Public Health Reassessment and Order Suspending the Right To Introduce Certain Persons From Countries Where a Quarantinable Communicable Disease Exists, 42828-42841 [2021-16856]
Download as PDF
<![CDATA[
42828
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
state, local and courtroom requirements
and seek a commitment to adhere to
those requirements. The requirements
apply to all attorneys, assistants, parties,
and witnesses. The discussion will also
address who may enter the courtroom,
when, and what safety measures, such
as masks and social distancing, must be
implemented. No person may enter the
courtroom, or the witness room without
the permission of the Judge. The Judge
may consider allowing persons who are
not fully vaccinated to enter the
courtroom, but they must wear masks
and practice social distancing.
All court reporters will be notified
that they must be vaccinated.
The Judge may consider all factors, in
totality, in determining if a remote
hearing will be held and who may be
present for the hearing. No single factor
is dispositive. These procedures shall be
in place until December 31, 2021, unless
extended or modified by order. The
order shall be posted on the
Commission’s website
(www.fmshrc.gov) and the contents of
the order will be published in a notice
appearing in the Federal Register.
Authority: 30 U.S.C. 823; 29 CFR part
2700.
Dated: July 30, 2021.
Sarah L. Stewart,
Deputy General Counsel, Federal Mine Safety
and Health Review Commission.
[FR Doc. 2021–16661 Filed 8–4–21; 8:45 am]
BILLING CODE 6735–01–P
FEDERAL RESERVE SYSTEM
Solicitation of Statements of Interest
for Membership on the Insurance
Policy Advisory Committee
The Economic Growth,
Regulatory Relief, and Consumer
Protection Act established at the Board
an Insurance Policy Advisory
Committee (IPAC). This notice advises
individuals who wish to serve as IPAC
members of the annual opportunity to
be considered for the IPAC.
DATES: Individuals that submit a
Statement of Interest that is received by
the Board from the first Monday in
August through the first Monday in
October of each year will be considered
for appointments to the IPAC
announced in the fourth calendar
quarter of the same year. Statements of
Interest received outside the period
from the first Monday in August
through the first Monday in October
generally will not be considered.
khammond on DSKJM1Z7X2PROD with NOTICES
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
• Email address
At their option, candidates may
provide additional information for
consideration.
Qualifications
IPAC candidates should be insurance
experts. The Board provides equal
appointment opportunity to all persons
without regard to race, color, religion,
sex (including sexual orientation,
gender identity, and pregnancy),
national origin, age, disability, genetic
information, or military service. In
addition, the Board is committed to a
diverse committee and seeks a diverse
set of expert perspectives from the
various sectors of the U.S. insurance
industry including life insurance,
property and casualty insurance and
reinsurance, agents and brokers,
academics, consumer advocates, and
experts on issues facing underserved
insurance communities and consumers.
The Board also seeks relevant actuarial,
legal, regulatory, and accounting
expertise, as well as expertise on lines
of business underwritten by its
currently supervised population of
insurance institutions.
Members must be willing and able to
participate in conference calls and
prepare for and attend meetings in
person. Membership and attendance is
not delegable.
By order of the Board of Governors of the
Federal Reserve System, acting through the
Director of the Division of Supervision and
Regulation under delegated authority.
Ann Misback,
Secretary of the Board.
[FR Doc. 2021–16669 Filed 8–4–21; 8:45 am]
BILLING CODE P
Council Size and Terms
Board of Governors of the
Federal Reserve System (Board).
ACTION: Notice.
AGENCY:
SUMMARY:
Individuals seeking an
appointment to the IPAC may send a
Statement of Interest by email to IPAC@
frb.gov. The Statement of Interest
contains only contact information.
Candidates also may choose to provide
additional information. Candidates may
send this information by email to IPAC@
frb.gov. The Privacy Act Statement for
IPAC Member Selection, which
describes the purposes, authority,
effects of nondisclosure, and uses of this
information, can be found at https://
www.federalreserve.gov/aboutthefed/
ipac-privacy.htm.
Individuals also may mail Statements
of Interest and any additional
information to the Board of Governors of
the Federal Reserve System, Attn:
Insurance Policy Advisory Committee,
20th Street and Constitution Ave. NW,
Washington, DC 20551.
FOR FURTHER INFORMATION CONTACT: Jan
Bauer, Senior Insurance Policy Analyst,
(202) 475–7697 or Thomas Sullivan,
Senior Associate Director, (202) 452–
3000, Division of Supervision and
Regulation; or IPAC@frb.gov.
SUPPLEMENTARY INFORMATION: The
Economic Growth, Regulatory Relief,
and Consumer Protection Act
established at the Board an Insurance
Policy Advisory Committee (IPAC) to
advise the Board on international
capital standards and other insurance
matters. This notice advises individuals
of the opportunity to be considered for
appointment to the IPAC. To assist with
the appointment of IPAC members, the
Board considers information submitted
by the candidate, public information,
and any other relevant information the
Board determines to consider.
ADDRESSES:
The IPAC has at most 21 members.
IPAC members serve staggered threeyear terms. Members are appointed to
three-year terms unless the Board
appoints a member to fill a vacant
unexpired term. A member that is
appointed to serve a three-year term
begins his or her service on the first
January 1 occurring after his or her
appointment. A member appointed to
fill an vacant unexpired term serves for
the remaining time of the term. The
Board provides a nominal honorarium
and reimburses members only for their
actual travel expenses, subject to Board
policy.
A Statement of Interest must contain
the following information:
• Full name;
• Address;
• Phone number; and
Frm 00053
Fmt 4703
Centers for Disease Control and
Prevention
Public Health Reassessment and Order
Suspending the Right To Introduce
Certain Persons From Countries
Where a Quarantinable Communicable
Disease Exists
Centers for Disease Control and
Prevention (CDC), Department of Health
and Human Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Disease
Control and Prevention (CDC), a
component of the Department of Health
and Human Services (HHS), announces
an Order to replace and supersede the
Order Suspending the Right to
Introduce Certain Persons from
SUMMARY:
Statement of Interest
PO 00000
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Sfmt 4703
E:\FR\FM\05AUN1.SGM
05AUN1
khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
Countries Where a Quarantinable
Communicable Disease Exists, issued on
October 13, 2020 (‘‘October Order’’).
Following an assessment of the current
status of the COVID–19 public health
emergency and the situation in
congregate settings where noncitizens
seeking to enter the United States are
processed and held, CDC has
determined that an Order remains
appropriate at this time for all ‘‘covered
noncitizens’’ as defined in the order.
Unaccompanied noncitizen children,
already excepted under a July 16, 2021
order, remain excepted from the order’s
coverage. In addition, CDC is continuing
an exception for individuals on a caseby-case basis, based on the totality of
the circumstances, and is incorporating
an additional exception for programs
approved by the U.S. Department of
Homeland Security (DHS) that
incorporate appropriate COVID–19
mitigation protocols as recommended
by CDC.
DATES: This Order went into effect
August 2, 2021.
FOR FURTHER INFORMATION CONTACT:
Tiffany Brown, Deputy Chief of Staff,
Centers for Disease Control and
Prevention, 1600 Clifton Road NE, MS
H21–10, Atlanta, GA 30329. Phone:
404–639–7000. Email: cdcregulations@
cdc.gov.
SUPPLEMENTARY INFORMATION: CDC has
determined that an Order under 42
U.S.C. 265 remains necessary to protect
U.S. citizens, U.S. nationals, lawful
permanent residents, personnel and
noncitizens at the ports of entry (POE)
and U.S. Border Patrol stations, and
destination communities in the United
States during the COVID–19 public
health emergency. This Order reflects
the current, highly dynamic conditions
regarding COVID–19, including variants
of concern and levels of vaccination, as
well as evolving circumstances specific
to the U.S. borders. As facts change,
CDC may further modify the Order. This
Order will remain in place until either
the expiration of the Secretary of HHS’
declaration that COVID–19 constitutes a
public health emergency, or the CDC
Director determines that the danger of
further introduction of COVID–19 into
the United States has declined such that
continuation of the Order is no longer
necessary to protect public health,
whichever occurs first. The
circumstances necessitating the Order
will be reassessed at least every 60 days.
This Order continues the suspension of
the right to introduce ‘‘covered
noncitizens,’’ 1 into the United States
1 The term ‘‘covered noncitizens’’ is defined as
persons traveling from Canada or Mexico
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
along the U.S. land and adjacent coastal
borders. In recognition of the specific
COVID–19 mitigation measures
available in facilities providing care for
Unaccompanied Noncitizen Children
(UC), CDC excepted UC from the
October Order 2 on July 16, 2021 (July
Exception) and continues that exception
herein.3 In addition, CDC is continuing
an exception for individuals on a caseby-case basis, based on the totality of
the circumstances, and is incorporating
an additional exception for programs
approved by the U.S. Department of
Homeland Security (DHS) that
incorporate appropriate COVID–19
mitigation protocols as recommended
by CDC.
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/downloads/
CDC-Order-Suspending-Right-toIntroduce-_Final_8-2-21.pdf.
(regardless of their country of origin) who would
otherwise be introduced into a congregate setting in
a POE or U.S. Border Patrol station at or near the
U.S. land and adjacent coastal borders subject to
certain exceptions detailed below; this includes
noncitizens who do not have proper travel
documents, noncitizens whose entry is otherwise
contrary to law, and noncitizens who are
apprehended at or near the border seeking to
unlawfully enter the United States between POE.
2 Order Suspending the Right to Introduce Certain
Persons from Countries Where a Quarantinable
Communicable Disease Exists, 85 FR 65806 (Oct.
16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from
Countries Where a Communicable Disease Exists,
issued on March 20, 2020 (March Order) and
subsequently extended and amended. Notice of
Order Under Sections 362 and 365 of the Public
Health Service Act Suspending Introduction of
Certain Persons from Countries Where a
Communicable Disease Exists, 85 FR 17060 (Mar.
26, 2020); Extension of Order Under Sections 362
and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From
Countries Where a Communicable Disease Exists,
85 FR 22424 (Apr. 22, 2020); Amendment and
Extension of Order Under Sections 362 and 365 of
the Public Health Service Act; Order Suspending
Introduction of Certain Persons from Countries
Where a Communicable Disease Exists, 85 FR 31503
(May 26, 2020).
3 Public Health Determination Regarding an
Exception for Unaccompanied Noncitizen Children
from Order Suspending the Right to Introduce
Certain Persons from Countries Where a
Quarantinable Communicable Disease Exists,
Centers for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/more/pdf/
NoticeUnaccompaniedChildren.pdf (July 16, 2021);
see 86 FR 38717 (July 22, 2021). The July Exception
relating to UC is hereby made a part of this Order
and incorporated by reference as if fully set forth
herein.
PO 00000
Frm 00054
Fmt 4703
Sfmt 4703
42829
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) and 42 CFR 71.40
Public Health Reassessment and Order
Suspending the Right To Introduce
Certain Persons From Countries Where
a Quarantinable Communicable Disease
Exists
Executive Summary
The Centers for Disease Control and
Prevention (CDC), a component of the
U.S. Department of Health and Human
Services (HHS), is hereby replacing and
superseding the Order Suspending the
Right to Introduce Certain Persons from
Countries Where a Quarantinable
Communicable Disease Exists, issued on
October 13, 2020 (October Order). The
instant Order continues the suspension
of the right to introduce ‘‘covered
noncitizens,’’ as defined herein,4 into
the United States along the U.S. land
and adjacent coastal borders. In
recognition of the specific COVID–19
mitigation measures available in
facilities providing care for
Unaccompanied Noncitizen Children
(UC), CDC excepted UC from the
October Order on July 16, 2021 (July
Exception) and continues that exception
herein.5 Following an assessment of the
current status of the COVID–19 public
health emergency and the situation in
congregate settings where noncitizens
seeking to enter the United States are
processed and held, CDC has
determined that an Order remains
appropriate at this time for all other
covered noncitizens as described herein.
As outlined below, CDC is continuing
an exception for individuals on a caseby-case basis, based on the totality of
the circumstances, and is incorporating
an additional exception for programs
approved by the U.S. Department of
Homeland Security (DHS) that
incorporate appropriate COVID–19
mitigation protocols as recommended
by CDC.
CDC has determined that an Order
under 42 U.S.C. 265 remains necessary
4 See
infra Section III.A.
Health Determination Regarding an
Exception for Unaccompanied Noncitizen Children
from Order Suspending the Right to Introduce
Certain Persons from Countries Where a
Quarantinable Communicable Disease Exists,
Centers for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/more/pdf/
NoticeUnaccompaniedChildren.pdf (July 16, 2021);
see 86 FR 38717 (July 22, 2021). The July Exception
relating to UC is hereby made a part of this Order
and incorporated by reference as if fully set forth
herein.
5 Public
E:\FR\FM\05AUN1.SGM
05AUN1
42830
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
to protect U.S. citizens, U.S. nationals,
lawful permanent residents, personnel
and noncitizens at the ports of entry
(POE) and U.S. Border Patrol stations,
and destination communities in the
United States during the COVID–19
public health emergency. This Order
reflects the current, highly dynamic
conditions regarding COVID–19,
including variants of concern and levels
of vaccination, as well as evolving
circumstances specific to the U.S.
borders. As facts change, CDC may
further modify the Order. This Order
will remain in place until either the
expiration of the Secretary of HHS’
declaration that COVID–19 constitutes a
public health emergency, or the CDC
Director determines that the danger of
further introduction of COVID–19 into
the United States has declined such that
continuation of the Order is no longer
necessary to protect public health,
whichever occurs first. The
circumstances necessitating the Order
will be reassessed at least every 60 days.
Outline of Reassessment and Order
I. Background
A. Current Status of COVID–19 Public
Health Emergency
B. Public Health Factors Related to
COVID–19
1. Manner of COVID–19 Transmission
2. Emerging Variants of the SARS–CoV–2
Virus
3. Risks of COVID–19 Transmission
Specific To Congregate Settings
4. Availability of Testing, Vaccines, and
Other Mitigation Measures
5. Impact on U.S. Communities and
Healthcare Resources
II. Public Health Reassessment
A. Immigration Processing and Public
Health Impacts
B. Public Health Assessment of Single
Adults and Family Units
C. Comparison to Unaccompanied
Noncitizen Children
D. Summary of Findings
III. Legal Basis for the Order
IV. Issuance and Implementation of the Order
A. Covered Noncitizens
B. Exceptions
C. APA, Review, and Termination
khammond on DSKJM1Z7X2PROD with NOTICES
I. Background
Coronavirus disease 2019 (COVID–19)
is a quarantinable communicable
disease 6 caused by the SARS–CoV–2
6 Quarantinable communicable diseases are any
of the communicable diseases listed in Executive
Order, as provided under § 361 of the Public Health
Service Act (42 U.S.C. 264). 42 CFR 71.1. The list
of quarantinable communicable diseases currently
includes cholera, diphtheria, infectious
tuberculosis, plague, smallpox, yellow fever, viral
hemorrhagic fevers (Lassa, Marburg, Ebola,
Crimean-Congo, South American, and others not yet
isolated or named), severe acute respiratory
syndromes (including Middle East respiratory
syndrome and COVID–19), and influenza caused by
novel or reemergent influenza viruses that are
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
virus. As part of U.S. government efforts
to mitigate the introduction,
transmission, and spread of COVID–19,
CDC issued an Order on October 13,
2020 (October Order), replacing an
Order initially issued on March 20, 2020
(March Order),7 suspending the right to
introduce 8 certain persons into the
United States from countries or places
where the quarantinable communicable
disease exists in order to protect the
public health from an increase in risk of
the introduction of COVID–19. The
October Order applied specifically to
covered noncitizens who would
otherwise be introduced into a
congregate setting in land or coastal
POE or U.S. Border Patrol stations at or
near the U.S. borders 9 with Canada and
Mexico. On February 17, 2021, CDC
published a notice announcing the
temporary exception of unaccompanied
noncitizen children (UC) 10 encountered
in the United States from the October
causing, or have the potential to cause, a pandemic.
See Exec. Order 13295, 68 FR 17255 (Apr. 4, 2003),
as amended by Exec. Order 13375, 70 FR 17299
(Apr. 1, 2005) and Exec. Order 13674, 79 FR 45671
(July 31, 2014).
7 Order Suspending the Right to Introduce Certain
Persons from Countries Where a Quarantinable
Communicable Disease Exists, 85 FR 65806 (Oct.
16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from
Countries Where a Communicable Disease Exists,
issued on March 20, 2020 (March Order), and
subsequently extended and amended. Notice of
Order Under Sections 362 and 365 of the Public
Health Service Act Suspending Introduction of
Certain Persons from Countries Where a
Communicable Disease Exists, 85 FR 17060 (Mar.
26, 2020); Extension of Order Under Sections 362
and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From
Countries Where a Communicable Disease Exists,
85 FR 22424 (Apr. 22, 2020); Amendment and
Extension of Order Under Sections 362 and 365 of
the Public Health Service Act; Order Suspending
Introduction of Certain Persons from Countries
Where a Communicable Disease Exists, 85 FR 31503
(May 26, 2020).
8 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).
9 When U.S. Customs and Border Protection
(CBP) or the U.S. Department of Homeland Security
(DHS) partner agencies encounter noncitizens off
the coast closely adjacent to the land borders, it
transfers the noncitizens for processing in POE or
U.S. Border Patrol stations closest to the encounter.
Absent the October Order, such noncitizens would
be held in the same congregate settings and holding
facilities as any encounters along the land border,
resulting in similar public health concerns related
to the introduction, transmission, and spread of
COVID–19.
