Order Suspending the Right To Introduce Certain Persons From Countries Where a Quarantinable Communicable Disease Exists, 65806-65812 [2020-22978]

Agencies

• Centers for Disease Control and Prevention
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 85, Number 201 (Friday, October 16, 2020)]
[Notices]
[Pages 65806-65812]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2020-22978]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention


Order Suspending the Right To Introduce Certain Persons From 
Countries Where a Quarantinable Communicable Disease Exists

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice.

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SUMMARY: The Centers for Disease Control and Prevention (CDC), a 
component of the Department of Health and Human Services (HHS), 
announces the issuance of an Order suspending the right to introduce 
certain persons into the United States from countries where a 
quarantinable communicable disease exists. This Order is based on the 
CDC Director's determination that introduction of aliens, regardless of 
their country of origin, migrating through Canada and Mexico into the 
United States creates a serious danger of the introduction of COVID-19 
into the United States, and the danger is so increased by the 
introduction of such aliens that a temporary suspension is necessary to 
protect the public health.

DATES: This action took effect October 13, 2020.

FOR FURTHER INFORMATION CONTACT: Nina B. Witkofsky, Office of the Chief 
of Staff, Centers for Disease Control and Prevention, 1600 Clifton Road 
NE, MS V18-2, Atlanta, GA 30329. Phone: 404-639-7000. Email: 
[email protected].

SUPPLEMENTARY INFORMATION: The Director of the CDC (Director) is 
issuing this Order pursuant to Sections 362 and 365 of the Public 
Health Service (PHS) Act, 42 U.S.C. 265, 268, and their implementing 
regulations,\1\ which authorize the Director of the Centers for Disease 
Control and Prevention (CDC) to

[[Page 65807]]

suspend the right to introduce \2\ persons into the United States when 
the Director determines that the existence of a quarantinable 
communicable disease in a foreign country or place creates a serious 
danger of the introduction of such disease into the United States and 
the danger is so increased by the introduction of persons from the 
foreign country or place that a temporary suspension of the right of 
such introduction is necessary to protect public health. This Order 
replaces the Order Suspending Introduction of Certain Persons from 
Countries Where a Communicable Disease Exists, issued on March 20, 2020 
(March 20, 2020 Order), extended on April 20, 2020, and amended May 19, 
2020, which were based on the prior interim final rule.\3\
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    \1\ 85 FR 56424.
    \2\ Suspension of the right to introduce means to cause the 
temporary cessation of the effect of any law, rule, decree, or order 
pursuant to which a person might otherwise have the right to be 
introduced or seek introduction into the United States. 42 CFR 
71.40(b)(5).
    \3\ 85 FR 16559, 85 FR 17060, 85 FR 22424, 85 FR 31503.
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    This Order applies to persons traveling from Canada or Mexico 
(regardless of their country of origin) who would otherwise be 
introduced into a congregate setting in a land or coastal Port of Entry 
(POE) or Border Patrol station at or near the United States borders 
with Canada or Mexico, subject to the exceptions detailed below.
    This Order does not apply to U.S. citizens and lawful permanent 
residents; members of the armed forces of the United States, and 
associated personnel, and their spouses and children; persons from 
foreign countries who hold valid travel documents and arrive at a POE; 
or persons from foreign countries in the visa waiver program who are 
not otherwise subject to travel restrictions and arrive at a POE. 
Additionally, this Order does not apply to any alien who must test 
negative for COVID-19 before they are expelled to their home country. 
Further, this Order does not apply to persons whom customs officers 
determine, with approval from a supervisor, should be excepted based on 
the totality of the circumstances, including consideration of 
significant law enforcement, officer and public safety, humanitarian, 
and public health interests. DHS shall consult with CDC concerning how 
these types of case-by-case, individualized exceptions shall be made to 
help ensure consistency with current CDC guidance and public health 
assessments.
    DHS has informed CDC that persons who are traveling from Canada or 
Mexico (regardless of their country of origin), and who must be held 
longer in congregate settings in POEs or Border Patrol stations to 
facilitate immigration processing, would typically be aliens seeking to 
enter the United States at POEs who do not have proper travel 
documents, aliens whose entry is otherwise contrary to law, and aliens 
who are apprehended at or near the border seeking to unlawfully enter 
