary status. (Most federal employees are considered probationary in their first year or two on the job, and recently promoted staffers can also count as probationary.) EIS fellows typically serve two-year stints, which makes them probationary and thus natural targets for the most recent purge. EIS fellows told me they were bracing to be let go last Friday afternoon, but the pink slips never came. Exactly why remains unclear. In response to backlash about the planned firings, Musk posted on X on Monday that EIS is 'not canceled' and that those suggesting otherwise should 'stop saying bullshit.' A spokesperson for DOGE did not respond to multiple requests for comment. This doesn't mean EIS is safe. Both DOGE and Robert F. Kennedy Jr., Donald Trump's newly confirmed health secretary, are just getting started. More layoffs could still be coming, and significant cuts to EIS would send a clear message that the administration does not believe that investigating infectious-disease outbreaks is a good use of tax dollars. In that way, the future of EIS is a barometer of how seriously the Trump administration takes the task of protecting public health. Trump and his advisers have made it abundantly clear that, after the pandemic shutdowns in 2020, they want a more hands-off approach to dealing with outbreaks. Both Trump and Kennedy have repeatedly downplayed the destruction caused by COVID. But so far, the second Trump administration's approach to public health has been confusing. Last year, Trump said he would close the White House's pandemic office; now he is reportedly picking a highly qualified expert to lead it. The president hasn't laid out a bird-flu plan, but amid soaring egg prices, the head of his National Economic Council recently said that the plan is coming. Kennedy has also previously said that he wants to give infectious-disease research a 'break' and focus on chronic illness; in a written testimony during his confirmation hearings, he claimed that he wouldn't actually do anything to reduce America's capacity to respond to outbreaks. The decision to spare EIS, at least for now, only adds to the confusion. (Nor is it the sole murky aspect of the layoffs: Several USDA workers responding to bird flu were also targeted, although the USDA told me that those cuts were made in error and that it is working to 'rectify the situation.') On paper, EIS might look like a relatively inconsequential training program that would be apt for DOGEing. In reality, the program is less like a cushy internship and more akin to public health's version of the CIA. Fellows are deployed around the world to investigate, and hopefully stop, some of the world's most dangerous pathogens. The actual work of an EIS officer varies depending on where they're deployed, though the program's approach is often described as 'shoe-leather epidemiology'—going door to door or village to village probing the cause of an illness in the way a New York City detective might investigate a stabbing on the subway. Fellows are highly credentialed experts, but the process provides hands-on training in how to conduct an outbreak investigation, according to Nash, the CUNY professor, who took part in the program. Nash entered EIS with a Ph.D. in epidemiology, but 'none of our training could prepare us for the kinds of things we would learn through EIS,' he said. In many cases, EIS officials are on the ground investigating before most people even know there's a potential problem. An EIS officer investigated and recorded the United States' first COVID case back in January 2020, when the virus was still known as 2019-nCoV. It would be another month before the CDC warned that the virus would cause widespread disruption to American life. More recently, in October, EIS officers were on the ground in Washington when the state was hit with its first human cases of bird flu, Roberto Bonaccorso, a spokesperson with the Washington State Department of Health, wrote to me. 'Every single outbreak in the United States and Washington State requires deployment of our current EIS officers,' Bonaccorso said. EIS is hardly the only tool the federal government uses to protect the country against public-health threats. Managing an outbreak requires coordination across an alphabet soup of agencies and programs; an EIS fellow may have investigated the first COVID case, but that of course didn't stop the pandemic from happening. Other vital parts of how America responds to infectious diseases were not spared by the DOGE layoffs. Two training programs with missions similar to that of EIS were affected by the cuts, according to a CDC employee whom I agreed not to identify by name because the staffer is not authorized to talk to the press. The DOGE website boasts of saving nearly $4 million on the National Immunization Surveys, collectively one of the nation's key tools for tracking how many Americans, particularly children, are fully vaccinated. What those cuts will ultimately mean for the future of the surveys is unknown. A spokesperson for the research group that runs the surveys, the National Opinion Research Center, declined to comment and directed all questions to the CDC. And more cuts to the nation's public-health infrastructure, including EIS, could be around the corner. RFK Jr. has already warned that certain FDA workers should pack their bags. Kennedy has repeatedly claimed that public-health officials inflate the risks of infectious disease threats to bolster their importance with the public; EIS fellows are the first responders who hit the ground often before public officials are even sounding the alarm bells. Ironically, the work of the EIS is poised to become especially pressing during Trump's second term. If measles, bird flu, or any other infectious disease begins spreading through America unabated after we have fired the public-health workforce, undermined vaccines, or halted key research, it will be the job of EIS fellows to figure out what went wrong. Article originally published at The Atlantic
Atlantic
20-02-2025
- Health
- Atlantic
The Axe Hanging Over America's Disease Detectives