10 As stated in the July Exception, CDC’s
understanding is that UC are a class of individuals
similar to or the same as those individuals who
would be considered ‘‘unaccompanied alien
children’’ (see 6 U.S.C. 279) for purposes of HHS
Office of Refugee Resettlement custody, were DHS
to make the necessary immigration determinations
under Title 8 of the U.S. Code. 86 FR 38717, 38718
at note 4.
PO 00000
Frm 00055
Fmt 4703
Sfmt 4703
Order.11 The exception of UC from the
October Order was confirmed with the
publication of the July Exception.12
POE and U.S. Border Patrol stations
are operated by U.S. Customs and
Border Protection (CBP), an agency
within DHS. The March and October
Orders were intended to reduce the risk
of COVID–19 introduction,
transmission, and spread in POE and
U.S. Border Patrol stations by
significantly reducing the number and
density of covered noncitizens held in
these congregate settings, thereby
reducing risks to U.S. citizens and
residents, DHS/CBP personnel and
noncitizens at the facilities, and the
healthcare systems in local communities
overall. Because of the congregate
nature of these facilities and the
sustained community transmission of
COVID–19, including the highly
transmissible B.1.617.2 (Delta) variant,
in both the United States and migrants’
countries of origin and transit, at this
time, there continues to be a high risk
of COVID–19 outbreaks in these
facilities following the introduction of
an infected person. Upon reassessment
of the current situation with respect to
the pandemic and the situation at the
U.S. borders, CDC finds an Order under
42 U.S.C. 265 for Single Adults (SA) 13
and Family Units (FMU) 14 remains
necessary at this time, as discussed in
detail below. CDC also recognizes the
availability of testing, vaccines, and
other mitigation protocols can minimize
risk in this area. As the ability of DHS
facilities to employ mitigation measures
to address the COVID–19 public health
emergency increases, CDC anticipates
additional lifting of restrictions.
A. Current Status of COVID–19 Public
Health Emergency
Since late 2019, SARS–CoV–2, the
virus that causes COVID–19, has spread
throughout the world, resulting in a
pandemic. As of July 28, 2021, there
have been over 195 million confirmed
cases of COVID–19 globally, resulting in
over 4.1 million deaths.15 The United
11 Notice of Temporary Exception from Expulsion
of Unaccompanied Noncitizen Children Pending
Forthcoming Public Health Determination, 86 FR
9942 (Feb. 17, 2021).
12 Supra note 2.
13 A single adult (SA) is any noncitizen adult 18
years or older who is not an individual in a ‘‘family
unit,’’ see infra note 11.
14 An individual in a family unit (FMU) includes
any individual in a group of two or more
noncitizens consisting of a minor or minors
accompanied by their adult parent(s) or legal
guardian(s). Any statistics regarding FMU count the
number of individuals in a family unit rather than
counting the groups.
15 Coronavirus disease (COVID–19) pandemic,
World Health Organization, https://
covid19.who.int/ (last visited July 28, 2021).
E:\FR\FM\05AUN1.SGM
05AUN1
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
States has reported over 34 million
cases resulting in over 609,000 deaths
due to the disease 16 and is currently
averaging around 61,976 new cases of
COVID–19 a day as of July 27, 2021 with
high community transmission.17
Although several of the key indicators of
transmission and spread of COVID–19
in the United States improved during
the first half of 2021, variants of
concern, particularly the more
transmissible Delta variant, have driven
a stark increase in COVID–19 cases,
hospitalizations, and deaths. COVID–19
cases increased approximately 400%
between June 19 and July 28, 2021.18
Many countries have begun
widespread vaccine administration;
however, 78 countries continue to
experience high or substantial incidence
rates (≥50 cases per 100,000 people in
the last seven days) and 123 countries,
including the United States, are
experiencing an increasing incidence of
reported new cases.19 It is imperative
that individuals and communities stay
vigilant and that vaccination and other
COVID–19 mitigation efforts are
maintained. As the Delta variant
continues to spread, both the United
States and Mexico are experiencing high
or substantial incidence rates with 137.9
and 68.6 daily cases per 100,000
persons over a seven-day average,
respectively; in Canada, the incidence
rate is 8.0. The United States saw a
91.0% increase in new cases over the
past week, Mexico experienced a 30.2%
increase in new cases. During the same
time period, the incidence rate in
Canada increased by 14.8%.20
COVID–19 was first declared a public
health emergency in January 2020 21 and
16 COVID Data Tracker, Centers for Disease
Control and Prevention, https://covid.cdc.gov/
covid-data-tracker/#datatracker-home (last visited
July 28, 2021).
17 United States COVID–19 Cases, Deaths, and
Laboratory Testing (NAATs) by State, Territory, and
Jurisdiction, Centers for Disease Control and
Prevention, https://covid.cdc.gov/covid-datatracker/#cases_community (last visited July 28,
2021).
18 Christie A, Brooks JT, Hicks LA, et al. Guidance
for Implementing COVID–19 Prevention Strategies
in the Context of Varying Community Transmission
Levels and Vaccination Coverage. MMWR Morb
Mortal Wkly Rep. ePub: 27 July 2021. DOI: https://
dx.doi.org/10.15585/mmwr.mm7030e2.
19 See Global Trends, Epidemic Curve trajectory
Classification, WHO, as reported at https://
covid.cdc.gov/covid-data-tracker/#global-trends
(last visited July 28, 2021).
20 Low/Moderate incidence describes <50 cases
per 100,000 people during the past 7 days.
Increasing or Decreasing incidence is based on the
percentage change in the number of cases reported
in the past 7 days compared to the 7 days prior to
that (Increasing: >0% change, Decreasing: <0%
change).
21 Determination that a Public Health Emergency
Exists, U.S. Department of Health and Human
Services (Jan. 31, 2020), https://www.phe.gov/
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
the U.S. government and CDC have
implemented a number of COVID–19
mitigation and response measures since
that time. Many of these mitigation
measures have involved restrictions on
international travel and migration.22
Other measures have focused on
recommending and enforcing COVID–19
mitigation efforts, including physical
distancing and mask-wearing.23 Recent
concerns regarding the spread of the
Delta variant prompted CDC to release
updated guidance calling for vaccinated
persons to wear a mask indoors in
public when in an area of substantial or
high transmission.24 Furthermore, CDC
emergency/news/healthactions/phe/Pages/2019nCoV.aspx (last visited July 21, 2021). The public
health emergency determination has been
subsequently renewed at 90-day intervals, most
recently on July 28, 2021. See https://www.phe.gov/
emergency/news/healthactions/phe/Pages/COVID19July2021.aspx (last visited July 28, 2021).
22 The President issued proclamations
suspending entry into the United States of
immigrants or nonimmigrants who were physically
present within a number of countries during the 14day period preceding their entry or attempted entry
into the U.S. See Proclamation 9984 (Jan. 31, 2020);
Proclamation 9992 (Feb. 28, 2020); Proclamation
10143 (Jan. 25, 2021); and Proclamation 10199 (Apr.
30, 2021). Since March 2020, Canada and Mexico
have joined with the U.S. to restrict non-essential
travel along land borders to prevent the
introduction and spread of the virus that causes
COVID–19; these restrictions are in place until at
least August 21, 2021. Notification of Temporary
Travel Restrictions Applicable to Land Ports of
Entry and Ferries Service Between the U.S. and
Canada, 86 FR 38556 (July 22, 2021); Notification
of Temporary Travel Restrictions Applicable to
Land Ports of Entry and Ferries Service Between the
U.S. and Mexico, 86 FR 38554 (July 22, 2021). CDC
has also issued orders to mitigate risk of further
introducing and spreading SARS CoV–2 and its
variants into the United States. See Framework for
Conditional Sailing and Initial Phase COVID–19
Testing Requirements for Protection of Crew, 85 FR
70153 (Nov. 4, 2020) (outlining the process for the
phased resumption of cruise ship passenger
operations); Requirement for Negative PreDeparture COVID–19 Test Result or Documentation
of Recovery from COVID–19 for all Airline or Other
Aircraft Passengers Arriving into the U.S. from Any
Foreign Country, 86 FR 7387 (Jan. 28, 2021); and
COVID–19 Travel Recommendations by
Destination, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/travelers/map-and-travel-notices.html#travel1 (last updated July 26, 2021) (COVID–19-related
travel recommendations, including 62 Level 4
Travel Health Notices for countries with very high
COVID–19 rates).
23 CDC’s Order requiring the wearing of face
masks by travelers while on a conveyance entering,
traveling within, or departing the United States and
in U.S. transportation hubs remains in place for all
travelers at indoor settings on public transportation
conveyances and at transportation hubs, regardless
of vaccination. Requirement for Persons to Wear
Masks While on Conveyances and at Transportation
Hubs, 86 FR 8025 (Feb. 3, 2021). See Requirement
for Face Masks on Public Transportation
Conveyances and at Transportation Hubs, Centers
for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/travelers/facemasks-public-transportation.html (last updated
June 10, 2021).
24 Supra note 15 (CDC also recommends fully
vaccinated persons consider wearing a mask
PO 00000
Frm 00056
Fmt 4703
Sfmt 4703
42831
recommends that all individuals,
including those fully vaccinated,
continue to wear a well-fitted face mask
in correctional and detention
facilities.25
B. Public Health Factors Related to
COVID–19
As directed by Executive Order,26
CDC conducted a comprehensive
reassessment of the October Order to
determine whether the suspension of
the right to introduce certain persons
into the United States remains necessary
in light of the current circumstances,
including the evolving understanding of
the epidemiology of COVID–19 variants
and available mitigation measures
including testing and vaccination.27 In
conducting this reassessment, CDC
examined a number of public health
factors, and evaluated how these factors
impact POE and U.S. Border Patrol
stations and the personnel and
noncitizens in those facilities. CDC also
scrutinized whether the potential
impacts varied by category of
noncitizen: SA, FMU, and UC. In
carrying out its reassessment, CDC
evaluated the following public health
factors: (1) The manner of COVID–19
transmission, including asymptomatic
and pre-symptomatic transmission; (2)
the emerging variants of the SARS–
CoV–2 virus; (3) the risks specific to the
type of facility or congregate setting; (4)
the availability of testing and vaccines
and the applicability of other mitigation
efforts; and (5) the impact on U.S.
communities and healthcare resources.
CDC views this public health
reassessment as setting forth a roadmap
toward the safe resumption of normal
processing of arriving noncitizens,
taking into account COVID–19 concerns
and immigration facilities’ ability to
implement mitigation measures.
regardless of transmission level if they or someone
in their household is immunocompromised or at
increased risk for severe disease, or if someone in
their household is unvaccinated (including children
currently ineligible for vaccination)); see also infra
page 11, section 5 (discussion of ‘‘high’’ and
‘‘substantial transmission’’).
25 Interim Public Health Recommendations for
Fully Vaccinated People, Centers for Disease
Control and Prevention, https://www.cdc.gov/
coronavirus/2019-ncov/vaccines/fully-vaccinatedguidance.html (last updated May 28, 2021).
26 Exec. Order 14010, ‘‘Creating a Comprehensive
Regional Framework To Address the Causes of
Migration, To Manage Migration Throughout North
and Central America, and To Provide Safe and
Orderly Processing of Asylum Seekers at the United
States Border,’’ 86 FR 8267 (Feb. 2, 2021).
27 CDC’s reassessment of the public health
situation with respect to covered noncitizens and
border facilities relies upon information and data
provided by DHS, CBP, and HHS’ Office of Refugee
Resettlement, including information regarding those
entities’ policies and practices.
E:\FR\FM\05AUN1.SGM
05AUN1
42832
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
1. Manner of COVID–19 Transmission
SARS–CoV–2, the virus that causes
COVID–19, spreads mainly from personto-person through respiratory fluids
released during exhalation, such as
when an infected person coughs,
sneezes, or talks. Exposure to these
respiratory fluids occurs in three
principal ways: (1) Inhalation of very
fine respiratory droplets and aerosol
particles, (2) deposition of respiratory
droplets and particles on exposed
mucous membranes in the mouth, nose,
or eye by direct splashes and sprays,
and (3) touching mucous membranes
with hands that have been soiled either
directly by virus-containing respiratory
fluids or indirectly by touching surfaces
with virus on them.28 Spread is more
likely when people are in close contact
with one another (within about 6 feet),
especially in crowded or poorly
ventilated indoor settings. Unvaccinated
persons with asymptomatic and presymptomatic infection are significant
contributors to community SARS–CoV–
2 transmission and occurrence of
COVID–19.29 Asymptomatic cases are
currently believed to represent roughly
30% of all COVID–19 infections and the
infectiousness of asymptomatic
individuals is believed to be about 75%
of the infectiousness of symptomatic
individuals. CDC’s current best estimate
is that 50% of infections are transmitted
prior to symptom onset (presymptomatic transmission).30 Although
rare, as discussed below, breakthrough
infections may occur in vaccinated
individuals. Due to the variety of source
of spread—transmission by
asymptomatic, pre-symptomatic,
symptomatic, and vaccinated
individuals—testing is critical to
identify those infected with COVID–19.
Among those who are not vaccinated,
serious COVID–19 illness necessitating
28 Scientific Brief: SARS–CoV–2 Transmission,
Centers for Disease Control and Prevention (May 7,
2021), https://www.cdc.gov/coronavirus/2019-ncov/
science/science-briefs/sars-cov-2-transmission.html;
Science Brief: SARS–CoV–2 and Surface (Fomite)
Transmission for Indoor Community Environments,
Centers for Disease Control and Prevention (Apr. 5,
2021), https://www.cdc.gov/coronavirus/2019-ncov/
more/science-and-research/surfacetransmission.html.
29 Moghadas SM, Fitzpatrick MC, Sah P, et al. The
implications of silent transmission for the control
of COVID–19 outbreaks. Proc Natl Acad Sci U S A.
2020;117(30):17513–17515.10.1073/
pnas.2008373117, available at https://
www.ncbi.nlm.nih.gov/pubmed/32632012;
Johansson MA, Quandelacy TM, Kada S, et al.
SARS–CoV–2 Transmission From People Without
COVID–19 Symptoms. Johansson MA, et al. JAMA
Netw Open. 2021 January4;4(1):e2035057. doi:
10.1001/jamanetworkopen.2020.35057.
30 COVID–19 Pandemic Planning Scenarios,
Centers for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/hcp/planningscenarios.html (last visited July 28, 2021).
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
treatment occurs with greater frequency
in older adults and those with certain
pre-existing conditions.31 Although
children can be infected with SARS–
CoV–2, get sick from COVID–19, and
spread the virus to others, when
compared with adults, children and
adolescents who have COVID–19 are
more commonly asymptomatic or have
mild, non-specific symptoms. Children
are less likely to develop severe illness
or die from COVID–19.32 They typically
present with mild symptoms, if any, and
have a good prognosis, recovering
within one to two weeks after disease
onset.33
2. Emerging Variants of the SARS–CoV–
2 Virus
Like all viruses, SARS–CoV–2
constantly changes through mutation as
it circulates, resulting in new virus
variants over time.34 Unchecked
transmission of SARS–CoV–2 may
result in increased viral mutations and
the emergence of new variants. New
variants of SARS–CoV–2 have emerged
globally,35 several of which have been
identified as variants of concern,36
including the Alpha, Beta, Gamma, and
Delta variants. These variants of concern
have evidence of an increase in
31 People at Increased Risk and Other People Who
Need to Take Extra Precautions, Centers for Disease
Control and Prevention, https://www.cdc.gov/
coronavirus/2019-ncov/need-extra-precautions/
index.html (last updated Apr. 20, 2021).
32 Science Brief: Transmission of SARS–CoV–2 in
K–12 Schools and Early Care and Education
Programs—Updated, Centers for Disease Control
and Prevention, https://www.cdc.gov/coronavirus/
2019-ncov/science/science-briefs/transmission_k_
12_schools.html (last updated July 9, 2021).
33 See Leeb RT, Price S, Sliwa S, et al. COVID–
19 Trends Among School-Aged Children—United
States, March 1–September 19, 2020. MMWR Morb
Mortal Wkly Rep 2020;69:1410–1415. DOI: https://
dx.doi.org/10.15585/mmwr.mm6939e2; Leidman E,
Duca LM, Omura JD, Proia K, Stephens JW, SauberSchatz EK. COVID–19 Trends Among Persons Aged
0–24 Years—United States, March 1–December 12,
2020. MMWR Morb Mortal Wkly Rep 2021;70:88–
94. DOI: https://dx.doi.org/10.15585/
mmwr.mm7003e1; Rankin DA, Talj R, Howard LM,
Halasa NB. Epidemiologic trends and
characteristics of SARS–CoV–2 infections among
children in the United States. Curr Opin Pediatr.
2021 Feb 1;33(1):114–121. doi: 10.1097/
MOP.0000000000000971. PMID: 33278112; PMCID:
PMC8011299; and Castagnoli R, Votto M, Licari A,
et al. Severe Acute Respiratory Syndrome
Coronavirus 2 (SARS–CoV–2) Infection in Children
and Adolescents: A Systematic Review. JAMA
Pediatr. 2020;174(9):882–889. doi:10.1001/
jamapediatrics.2020.1467.
34 About Variants of the Virus that Causes
COVID–19, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/transmission/variant.html (last updated Apr.
2, 2021).
35 Abdool Karim SS, de Oliveira T. New SARS–
CoV–2 Variants—Clinical, Public Health, and
Vaccine Implications [published online ahead of
print, 2021 Mar 24]. N Engl J Med. 2021;10.1056/
NEJMc2100362. doi:10.1056/NEJMc2100362.