the United States between POEs. This Order is intended to cover all 
such aliens. For simplicity, I shall refer to the persons covered by 
this Order as ``covered aliens.''
    This Order, which is substantially the same as the amended and 
extended March 20, 2020 Order, is necessary to continue to protect the 
public health from an increase in the serious danger of the 
introduction of Coronavirus Disease 2019 (COVID-19) into the POEs, and 
the Border Patrol stations between POEs, at or near the United States 
borders with Canada and Mexico. Those facilities are operated by U.S. 
Customs and Border Protection (CBP), an agency within DHS. This Order 
is intended to help mitigate the continued risks of transmission and 
spread of COVID-19 to CBP personnel, U.S. citizens, lawful permanent 
residents, and other persons in the POEs and Border Patrol stations; 
further transmission and spread of COVID-19 in the interior of the 
United States; and the increased strain that further transmission and 
spread of COVID-19 would put on the United States healthcare system and 
supply chain during the current public health emergency.\4\
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    \4\ As of October 1, 2020, CBP has had 2,195 employees contract 
COVID-19. In addition, 13 employees and one USBP transportation 
contractor have died due to the virus. Any outbreak of COVID-19 
among CBP personnel in land POEs or Border Patrol stations would 
impact CBP operations negatively. Although not part of the CDC 
public health analysis, it bears emphasizing that the impact on CBP 
could reduce the security of U.S. land borders and the speed with 
which cargo moves across the same.
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    There is a serious danger of the introduction of COVID-19 into the 
POEs and Border Patrol stations at or near the United States borders 
with Canada and Mexico, and into the interior of the country as a 
whole, because COVID-19 exists in Canada, Mexico, and the other 
countries of origin of persons who migrate to the United States across 
the United States land and coastal borders with Canada and Mexico. 
Those persons are subject to immigration processing in the POEs and 
Border Patrol stations. Many of those persons (typically aliens who 
lack valid travel documents and are therefore inadmissible) are held in 
the common areas of the facilities, in close proximity to one another, 
for hours or days, as they undergo immigration processing. The common 
areas of such facilities were not designed for, and are not equipped 
to, quarantine, isolate, or enable social distancing by persons who are 
or may be infected with COVID-19. The introduction into congregate 
settings in land and coastal POEs and Border Patrol stations of persons 
from Canada or Mexico increases the already serious danger to the 
public health to the point of requiring a temporary suspension of the 
right of introduction of such persons into the United States.
    The public health risks of inaction include transmission and spread 
of COVID-19 to CBP personnel, U.S. citizens, lawful permanent 
residents, and other persons in the POEs and Border Patrol stations; 
further transmission and spread of COVID-19 in the interior; and the 
increased strain that further transmission and spread of COVID-19 would 
put on the United States healthcare system and supply chain during the 
current public health emergency.
    These risks are troubling because POEs and Border Patrol stations 
were not designed and are not equipped to deliver medical care to 
numerous persons exposed to or infected with a quarantinable 
communicable disease, nor are they capable of providing the level of 
medical care that would be necessary in the cases of serious COVID-19 
infection that occur with greater frequency in vulnerable populations 
like the elderly and those with certain pre-existing conditions. 
Indeed, CBP transfers persons with acute presentations of illness to 
local or regional healthcare providers for treatment. Outbreaks of 
COVID-19 in POEs or Border Patrol stations would lead to transfers of 
such persons to local or regional health care providers, which would 
exhaust the local or regional healthcare resources, or at least reduce 
the availability of such resources to the domestic population, and 
further expose local or regional healthcare workers to COVID-19. The 
continuing availability of healthcare resources to the domestic 
population is a critical component of the federal government's overall 
public health response to COVID-19.
    Based on these ongoing concerns and to protect the public health, I 
hereby suspend the introduction of all covered aliens into the United 
States until I determine that the danger of further introduction of 
COVID-19 into the United States has ceased to be a serious danger to 
the public health, and continuation of the Order is no longer necessary 
to protect the public health. Every 30 days, CDC shall review the 
latest information regarding the status of the COVID-19 pandemic and 
associated