Americans have plenty to worry about these days when it comes to infectious-disease outbreaks. This is the worst flu season in 15 years, there's a serious measles outbreak roiling Texas, and the threat of bird flu isn't going away. 'The house is on fire,' Denis Nash, an epidemiologist at CUNY School of Public Health, told me. The more America is pummeled by disease, the greater the chance of widespread outbreaks and even another pandemic. As of this week, the federal government may be less equipped to deal with these threats. Elon Musk's efforts to shrink the federal workforce have hit public-health agencies, including the CDC, NIH, and FDA. The Trump administration has not released details on the layoffs, but the cuts appear to be more than trivial. The CDC lost an estimated 700 people, according to the Associated Press. Meanwhile, more than 1,000 NIH staffers reportedly lost their jobs. Perhaps as notable as who was laid off is who wasn't. The Trump administration initially seemed likely to target the CDC's Epidemic Intelligence Service, a cohort of doctors, scientists, nurses, and even veterinarians who investigate and respond to disease outbreaks around the world. Throughout the program's history, EIS officers have been the first line of defense against anthrax, Ebola, smallpox, polio, E. coli, and, yes, bird flu. Four recent CDC directors have been part of the program. The layoffs were mostly based on workers' probationary status. (Most federal employees are considered probationary in their first year or two on the job, and recently promoted staffers can also count as probationary.) EIS fellows typically serve two-year stints, which makes them probationary and thus natural targets for the most recent purge. EIS fellows told me they were bracing to be let go on Friday afternoon, but the pink slips never came. Exactly why remains unclear. In response to backlash about the planned firings, Musk posted on X on Monday that EIS is 'not canceled' and that those suggesting otherwise should 'stop saying bullshit.' A spokesperson for DOGE did not respond to multiple requests for comment. This doesn't mean EIS is safe. Both DOGE and Robert F. Kennedy Jr., Trump's newly confirmed health secretary, are just getting started. More layoffs could still be coming, and significant cuts to EIS would send a clear message that the administration does not believe investigating infectious-disease outbreaks is a good use of tax dollars. In that way, the future of EIS is a barometer of how seriously the Trump administration takes the task of protecting public health. Trump and his advisers have made it abundantly clear that, after the pandemic shutdowns in 2020, they want a more hands-off approach to dealing with outbreaks. Both Trump and Kennedy have repeatedly downplayed the destruction caused by COVID. But so far, the second Trump administration's approach to public health has been confusing. Last year, Trump said he would close the White House's pandemic office; now he is reportedly picking a highly qualified expert to lead it. The president hasn't laid out a bird-flu plan, but amid soaring egg prices, the head of his National Economic Council recently said the plan was coming. Kennedy has also previously said he wants to give infectious-disease research a 'break' and focus on chronic illness; in a written testimony during his confirmation hearings, he claimed that he wouldn't actually do anything to reduce America's capacity to respond to outbreaks. The decision to spare EIS, at least for now, only adds to the confusion. (Nor is it the sole murky aspect of the layoffs: Several USDA workers responding to bird flu were also targeted, although the USDA told me those cuts were made in error and it is working to 'rectify the situation.') On paper, EIS might look like a relatively inconsequential training program that would be apt for DOGEing. In reality, the program is less like a cushy internship and more akin to public health's version of the CIA. Fellows are deployed around the world to investigate, and hopefully stop, some of the world's most dangerous pathogens. The actual work of an EIS officer varies depending on where they're deployed, though the program's approach is often described as ' shoe-leather epidemiology '—going door to door or village to village probing the cause of an illness in the way a New York City detective might investigate a stabbing on the subway. Fellows are highly credentialed experts, but the process provides hands-on training in how to conduct an outbreak investigation, according to Nash, the CUNY professor, who took part in the program. Nash entered EIS with a Ph.D. in epidemiology, but 'none of our training could prepare us for the kinds of things we would learn through EIS,' he said. In many cases, EIS officials are on the ground investigating before most people even know there's a potential problem. An EIS officer investigated and recorded the United States' first COVID case back in January 2020, when the virus was still known as 2019-nCoV. It would be another month before the CDC warned that the virus would cause widespread disruption to American life. More recently, in October, EIS officers were on the ground in Washington when the state was hit with its first human cases of bird flu, Roberto Bonaccorso, a spokesperson with the Washington State Department of Health, wrote to me. 'Every single outbreak in the United States and Washington State requires deployment of our current EIS officers,' Bonaccorso said. EIS is hardly the only tool the federal government uses to protect the country against public-health threats. Managing an outbreak requires coordination across an alphabet soup of agencies and programs; an EIS fellow may have investigated the first COVID case, but of course that did not stop the pandemic from happening. Other vital parts of how America responds to infectious diseases were not spared by the DOGE layoffs. Two training programs with missions similar to that of EIS were affected by the cuts, according to a CDC employee whom I agreed not to identify by name because the staffer is not authorized to talk to the press. The DOGE website boasts of saving nearly $4 million on the National Immunization Surveys, collectively one of the nation's key tools for tracking how many Americans, particularly children, are fully vaccinated. What those cuts ultimately will mean for the future of the surveys is unknown. A spokesperson for the research group that runs the surveys, the National Opinion Research Center, declined to comment and directed all questions to CDC. And more cuts to the nation's public-health infrastructure, including EIS, could be around the corner. RFK Jr. has already warned that certain FDA workers should pack their bags. Kennedy has repeatedly claimed that public-health officials inflate the risks of infectious disease threats to bolster their importance with the public; EIS fellows are the first responders that hit the ground often before public officials are even sounding the alarm bells. Ironically, the work of the EIS is poised to become especially pressing during Trump's second term. If measles, bird flu, or any other infectious disease begins spreading through America unabated after we have fired the public-health workforce, undermined vaccines, or halted key research, it will be the job of EIS fellows to figure out what went wrong.