36 Id.
PO 00000
Frm 00057
Fmt 4703
Sfmt 4703
transmissibility and more severe
disease, which may lead to higher
incidence, hospitalization, and death
rates among exposed persons.37
Furthermore, findings suggest variants
may reduce levels of neutralization by
antibodies generated during previous
infection or vaccination, resulting in
reduced effectiveness of treatments or
vaccines, or increased diagnostic
detection failures.38 The ultimate
concern is a variant that substantially
decreases the effectiveness of available
vaccines against severe or deadly
disease.
Currently, the Delta variant is the
predominant SARS–CoV–2 strain
circulating in the United States,
accounting for over 82% of cases as of
July 17, 2021.39 Of critical significance
for this Order, the Delta variant has
demonstrated increased levels of
transmissibility among unvaccinated
persons and might increase the risk of
vaccine breakthrough infections in the
absence of other mitigation strategies.40
For the unvaccinated, Delta remains a
formidable threat and rates of infection
of the Delta variant are growing more
rapidly in U.S. counties with lower
vaccination rates.41 Available evidence
suggests all three vaccines currently
authorized for emergency use in the
United States provide significant
protection against variants circulating in
the United States.42 However, a small
37 Dougherty K, Mannell M, Naqvi O, Matson D,
Stone J. SARS–CoV–2 B.1.617.2 (Delta) Variant
COVID–19 Outbreak Associated with a Gymnastics
Facility—Oklahoma, April–May 2021. MMWR
Morb Mortal Wkly Rep 2021;70:1004–1007. DOI:
https://dx.doi.org/10.15585/mmwr.mm7028e2
(describing a B.1.617.2 (Delta) Variant COVID–19
outbreak associated with a gymnastics facility and
finding that the Delta variant is highly transmissible
in indoor sports settings and households, which
might lead to increased incidence rates).
38 SARS–CoV–2 Variant Classifications and
Definitions, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/variants/variant-info.html#Concern (last
updated June 29, 2021).
39 Variant Proportions, Centers for Disease
Control and Prevention, https://covid.cdc.gov/
covid-data-tracker/#variant-proportions (citing data
for the two-week interval ending July 17, 2021).
40 About Variants of the Virus that Causes
COVID–19, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/variants/variant.html (last updated June 28,
2021).
41 COVID Data Tracker Weekly Review,
Interpretive Summary for July 23, 2021, Centers for
Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/covid-data/
covidview/ (attributing rising numbers of
COVID–19 cases in nearly 90% of U.S. jurisdictions
to the rapid spread of the Delta variant).
42 Science Brief: COVID–19 Vaccines and
Vaccination, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/science/science-briefs/fully-vaccinatedpeople.html (last updated May 27, 2021). Other
vaccines, particularly the one manufactured by
AstraZeneca, show reduced efficacy against
E:\FR\FM\05AUN1.SGM
05AUN1
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
proportion of people who are fully
vaccinated may become infected with
the Delta variant (known as
breakthrough infection); emerging
evidence suggests that fully vaccinated
persons who do become infected with
the Delta variant are at risk for
transmitting it to others.43
CDC continues to monitor the
situation and may adapt
recommendations based on the
epidemiology of variants of concern.
Given the transmissibility of variant
strains and the continued emergence of
new variants, ongoing monitoring of
vaccine effectiveness is needed to
identify mutations that could render
vaccines most commonly used in the
United States less effective against more
transmissible variants.44
khammond on DSKJM1Z7X2PROD with NOTICES
3. Risks of COVID–19 Transmission
Specific to Congregate Settings
Given the manner of transmission,
including asymptomatic or presymptomatic transmission, the risk of
spreading COVID–19 is particularly
pronounced among those who are
unvaccinated, partially vaccinated, or
vaccinated with less effective
vaccines.45 This risk is acutely present
in congregate settings, where a number
of people reside, meet, or gather in close
proximity for either a limited or
extended period of time.46 Facilities
must often carefully weigh the risks of
increased transmission not only in the
facilities, but also in the local
community, due to secondary
transmission. These congregate facilities
must also consider individual facility
infection with certain variants but may still protect
against severe disease; at the time of the issuance
of this Order, the FDA has not authorized the
AstraZeneca COVID–19 vaccine for use in the
United States.
43 Supra note 15.
44 See About Variants of the Virus that Causes
COVID–19, supra note 37.
45 Vaccines with effectiveness of less than 50%
against wildtype strains of COVID–19 are
considered less effective.
46 Notably, COVID–19 has disproportionately
affected persons in congregate settings and highdensity workplaces. Studies conducted prior to the
availability of vaccines showed that a single
introduction of SARS–CoV–2 into a facility can
result in a widespread outbreak. Lehnertz NB, Wang
X, Garfin J, Taylor J, Zipprich J, VonBank B, et al.
Transmission Dynamics of Severe Acute
Respiratory Syndrome Coronavirus 2 in HighDensity Settings, Minnesota, USA, March–June
2020. Emerg Infect Dis. 2021;27(8):2052–2063.
https://doi.org/10.3201/eid2708.204838. Whole
genome sequencing of samples taken following an
outbreak at a correctional facility demonstrated that
92.2% of the samples taken from patients were
genetically related, indicating that a single case had
likely led to the infection of 48 individuals.
Similarly, phylogenetic analysis established that
29.6% of cases from an outbreak at a second
correctional facility were closely related and
genetically identical, indicating that the index case
had led to the infection of approximately 60 others.
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
and community characteristics (e.g.,
ability to maintain physical distancing,
compliance with universal mask-use
policies, ability to properly ventilate,
proportion of staff and occupants
vaccinated, numbers of those who are at
increased risk for severe illness from
COVID–19, the availability of resources
for broad-based vaccination, testing, and
outbreak response, and level of
community transmission).47
Congregate settings, particularly
detention facilities with limited ability
to provide adequate physical distancing
and cohorting, have a heightened risk of
COVID–19 outbreaks.48 CDC has long
recognized the risks specific to such
settings, including homeless shelters,
detention centers, schools, and
workplaces and has provided a number
of guidance documents to address the
concerns in such spaces. Specifically,
CDC developed interim guidance for
law enforcement agencies that have
custodial authority for detained
populations, including civil and pretrial detention settings. Among the
recommendations are physical
distancing strategies, isolation of
individuals with confirmed or
suspected COVID–19, quarantine of
close contacts, cohorting of individuals
when space is limited, testing,
healthcare evaluations for individuals
with suspected COVID–19, clinical care
as needed for individuals with
confirmed or suspected COVID–19, and
addressing specific considerations for
people who are at increased risk for
severe illness.49
Vaccine coverage in congregate
settings varies and infection risk is
greater where there is sustained
community transmission.50 In light of
47 See Recommendations for Quarantine Duration
in Correctional Facilities, Centers for Disease
Control and Prevention, https://www.cdc.gov/
coronavirus/2019-ncov/community/quarantineduration-correctional-facilities.html (last visited
July 28, 2021).
48 Since March 31, 2020, the U.S. Federal Bureau
of Prisons and state departments of corrections have
together recorded 416,854 COVID–19 cases among
residents and 108,945 cases among staff in
correctional and detention facilities, resulting in
2,911 deaths. Confirmed COVID–19 Cases and
Deaths in U.S. Correctional and Detention Facilities
by State, Centers for Disease Control and
Prevention, https://covid.cdc.gov/covid-datatracker/#correctional-facilities (last visited July 28,
2021).
49 See Guidance for Correctional & Detention
Facilities, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/community/correction-detention/guidancecorrectional-detention.html (last updated June 9,
2021).
50 Falk A, Benda A, Falk P, Steffen S, Wallace Z,
H<eg TB. COVID–19 Cases and Transmission in 17
K–12 Schools—Wood County, Wisconsin, August
31–November 29, 2020. MMWR Morb Mortal Wkly
Rep 2021;70:136–140. DOI: https://dx.doi.org/
10.15585/mmwr.mm7004e3. See also Link-Gelles R,
PO 00000
Frm 00058
Fmt 4703
Sfmt 4703
42833
this, CDC strongly recommends
vaccination against COVID–19 for
everyone who is eligible, including
people who are incarcerated or detained
and staff at correctional and detention
facilities.51 CDC is discussing additional
guidance with DHS, highlighting the
key metrics to consider before
modifying COVID–19 prevention and
mitigation measures in facilities that
hold or detain migrants.52
4. Availability of Testing, Vaccines, and
Other Mitigation Measures
The potential for asymptomatic and
pre-symptomatic transmission makes
testing an essential part of COVID–19
mitigation protocols. With the
additional testing capacity available
through antigen tests, rapid testing can
be implemented to identify infected
persons so they can be isolated until
they no longer pose a risk of spreading
infections and their close contacts can
be identified and quarantined.53 Testing
is especially important in congregate
settings where even a single
asymptomatic case can trigger an
outbreak that may quickly exceed a
facility’s capacity to isolate and
quarantine residents. Furthermore, if
personnel are infected or exposed, the
number of available staff members may
be reduced, further stressing facility
operations. Testing facility residents
and personnel can help facilitate
prompt mitigation actions.
COVID–19 vaccines are now widely
available in the United States, and
vaccination is recommended for all
people 12 years of age and up. Three
COVID–19 vaccines are currently
authorized by the U.S. Food and Drug
Administration (FDA) for emergency
use: Two mRNA vaccines (produced by
Pfizer-BioNTech and Moderna) and one
viral vector vaccine (produced by
DellaGrotta AL, Molina C, et al. Limited Secondary
Transmission of SARS–CoV–2 in Child Care
Programs—Rhode Island, June 1–July 31, 2020.
MMWR Morb Mortal Wkly Rep 2020;69:1170–1172.
DOI: https://dx.doi.org/10.15585/mmwr.mm6934e2.
51 COVID–19 Vaccine FAQs in Correctional and
Detention Centers, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/community/correction-detention/vaccinefaqs.html (last updated June 1, 2021).
52 See CDC memo to DHS ‘‘Considerations for
modifying COVID–19 prevention and mitigation
measures in Department of Homeland Security
migrant holding facilities in response to declining
transmission,’’ Centers for Disease Control and
Prevention (last updated June 11, 2021).
53 See COVID–19 Testing and Diagnostics
Working Group (TDWG). U.S. Department of Health
and Human Services, https://www.hhs.gov/
coronavirus/testing/testing-diagnostics-workinggroup/ (last visited July 28, 2021)
(defining the role of the COVID–19 TDWG, which
develops testing-related guidance and provides
targeted investments to expand the available testing
supply and maximize testing capacity).
E:\FR\FM\05AUN1.SGM
05AUN1
42834
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
Johnson & Johnson/Janssen), each of
which has been determined to be safe
and effective against COVID–19. As of
July 28, 2021, over 163 million people
in the United States (57.6% of the
population 12 years or older) have been
fully vaccinated and over 189 million
people in the United States (66.8% of
the population 12 years or older) have
received at least one dose.54 After
substantial vaccine uptake in the first
months of 2021, however, vaccination
uptake has plateaued, particularly in
those under the age of 65 years.55 The
combination of reduced vaccine uptake
and the extreme transmissibility of the
Delta variant has resulted in rising
numbers of COVID–19 cases, primarily
and disproportionately affecting the
unvaccinated population.
The availability of COVID–19
vaccines is rising globally but still
dwarfed by the rates of vaccination in
the United States and a handful of other
countries.56 Countries of origin for the
majority of incoming covered
noncitizens have markedly lower
vaccination rates.57 Given this, the
increased movement of typically
unvaccinated covered noncitizens into
the United States presents a heightened
risk of morbidity and mortality to this
population due to the congregate
holding facilities at the border and the
khammond on DSKJM1Z7X2PROD with NOTICES
54 COVID–19
Vaccinations in the United States,
Centers for Disease Control and Prevention, https://
covid.cdc.gov/covid-data-tracker/#vaccinations
(last updated July 28, 2021).
55 Diesel J, Sterrett N, Dasgupta S, et al. COVID–
19 Vaccination Coverage Among Adults—United
States, December 14, 2020–May 22, 2021. MMWR
Morb Mortal Wkly Rep 2021;70: 922–927. DOI:
https://dx.doi.org/10.15585/mmwr.mm7025e1. The
study found that the lowest vaccination coverage
and the intent to be vaccinated among adults aged
18–24 years, non-Hispanic Black adults, and
individuals with less education, no insurance, and
lower household incomes. Concerns about vaccine
safety and effectiveness were commonly cited
barriers to vaccination. See also supra note 15
(finding that vaccine uptake has slowed nationally
with wide variation in coverage by state (range =
33.9%–67.2%) and by county (range = 8.8%–
89.0%)).
56 See ‘‘PAHO Director calls for fair and broad
access to COVID–19 vaccines for Latin America and
the Caribbean,’’ Pan American Health Organization,
https://www.paho.org/en/news/7-7-2021-pahodirector-calls-fair-and-broad-access-covid-19vaccines-latin-america-and (July 7, 2021) (noting
the discrepancies in vaccine availability coverage
among North, Central, and South American
countries).
57 Thus far in 2021, Ecuador, El Salvador,
Guatemala, Honduras, and Mexico constitute the
top five countries of origin for covered noncitizens.
Rates of vaccination for each country are as follows:
Ecuador: 11% fully vaccinated, 30% only partly
vaccinated; El Salvador: 22% fully vaccinated, 17%
only partly vaccinated; Guatemala: 1.6% fully
vaccinated, 5.3% only partly vaccinated; Honduras:
1.8% fully vaccinated, 12% only partly vaccinated;
Mexico: 18% fully vaccinated, 14% only partly
vaccinated, https://ourworldindata.org/covidvaccinations (last visited July 24, 2021).
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
practical constraints on implementation
of mitigation measures in such facilities.
Outbreaks in these settings increase the
serious danger of further introduction,
transmission, and spread of COVID–19
and variants into the country.
CDC is aware of a rising number of
breakthrough SARS–CoV–2 infections 58
in vaccinated individuals; even without
variants of concern, more vaccine
breakthroughs are to be expected due to
the rising number of vaccinated
individuals. While the vaccines
currently authorized by the FDA are
successful in mitigating severe illness
from the highly transmissible Delta
variant, infection and even mild to
moderate illness has been documented
in a small percentage of vaccinated
persons.59 The emergence of these more
transmissible variants increases the
urgency to expand vaccination coverage
for everyone and especially those in
densely populated congregate settings.60
Public health agencies and other
organizations must collaboratively
monitor the status of the pandemic in
their communities. As widespread
vaccination efforts continue, ongoing
use of the full panoply of mitigation
measures is nevertheless especially
important in congregate settings and
remains key to slowing introduction,
transmission, and spread of COVID–19.
5. Impact on U.S. Communities and
Healthcare Resources
COVID–19 cases are on the rise in
nearly 90% of U.S. jurisdictions, and
multiple outbreaks are occurring in
parts of the country that have low
vaccination coverage. A person’s risk for
SARS–CoV–2 infection is directly
related to the risk for exposure to
infectious persons, which is largely
determined by the extent of SARS–CoV–
2 circulation in the surrounding
community. Emerging evidence
regarding the Delta variant finds that it
is more than two times as transmissible
as the original strains of SARS–CoV–2
circulating at the start of the pandemic.
In light of this, CDC recommends
assessing the level of community
transmission using, at a minimum, two
58 A vaccine breakthrough infection is defined as
the detection of SARS–CoV–2 RNA or antigen in a
respiratory specimen collected from a person ≥14
days after receipt of all recommended doses of an
FDA-authorized COVID–19 vaccine. COVID–19
Vaccine Breakthrough Infections Reported to CDC—
United States, January 1–April 30, 2021. MMWR
Morb Mortal Wkly Rep 2021;70:792–793. DOI:
https://dx.doi.org/10.15585/mmwr.mm7021e3.
59 COVID–19 Vaccine Breakthrough Case
Investigation and Reporting, Centers for Disease
Control and Prevention, https://www.cdc.gov/
vaccines/covid-19/health-departments/
breakthrough-cases.html (last updated July 15,
2021).
60 Supra at note 55.
PO 00000
Frm 00059
Fmt 4703
Sfmt 4703
metrics: New COVID–19 cases per
100,000 persons in the last 7 days and
percentage of positive SARS–CoV–2
diagnostic nucleic acid amplification
tests in the last 7 days. For each of these
metrics, CDC classifies transmission
values as low, moderate, substantial, or
high. At the time of this Order’s
issuance, over 70% of the U.S. counties
along the U.S.-Mexico border were
classified as experiencing high or
substantial levels of community
transmission.61 In areas of substantial or
high transmission, CDC recommends
community leaders encourage
vaccination and universal masking in
indoor public spaces in addition to
other layered prevention strategies to
prevent further spread.
Between March and June 2021, rates
of hospitalization due to COVID–19
decreased dramatically, easing long
endured pressures on the U.S.
healthcare system. However, in July
2021, with the rise of the Delta variant,
the seven-day average for new hospital
admissions in the United States
increased 35.8% over the prior sevenday period.62 Rates of hospitalization
are rising most sharply in areas with
low vaccination coverage.63 CDC
recommends continuous monitoring of
the availability of staffed inpatient and
intensive care unit beds, as data on
usage of clinical care resources to
manage patients with COVID–19 reflect
underlying community disease
incidence. This information can signal
when urgent implementation of layered
prevention strategies might be necessary
to prevent overloading local and
regional health care systems. Strains on
61 Of the 22 U.S. counties along the U.S.-Mexico
border, 13 counties are experiencing high levels of
community transmission (San Diego County, CA;
Hidalgo County, NM; Presidio County, TX; Brewster
County, TX; Terrell County, TX; Val Verde County,
TX; Kinney County, TX; Maverick County, TX;
Webb County, TX; Zapata County, TX; Starr
County, TX; Hidalgo County, TX; and Cameron
County, TX) and four counties are experiencing
substantial levels of community transmission
(Imperial County, CA; Pima County, AZ; Santa Cruz
County, AZ; and Luna County, NM;). Five counties
are experiencing moderate levels of community
transmission (Yuma County, AZ; Cochise County,
AZ; Dona Ana County, NM; El Paso County, TX;
and Hudspeth County, TX). No counties along the
border are experiencing low levels of community
transmission. COVID–19 Integrated County View,
Centers for Disease Control and Prevention, https://
covid.cdc.gov/covid-data-tracker/#county-view (last
updated July 28, 2021).