[[Page 65808]]

public health risks to ensure that the Order remains necessary to 
protect the public health. Upon determining that the further 
introduction of COVID-19 into the United States is no longer a serious 
danger to the public health necessitating the continuation of this 
Order, I will publish a notice in the Federal Register terminating this 
Order and its Extensions. I may amend this Order as necessary to 
protect the public health.
    A copy of the Order is provided below and a copy of the signed 
Order can be found at https://www.cdc.gov/coronavirus/2019-ncov/order-suspending-introduction-certain-persons.html.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention (CDC)

Order Under Sections 362 & 365 of the Public Health Service Act

(42 U.S.C. 265, 268):

Order Suspending the Right To Introduce Certain Persons From Countries 
Where a Quarantinable Communicable Disease Exists

I. Purpose and Application

    I issue this Order pursuant to Sections 362 and 365 of the Public 
Health Service (PHS) Act, 42 U.S.C. 265, 268, and their implementing 
regulations,\5\ which authorize the Director of the Centers for Disease 
Control and Prevention (CDC) to suspend the right to introduce \6\ 
persons into the United States when the Director determines that the 
existence of a quarantinable communicable disease in a foreign country 
or place creates a serious danger of the introduction of such disease 
into the United States and the danger is so increased by the 
introduction of persons from the foreign country or place that a 
temporary suspension of the right of such introduction is necessary to 
protect public health. This Order replaces the Order Suspending 
Introduction of Certain Persons from Countries Where a Communicable 
Disease Exists, issued on March 20, 2020 (March 20, 2020 Order), 
extended on April 20, 2020, and amended May 19, 2020, which were based 
on the prior interim final rule.\7\
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    \5\ 85 FR 56424, 42 CFR 71.40.
    \6\ Suspension of the right to introduce means to cause the 
temporary cessation of the effect of any law, rule, decree, or order 
pursuant to which a person might otherwise have the right to be 
introduced or seek introduction into the United States. 42 CFR 
71.40(b)(5).
    \7\ 85 FR 17060, 85 FR 22424, 85 FR 31503.
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    This Order applies to persons traveling from Canada or Mexico 
(regardless of their country of origin) who would otherwise be 
introduced into a congregate setting in a land or coastal Port of Entry 
(POE) or Border Patrol station at or near the United States borders 
with Canada or Mexico, subject to the exceptions detailed below.
    This Order does not apply to U.S. citizens and lawful permanent 
residents; members of the armed forces of the United States or U.S. 
government personnel serving overseas, and associated personnel, and 
their spouses and children; persons from foreign countries who hold 
valid travel documents and arrive at a POE; or persons from foreign 
countries in the visa waiver program who are not otherwise subject to 
travel restrictions and arrive at a POE. Additionally, this Order does 
not apply to any alien who must test negative for COVID-19 before they 
are expelled directly to their home country. Further, this Order does 
not apply to persons whom customs officers determine, with approval 
from a supervisor, should be excepted based on the totality of the 
circumstances, including consideration of significant law enforcement, 
officer and public safety, humanitarian, and public health interests. 
DHS shall consult with CDC concerning how these types of case-by-case, 
individualized exceptions shall be made to help ensure consistency with 
current CDC guidance and public health assessments.
    DHS has informed CDC that persons who are traveling from Canada or 
Mexico (regardless of their country of origin), and who must be held 
longer in congregate settings in POEs or Border Patrol stations to 
facilitate immigration processing, would typically be aliens seeking to 
enter the United States at POEs who do not have proper travel 
documents, aliens whose entry is otherwise contrary to law, and aliens 
who are apprehended at or near the border seeking to unlawfully enter 
the United States between POEs. This Order is intended to cover all 
such aliens. For simplicity, I shall refer to the persons covered by 
this Order as ``covered aliens.''
    This Order, which is substantially the same as the amended and 
extended March 20, 2020 Order, is necessary to continue to protect the 
public health from an increase in the serious danger of the 
introduction of Coronavirus Disease 2019 (COVID-19) into the POEs, and 
the Border Patrol stations between POEs, at or near the United States 
borders with Canada and Mexico. Those facilities are operated by U.S. 
Customs and Border Protection (CBP), an agency within the U.S. 
Department of Homeland Security (DHS). This Order is intended to help 
mitigate the continued risks of transmission and spread of COVID-19 to 
CBP personnel, U.S. citizens, lawful permanent residents, and other 
persons in the POEs and Border Patrol stations; further transmission 
and spread of COVID-19 in the interior of the United States; and the 
increased strain that further transmission and spread of COVID-19 would 
put on the United States healthcare system and supply chain during the 
current public health emergency.\8\
---------------------------------------------------------------------------

    \8\ As of October 1, 2020, CBP has had 2,195 employees contract 
COVID-19. In addition, 13 employees and one USBP transportation 
contractor have died due to the virus. Any outbreak of COVID-19 
among CBP personnel in land and coastal POEs or Border Patrol 
stations would impact CBP operations negatively. Although not part 
of the CDC public health analysis, it bears emphasizing that the 
impact on CBP could reduce the security of U.S. borders and the 
speed with which cargo moves across the same.
---------------------------------------------------------------------------

    There is a serious danger of the introduction of COVID-19 into the 
POEs and Border Patrol stations at or near the United States borders 
with Canada and Mexico, and into the interior of the country as a 
whole, because COVID-19 exists in Canada, Mexico, and the other 
countries of origin of persons who migrate to the United States across 
the United States land and coastal borders with Canada and Mexico. 
Those persons are subject to immigration processing in the POEs and 
Border Patrol stations. Many of those persons (typically aliens who 
lack valid travel documents and are therefore inadmissible) are held in 
the common areas of the facilities, in close proximity to one another, 
for hours or days, as they undergo immigration processing. The common 
areas of such facilities were not designed for, and are not equipped 
to, quarantine, isolate, or enable social distancing by persons who are 
or may be infected with COVID-19. The introduction into congregate 
settings in land and coastal POEs and Border Patrol stations of persons 
from Canada or Mexico increases the already serious danger to the 
public health to the point of requiring a temporary suspension of the 
right of introduction of such persons into the United States.
    The public health risks of inaction include transmission and spread 
of COVID-19 to CBP personnel, U.S. citizens, lawful permanent 
residents, and other persons in the POEs and Border Patrol stations; 
further transmission and spread of COVID-19 in the interior; and the 
increased strain that further transmission and spread of COVID-19 would 
put on the United States healthcare system and supply chain during the 
current public health emergency.

[[Page 65809]]

    These risks are troubling because POEs and Border Patrol stations 
were not designed and are not equipped to deliver medical care to 
numerous persons exposed to or infected with a quarantinable 
communicable disease, nor are they capable of providing the level of 
medical care that would be necessary in the cases of serious COVID-19 
infection that occur with greater frequency in vulnerable populations 
like the elderly and those with certain pre-existing conditions. 
Indeed, CBP transfers persons with acute presentations of illness to 
local or regional healthcare providers for treatment. Outbreaks of 
COVID-19 in POEs or Border Patrol stations would lead to transfers of 
such persons to local or regional health care providers, which would 
exhaust the local or regional healthcare resources, or at least reduce 
the availability of such resources to the domestic population, and 
further expose local or regional healthcare workers to COVID-19. The 
continuing availability of healthcare resources to the domestic 
population is a critical component of the federal government's overall 
public health response to COVID-19.
    Based on these ongoing concerns and to protect the public health, I 
hereby suspend the introduction of all covered aliens into the United 
States until I determine that the danger of further introduction of 
COVID-19 into the United States has ceased to be a serious danger to 
the public health, and continuation of the Order is no longer necessary 
to protect the public health. Every 30 days, CDC shall review the 
latest information regarding the status of the COVID-19 pandemic and 
associated public health risks to ensure that the Order remains 
necessary to protect the public health. Upon determining that the 
further introduction of COVID-19 into the United States is no longer a 
serious danger to the public health necessitating the continuation of 
this Order, I will publish a notice in the Federal Register terminating 
this Order and its Extensions. I may amend this Order as necessary to 
protect the public health.