62 COVID Data Tracker Weekly Review,
Interpretive Summary for July 16, 2021, Centers for
Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/covid-data/
covidview/past-reports/07162021.html (last visited
July 28, 2021).
63 COVID Data Tracker Weekly Review,
Interpretive Summary for July 9, 2021, Centers for
Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/covid-data/
covidview/past-reports/07092021.html.
E:\FR\FM\05AUN1.SGM
05AUN1
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
critical care capacity can increase
COVID–19 mortality while decreasing
the availability and use of health care
resources for non-COVID–19 related
medical care.64 Increased hospital
admissions are forecasted in the coming
weeks as the Delta variant continues to
predominate.65
The rapid spread of the highly
transmissible Delta variant is leading to
worrisome trends in healthcare and
community resources. Signs of stress are
already present in the southern regions
of the United States.66 Ultimately, the
flow of migration directly impacts not
only border communities and regions,
but also destination communities and
the healthcare resources of both. In light
of this, the totality of the U.S.
community transmission, health system
capacity, and public health capacity, as
well as local capacity to implement
mitigation protocols, are important
considerations when reassessing the
need for this Order.67
II. Public Health Reassessment
A. Immigration Processing and Public
Health Impacts
Noncitizens arriving in the United
States who lack proper travel
documents, whose entry is otherwise
contrary to law, or who are
apprehended at or near the border
seeking to unlawfully enter the United
States between POE are normally
subject to initial immigration processing
by CBP in POE facilities and U.S. Border
Patrol stations. Absent CDC’s issuance
of an order under 42 U.S.C. 265
directing otherwise, immigration
processing takes place pursuant to Title
8 of the U.S. Code. Although some
number of inadmissible noncitizens
present at POE, the vast majority are
encountered by CBP between POE.68
Upon such encounters, Border Patrol
agents conduct an initial field
assessment and transport the
64 Supra
note 15.
Forecasts: Hospitalizations, Centers
for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/science/
forecasting/hospitalizations-forecasts.html (last
updated July 21, 2021).
66 See COVID Data Tracker: New Hospital
Admissions, https://covid.cdc.gov/covid-datatracker/#new-hospital-admissions (last updated July
22, 2021) (showing HHS Regions 4, 6, and 9,
encompassing all southern states, experiencing
increased rates of new admissions of COVID–19confirmed patients).
67 See Implementation of Mitigation Strategies for
Communities with Local COVID–19 Transmission,
Centers for Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/community/
community-mitigation.html (last visited May 6,
2021).
68 Fiscal year to date, 96% (1,076,242 of
1,119,204) of encounters of noncitizens occurred
between POE.
khammond on DSKJM1Z7X2PROD with NOTICES
65 COVID–19
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
individuals to a CBP facility for intake
processing.69
CBP facilities are designed to provide
this short-term intake processing and
are thus space-constrained.70 While
undergoing intake processing under
Title 8 at CBP facilities, noncitizens are
regularly held in close proximity to one
another anywhere from several hours to
several days. Depending on the outcome
of intake processing, a noncitizen is
generally referred to the DHS’
Immigration and Customs Enforcement
(ICE), where they are often subject to
longer-term detention.71 72
Compared to CBP facilities, ICE
facilities have space allocations similar
to traditional long-term correctional
facilities. Still, during migratory surges,
capacity constraints hinder CBP and ICE
operations and facilities alike. If
downstream ICE operations and
facilities reach capacity limits, ICE may
be unable to take custody of additional
noncitizens in a timely manner. When
this movement of noncitizens from CBP
to ICE custody is impeded or delayed,
noncitizens may remain in CBP’s
densely populated, short-term holding
facilities for much longer periods. Of
note, the United States is currently
experiencing such a migratory surge of
noncitizens attempting to enter the
country at and between POE at the
southern border.73 DHS has already
recorded more encounters this fiscal
year to date than the approximate
977,000 encounters in the whole of FY
2019.74
CBP has implemented a variety of
mitigation efforts to prevent the spread
of COVID–19 in POE and U.S. Border
Patrol facilities based on the infection
prevention strategy referred to as the
69 CBP facilities include POE, U.S. Border Patrol
stations, and facilities managed by the Office of
Field Operations.
70 CBP facilities were designed for the immediate
processing of persons and are statutorily designated
as short-term (less than 72 hours) holding facilities.
6 U.S.C. 211(m).
71 FMU transferred to ICE custody are generally
held at a Family Staging Center (FSC). Following
intake processing, UC are referred to the Office of
Refugee Resettlement (ORR) within HHS’
Administration for Children and Families (ACF) for
care.
72 While CBP policies regarding transfer and
release decisions are the same across the Southwest
Border, implementation varies based on local CBP
capacity, and ICE capacity.
73 According to data from DHS, encounters at the
southern border have been rising since April 2020
due to several factors, including ongoing violence,
insecurity, and famine in the Northern Triangle
countries of Central America (El Salvador,
Honduras, Guatemala).
74 Southwest Land Border Encounters, U.S.
Customs and Border Protection, available at https://
www.cbp.gov/newsroom/stats/southwest-landborder-encounters (last visited July 28, 2021).
PO 00000
Frm 00060
Fmt 4703
Sfmt 4703
42835
hierarchy of controls.75 CBP has
invested in engineering upgrades, such
as installing plexiglass dividers in
facilities where physical distancing is
not possible and enhancing ventilation
systems. All CBP facilities adhere to
CDC guidance for cleaning and
disinfection. Surgical masks are
provided to all persons in custody and
are changed at least daily and if or when
they become wet or soiled. Personal
protective equipment (PPE) and
guidance are regularly provided to CBP
personnel. Recognizing the value of
vaccination, CBP is encouraging
vaccination among its workforce. All
noncitizens brought into CBP custody
are subject to health intake interviews,
including COVID–19 screening
questions and temperature checks. If a
noncitizen in custody displays
symptoms of COVID–19 or has a known
exposure, CBP facilitates referral to the
local healthcare system for testing.
Finally, in the event CBP decides to
release a noncitizen prior to removal
proceedings, the agency has coordinated
with local governments and nongovernmental organizations to arrange
COVID–19 testing at release.76
In addition to these mitigation
measures, enhanced physical distancing
and cohorting remain key to preventing
transmission and spread of COVID–19,
particularly in congregate settings. To
address this, as the pandemic emerged,
CBP greatly reduced capacity in their
holding facilities. While U.S. Border
Patrol facilities along the southern
border currently have a non-pandemic
total holding capacity of 14,553
individuals, implementation of
mitigation measures led to a 50–75%
reduction in holding capacity
depending on the design of a given
facility, resulting in COVID-constrained
holding capacity of 4,706.77 However,
the current surge has caused CBP to
exceed COVID-constrained capacity and
routinely exceed its non-COVID
capacity.78 From July 3 to July 24, 2021,
75 Hierarchy of Controls, Centers for Disease
Control and Prevention, available at https://
www.cdc.gov/niosh/topics/hierarchy/default.html
(last visited July 6, 2021). The hierarchy of controls
is used as a means of determining how to
implement feasible and effective control solutions.
The hierarchy is outlined as: (1) Elimination
(physically remove the hazard); (2) Substitution
(replace the hazard); (3) Engineering Controls
(isolate people from the hazard); (4) Administrative
Controls (change the way people work); and (5) PPE
(protect people with Personal Protective
Equipment).
76 This is also true of ICE facilities.
77 Similarly, the operational holding capacity for
SA in ICE facilities was reduced by 30% from a
regular total capacity of 56,888 beds to 39,821 beds.
78 Non-COVID–19 holding capacity was exceeded
as recently as July 25, 2021.
E:\FR\FM\05AUN1.SGM
05AUN1
42836
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
CBP encountered an average of 3,573 SA
and 2,479 FMU daily, over a 21-day
period, even with the CDC Order in
place. This extreme population density
and the resulting increased time spent
in custody by noncitizens presents a
serious risk of increased COVID–19
transmission in CBP facilities.
CBP faces unique challenges in
implementing certain COVID–19
mitigation measures. All individuals
encountered by U.S. Border Patrol must
be processed in CBP facilities. Not only
does this involve close and often
continuing contact between CBP
personnel and noncitizens, but CBP is
further constrained by requirements
separate noncitizens within its holding
facilities according to specific
permutations.79 These cohorting
requirements significantly complicate
CBP’s ability to address COVID–19related risks, as CBP facility capacity to
accommodate COVID–19 mitigation
protocols may not always align with the
makeup of the incoming population of
noncitizens and the categorical
separations required of DHS.
Immigration Processing Under Title 8 of
the U.S. Code
The vast majority of noncitizens
attempting to enter the United States
without proper travel documents are
SA; SA account for 68% of overall CBP
encounters this fiscal year as of July 26,
2021. Under normal Title 8 immigration
processes, SA are transferred to ICE
custody pending removal proceedings.
As noted above, absent expulsions
directed by an order under 42 U.S.C.
265, SA presenting at POE or attempting
entry between POE would be processed
and held in CBP facilities while
awaiting transfer to ICE. Generally, CBP
only releases SA into U.S. communities
as a last resort, due to severe
overcrowding and when all possible
detention options have been explored.
A smaller percentage, 23%, of
noncitizens encountered by CBP are
members of an FMU.80 As with SA, CBP
has limited capacity to hold FMU.
Under Title 8, due to court-ordered
restrictions that largely prohibit the
long-term detention of families, FMU
are generally released from DHS custody
pending removal proceedings. Prior to
release, some FMU are transferred from
CBP custody to Family Staging Centers
(FSC) operated by ICE. Only a limited
number of FMU may be held in an FSC,
and time in custody for an FMU is
79 For example, criminal cases must be held
separately from administrative cases, SA must be
separated by gender identity, FMU and UC must be
separated from SA, and all vulnerable individuals
must be protected from harm.
80 Thus far this fiscal year, as of July 26, 2021.
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
generally about 2–3 days before being
released. FSC capacity is further limited
by COVID–19 mitigation protocols.81
Releasing FMU to communities
necessitates robust testing, vaccination
where possible, and careful attention to
consequence management (e.g., facilities
for isolation and quarantine). DHS has
partnered with state and local agencies
and non-governmental organizations to
facilitate COVID–19 testing of FMU
upon release from CBP custody.
Pursuant to these arrangements, CBP
generally transports FMU to release
locations where partner agencies and
organizations are on-site to provide
testing and facilitate consequence
management. Although the
implementing partners and their
capacities (including for consequence
management such as housing) vary, the
objectives are constant. These resources,
however, are limited. They are already
stretched thin, and certainly not
available for all FMU who would be
processed under Title 8 in the absence
of an order issued under 42 U.S.C. 265.
DHS has committed to supporting and,
where possible, expanding these efforts,
including exploring the incorporation of
vaccination into this model. CDC
strongly supports DHS efforts that
include broad-based testing and
vaccination.
Immigration Processing With an Order
Under 42 U.S.C. 265
Following the issuance of the March
and October Orders, covered
noncitizens apprehended at or near U.S.
borders, regardless of their country of
origin, generally were expelled to
Mexico or Canada, whichever they
entered from, via the nearest POE, or to
their country of origin. Where possible,
SA and FMU eligible for expulsion
based on the March and October Orders
have been processed pursuant to the
Title 42 authority, unless a case-by-case
exception was made by DHS.82
81 The total capacity for these FSCs is 3,230.
However, due to COVID–19 mitigation protocols
and family composition limitations, current
operational capacity for the FSCs is approximately
2,400. In July 2021, due to an influx of single adults
at the SWB, ICE ceased intake of family units at one
of the FSCs and began to transition the facility to
hold single adults. With this transition, the
remaining COVID-limited FSC capacity for family
units is approximately 1,800. Additionally, ICE has
procured 1,200 additional beds at Emergency
Family Staging Centers (EFSCs); this bed space is
not limited by family composition or COVID–19.
82 Some countries have put in place limitations
that make expulsion pursuant to Title 42
inapplicable. The October Order excepted covered
noncitizens ‘‘who must test negative for COVID–19
before they are expelled to their home country’’ and
several countries refuse to accept the return of SA
and FMU and other individuals unless DHS first
secures a negative test result for each individual to
be returned. These noncitizens are thus not covered
PO 00000
Frm 00061
Fmt 4703
Sfmt 4703
Even with the March and October
Orders in place, a significant percentage
of FMU were unable to be expelled
pursuant to the order, given a range of
factors, including, most notably,
restrictions imposed by foreign
governments.83 For example, the
Mexican government has placed certain
nationality- and demographic-specific
restrictions on the individuals it will
accept for return via the Title 42
expulsion process. With limited
exceptions, the Mexican government
will only accept the return of Mexican
and Northern Triangle nationals.
Moreover, along sections of the border,
Mexican officials refuse to accept the
return of any non-Mexican family with
children under the age of seven, greatly
reducing DHS’ ability to expel FMU. In
addition, many countries impose travel
requirements, including COVID–19
testing, consular interviews, and
identity verification that can delay
repatriation. These added requirements
often make prompt expulsion a practical
impossibility. Conversely, DHS
continues to be able to process the
majority of SA under Title 42.84 In those
cases where Title 42 processing is not
possible, SA and FMU are instead
processed pursuant to Title 8.
Processing noncitizens and issuing a
Notice to Appear under Title 8
processes takes approximately an hour
and a half to two hours per person.
Conversely, processing an individual for
expulsion under the CDC order takes
roughly 15 minutes and generally
happens outdoors.
The March and October Orders
permitted noncitizens to be promptly
returned to their country of origin,
rather than being transferred to ICE
custody or released into the United
States, resulting in noncitizens spending
shorter amounts of time in custody at
CBP facilities. However, as the number
of noncitizens attempting to enter the
United States has surged and as
individuals cannot be expelled pursuant
to Title 42 given the restrictions in
place, the time in custody at CBP
facilities has increased for SA and FMU,
even with the October Order in place.
As of July 29, 2021, the current average
time in custody at CBP facilities for SA
by the prior Order and thus cannot be expelled
pursuant to Title 42. See 85 FR at 65807.
83 Only 33% of FMU encountered fiscal year to
date have been expelled under Title 42 and this
percentage has fallen over time. In June 2021, only
14% of FMU were expelled under Title 42, an
average of approximately 300 per day.
84 Fiscal year to date, 89% of SA have been
expelled under Title 42. This percentage has fallen
slightly as the constraints on expelling individuals
have increased. In June 2021, 82% of SA were
expelled under Title 42, an average of over 3,000
per day.
E:\FR\FM\05AUN1.SGM
05AUN1
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
not subject to expulsion under the
October Order is 50 hours. FMU
currently spend an average of 62 hours
in CBP custody prior to release or
transfer to ICE. If the CDC Order were
not in place, both SA and FMU time in
custody would likely increase
significantly.
khammond on DSKJM1Z7X2PROD with NOTICES
B. Public Health Assessment of Single
Adults and Family Units
Implementation of CDC’s March and
October Orders significantly reduced
the length of time covered noncitizen
SA and FMU are held in congregate
settings at POE and U.S. Border Patrol
stations, as well as in the ICE facilities
that subsequently hold noncitizens.85
By reducing congestion in these
facilities, the Orders have helped lessen
the introduction, transmission, and
spread of COVID–19 among border
facilities and into the United States
while also decreasing the risk of
exposure to COVID–19 for DHS
personnel and others in the facilities.
Implementation of the Orders has
mitigated the potential erosion of DHS
operational capacity due to COVID–19
outbreaks. The reduction in the number
of SA and FMU held in these congregate
settings continues to be a necessary
mitigation measure as DHS moves
towards the resumption of normal
border operations.
The availability of testing,
vaccination, and other mitigation
measures 86 at migrant holding facilities
must also be considered. While
downstream ICE facilities may have
greater ability to provide these
measures, CBP cannot appropriately
execute consequence management
measures to minimize spread or
transmission of COVID–19 within its
facilities. Space constraints, for
example, preclude implementation of
cohorting and consequence management
such as quarantine and isolation.
Covered noncitizens housed in
congregate settings who may be infected
with COVID–19 may ultimately increase
community transmission rates in the
United States, especially among
susceptible populations (i.e., non85 For example, when processing noncitizens
under Title 8, prior to referral to ICE or release into
the community, CBP generally issues the noncitizen
a ‘‘Notice to Appear’’ (also called an I–862), which
is a charging document that initiates removal
proceedings against the noncitizen and may include
a court date or direct the noncitizen to report to an
ICE office to receive a court date.
86 See Interim Guidance on Management of
Coronavirus Disease 2019 (COVID–19) in
Correctional and Detention Facilities, Centers for
Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/community/
correction-detention/guidance-correctionaldetention.html#correctional-facilities (last visited
July 28, 2021).
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
immune, under-vaccinated, and nonvaccinated persons). Mitigation
measures, especially testing and
vaccination, must be considered for the
noncitizens being held, as well as for
facility personnel. On-site COVID–19
testing for noncitizens at CBP holding
facilities is very limited and the
majority of testing takes place off-site.
For example, if a noncitizen is
transported to a community healthcare
facility for medical care, testing is
provided based on local protocols. Once
transferred to ICE custody, testing for
SA and FMU is more widely available.