II. Factual Basis for Order 9
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    \9\ Given the dynamic nature of the public health emergency, CDC 
recognizes that the types of facts and data set forth in this 
section may change rapidly (even within a matter of hours). The 
facts and data cited by CDC in this order represent a good-faith 
effort by the agency to present the current factual justification 
for the order.
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1. COVID-19 is a global pandemic that has spread rapidly

    COVID-19 is a quarantinable communicable disease caused by a novel 
(new) coronavirus, SARS-CoV-2, that was first identified as the cause 
of an outbreak of respiratory illness that began in Wuhan, Hubei 
Province, People's Republic of China (China). As of October 1, 2020, 
there were over 34,103,279 cases of COVID-19 globally, resulting in 
over 1,016,167 deaths.
    COVID-19 spreads easily and sustainably within communities.\10\ The 
virus is thought to transfer principally by person-to-person contact 
through respiratory droplets produced during exhalation, such as 
breathing, speaking, coughing, and sneezing. Droplets can span a wide 
spectrum of sizes that can remain airborne from seconds for larger 
droplets to several hours for smaller droplets and particles. The virus 
may also transfer through contact with surfaces or objects contaminated 
with these droplets.\11\ There is also evidence of asymptomatic 
transmission, in which an individual infected with COVID-19 is capable 
of spreading the virus to others before exhibiting symptoms.\12\
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    \10\ COVID-19 Pandemic Planning Scenarios, Ctrs. for Disease 
Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html, (last visited Oct. 3, 2020), (CDC estimates 
that the viral transmissibility (R0) of COVID-19 is 
around 2.5, but may be as high as 4, meaning that a single infected 
person will on average infect between 2 to 4 others).
    \11\ Interim Infection Prevention and Control Recommendations 
for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-
19) Pandemic, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html 
(last visited Sept. 29, 2020),
    \12\ COVID-19 Pandemic Planning Scenarios, Ctrs. for Disease 
Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html, (last visited Sept. 29, 2020), (CDC's 
current best estimate is that between 30 to 70% of infections are 
transmitted prior to symptom onset (pre-symptomatic transmission)).
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    Symptoms may include fever or chills, cough, and shortness of 
breath or difficulty breathing, fatigue, muscle or body aches, 
headache, new loss of taste or smell, sore throat, congestion or runny 
nose, nausea or vomiting, and diarrhea, and typically appear 2-14 days 
after exposure to the virus.\13\ Manifestations of severe disease have 
included severe pneumonia, acute respiratory distress syndrome (ARDS), 
septic shock, and multi-organ failure.\14\ Mortality rates are higher 
among seniors and those with certain underlying medical conditions, 
such as chronic obstructive pulmonary disease (COPD), serious heart 
conditions, cancer, Type 2 diabetes, and those with compromised immune 
systems.\15\
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    \13\ Coronavirus Disease 2019 (COVID-19): Symptoms of 
Coronavirus, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html 
(last updated May 13, 2020).
    \14\ Sevim Zaim, et al., COVID-19 and Multiorgan Response, 00 
Current Problems in Cardiology 2020, (available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7187881/pdf/main.pdf).
    \15\ Coronavirus Disease 2019 (COVID-19): People with Certain 
Medical Conditions, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed;-extra-precautions%2Fgroups-at-higher-risk.html 
(last updated Sept. 11, 2020).
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    Unfortunately, at this time, there is no vaccine against COVID-19, 
although several are in development. While U.S. Food and Drug 
Administration (FDA) has not approved drugs to treat patients with 
COVID-19 based on a demonstration of safety and efficacy in randomized 
controlled trials, FDA has granted an Emergency Use Authorization for 
the use of VEKLURY[supreg] (remdesivir) and other investigational 
therapeutics in the treatment of COVID-19 infection. Beyond these 
therapeutics, treatment is currently limited to supportive care to 
manage symptoms. Hospitalization may be required in severe cases and 
mechanical respiratory support may be needed in the most severe cases.
    Global efforts to slow the spread of COVID-19 have included 
sweeping travel limitations and lockdowns. Nations such as the European 
Union (EU) Member States and Schengen Area countries,\16\ Australia, 
New Zealand, and Canada have imposed restrictions on international 
travelers.\17\ In many countries, individuals are being asked to self-
quarantine for 14 days--the outer limit of the COVID-19's estimated 
incubation period--following return from a foreign country with 
sustained community transmission. For example, all returning citizens 
and residents of Australia and New Zealand are subject to a mandatory 
14-day quarantine at

[[Page 65810]]

designated secure facilities, such as a hotel at their port of 
arrival.\18\
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    \16\ Migration and Home Affairs: Schengen Area, Eur. Comm'n 
(Jan. 1, 2020), https://ec.europa.eu/home-affairs/what-we-do/policies/order-and-visas/schengen_en (``Today, the Schengen Area [of 
the EU] encompasses most EU States, except for Bulgaria, Croatia, 
Cyprus, Ireland and Romania. However, Bulgaria, Croatia and Romania 
are currently in the process of joining the Schengen Area. Of non-EU 
States, Iceland, Norway, Switzerland and Liechtenstein have joined 
the Schengen Area.''); Travel to and from the EU during the 
pandemic: Travel restrictions, Eur. Comm'n, https://ec.europa.eu/info/live-work-travel-eu/health/coronavirus-response/travel-and-transportation-during-coronavirus-pandemic/travel-and-eu-during-pandemic_en (last visited Aug. 31, 2020).
    \17\ See Andrea Salcedo, Sanam Yar, & Gina Cherelus, Coronavirus 
Travel Restrictions, Across the Globe, N.Y. Times (July 16, 2020), 
https://www.nytimes.com/article/coronavirus-travel-restrictions.html.
    \18\ Id.; COVID-19 and the border: Travel restrictions, Cmlth. 
of Austl, Dep't of Home Aff., https://covid19.homeaffairs.gov.au/travel-restrictions-0 (last updated Aug. 28, 2020); COVID-19: New 
Zealanders in the UK--Frequently Asked Questions, N.Z. Foreign Aff. 
& Trade, https://www.mfat.govt.nz/en/countries-and-regions/europe/united-kingdom/new-zealand-high-commission/living-in-the-uk/covid-19-coronavirus/ (last visited Aug. 28, 2020).
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2. The March 20, 2020 Order has reduced the risk of COVID-19 
transmission in POEs and Border Patrol stations

    I issued the March 20, 2020 Order pursuant to Sections 362 and 365 
of the Public Health Service (PHS) Act, 42 U.S.C. 265, 268, and an 
interim final rule implementing Section 362.\19\ The March 20, 2020 
Order suspended the introduction of certain ``covered aliens'' into the 
United States for a period of 30 days. The definition of ``covered 
aliens'' in the March 20, 2020 Order is substantially the same as in 
this Order. The March 20, 2020 Order was based on the following 
determinations:
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    \19\ 85 FR 16559.
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     COVID-19 is a communicable disease that poses a danger to 
the public health;
     COVID-19 is present in numerous foreign countries, 
including Canada and Mexico;
     There is a serious danger of the introduction of COVID-19 
into the land POEs and Border Patrol stations at or near the United 
States borders with Canada and Mexico, and into the interior of the 
country as a whole, because COVID-19 exists in Canada, Mexico, and the 
other countries of origin of persons who migrate to the United States 
across the land borders with Canada and Mexico;
     But for a suspension-of-entry order under 42 U.S.C. Sec.  
265, covered aliens would be subject to immigration processing at the 
land POEs and Border Patrol stations and, during that processing, many 
of them (typically aliens who lack valid travel documents and are 
therefore inadmissible) would be held in the congregate areas of the 
facilities, in close proximity to one another, for hours or days; and
     Such introduction into congregate settings of persons from 
Canada or Mexico would increase the already serious danger to the 
public health of the United States to the point of requiring a 
temporary suspension of the introduction of covered aliens into the 
United States.
    The March 20, 2020 Order was extended on April 20, 2020 and amended 
on May 19, 2020, to clarify that it applies to all land and coastal 
POEs and Border Patrol stations \20\ at or near the United States' 
border with Canada or Mexico that would otherwise hold covered aliens 
in a congregate setting.\21\ Pursuant to the May 19, 2020 Amendment, 
the March 20, 2020 Order was again extended with CDC thereafter 
conducting reviews every 30 days.\22\ Upon conducting these reviews, I 
have kept the amended Order in place; the current 30 day period lapses 
on October 17, 2020.
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    \20\ As explained below, air POEs are excluded from the Amended 
Order and Extension because they do not present the same public 
health risk as land and coastal POEs.
    \21\ 85 FR 22424.
    \22\ 85 FR 31503.
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    In general, the federal government's overall experience under the 
March 20, 2020 Order, together with the factual developments since May 
20, 2020, sustain the policy rationales for issuing this Order.
    Since the March 20, 2020 Order was issued, the daily average 
population in CBP custody is 1,134 individuals. This is a 64% reduction 
of daily in custody numbers since the March 20, 2020 Order went into 
effect and a 67% reduction from the same period in 2019. In the 50 days 
preceding the March 20, 2020 Order, CBP officers made over 1,600 trips 
to community hospitals to facilitate advanced medical care for 
individuals. For the first 80 days after the March 20, 2020 Order's 
implementation, CBP made only 400 trips for individuals to receive 
medical care from community hospitals. This represents a 75% decrease 
in utilization. In the 60 days preceding September 16, 2020, CBP made 
746 trips for individuals to receive medical care from community 
hospitals. The increase in hospital utilization corresponds with a 
month-over-month increase in CBP enforcement encounters, including 
encounters with covered aliens who have subsequently tested positive 
for COVID-19. The risks of COVID-19 transmission and overutilization in 
community hospitals serving domestic populations would have been 
greater absent the March 20, 2020 Order.
    The March 20, 2020 Order has reduced the risk of COVID-19 
transmission in POEs and Border Patrol stations, and thereby reduced 
risks to DHS personnel and the U.S. health care system. The public 
health risks to the DHS workforce--and the erosion of DHS operational 
capacity--would have been greater absent the March 20, 2020 Order. DHS 
data shows that the March 20, 2020 Order has significantly reduced the 
population of covered aliens held in congregate settings in POEs and 
Border Patrol stations, thereby reducing the risk of COVID-19 
transmission for DHS personnel and others within these facilities.
    By significantly reducing the number of covered aliens held in POEs 
and Border Patrol stations, the March 20, 2020 Order reduced the 
density of covered aliens held in congregate custody within these 
facilities, which reduced the risk of exposure to COVID-19 for DHS 
personnel and others in POEs and Border Patrol stations.