Although COVID–19-related
healthcare resources have substantially
improved since the October Order was
issued, emerging variants and the
potential for a future vaccine-resistant
variant mean the possible impacts on
U.S. communities and local healthcare
resources in the event of a COVID–19
outbreak at CBP facilities cannot be
ignored. The introduction, transmission,
and spread of SARS–CoV–2—including
its variants—among covered noncitizens
during processing and holding at
congregate CBP settings remain a
significant concern to the noncitizens,
CBP personnel, as well as the
community at large in light of
transmission to unvaccinated
individuals and the potential for
breakthrough cases. Of particular note,
POE and U.S. Border Patrol stations are
ill-equipped to manage an outbreak and
these facilities are heavily reliant on
local healthcare systems for the
provision of more extensive medical
services to noncitizens.87 Transfers to
local healthcare systems for care could
strain local or regional healthcare
resources. Reliance on healthcare
resources in border and destination
communities may increase the pressure
on the U.S. healthcare system and
supply chain during the current public
health emergency.88 Of note,
hospitalization rates are once again
soaring nationally as the Delta variant
spreads and the vaccination rate of the
87 See CBP Directive No. 2210–004, U.S. Customs
and Border Protection, https://www.cbp.gov/sites/
default/files/assets/documents/2019-Dec/CBP_
Final_Medical_Directive_123019.pdf (Dec. 30,
2019). Many of the U.S. Border Patrol stations and
POE facilities are located in remote areas and do not
have ready access to local healthcare systems
(which typically serve small, rural populations and
have limited resources). 85 FR 56424, 56433. See
also Abubakar I, Aldridge RW, Devakumar D, et al.
The UCL-Lancet Commission on Migration and
Health: the health of a world on the move. Lancet.
2018;392(10164):2606–2654. doi:10.1016/S0140–
6736(18)32114–7.
88 See COVID–19 State Profile Report—Combined
Set, HealthData.gov, https://healthdata.gov/
Community/COVID-19-State-Profile-ReportCombined-Set/5mth-2h7d (last updated July 28,
2021).
PO 00000
Frm 00062
Fmt 4703
Sfmt 4703
42837
public lags. Ensuring the continued
availability of healthcare resources is a
critical component of the federal
government’s overall public health
response to COVID–19.
Given the nature of COVID–19, there
is no zero-risk scenario, particularly in
congregate settings and with variants as
transmissible as that of Delta in high
circulation in the country. The ongoing
pandemic presents complex and
dynamic challenges relating to public
health that limit DHS’ ability to process
noncitizens safely under normal Title 8
procedures. Processing a noncitizen
under Title 8 can take up to eight times
as long as processing a noncitizen under
Title 42. Importantly, longer processing
times result in longer exposure times to
a heightened risk of COVID–19
transmission for both noncitizens and
CBP personnel. Amid the ongoing
migrant surge, both the COVID–19reduced capacity and higher non-COVID
holding capacity limits have been
exceeded in CBP facilities. Complete
termination of any order under 42
U.S.C. 265 would increase the number
of noncitizens requiring processing
under Title 8, resulting in severe
overcrowding and a high risk of COVID–
19 transmission among those held in the
facilities and the CBP workforce,
ultimately burdening the local
healthcare system.89
All of this is of particular concern as
the Delta variant continues to drive an
increase in COVID–19 cases. While
scientists learn more about Delta and
other emerging variants, rigorous and
increased compliance with public
health mitigation strategies is essential
to protect public health.90 Reducing the
further introduction, transmission, and
spread of these variants and future
variants of concern into the United
States is key to defeating COVID–19.
CDC has concluded that SA and FMU
should continue to be subject to the
Order at this time pending further
improvements in the public health
situation.
C. Comparison to Unaccompanied
Noncitizen Children
As discussed in the July Exception,
UC are differently situated than SA and
89 Throughout the course of the COVID–19
pandemic, CDC has observed numerous outbreaks
in similar congregate settings. See FAQs for
Correctional and Detention Facilities, Centers for
Disease Control and Prevention, https://
www.cdc.gov/coronavirus/2019-ncov/community/
correction-detention/faq.html (last visited Apr. 15,
2021).
90 About Variants of the Virus that Causes
COVID–19, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019ncov/transmission/variant.html (last updated Apr.
2, 2021).
E:\FR\FM\05AUN1.SGM
05AUN1
42838
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
FMU. The Government has greater
ability to care for UC while
implementing appropriate COVID–19
mitigation measures. ORR has
established a robust network of care
facilities that provide testing and
medical care and institute COVID–19
mitigation protocols, including
vaccination for personnel and eligible
UC. In light of these considerations,
there is very low likelihood that
processing UC in accordance with
existing Title 8 procedures will result in
undue strain on the U.S. healthcare
system or healthcare resources.
Moreover, UC released to a vetted
sponsor or placed in a temporary or
licensed ORR shelter do not pose a
significant level of risk for COVID–19
spread into the community. UC are
released only after having undergone
testing, quarantine and/or isolation, and
vaccination when possible, and their
sponsors are provided with appropriate
medical and public health direction.
CDC thus finds that, at this time,91 there
is appropriate infrastructure in place to
protect the children, caregivers, and
local and destination communities from
elevated risk of COVID–19 transmission.
CDC believes the COVID–19-related
public health concerns associated with
UC introduction can be adequately
addressed without UC being subject to
this Order. As outlined in the July
Exception and incorporated herein, CDC
is fully excepting UC from this Order.
The number of UC entering the United
States is smaller than both the number
of SA 92 and of FMU. Whereas UC can
be excepted from the Order without
posing a significant public health risk,
the same is not true of SA and FMU, as
described above.
D. Summary of Findings
Upon review of the various public
health factors outlined above and in
consideration of the circumstances at
DHS facilities, it is CDC’s assessment
that suspending the right to introduce
covered noncitizen SA and FMU who
would otherwise be held at POE and
U.S. Border Patrol stations remains
necessary as the United States continues
to combat the COVID–19 public health
emergency. In making this
determination, CDC has considered
various possible alternatives (including
but not limited to terminating the
application of an order under 42 U.S.C.
265 for some or all SA and FMU,
91 This situation could change based on an
increased influx of UC, changes in COVID–19
infection dynamics among UC, or unforeseen
reductions in housing capacity.
92 Note, the total number of SA encounters may
include repeat encounters with SA who attempt
entry again following expulsion.
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
modifying the availability of exceptions
for individual SA and FMU in an order
under 42 U.S.C. 265, and reissuing an
order under 42 U.S.C. 265 for some or
all UC); but for the reasons discussed
herein, CDC finds that the continued
suspension of the right to introduce SA
and FMU under the terms set forth
herein, combined with the exception for
UC, is appropriate at this time. This
temporary suspension pending further
improvements in the public health
situation and greater ability to
implement COVID–19 mitigation
measures in migrant holding facilities
will slow the influx of noncitizens into
environments at higher risk for COVID–
19 transmission and spread.
DHS has indicated a commitment to
restoring border operations in a manner
that complies with applicable COVID–
19 mitigation protocols while also
accounting for other public health and
humanitarian concerns. In light of
available mitigation measures, and with
DHS’ pledge to expand capacity in a
COVID-safe manner similar to
expansions undertaken by HHS and
ORR to address UC influx, CDC believes
that the gradual resumption of normal
border operations under Title 8 is
feasible. With careful planning, this may
be initiated in a stepwise manner that
complies with COVID–19 mitigation
protocols. HHS and CDC intend to
support DHS in this effort and continues
to work with DHS to provide technical
guidance on COVID–19 mitigation
strategies for their unique facilities and
populations.93 CDC understands that
DHS intends to continue exercising
case-by-case exceptions for individual
SA and FMU based on a totality of the
circumstances as CDC transitions away
from this Order. CDC is also providing
an additional exception to permit DHS
to except noncitizens participating in a
DHS-approved program that
incorporates pre-processing COVID–19
testing in Mexico of the noncitizens,
prior to their safe and orderly entry to
the U.S. via ports of entry. Based on the
incorporation of relevant COVID–19
mitigation measures in such programs,
in consultation with CDC, CDC believes
93 CDC has advised DHS on best practices with
regard to testing noncitizens at the point they are
released to U.S. communities to await further
immigration proceedings. In addition to enforcing
physical distancing (as practicable), mask-wearing,
and testing for both noncitizens and personnel alike
in POE and U.S. Border Patrol stations, CDC advises
vaccination of DHS/CBP personnel to further
reduce the risk of COVID–19 introduction,
transmission, and spread in facilities and
communities and protect the federal workforce.
Widespread vaccination of federal employees and
other personnel in congregate settings at POE and
U.S. Border Patrol stations is another layer of the
strategy that will lead to the normalization of border
operations.
PO 00000
Frm 00063
Fmt 4703
Sfmt 4703
such an exception is consistent with its
legal authorities and in the public
health interest.
II. Legal Basis for This Order Under
Sections 362 and 365 of the Public
Health Service Act and 42 CFR 71.40
CDC is issuing this Order pursuant to
sections 362 and 365 of the Public
Health Service Act (42 U.S.C. 265, 268)
and the implementing regulation at 42
CFR 71.40. In accordance with these
authorities, the CDC Director is
permitted to prohibit, in whole or in
part, the introduction into the United
States of persons from designated
foreign countries (or one or more
political subdivisions or regions thereof)
or places, only for such period of time
that the Director deems necessary to
avert the serious danger of the
introduction of a quarantinable
communicable disease, by issuing an
Order in which the Director determines
that:
(1) By reason of the existence of any
quarantinable communicable disease in
a foreign country (or one or more
political subdivisions or regions thereof)
or place there is serious danger of the
introduction of such quarantinable
communicable disease into the United
States; and
(2) This danger is so increased by the
introduction of persons from such
country (or one or more political
subdivisions or regions thereof) or place
that a suspension of the right to
introduce such persons into the United
States is required in the interest of
public health.94
CDC has authority under Section 362
and the implementing regulation to
issue this Order to mitigate the further
spread of COVID–19 disease, especially
as the need to prevent proliferation of
COVID–19 disease related to SARS–
CoV–2 virus variants is heightened
while vaccination efforts continue.
Section 362 and the implementing
regulation provide the Director with a
public health tool to suspend
introduction of persons not only to
prevent the introduction of a
quarantinable communicable disease,
but also to aid in continued efforts to
mitigate spread of that disease.95
The term ‘‘introduction into the
United States’’ is defined in 42 CFR
71.40 as ‘‘the movement of a person
from a foreign country (or one or more
political subdivisions or regions thereof)
or place, or series of foreign countries or
places, into the United States so as to
bring the person into contact with
persons or property in the United States,
94 42
95 85
E:\FR\FM\05AUN1.SGM
U.S.C. 265; 42 CFR 71.40.
FR 56424 at 56425–26.
05AUN1
khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
in a manner that the Director determines
to present a risk of transmission of a
quarantinable communicable disease to
persons, or a risk of contamination of
property with a quarantinable
communicable disease, even if the
quarantinable communicable disease
has already been introduced,
transmitted, or is spreading within the
United States.’’ 42 CFR 71.40(b)(1).
Similarly, the term ‘‘serious danger of
the introduction of such quarantinable
communicable disease into the United
States’’ is defined as, ‘‘the probable
introduction of one or more persons
capable of transmitting the
quarantinable communicable disease
into the United States, even if persons
or property in the United States are
already infected or contaminated with
the quarantinable communicable
disease.’’ 42 CFR 71.40(b)(3).
In promulgating § 71.40, CDC and
HHS noted that ‘‘‘introduction’ does not
necessarily conclude the instant that a
person first steps onto U.S. soil. The
introduction of a person into the United
States can occur not only when a person
first steps onto U.S. soil, but also when
a person on U.S. soil moves further into
the United States, and begins to come
into contact with persons or property in
ways that increase the risk of
transmitting the quarantinable
communicable disease.’’ 96 This
language recognizes that many
quarantinable communicable diseases,
including COVID–19, may be spread by
infected individuals who are
asymptomatic and therefore unaware
that they are capable of transmitting the
disease. Even when a communicable
disease is already circulating within the
United States, prevention and
mitigation of continued transmission of
the virus is nevertheless a key public
health measure. In this case, although
COVID–19 has already been introduced
and is spreading within the United
States, this Order serves as an important
disease-mitigation tool to protect public
health. This is particularly true as new
variants of the virus continue to emerge.
By continuing to suspend the
introduction of persons from foreign
countries into the United States, this
Order will help minimize the spread of
variants and their ability to accelerate
disease transmission.
Section 71.40(b)(2) defines
‘‘[p]rohibit, in whole or in part, the
introduction into the United States of
persons’’ in Section 362 as ‘‘to prevent
the introduction of persons into the
United States by suspending any right to
introduce into the United States,
physically stopping or restricting
96 Id.
at 56425.
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
movement into the United States, or
physically expelling from the United
States some or all of the persons.’’ See
also 42 U.S.C. 265 (authorizing the
prohibition when the danger posed by
the communicable disease ‘‘is so
increased by the introduction of persons
from such country . . . or place that a
suspension of the right to introduce
such persons into the United States is
required in the interest of public
health’’). Pursuant to that provision, this
Order permits expulsion of persons
covered by it, as did the prior Orders
issued under this authority.97 CDC
recognizes that expulsion is an
extraordinary action but, as explained in
the Final Rule, the power to expel is
critical where neither HHS/CDC, nor
other Federal agencies, nor state or local
governments have the facilities and
personnel necessary to quarantine,
isolate, or conditionally release the
number of persons who would
otherwise increase the serious danger of
the introduction of a quarantinable
communicable disease into the United
States.98 In those situations, the rapid
expulsion of persons from the United
States may be the most effective public
health measure that HHS/CDC can
implement within the finite resources of
HHS/CDC and its Federal, State, and
local partners.99
As stated in the Final Rule for 42 CFR
71.40, CDC ‘‘may, in its discretion,
consider a wide array of facts and
circumstances when determining what
is required in the interest of public
health in a particular situation . . .
includ[ing]: the overall number of cases
of disease; any large increase in the
number of cases over a short period of
time; the geographic distribution of
cases; any sustained (generational)
transmission; the method of disease
transmission; morbidity and mortality
associated with the disease; the
effectiveness of contact tracing; the
adequacy of state and local healthcare
systems; and the effectiveness of state
and local public health systems and
control measures.’’ 100 Other factors
noted in the Final Rule are the potential
for disease spread among persons held
in congregate settings, specifically
during processing and holding at CBP
facilities, and the potential for disease
spread to the community at large.101
97 See
id. at 56425, 56433.
at 56425, 56445–46.
99 Id. at 56425.
100 Id. at 56444.
101 Id. at 56434. Strain on healthcare systems was
also cited as a factor in the Final Rule, specifically
the additional strain that noncitizen migrant
healthcare needs may place on already
overburdened systems; the Final Rule described the
98 Id.
PO 00000
Frm 00064
Fmt 4703
Sfmt 4703
42839
As stated in 42 CFR 71.40, this Order
does not apply to U.S. citizens, U.S.
nationals, lawful permanent residents,
members of the armed forces of the
United States and associated personnel
if the Secretary of Defense provides
assurance to the Director that the
Secretary of Defense has taken or will
take measures such as quarantine or
isolation, or other measures maintaining
control over such individuals, to
prevent the risk of transmission of the
quarantinable communicable disease
into the United States, and U.S.
government employees or contractors on
orders abroad, or their accompanying
family members who are on their orders
or are members of their household, if
the Director receives assurances from
the relevant head of agency and
determines that the head of the agency
or department has taken or will take
measures such as quarantine or
isolation, to prevent the risk of
transmission of a quarantinable
communicable disease into the United
States.102
In addition, this Order does not apply
to those classes of persons excepted by
the CDC Director. Including exceptions
in the Order is consistent with Section
362 and 42 CFR 71.40, which permit the
prohibition of introduction into the
United States to be ‘‘in whole or in
part.’’ As explained in the Final Rule for
section 71.40, this language is intended
to allow the Director to narrowly tailor
the use of the authority to what is
required in the interest of public
health.103 Pursuant to this capability,
CDC is therefore excepting specific
categories of persons from the Order, as
described herein.
As required by Section 362, this Order
will be in effect only for as long as it is
needed to avert the serious danger of the
introduction, transmission, and spread
of COVID–19 into the United States and
will be terminated when the
continuation of the Order is no longer
necessary to protect the public health.
Finally, as directed by 42 CFR 71.40(c),
the Order sets out the following:
(1) The foreign countries (or one or
more political subdivisions or regions
thereof) or places from which the
introduction of persons is being
prohibited;
(2) The period of time or
circumstances under which the
introduction of any persons or class of
persons into the United States is being
prohibited;
reduction of this strain as a result of CDC’s
previously issued orders. Id. at 56431.
102 42 CFR 71.40(e) and (f).
103 85 FR 56424, 56444.
E:\FR\FM\05AUN1.SGM
05AUN1
42840
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
khammond on DSKJM1Z7X2PROD with NOTICES
(3) The conditions under which that
prohibition on introduction will be
effective, in whole or in part, including
any relevant exceptions that the Director
determines are appropriate;
(4) The means by which the
prohibition will be implemented; and
(5) The serious danger posed by the
introduction of the quarantinable
communicable disease in the foreign
country or countries (or one or more
political subdivisions or regions thereof)
or places from which the introduction of
persons is being prohibited.