3. Conditions in Canada, Mexico, and the United States warrant issuing 
this Order

    COVID-19 has continued to spread since the March 20, 2020 Order. 
Canada, Mexico, and the countries of origin of many of the individuals 
who travel to the United States through Canada or Mexico continue to 
see increasing numbers of COVID-19 infections and deaths.
i. Canada
    As detailed in the March 20, 2020 Order, approximately 33 million 
individuals crossed the Canadian border into the United States in 2017. 
Historically, inadmissible aliens attempting to unlawfully enter the 
United States from Canada have included not only Canadian nationals, 
but also nationals of countries experiencing, or suspected of 
experiencing, widespread COVID-19 transmission such as the member 
countries of the Schengen Area, China, and Iran.\23\ From March through 
August, 2020, CBP has processed 28,841 inadmissible aliens at POEs at 
the U.S.-Canadian border, and CBP has apprehended 2,014 inadmissible 
aliens attempting to unlawfully enter the United States between POEs, 
of which DHS determined 1,126 were covered aliens subject to the March 
20, 2020 Order.\24\
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    \23\ U.S. Border Patrol Nationwide Apprehensions by Citizenship 
and Sector in Fiscal Years 2007 to 2019, U.S. Border Patrol, U.S. 
Dep't. of Homeland Security, https://www.cbp.gov/sites/default/files/assets/documents/2020-Jan/U.S.%20Border%20Patrol%20Nationwide%20Apprehensions%20by%20Citizenship%20and%20Sector%20%28FY2007%20-%20FY%202019%29_1.pdf (last visited 
Oct. 9, 2020).
    \24\ Nationwide Enforcement Encounters: Title 8 Enforcement 
Actions and Title 42 Expulsions, U.S. Customs and Border Protection, 
U.S. Dep't. of Homeland Security, https://www.cbp.gov/newsroom/stats/cbp-enforcement-statistics/title-8-and-title-42-statistics 
(last visited Oct. 9, 2020).
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    As of October 6, 2020, Canada reported over 171,300 cases of COVID-
19 and over 9,500 confirmed deaths with a seven day average of 1,797 
new

[[Page 65811]]