III. Issuance and Implementation of
Order
Based on the foregoing public health
reassessment, I hereby 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 under 42 CFR part 71,104
which authorize the CDC Director to
suspend the right to introduce 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 hereby
replaces and supersedes the Order
Suspending the Right to Introduce
Certain Persons from Countries Where a
Quarantinable Communicable Disease
Exists, issued on October 13, 2020
(October Order) 105 and affirms and
incorporates the exception for UC
published in the July Exception, such
that UC are excepted from this Order.106
This Order addresses the current
status of the COVID–19 public health
emergency and ongoing public health
concerns, including virus transmission
dynamics, viral variants, mitigation
efforts, the public health risks inherent
to high migration volumes, low
vaccination rates among migrants, and
crowding of immigration facilities. In
making this determination, I have
considered myriad facts, including the
congregate nature of border facilities
and the high risk for COVID–19
outbreaks—especially now with the
predominant, more transmissible Delta
104 Control of Communicable Diseases; Foreign
Quarantine: Suspension of the Right to Introduce
and Prohibition of Introduction of Persons into
United States from Designated Foreign Countries or
Places for Public Health Purposes, 85 FR 56424
(Sept. 11, 2020); 42 CFR 71.40.
105 Supra note 4.
106 Supra note 3.
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
variant—presented following the
introduction of an infected person, as
well as the benefits of reducing such
risks. I have also considered
epidemiological information, including
the viral transmissibility and
asymptomatic transmission of COVID–
19, the epidemiology and spread of
SARS–CoV–2 variants, the morbidity
and mortality associated with the
disease for individuals in certain risk
categories, as well as public health
concerns with crowding at border
facilities and resultant risk of
transmission of additional quarantinable
communicable diseases. I am issuing
this Order to preserve the health and
safety of U.S. citizens, U.S. nationals,
and lawful permanent residents, and
personnel and noncitizens in POE and
U.S. Border Patrol stations by reducing
the introduction, transmission, and
spread of the virus that causes COVID–
19, including new and existing variants,
in congregate settings where covered
noncitizens would otherwise be held
while undergoing immigration
processing, including at POE and U.S.
Border Patrol stations at or near the U.S.
land and adjacent coastal borders.
Based on an assessment of the current
COVID–19 epidemiologic landscape and
the U.S. government’s ongoing efforts to
accommodate UC, CDC does not find
public health justification for this Order
to apply with respect to UC, as outlined
in the July Exception. Although CDC
finds that, at this time, this Order
should be applicable to FMU, CDC notes
that there are fewer FMU than SA
unlawfully entering the United States
and many FMU are already being
processed pursuant to Title 8 versus
Title 42 given a variety of practical and
other limitations on immediately
expelling FMU. DHS has indicated that
it plans to continue to partner with state
and local agencies and
nongovernmental organizations to
provide testing, consequence
management, and eventually
vaccination to FMU who are determined
to be eligible for Title 8 processing. CDC
considers these efforts to be a critical
risk reduction measure and encourages
DHS to evaluate the potential expansion
of such COVID–19 mitigation programs
for FMU such that they may be excepted
from this Order in the future. Although
vaccination programs are not available
at this time, CDC encourages DHS to
develop such programs as quickly as
practicable. While the migration of SA
and FMU into the United States during
the COVID–19 public health emergency
continues and given the inherent risks
that accompany holding these groups in
crowded congregate settings with
PO 00000
Frm 00065
Fmt 4703
Sfmt 4703
insufficient options for effective
mitigation, CDC finds the public health
justification for this Order is sustained
at this time.
DHS has indicated that it is
committed to restoring border
operations and facilitating arrivals to the
United States in a manner that comports
with CDC’s recommended COVID–19
mitigation protocols. Given the recent
migrant surge, DHS believes that an
incremental approach is the best way to
recommence normal border operations
while ensuring health and safety
concerns are addressed. To this end,
DHS will work to establish safe,
efficient, and orderly processes that are
consistent with appropriate health and
safety protocols and the epidemiology of
the COVID–19 pandemic, in
consultation with CDC.
CDC’s expectation is that although
this Order will continue with respect to
SA and FMU, DHS will use case-by-case
exceptions based on the totality of the
circumstances where appropriate to
except individual SA and FMU in a
manner that gradually recommences
normal migration operations as COVID–
19 health and safety protocols and
capacity allows. DHS will consult with
CDC to ensure that the standards for
such exceptions are consistent with
current CDC guidance and public health
recommendations. Based on this
incorporation of relevant COVID–19
mitigation measures, CDC believes it is
consistent with the legal authorities and
in the public health interest to continue
the use of case-by-case exceptions as a
step towards the resumption of normal
border operations under Title 8.
Additionally, DHS is working in
coordination with nongovernmental
organizations, state and local health
departments, and other relevant
facilitating organizations and entities as
appropriate to develop DHS-approved
processes that include pre-entry
COVID–19 testing. Additional public
health mitigation measures, such as
maintaining physical distancing and use
of masks, testing, and isolation and
quarantine as appropriate, are included
in such processes. DHS has documented
these processes and shared them with
CDC. CDC has consulted with DHS to
ensure that the processes appropriately
address public health concerns and
align with relevant CDC COVID–19
mitigation protocols. Based on these
plans and processes, CDC believes it is
consistent with legal authorities and in
the public health interest to permit an
exception for noncitizens in such DHSapproved processes to allow for safe and
orderly entry into the United States.
E:\FR\FM\05AUN1.SGM
05AUN1
Federal Register / Vol. 86, No. 148 / Thursday, August 5, 2021 / Notices
A. Covered Noncitizens
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 POE or
U.S. Border Patrol station at or near the
U.S. land and adjacent coastal borders
subject to certain exceptions detailed
below; this includes noncitizens who do
not have proper travel documents,
noncitizens whose entry is otherwise
contrary to law, and noncitizens who
are apprehended at or near the border
seeking to unlawfully enter the United
States between POE. For purposes of
this Order, I refer to persons covered by
the Order as ‘‘covered noncitizens.’’
B. Exceptions
khammond on DSKJM1Z7X2PROD with NOTICES
This Order does not apply to the
following:
• U.S. citizens, U.S. nationals, and
lawful permanent residents; 107
• Members of the armed forces of the
United States and associated personnel,
U.S. government employees or
contractors on orders abroad, or their
accompanying family members who are
on their orders or are members of their
household, subject to required
assurances; 108
• Noncitizens who hold valid travel
documents and arrive at a POE;
• Noncitizens in the visa waiver
program who are not otherwise subject
to travel restrictions and arrive at a POE;
• Unaccompanied Noncitizen
Children; 109
• Noncitizens who would otherwise
be subject to this Order, who are
permitted to enter the U.S. as part of a
DHS-approved process, where the
process approved by DHS has been
documented and shared with CDC, and
includes appropriate COVID–19
mitigation protocols, per CDC guidance;
and
• Persons whom customs officers
determine, with approval from a
supervisor, should be excepted from
this Order based on the totality of the
circumstances, including consideration
of significant law enforcement, officer
and public safety, humanitarian, and
public health interests. DHS will
consult with CDC regarding the
standards for such exceptions to help
ensure consistency with current CDC
CFR 71.40(f).
CFR 71.40(e)(1) and (3).
109 As excepted pursuant to the Public Health
Determination Regarding an Exception for
Unaccompanied Noncitizen Children from Order
Suspending the Right to Introduce Certain Persons
from Countries Where a Quarantinable
Communicable Disease Exists. 86 FR 38717 (July
22, 2021).
guidance and public health
recommendations.
C. APA, Review, and Termination
This Order shall be immediately
effective. I consulted with DHS and
other federal departments as needed
before I issued this Order and requested
that DHS continue to aid in the
enforcement of this Order because CDC
does not have the capability, resources,
or personnel needed to do so.110 As part
of the consultation, DHS developed
operational plans for implementing this
Order. CDC has reviewed these plans
and finds them to be consistent with the
language of this Order directing that
covered noncitizens spend as little time
in congregate settings as practicable
under the circumstances. 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 noncitizens involved, and
the likelihood that covered noncitizens
do not have homes in the United
States.111
This Order is not a rule subject to
notice and comment under the
Administrative Procedure Act (APA).
Even if it were, 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 delayed effective date. Given the
public health emergency caused by
COVID–19, it would be impracticable
and contrary to public health practices
and the public interest to delay the
issuing and effective date of this Order
with respect to all covered noncitizens.
In addition, this Order concerns ongoing
discussions with Canada and Mexico on
how best to control COVID–19
transmission over our shared borders
and therefore directly ‘‘involve[s] . . . a
. . . foreign affairs function of the
United States;’’ 112 thus, notice and
comment and a delay in effective date
are not required.
This Order shall remain effective until
either the expiration of the Secretary of
HHS’ declaration that COVID–19
constitutes a public health emergency,
or I determine that the danger of further
introduction, transmission, or spread of
COVID–19 into the United States has
ceased to be a serious danger to the
107 42
108 42
VerDate Sep<11>2014
17:07 Aug 04, 2021
Jkt 253001
110 42
U.S.C. 268; 42 CFR 71.40(d).
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 noncitizens.
112 5 U.S.C. 553(a)(1).
111 CDC
PO 00000
Frm 00066
Fmt 4703
Sfmt 4703
42841
public health and continuation of this
Order is no longer necessary to protect
public health, whichever occurs first. At
least every 60 days, the CDC shall
review the latest information regarding
the status of the COVID–19 public
health emergency and associated public
health risks, including migration
patterns, sanitation concerns, and any
improvement or deterioration of
conditions at the U.S. border, to
determine whether 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. I retain the
authority to modify or terminate the
Order, or its implementation, 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.
Dated: August 3, 2021.
Sherri Berger,
Chief of Staff, Centers for Disease Control
and Prevention.
[FR Doc. 2021–16856 Filed 8–3–21; 4:15 pm]
BILLING CODE 4163–18–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid
Services
[Document Identifier: CMS–10148 and CMS–
10784]
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Centers for Medicare &
Medicaid Services, Health and Human
Services (HHS).
ACTION: Notice.
AGENCY:
The Centers for Medicare &
Medicaid Services (CMS) is announcing
an opportunity for the public to
comment on CMS’ intention to collect
information from the public. Under the
Paperwork Reduction Act of 1995 (the
PRA), federal agencies are required to
publish notice in the Federal Register
concerning each proposed collection of
information (including each proposed
extension or reinstatement of an existing
collection of information) and to allow
60 days for public comment on the
proposed action. Interested persons are
invited to send comments regarding our
SUMMARY:
E:\FR\FM\05AUN1.SGM
05AUN1
]]>Agencies
[Federal Register Volume 86, Number 148 (Thursday, August 5, 2021)]
[Notices]
[Pages 42828-42841]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-16856]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
Public Health Reassessment and 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.
-----------------------------------------------------------------------
SUMMARY: The Centers for Disease Control and Prevention (CDC), a
component of the Department of Health and Human Services (HHS),
announces an Order to replace and supersede the Order Suspending the
Right to Introduce Certain Persons from
[[Page 42829]]
Countries Where a Quarantinable Communicable Disease Exists, issued on
October 13, 2020 (``October Order''). Following an assessment of the
current status of the COVID-19 public health emergency and the
situation in congregate settings where noncitizens seeking to enter the
United States are processed and held, CDC has determined that an Order
remains appropriate at this time for all ``covered noncitizens'' as
defined in the order. Unaccompanied noncitizen children, already
excepted under a July 16, 2021 order, remain excepted from the order's
coverage. In addition, CDC is continuing an exception for individuals
on a case-by-case basis, based on the totality of the circumstances,
and is incorporating an additional exception for programs approved by
the U.S. Department of Homeland Security (DHS) that incorporate
appropriate COVID-19 mitigation protocols as recommended by CDC.
DATES: This Order went into effect August 2, 2021.
FOR FURTHER INFORMATION CONTACT: Tiffany Brown, Deputy Chief of Staff,
Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS
H21-10, Atlanta, GA 30329. Phone: 404-639-7000. Email:
[email protected].
SUPPLEMENTARY INFORMATION: CDC has determined that an Order under 42
U.S.C. 265 remains necessary to protect U.S. citizens, U.S. nationals,
lawful permanent residents, personnel and noncitizens at the ports of
entry (POE) and U.S. Border Patrol stations, and destination
communities in the United States during the COVID-19 public health
emergency. This Order reflects the current, highly dynamic conditions
regarding COVID-19, including variants of concern and levels of
vaccination, as well as evolving circumstances specific to the U.S.
borders. As facts change, CDC may further modify the Order. This Order
will remain in place until either the expiration of the Secretary of
HHS' declaration that COVID-19 constitutes a public health emergency,
or the CDC Director determines that the danger of further introduction
of COVID-19 into the United States has declined such that continuation
of the Order is no longer necessary to protect public health, whichever
occurs first. The circumstances necessitating the Order will be
reassessed at least every 60 days. This Order continues the suspension
of the right to introduce ``covered noncitizens,'' \1\ into the United
States along the U.S. land and adjacent coastal borders. In recognition
of the specific COVID-19 mitigation measures available in facilities
providing care for Unaccompanied Noncitizen Children (UC), CDC excepted
UC from the October Order \2\ on July 16, 2021 (July Exception) and
continues that exception herein.\3\ In addition, CDC is continuing an
exception for individuals on a case-by-case basis, based on the
totality of the circumstances, and is incorporating an additional
exception for programs approved by the U.S. Department of Homeland
Security (DHS) that incorporate appropriate COVID-19 mitigation
protocols as recommended by CDC.
---------------------------------------------------------------------------
\1\ The term ``covered noncitizens'' is defined as persons
traveling from Canada or Mexico (regardless of their country of
origin) who would otherwise be introduced into a congregate setting
in a POE or U.S. Border Patrol station at or near the U.S. land and
adjacent coastal borders subject to certain exceptions detailed
below; this includes noncitizens who do not have proper travel
documents, noncitizens whose entry is otherwise contrary to law, and
noncitizens who are apprehended at or near the border seeking to
unlawfully enter the United States between POE.
\2\ Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists, 85 FR
65806 (Oct. 16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from Countries Where a
Communicable Disease Exists, issued on March 20, 2020 (March Order)
and subsequently extended and amended. Notice of Order Under
Sections 362 and 365 of the Public Health Service Act Suspending
Introduction of Certain Persons from Countries Where a Communicable
Disease Exists, 85 FR 17060 (Mar. 26, 2020); Extension of Order
Under Sections 362 and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From Countries Where a
Communicable Disease Exists, 85 FR 22424 (Apr. 22, 2020); Amendment
and Extension of Order Under Sections 362 and 365 of the Public
Health Service Act; Order Suspending Introduction of Certain Persons
from Countries Where a Communicable Disease Exists, 85 FR 31503 (May
26, 2020).
\3\ Public Health Determination Regarding an Exception for
Unaccompanied Noncitizen Children from Order Suspending the Right to
Introduce Certain Persons from Countries Where a Quarantinable
Communicable Disease Exists, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019-ncov/more/pdf/NoticeUnaccompaniedChildren.pdf (July 16, 2021); see 86 FR 38717
(July 22, 2021). The July Exception relating to UC is hereby made a
part of this Order and incorporated by reference as if fully set
forth herein.
---------------------------------------------------------------------------
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/downloads/CDC-Order-Suspending-Right-to-Introduce-_Final_8-2-21.pdf.
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) and 42 CFR 71.40
Public Health Reassessment and Order Suspending the Right To Introduce
Certain Persons From Countries Where a Quarantinable Communicable
Disease Exists
Executive Summary
The Centers for Disease Control and Prevention (CDC), a component
of the U.S. Department of Health and Human Services (HHS), is hereby
replacing and superseding the Order Suspending the Right to Introduce
Certain Persons from Countries Where a Quarantinable Communicable
Disease Exists, issued on October 13, 2020 (October Order). The instant
Order continues the suspension of the right to introduce ``covered
noncitizens,'' as defined herein,\4\ into the United States along the
U.S. land and adjacent coastal borders. In recognition of the specific
COVID-19 mitigation measures available in facilities providing care for
Unaccompanied Noncitizen Children (UC), CDC excepted UC from the
October Order on July 16, 2021 (July Exception) and continues that
exception herein.\5\ Following an assessment of the current status of
the COVID-19 public health emergency and the situation in congregate
settings where noncitizens seeking to enter the United States are
processed and held, CDC has determined that an Order remains
appropriate at this time for all other covered noncitizens as described
herein. As outlined below, CDC is continuing an exception for
individuals on a case-by-case basis, based on the totality of the
circumstances, and is incorporating an additional exception for
programs approved by the U.S. Department of Homeland Security (DHS)
that incorporate appropriate COVID-19 mitigation protocols as
recommended by CDC.
---------------------------------------------------------------------------
\4\ See infra Section III.A.
\5\ Public Health Determination Regarding an Exception for
Unaccompanied Noncitizen Children from Order Suspending the Right to
Introduce Certain Persons from Countries Where a Quarantinable
Communicable Disease Exists, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019-ncov/more/pdf/NoticeUnaccompaniedChildren.pdf (July 16, 2021); see 86 FR 38717
(July 22, 2021). The July Exception relating to UC is hereby made a
part of this Order and incorporated by reference as if fully set
forth herein.
---------------------------------------------------------------------------
CDC has determined that an Order under 42 U.S.C. 265 remains
necessary
[[Page 42830]]
to protect U.S. citizens, U.S. nationals, lawful permanent residents,
personnel and noncitizens at the ports of entry (POE) and U.S. Border
Patrol stations, and destination communities in the United States
during the COVID-19 public health emergency. This Order reflects the
current, highly dynamic conditions regarding COVID-19, including
variants of concern and levels of vaccination, as well as evolving
circumstances specific to the U.S. borders. As facts change, CDC may
further modify the Order. This Order will remain in place until either
the expiration of the Secretary of HHS' declaration that COVID-19
constitutes a public health emergency, or the CDC Director determines
that the danger of further introduction of COVID-19 into the United
States has declined such that continuation of the Order is no longer
necessary to protect public health, whichever occurs first. The
circumstances necessitating the Order will be reassessed at least every
60 days.
Outline of Reassessment and Order
I. Background
A. Current Status of COVID-19 Public Health Emergency
B. Public Health Factors Related to COVID-19
1. Manner of COVID-19 Transmission
2. Emerging Variants of the SARS-CoV-2 Virus
3. Risks of COVID-19 Transmission Specific To Congregate
Settings
4. Availability of Testing, Vaccines, and Other Mitigation
Measures
5. Impact on U.S. Communities and Healthcare Resources
II. Public Health Reassessment
A. Immigration Processing and Public Health Impacts
B. Public Health Assessment of Single Adults and Family Units
C. Comparison to Unaccompanied Noncitizen Children
D. Summary of Findings
III. Legal Basis for the Order
IV. Issuance and Implementation of the Order
A. Covered Noncitizens
B. Exceptions
C. APA, Review, and Termination
I. Background
Coronavirus disease 2019 (COVID-19) is a quarantinable communicable
disease \6\ caused by the SARS-CoV-2 virus. As part of U.S. government
efforts to mitigate the introduction, transmission, and spread of
COVID-19, CDC issued an Order on October 13, 2020 (October Order),
replacing an Order initially issued on March 20, 2020 (March Order),\7\
suspending the right to introduce \8\ certain persons into the United
States from countries or places where the quarantinable communicable
disease exists in order to protect the public health from an increase
in risk of the introduction of COVID-19. The October Order applied
specifically to covered noncitizens who would otherwise be introduced
into a congregate setting in land or coastal POE or U.S. Border Patrol
stations at or near the U.S. borders \9\ with Canada and Mexico. On
February 17, 2021, CDC published a notice announcing the temporary
exception of unaccompanied noncitizen children (UC) \10\ encountered in
the United States from the October Order.\11\ The exception of UC from
the October Order was confirmed with the publication of the July
Exception.\12\
---------------------------------------------------------------------------
\6\ Quarantinable communicable diseases are any of the
communicable diseases listed in Executive Order, as provided under
Sec. 361 of the Public Health Service Act (42 U.S.C. 264). 42 CFR
71.1. The list of quarantinable communicable diseases currently
includes cholera, diphtheria, infectious tuberculosis, plague,
smallpox, yellow fever, viral hemorrhagic fevers (Lassa, Marburg,
Ebola, Crimean-Congo, South American, and others not yet isolated or
named), severe acute respiratory syndromes (including Middle East
respiratory syndrome and COVID-19), and influenza caused by novel or
reemergent influenza viruses that are causing, or have the potential
to cause, a pandemic. See Exec. Order 13295, 68 FR 17255 (Apr. 4,
2003), as amended by Exec. Order 13375, 70 FR 17299 (Apr. 1, 2005)
and Exec. Order 13674, 79 FR 45671 (July 31, 2014).
\7\ Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists, 85 FR
65806 (Oct. 16, 2020). The October Order replaced the Order
Suspending Introduction of Certain Persons from Countries Where a
Communicable Disease Exists, issued on March 20, 2020 (March Order),
and subsequently extended and amended. Notice of Order Under
Sections 362 and 365 of the Public Health Service Act Suspending
Introduction of Certain Persons from Countries Where a Communicable
Disease Exists, 85 FR 17060 (Mar. 26, 2020); Extension of Order
Under Sections 362 and 365 of the Public Health Service Act; Order
Suspending Introduction of Certain Persons From Countries Where a
Communicable Disease Exists, 85 FR 22424 (Apr. 22, 2020); Amendment
and Extension of Order Under Sections 362 and 365 of the Public
Health Service Act; Order Suspending Introduction of Certain Persons
from Countries Where a Communicable Disease Exists, 85 FR 31503 (May
26, 2020).
\8\ 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).
\9\ When U.S. Customs and Border Protection (CBP) or the U.S.
Department of Homeland Security (DHS) partner agencies encounter
noncitizens off the coast closely adjacent to the land borders, it
transfers the noncitizens for processing in POE or U.S. Border
Patrol stations closest to the encounter. Absent the October Order,
such noncitizens would be held in the same congregate settings and
holding facilities as any encounters along the land border,
resulting in similar public health concerns related to the
introduction, transmission, and spread of COVID-19.
\10\ As stated in the July Exception, CDC's understanding is
that UC are a class of individuals similar to or the same as those
individuals who would be considered ``unaccompanied alien children''
(see 6 U.S.C. 279) for purposes of HHS Office of Refugee
Resettlement custody, were DHS to make the necessary immigration
determinations under Title 8 of the U.S. Code. 86 FR 38717, 38718 at
note 4.
\11\ Notice of Temporary Exception from Expulsion of
Unaccompanied Noncitizen Children Pending Forthcoming Public Health
Determination, 86 FR 9942 (Feb. 17, 2021).
\12\ Supra note 2.
---------------------------------------------------------------------------
POE and U.S. Border Patrol stations are operated by U.S. Customs
and Border Protection (CBP), an agency within DHS. The March and
October Orders were intended to reduce the risk of COVID-19
introduction, transmission, and spread in POE and U.S. Border Patrol
stations by significantly reducing the number and density of covered
noncitizens held in these congregate settings, thereby reducing risks
to U.S. citizens and residents, DHS/CBP personnel and noncitizens at
the facilities, and the healthcare systems in local communities
overall. Because of the congregate nature of these facilities and the
sustained community transmission of COVID-19, including the highly
transmissible B.1.617.2 (Delta) variant, in both the United States and
migrants' countries of origin and transit, at this time, there
continues to be a high risk of COVID-19 outbreaks in these facilities
following the introduction of an infected person. Upon reassessment of
the current situation with respect to the pandemic and the situation at
the U.S. borders, CDC finds an Order under 42 U.S.C. 265 for Single
Adults (SA) \13\ and Family Units (FMU) \14\ remains necessary at this
time, as discussed in detail below. CDC also recognizes the
availability of testing, vaccines, and other mitigation protocols can
minimize risk in this area. As the ability of DHS facilities to employ
mitigation measures to address the COVID-19 public health emergency
increases, CDC anticipates additional lifting of restrictions.
---------------------------------------------------------------------------
\13\ A single adult (SA) is any noncitizen adult 18 years or
older who is not an individual in a ``family unit,'' see infra note
11.
\14\ An individual in a family unit (FMU) includes any
individual in a group of two or more noncitizens consisting of a
minor or minors accompanied by their adult parent(s) or legal
guardian(s). Any statistics regarding FMU count the number of
individuals in a family unit rather than counting the groups.
---------------------------------------------------------------------------
A. Current Status of COVID-19 Public Health Emergency
Since late 2019, SARS-CoV-2, the virus that causes COVID-19, has
spread throughout the world, resulting in a pandemic. As of July 28,
2021, there have been over 195 million confirmed cases of COVID-19
globally, resulting in over 4.1 million deaths.\15\ The United
[[Page 42831]]
States has reported over 34 million cases resulting in over 609,000
deaths due to the disease \16\ and is currently averaging around 61,976
new cases of COVID-19 a day as of July 27, 2021 with high community
transmission.\17\ Although several of the key indicators of
transmission and spread of COVID-19 in the United States improved
during the first half of 2021, variants of concern, particularly the
more transmissible Delta variant, have driven a stark increase in
COVID-19 cases, hospitalizations, and deaths. COVID-19 cases increased
approximately 400% between June 19 and July 28, 2021.\18\
---------------------------------------------------------------------------
\15\ Coronavirus disease (COVID-19) pandemic, World Health
Organization, https://covid19.who.int/ (last visited July 28, 2021).
\16\ COVID Data Tracker, Centers for Disease Control and
Prevention, https://covid.cdc.gov/covid-data-tracker/#datatracker-home (last visited July 28, 2021).
\17\ United States COVID-19 Cases, Deaths, and Laboratory
Testing (NAATs) by State, Territory, and Jurisdiction, Centers for
Disease Control and Prevention, https://covid.cdc.gov/covid-data-tracker/#cases_community (last visited July 28, 2021).
\18\ Christie A, Brooks JT, Hicks LA, et al. Guidance for
Implementing COVID-19 Prevention Strategies in the Context of
Varying Community Transmission Levels and Vaccination Coverage. MMWR
Morb Mortal Wkly Rep. ePub: 27 July 2021. DOI: https://dx.doi.org/10.15585/mmwr.mm7030e2.
---------------------------------------------------------------------------
Many countries have begun widespread vaccine administration;
however, 78 countries continue to experience high or substantial
incidence rates (>=50 cases per 100,000 people in the last seven days)
and 123 countries, including the United States, are experiencing an
increasing incidence of reported new cases.\19\ It is imperative that
individuals and communities stay vigilant and that vaccination and
other COVID-19 mitigation efforts are maintained. As the Delta variant
continues to spread, both the United States and Mexico are experiencing
high or substantial incidence rates with 137.9 and 68.6 daily cases per
100,000 persons over a seven-day average, respectively; in Canada, the
incidence rate is 8.0. The United States saw a 91.0% increase in new
cases over the past week, Mexico experienced a 30.2% increase in new
cases. During the same time period, the incidence rate in Canada
increased by 14.8%.\20\
---------------------------------------------------------------------------
\19\ See Global Trends, Epidemic Curve trajectory
Classification, WHO, as reported at https://covid.cdc.gov/covid-data-tracker/#global-trends (last visited July 28, 2021).
\20\ Low/Moderate incidence describes <50 cases per 100,000
people during the past 7 days. Increasing or Decreasing incidence is
based on the percentage change in the number of cases reported in
the past 7 days compared to the 7 days prior to that (Increasing:
>0% change, Decreasing: <0% change).
---------------------------------------------------------------------------
COVID-19 was first declared a public health emergency in January
2020 \21\ and the U.S. government and CDC have implemented a number of
COVID-19 mitigation and response measures since that time. Many of
these mitigation measures have involved restrictions on international
travel and migration.\22\ Other measures have focused on recommending
and enforcing COVID-19 mitigation efforts, including physical
distancing and mask-wearing.\23\ Recent concerns regarding the spread
of the Delta variant prompted CDC to release updated guidance calling
for vaccinated persons to wear a mask indoors in public when in an area
of substantial or high transmission.\24\ Furthermore, CDC recommends
that all individuals, including those fully vaccinated, continue to
wear a well-fitted face mask in correctional and detention
facilities.\25\
---------------------------------------------------------------------------
\21\ Determination that a Public Health Emergency Exists, U.S.
Department of Health and Human Services (Jan. 31, 2020), https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx
(last visited July 21, 2021). The public health emergency
determination has been subsequently renewed at 90-day intervals,
most recently on July 28, 2021. See https://www.phe.gov/emergency/news/healthactions/phe/Pages/COVID-19July2021.aspx (last visited
July 28, 2021).
\22\ The President issued proclamations suspending entry into
the United States of immigrants or nonimmigrants who were physically
present within a number of countries during the 14-day period
preceding their entry or attempted entry into the U.S. See
Proclamation 9984 (Jan. 31, 2020); Proclamation 9992 (Feb. 28,
2020); Proclamation 10143 (Jan. 25, 2021); and Proclamation 10199
(Apr. 30, 2021). Since March 2020, Canada and Mexico have joined
with the U.S. to restrict non-essential travel along land borders to
prevent the introduction and spread of the virus that causes COVID-
19; these restrictions are in place until at least August 21, 2021.
Notification of Temporary Travel Restrictions Applicable to Land
Ports of Entry and Ferries Service Between the U.S. and Canada, 86
FR 38556 (July 22, 2021); Notification of Temporary Travel
Restrictions Applicable to Land Ports of Entry and Ferries Service
Between the U.S. and Mexico, 86 FR 38554 (July 22, 2021). CDC has
also issued orders to mitigate risk of further introducing and
spreading SARS CoV-2 and its variants into the United States. See
Framework for Conditional Sailing and Initial Phase COVID-19 Testing
Requirements for Protection of Crew, 85 FR 70153 (Nov. 4, 2020)
(outlining the process for the phased resumption of cruise ship
passenger operations); Requirement for Negative Pre-Departure COVID-
19 Test Result or Documentation of Recovery from COVID-19 for all
Airline or Other Aircraft Passengers Arriving into the U.S. from Any
Foreign Country, 86 FR 7387 (Jan. 28, 2021); and COVID-19 Travel
Recommendations by Destination, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html#travel-1 (last updated July 26, 2021)
(COVID-19-related travel recommendations, including 62 Level 4
Travel Health Notices for countries with very high COVID-19 rates).
\23\ CDC's Order requiring the wearing of face masks by
travelers while on a conveyance entering, traveling within, or
departing the United States and in U.S. transportation hubs remains
in place for all travelers at indoor settings on public
transportation conveyances and at transportation hubs, regardless of
vaccination. Requirement for Persons to Wear Masks While on
Conveyances and at Transportation Hubs, 86 FR 8025 (Feb. 3, 2021).
See Requirement for Face Masks on Public Transportation Conveyances
and at Transportation Hubs, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019-ncov/travelers/face-masks-public-transportation.html (last updated June 10, 2021).
\24\ Supra note 15 (CDC also recommends fully vaccinated persons
consider wearing a mask regardless of transmission level if they or
someone in their household is immunocompromised or at increased risk
for severe disease, or if someone in their household is unvaccinated
(including children currently ineligible for vaccination)); see also
infra page 11, section 5 (discussion of ``high'' and ``substantial
transmission'').
\25\ Interim Public Health Recommendations for Fully Vaccinated
People, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html (last updated May 28, 2021).
---------------------------------------------------------------------------
B. Public Health Factors Related to COVID-19
As directed by Executive Order,\26\ CDC conducted a comprehensive
reassessment of the October Order to determine whether the suspension
of the right to introduce certain persons into the United States
remains necessary in light of the current circumstances, including the
evolving understanding of the epidemiology of COVID-19 variants and
available mitigation measures including testing and vaccination.\27\ In
conducting this reassessment, CDC examined a number of public health
factors, and evaluated how these factors impact POE and U.S. Border
Patrol stations and the personnel and noncitizens in those facilities.
CDC also scrutinized whether the potential impacts varied by category
of noncitizen: SA, FMU, and UC. In carrying out its reassessment, CDC
evaluated the following public health factors: (1) The manner of COVID-
19 transmission, including asymptomatic and pre-symptomatic
transmission; (2) the emerging variants of the SARS-CoV-2 virus; (3)
the risks specific to the type of facility or congregate setting; (4)
the availability of testing and vaccines and the applicability of other
mitigation efforts; and (5) the impact on U.S. communities and
healthcare resources. CDC views this public health reassessment as
setting forth a roadmap toward the safe resumption of normal processing
of arriving noncitizens, taking into account COVID-19 concerns and
immigration facilities' ability to implement mitigation measures.
---------------------------------------------------------------------------
\26\ Exec. Order 14010, ``Creating a Comprehensive Regional
Framework To Address the Causes of Migration, To Manage Migration
Throughout North and Central America, and To Provide Safe and
Orderly Processing of Asylum Seekers at the United States Border,''
86 FR 8267 (Feb. 2, 2021).
\27\ CDC's reassessment of the public health situation with
respect to covered noncitizens and border facilities relies upon
information and data provided by DHS, CBP, and HHS' Office of
Refugee Resettlement, including information regarding those
entities' policies and practices.
---------------------------------------------------------------------------
[[Page 42832]]
1. Manner of COVID-19 Transmission
SARS-CoV-2, the virus that causes COVID-19, spreads mainly from
person-to-person through respiratory fluids released during exhalation,
such as when an infected person coughs, sneezes, or talks. Exposure to
these respiratory fluids occurs in three principal ways: (1) Inhalation
of very fine respiratory droplets and aerosol particles, (2) deposition
of respiratory droplets and particles on exposed mucous membranes in
the mouth, nose, or eye by direct splashes and sprays, and (3) touching
mucous membranes with hands that have been soiled either directly by
virus-containing respiratory fluids or indirectly by touching surfaces
with virus on them.\28\ Spread is more likely when people are in close
contact with one another (within about 6 feet), especially in crowded
or poorly ventilated indoor settings. Unvaccinated persons with
asymptomatic and pre-symptomatic infection are significant contributors
to community SARS-CoV-2 transmission and occurrence of COVID-19.\29\
Asymptomatic cases are currently believed to represent roughly 30% of
all COVID-19 infections and the infectiousness of asymptomatic
individuals is believed to be about 75% of the infectiousness of
symptomatic individuals. CDC's current best estimate is that 50% of
infections are transmitted prior to symptom onset (pre-symptomatic
transmission).\30\ Although rare, as discussed below, breakthrough
infections may occur in vaccinated individuals. Due to the variety of
source of spread--transmission by asymptomatic, pre-symptomatic,
symptomatic, and vaccinated individuals--testing is critical to
identify those infected with COVID-19.
---------------------------------------------------------------------------
\28\ Scientific Brief: SARS-CoV-2 Transmission, Centers for
Disease Control and Prevention (May 7, 2021), https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html; Science Brief: SARS-CoV-2 and Surface (Fomite)
Transmission for Indoor Community Environments, Centers for Disease
Control and Prevention (Apr. 5, 2021), https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html.
\29\ Moghadas SM, Fitzpatrick MC, Sah P, et al. The implications
of silent transmission for the control of COVID-19 outbreaks. Proc
Natl Acad Sci U S A. 2020;117(30):17513-17515.10.1073/
pnas.2008373117, available at https://www.ncbi.nlm.nih.gov/pubmed/32632012; Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2
Transmission From People Without COVID-19 Symptoms. Johansson MA, et
al. JAMA Netw Open. 2021 January4;4(1):e2035057. doi: 10.1001/
jamanetworkopen.2020.35057.