cases.\25\ In response to increases in the level of community 
transmission, authorities in Toronto, Ottawa, and several other Ontario 
cities have mandated indoor mask use. On September 19, 2020, Ontario 
issued new restrictions limiting indoor gatherings to 10 people and 
outdoor gatherings to 25.\26\ In Quebec masks have been mandated in all 
indoor public places since July 27, 2020. In an effort to slow the 
transmission and spread of the virus, the Canadian government banned 
most foreign nationals from entry and mandated that returning Canadians 
and excepted foreign nationals (including Americans) self-monitor for 
COVID-19 symptoms for 14 days following their return.\27\ Canadian 
public health officials have expressed alarm at the recent increase in 
new COVID-19 cases after several months of low level community 
transmission, particularly as Canada begins to enter influenza 
season.\28\
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    \25\ Coronavirus Disease (COVID-19): Outbreak Update, Gov't of 
Can., https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html (last updated Oct. 6, 2020).
    \26\ Reopening Ontario in Stages: Gathering Limits, Gov't of 
Ontario, https://www.ontario.ca/page/reopening-ontario-stages#restrictions (last updated Oct. 2, 2020).
    \27\ Travel Restriction Measures: COVID-19 Program Delivery 
Travel Restriction Exemptions for Those Departing From a Country 
Other Than the U.S., Gov't of Canada, https://www.canada.ca/en/immigration-refugees-citizenship/corporate/publications-manuals/operational-bulletins-manuals/service-delivery/coronavirus/travel-restrictions.html#travel-restriction-exemptions (last updated Jul. 
23, 2020).
    \28\ Statement from the Chief Public Health Officer of Canada on 
October 3, 2020, Gov't of Canada, https://www.canada.ca/en/public-health/news/2020/10/statement-from-the-chief-public-health-officer-of-canada-on-october-3-2020.html (last updated Oct. 3, 2020).
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ii. Mexico
    As of October 1, 2020, Mexico has 738,163 confirmed cases, and 
77,163 reported deaths.\29\ While Mexico's official statistics for 
COVID-19 infections and number of deaths provide insights to general 
trends, they have serious deficiencies that greatly understate actual 
totals. COVID-19 infections and deaths are likely multiples of what is 
reported as Mexico has the lowest diagnostic testing per capital of 
OECD countries. Mexico's positivity rate is estimated to be around 44% 
based on confirmed positive cases, confirmed negative tests, and 
suspected cases. This is an improvement from a positivity rate of 
approximately 50% in mid-July. However, Mexico's Health Ministry, 
SALUD, reported on September 4, 2020 excess mortality totals of 122,765 
deaths through August 28, 2020 as compared to 2019 totals. This figure 
includes confirmed cases of COVID-19 and deaths confirmed from other 
causes, but the excess suggests the true number of deaths from COVID-19 
in Mexico is much higher than official counts.
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    \29\ WHO Coronavirus Disease (COVID-19) Dashboard, WHO, https://covid19.who.int/table (last visited Oct. 2, 2020).
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    While the data on Mexico is more limited, there are signs that the 
rate of COVID-19 community transmission in Mexico is slowing as the 
overall public health situation improves somewhat. As of September 25, 
2020, under SALUD's ``stoplight'' designation system, none of Mexico's 
32 states are red, 15 are orange, 16 are yellow and 1, Colima, is 
green. According to SALUD, Mexico City has the most lab-confirmed cases 
with 121,087 and the most deaths with 11,814 as of September 24, 2020. 
Hospital occupancy rates have also improved in recent weeks--the 
national hospital occupancy rate is 28 percent--hospital occupancy 
rates remain elevated in Mexican border-states such as Nuevo Leon (47 
percent). As of September 25, 2020, several Mexican border states 
report relatively high numbers of active COVID-19 infections: 
Tamaulipas (3,566 active cases), Nuevo Leon (6,028 actives cases) and 
Baja California (1,440 active cases).
    The COVID-19 pandemic in Mexican states along the U.S.-Mexico 
border region presents increased concerns for the United States because 
all covered aliens crossing the U.S.-Mexico border necessarily travel 
through that region and the level of migration is so high. From March 
to August, 2020, DHS has processed 54,503 inadmissible aliens at POEs 
along the border, and U.S. Border Patrol has apprehended 345,267 aliens 
attempting to unlawfully enter the United States between POEs.\30\ DHS 
determined 153,569 were covered aliens subject to the March 20, 2020 
Order, of which over 70% were Mexican nationals. With the continued 
growth of COVID-19 cases in Central and South America, the overwhelming 
majority of covered aliens encountered on the U.S.-Mexico border are 
nationals of countries experiencing sustained human to human 
transmission of COVID-19.
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    \30\ Supra, note 21.
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    The continued prevalence of COVID-19 in Mexico continues to present 
a serious danger of the introduction of COVID-19 into the United 
States. If community transmission in the Mexican border region 
accelerates, experience shows then the numbers of COVID-19 cases in 
that region are likely to increase, as are the numbers of infected 
covered aliens who seek to introduce themselves into the United States. 
The introduction of more infected covered aliens would likely have a 
negative impact on community transmission in the United States.
iii. United States
    While pandemic conditions have improved, community transmission of 
COVID-19 is continuing across the United States. The United States has 
recorded over 7,200,000 cumulative confirmed cases; and more than 
200,000 deaths.\31\ The country is averaging around 36,000 to 40,000 
new cases a day.\32\ Nationally, since mid-July, there has been an 
overall decreasing trend in the percentage of specimens testing 
positive and a decreasing or stable (change of <=0.1%) trend in the 
percentage of hospitalizations.\33\ To wit, as of October 3, 2020, the 
seven day average of new cases and deaths are down 35.8% and 40.3% 
respectively from their peak levels. Similarly, the seven day 
positivity rate, as of October 3, 2020, was 4.6%. This low positivity 
rate is not shared uniformly, Arizona and Texas both report positivity 
rates of between 11-20%.\34\
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    \31\ CDC COVID Data Tracker: United States COVID-19 Cases and 
Deaths by State, Ctrs. for Disease Control & Prevention https://covid.cdc.gov/covid-data-tracker/#cases_casesinlast7days (last 
visited Oct. 6, 2020).
    \32\ Id.
    \33\ COVID View: A Weekly Summary of U.S. COVID-19 Activity Week 
39, Ctrs. for Disease Control & Prevention https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/ (last visited 
Oct. 6, 2020).
    \34\ CDC COVID Data Tracker: United States Laboratory Testing, 
Ctrs. for Disease Control & Prevention https://covid.cdc.gov/covid-data-tracker/#testing_totalpercentpositive (last visited Oct. 6, 
2020).
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    Millions of Americans are subject to local and state public health 
restrictions and precautions calculated to slow the spread of, and 
protect others from, COVID-19. CDC continues to recommend that all 
Americans practice vigorous hand hygiene, engage in social 
distancing,\35\ limit non-essential travel,\36\ and wear cloth face 
coverings or masks when out in public.\37\ Public health measures 
intended to slow the spread of COVID-19 in order to avoid

[[Page 65812]]

overwhelming healthcare systems have largely proven successful. 
However, several cities and states, including several located at or 
near U.S. borders, continue to experience widespread, sustained 
community transmission that has strained their healthcare and public 
health systems. Furthermore, continuing to slow the rate of COVID-19 
transmission is critical as states and localities ease public health 
restrictions on businesses and public activities in an effort to 
mitigate the economic and other costs of the COVID-19 pandemic.
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    \35\ How to Protect Yourself & Others, Ctrs. for Disease Control 
& Prevention https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html (last visited Oct. 6, 2020).
    \36\ Travel During the COVID-19 Pandemic, Ctrs. for Disease 
Control & Prevention https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html (last visited Oct. 6, 2020).
    \37\ COVID-19: Use of Cloth Face Coverings to Help Slow the 
Spread of COVID-19, Ctrs. for Disease Control & Prevention, https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html (last reviewed Oct. 6, 2020).
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III. Determination and Implementation

    Based on the foregoing, I find that COVID-19 is a quarantinable 
communicable disease \38\ and that there is a serious danger of the 
introduction of COVID-19 into the POEs and Border Patrol stations at or 
near the United States borders with Canada and Mexico, and the interior 
of the country as a whole, because COVID-19 exists in Canada, Mexico, 
and the countries or places of origin of the covered aliens who migrate 
to the United States across the land and coastal borders with Canada 
and Mexico. I also find that the introduction into land and coastal 
POEs and Border Patrol stations of covered aliens increases the 
seriousness of the danger to the point of requiring a temporary 
suspension of the right to introduce covered aliens into the United 
States. Therefore, I am suspending the right to introduce and 
prohibiting the introduction of covered aliens travelling into the 
United States from Mexico and Canada.
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    \38\ COVID-19 is a severe acute respiratory syndrome, which is 
one of the diseases included in the ``Revised List of Quarantinable 
Communicable Diseases.'' Exec. Order 13295 (Apr. 4, 2003), as 
amended by Exec. Order 13375 (Apr. 1, 2005) and Exec. Order 13674 
(July 31, 2014).
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    In making this determination, I have considered facts including the 
overall number of cases of COVID-19 reported in Mexico, Canada, and the 
countries or places of origin of the covered aliens who migrate to the 
United States across the land and coastal borders with Canada and 
Mexico, the influx of cases in areas near the U.S.-Mexico border, 
epidemiological factors including the viral transmissibility and 
asymptomatic transmission of the disease, the morbidity and mortality 
associated with the disease for individuals in certain risk categories, 
and the negative effects of the disease already experienced by CBP. 
Therefore, it is necessary for the United States to continue the 
suspension of the right to introduce covered aliens at this time.
    The continued suspension of the right to introduce covered aliens 
requires the movement of all such aliens to the country from which they 
entered the United States, their country of origin, or another 
practicable location outside the United States, as rapidly as possible, 
with as little time spent in congregate settings as practicable under 
the circumstances. The faster a covered alien is returned to the 
country from which they entered the United States, to their country of 
origin, or another location as practicable, the lower the risk the 
alien poses of introducing, transmitting, or spreading COVID-19 into 
POEs, Border Patrol stations, other congregate settings, and the 
interior.
    I consulted with DHS and other federal departments as needed before 
I issued this Order, and requested that DHS aid in the enforcement this 
Order because CDC does not have the capability, resources, or personnel 
needed to do so. As part of the consultation, CBP developed an 
operational plan for implementing this Order. The plan is generally 
consistent with the language of this Order directing that covered 
aliens spend as little time in congregate settings as practicable under 
the circumstances. Additionally, DHS will continue to use repatriation 
flights as necessary to move covered aliens on a space-available basis, 
as authorized by law. In my view, DHS's assistance with implementing 
the Order is necessary, as CDC's other public health tools are not 
viable mechanisms given CDC resource and personnel constraints, the 
large numbers of covered aliens involved, and the likelihood that 
covered aliens do not have homes in the United States.\39\
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    \39\ CDC relies on the Department of Defense, other federal 
agencies, and state and local governments to provide both logistical 
support and facilities for federal quarantines. CDC lacks the 
resources, manpower, and facilities to quarantine covered aliens.
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    This Order is not a rule subject to notice and comment under the 
Administrative Procedure Act (APA). Notice and comment and a delay in 
effective date are not required because there is good cause to dispense 
with prior public notice and the opportunity to comment on this Order 
and a delay in effective date. Given the public health emergency caused 
by COVID-19, it would be impracticable and contrary to public health 
practices--and, by extension, the public interest--to delay the issuing 
and effective date of this Order. In addition, because this Order 
concerns the ongoing discussions with Canada and Mexico on how best to 
control COVID-19 transmission over our shared border, it directly 
``involve[s] . . . a . . . foreign affairs function of the United 
States.'' 5 U.S.C. 553(a)(1). Notice and comment and a delay in 
effective date would not be required for that reason as well.
* * * * *
    This Order shall remain effective until I determine that the danger 
of further introduction of COVID-19 into the United States has ceased 
to be a serious danger to the public health, and continuation of this 
Order is no longer necessary to protect public health. Every 30 days, 
the CDC shall review the latest information regarding the status of the 
COVID-19 pandemic and associated public health risks to ensure that the 
Order remains necessary to protect public health.
    Upon determining that the further introduction of COVID-19 into the 
United States is no longer a serious danger to the public health 
necessitating the continuation of this Order, I will publish a notice 
in the Federal Register terminating this Order and its Extensions. I 
retain the authority to extend, modify, or terminate the Order, or 
implementation of this Order, at any time as needed to protect public 
health.

Authority

    The authority for this Order is Sections 362 and 365 of the Public 
Health Service Act (42 U.S.C. 265, 268) and 42 CFR 71.40.

Nina B. Witkofsky,
Acting Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2020-22978 Filed 10-13-20; 4:15 pm]
BILLING CODE 4163-18-P