\30\ COVID-19 Pandemic Planning Scenarios, Centers for Disease
Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html (last visited July 28, 2021).
---------------------------------------------------------------------------
Among those who are not vaccinated, serious COVID-19 illness
necessitating treatment occurs with greater frequency in older adults
and those with certain pre-existing conditions.\31\ Although children
can be infected with SARS-CoV-2, get sick from COVID-19, and spread the
virus to others, when compared with adults, children and adolescents
who have COVID-19 are more commonly asymptomatic or have mild, non-
specific symptoms. Children are less likely to develop severe illness
or die from COVID-19.\32\ They typically present with mild symptoms, if
any, and have a good prognosis, recovering within one to two weeks
after disease onset.\33\
---------------------------------------------------------------------------
\31\ People at Increased Risk and Other People Who Need to Take
Extra Precautions, Centers for Disease Control and Prevention,
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/ (last updated Apr. 20, 2021).
\32\ Science Brief: Transmission of SARS-CoV-2 in K-12 Schools
and Early Care and Education Programs--Updated, Centers for Disease
Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/transmission_k_12_schools.html (last updated
July 9, 2021).
\33\ See Leeb RT, Price S, Sliwa S, et al. COVID-19 Trends Among
School-Aged Children--United States, March 1-September 19, 2020.
MMWR Morb Mortal Wkly Rep 2020;69:1410-1415. DOI: https://dx.doi.org/10.15585/mmwr.mm6939e2; Leidman E, Duca LM, Omura JD, Proia K,
Stephens JW, Sauber-Schatz EK. COVID-19 Trends Among Persons Aged 0-
24 Years--United States, March 1-December 12, 2020. MMWR Morb Mortal
Wkly Rep 2021;70:88-94. DOI: https://dx.doi.org/10.15585/mmwr.mm7003e1; Rankin DA, Talj R, Howard LM, Halasa NB.
Epidemiologic trends and characteristics of SARS-CoV-2 infections
among children in the United States. Curr Opin Pediatr. 2021 Feb
1;33(1):114-121. doi: 10.1097/MOP.0000000000000971. PMID: 33278112;
PMCID: PMC8011299; and Castagnoli R, Votto M, Licari A, et al.
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Infection in Children and Adolescents: A Systematic Review. JAMA
Pediatr. 2020;174(9):882-889. doi:10.1001/jamapediatrics.2020.1467.
---------------------------------------------------------------------------
2. Emerging Variants of the SARS-CoV-2 Virus
Like all viruses, SARS-CoV-2 constantly changes through mutation as
it circulates, resulting in new virus variants over time.\34\ Unchecked
transmission of SARS-CoV-2 may result in increased viral mutations and
the emergence of new variants. New variants of SARS-CoV-2 have emerged
globally,\35\ several of which have been identified as variants of
concern,\36\ including the Alpha, Beta, Gamma, and Delta variants.
These variants of concern have evidence of an increase in
transmissibility and more severe disease, which may lead to higher
incidence, hospitalization, and death rates among exposed persons.\37\
Furthermore, findings suggest variants may reduce levels of
neutralization by antibodies generated during previous infection or
vaccination, resulting in reduced effectiveness of treatments or
vaccines, or increased diagnostic detection failures.\38\ The ultimate
concern is a variant that substantially decreases the effectiveness of
available vaccines against severe or deadly disease.
---------------------------------------------------------------------------
\34\ About Variants of the Virus that Causes COVID-19, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html (last updated Apr. 2, 2021).
\35\ Abdool Karim SS, de Oliveira T. New SARS-CoV-2 Variants--
Clinical, Public Health, and Vaccine Implications [published online
ahead of print, 2021 Mar 24]. N Engl J Med. 2021;10.1056/
NEJMc2100362. doi:10.1056/NEJMc2100362.
\36\ Id.
\37\ Dougherty K, Mannell M, Naqvi O, Matson D, Stone J. SARS-
CoV-2 B.1.617.2 (Delta) Variant COVID-19 Outbreak Associated with a
Gymnastics Facility--Oklahoma, April-May 2021. MMWR Morb Mortal Wkly
Rep 2021;70:1004-1007. DOI: https://dx.doi.org/10.15585/mmwr.mm7028e2
(describing a B.1.617.2 (Delta) Variant COVID-19 outbreak associated
with a gymnastics facility and finding that the Delta variant is
highly transmissible in indoor sports settings and households, which
might lead to increased incidence rates).
\38\ SARS-CoV-2 Variant Classifications and Definitions, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html#Concern (last updated June 29,
2021).
---------------------------------------------------------------------------
Currently, the Delta variant is the predominant SARS-CoV-2 strain
circulating in the United States, accounting for over 82% of cases as
of July 17, 2021.\39\ Of critical significance for this Order, the
Delta variant has demonstrated increased levels of transmissibility
among unvaccinated persons and might increase the risk of vaccine
breakthrough infections in the absence of other mitigation
strategies.\40\ For the unvaccinated, Delta remains a formidable threat
and rates of infection of the Delta variant are growing more rapidly in
U.S. counties with lower vaccination rates.\41\ Available evidence
suggests all three vaccines currently authorized for emergency use in
the United States provide significant protection against variants
circulating in the United States.\42\ However, a small
[[Page 42833]]
proportion of people who are fully vaccinated may become infected with
the Delta variant (known as breakthrough infection); emerging evidence
suggests that fully vaccinated persons who do become infected with the
Delta variant are at risk for transmitting it to others.\43\
---------------------------------------------------------------------------
\39\ Variant Proportions, Centers for Disease Control and
Prevention, https://covid.cdc.gov/covid-data-tracker/#variant-proportions (citing data for the two-week interval ending July 17,
2021).
\40\ About Variants of the Virus that Causes COVID-19, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/variants/variant.html (last updated June 28, 2021).
\41\ COVID Data Tracker Weekly Review, Interpretive Summary for
July 23, 2021, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/
(attributing rising numbers of COVID-19 cases in nearly 90% of U.S.
jurisdictions to the rapid spread of the Delta variant).
\42\ Science Brief: COVID-19 Vaccines and Vaccination, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html (last
updated May 27, 2021). Other vaccines, particularly the one
manufactured by AstraZeneca, show reduced efficacy against infection
with certain variants but may still protect against severe disease;
at the time of the issuance of this Order, the FDA has not
authorized the AstraZeneca COVID-19 vaccine for use in the United
States.
\43\ Supra note 15.
---------------------------------------------------------------------------
CDC continues to monitor the situation and may adapt
recommendations based on the epidemiology of variants of concern. Given
the transmissibility of variant strains and the continued emergence of
new variants, ongoing monitoring of vaccine effectiveness is needed to
identify mutations that could render vaccines most commonly used in the
United States less effective against more transmissible variants.\44\
---------------------------------------------------------------------------
\44\ See About Variants of the Virus that Causes COVID-19, supra
note 37.
---------------------------------------------------------------------------
3. Risks of COVID-19 Transmission Specific to Congregate Settings
Given the manner of transmission, including asymptomatic or pre-
symptomatic transmission, the risk of spreading COVID-19 is
particularly pronounced among those who are unvaccinated, partially
vaccinated, or vaccinated with less effective vaccines.\45\ This risk
is acutely present in congregate settings, where a number of people
reside, meet, or gather in close proximity for either a limited or
extended period of time.\46\ Facilities must often carefully weigh the
risks of increased transmission not only in the facilities, but also in
the local community, due to secondary transmission. These congregate
facilities must also consider individual facility and community
characteristics (e.g., ability to maintain physical distancing,
compliance with universal mask-use policies, ability to properly
ventilate, proportion of staff and occupants vaccinated, numbers of
those who are at increased risk for severe illness from COVID-19, the
availability of resources for broad-based vaccination, testing, and
outbreak response, and level of community transmission).\47\
---------------------------------------------------------------------------
\45\ Vaccines with effectiveness of less than 50% against
wildtype strains of COVID-19 are considered less effective.
\46\ Notably, COVID-19 has disproportionately affected persons
in congregate settings and high-density workplaces. Studies
conducted prior to the availability of vaccines showed that a single
introduction of SARS-CoV-2 into a facility can result in a
widespread outbreak. Lehnertz NB, Wang X, Garfin J, Taylor J,
Zipprich J, VonBank B, et al. Transmission Dynamics of Severe Acute
Respiratory Syndrome Coronavirus 2 in High-Density Settings,
Minnesota, USA, March-June 2020. Emerg Infect Dis. 2021;27(8):2052-
2063. https://doi.org/10.3201/eid2708.204838. Whole genome
sequencing of samples taken following an outbreak at a correctional
facility demonstrated that 92.2% of the samples taken from patients
were genetically related, indicating that a single case had likely
led to the infection of 48 individuals. Similarly, phylogenetic
analysis established that 29.6% of cases from an outbreak at a
second correctional facility were closely related and genetically
identical, indicating that the index case had led to the infection
of approximately 60 others.
\47\ See Recommendations for Quarantine Duration in Correctional
Facilities, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/quarantine-duration-correctional-facilities.html (last visited July 28, 2021).
---------------------------------------------------------------------------
Congregate settings, particularly detention facilities with limited
ability to provide adequate physical distancing and cohorting, have a
heightened risk of COVID-19 outbreaks.\48\ CDC has long recognized the
risks specific to such settings, including homeless shelters, detention
centers, schools, and workplaces and has provided a number of guidance
documents to address the concerns in such spaces. Specifically, CDC
developed interim guidance for law enforcement agencies that have
custodial authority for detained populations, including civil and pre-
trial detention settings. Among the recommendations are physical
distancing strategies, isolation of individuals with confirmed or
suspected COVID-19, quarantine of close contacts, cohorting of
individuals when space is limited, testing, healthcare evaluations for
individuals with suspected COVID-19, clinical care as needed for
individuals with confirmed or suspected COVID-19, and addressing
specific considerations for people who are at increased risk for severe
illness.\49\
---------------------------------------------------------------------------
\48\ Since March 31, 2020, the U.S. Federal Bureau of Prisons
and state departments of corrections have together recorded 416,854
COVID-19 cases among residents and 108,945 cases among staff in
correctional and detention facilities, resulting in 2,911 deaths.
Confirmed COVID-19 Cases and Deaths in U.S. Correctional and
Detention Facilities by State, Centers for Disease Control and
Prevention, https://covid.cdc.gov/covid-data-tracker/#correctional-facilities (last visited July 28, 2021).
\49\ See Guidance for Correctional & Detention Facilities,
Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html (last updated June 9, 2021).
---------------------------------------------------------------------------
Vaccine coverage in congregate settings varies and infection risk
is greater where there is sustained community transmission.\50\ In
light of this, CDC strongly recommends vaccination against COVID-19 for
everyone who is eligible, including people who are incarcerated or
detained and staff at correctional and detention facilities.\51\ CDC is
discussing additional guidance with DHS, highlighting the key metrics
to consider before modifying COVID-19 prevention and mitigation
measures in facilities that hold or detain migrants.\52\
---------------------------------------------------------------------------
\50\ Falk A, Benda A, Falk P, Steffen S, Wallace Z, H[oslash]eg
TB. COVID-19 Cases and Transmission in 17 K-12 Schools--Wood County,
Wisconsin, August 31-November 29, 2020. MMWR Morb Mortal Wkly Rep
2021;70:136-140. DOI: https://dx.doi.org/10.15585/mmwr.mm7004e3. See
also Link-Gelles R, DellaGrotta AL, Molina C, et al. Limited
Secondary Transmission of SARS-CoV-2 in Child Care Programs--Rhode
Island, June 1-July 31, 2020. MMWR Morb Mortal Wkly Rep
2020;69:1170-1172. DOI: https://dx.doi.org/10.15585/mmwr.mm6934e2.
\51\ COVID-19 Vaccine FAQs in Correctional and Detention
Centers, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/vaccine-faqs.html (last updated June 1, 2021).
\52\ See CDC memo to DHS ``Considerations for modifying COVID-19
prevention and mitigation measures in Department of Homeland
Security migrant holding facilities in response to declining
transmission,'' Centers for Disease Control and Prevention (last
updated June 11, 2021).
---------------------------------------------------------------------------
4. Availability of Testing, Vaccines, and Other Mitigation Measures
The potential for asymptomatic and pre-symptomatic transmission
makes testing an essential part of COVID-19 mitigation protocols. With
the additional testing capacity available through antigen tests, rapid
testing can be implemented to identify infected persons so they can be
isolated until they no longer pose a risk of spreading infections and
their close contacts can be identified and quarantined.\53\ Testing is
especially important in congregate settings where even a single
asymptomatic case can trigger an outbreak that may quickly exceed a
facility's capacity to isolate and quarantine residents. Furthermore,
if personnel are infected or exposed, the number of available staff
members may be reduced, further stressing facility operations. Testing
facility residents and personnel can help facilitate prompt mitigation
actions.
---------------------------------------------------------------------------
\53\ See COVID-19 Testing and Diagnostics Working Group (TDWG).
U.S. Department of Health and Human Services, https://www.hhs.gov/coronavirus/testing/testing-diagnostics-working-group/
(last visited July 28, 2021) (defining the role of the COVID-19
TDWG, which develops testing-related guidance and provides targeted
investments to expand the available testing supply and maximize
testing capacity).
---------------------------------------------------------------------------
COVID-19 vaccines are now widely available in the United States,
and vaccination is recommended for all people 12 years of age and up.
Three COVID-19 vaccines are currently authorized by the U.S. Food and
Drug Administration (FDA) for emergency use: Two mRNA vaccines
(produced by Pfizer-BioNTech and Moderna) and one viral vector vaccine
(produced by
[[Page 42834]]
Johnson & Johnson/Janssen), each of which has been determined to be
safe and effective against COVID-19. As of July 28, 2021, over 163
million people in the United States (57.6% of the population 12 years
or older) have been fully vaccinated and over 189 million people in the
United States (66.8% of the population 12 years or older) have received
at least one dose.\54\ After substantial vaccine uptake in the first
months of 2021, however, vaccination uptake has plateaued, particularly
in those under the age of 65 years.\55\ The combination of reduced
vaccine uptake and the extreme transmissibility of the Delta variant
has resulted in rising numbers of COVID-19 cases, primarily and
disproportionately affecting the unvaccinated population.
---------------------------------------------------------------------------
\54\ COVID-19 Vaccinations in the United States, Centers for
Disease Control and Prevention, https://covid.cdc.gov/covid-data-tracker/#vaccinations (last updated July 28, 2021).
\55\ Diesel J, Sterrett N, Dasgupta S, et al. COVID-19
Vaccination Coverage Among Adults--United States, December 14, 2020-
May 22, 2021. MMWR Morb Mortal Wkly Rep 2021;70: 922-927. DOI:
https://dx.doi.org/10.15585/mmwr.mm7025e1. The study found that the
lowest vaccination coverage and the intent to be vaccinated among
adults aged 18-24 years, non-Hispanic Black adults, and individuals
with less education, no insurance, and lower household incomes.
Concerns about vaccine safety and effectiveness were commonly cited
barriers to vaccination. See also supra note 15 (finding that
vaccine uptake has slowed nationally with wide variation in coverage
by state (range = 33.9%-67.2%) and by county (range = 8.8%-89.0%)).
---------------------------------------------------------------------------
The availability of COVID-19 vaccines is rising globally but still
dwarfed by the rates of vaccination in the United States and a handful
of other countries.\56\ Countries of origin for the majority of
incoming covered noncitizens have markedly lower vaccination rates.\57\
Given this, the increased movement of typically unvaccinated covered
noncitizens into the United States presents a heightened risk of
morbidity and mortality to this population due to the congregate
holding facilities at the border and the practical constraints on
implementation of mitigation measures in such facilities. Outbreaks in
these settings increase the serious danger of further introduction,
transmission, and spread of COVID-19 and variants into the country.
---------------------------------------------------------------------------
\56\ See ``PAHO Director calls for fair and broad access to
COVID-19 vaccines for Latin America and the Caribbean,'' Pan
American Health Organization, https://www.paho.org/en/news/7-7-2021-paho-director-calls-fair-and-broad-access-covid-19-vaccines-latin-america-and (July 7, 2021) (noting the discrepancies in vaccine
availability coverage among North, Central, and South American
countries).
\57\ Thus far in 2021, Ecuador, El Salvador, Guatemala,
Honduras, and Mexico constitute the top five countries of origin for
covered noncitizens. Rates of vaccination for each country are as
follows: Ecuador: 11% fully vaccinated, 30% only partly vaccinated;
El Salvador: 22% fully vaccinated, 17% only partly vaccinated;
Guatemala: 1.6% fully vaccinated, 5.3% only partly vaccinated;
Honduras: 1.8% fully vaccinated, 12% only partly vaccinated; Mexico:
18% fully vaccinated, 14% only partly vaccinated, https://ourworldindata.org/covid-vaccinations (last visited July 24, 2021).
---------------------------------------------------------------------------
CDC is aware of a rising number of breakthrough SARS-CoV-2
infections \58\ in vaccinated individuals; even without variants of
concern, more vaccine breakthroughs are to be expected due to the
rising number of vaccinated individuals. While the vaccines currently
authorized by the FDA are successful in mitigating severe illness from
the highly transmissible Delta variant, infection and even mild to
moderate illness has been documented in a small percentage of
vaccinated persons.\59\ The emergence of these more transmissible
variants increases the urgency to expand vaccination coverage for
everyone and especially those in densely populated congregate
settings.\60\ Public health agencies and other organizations must
collaboratively monitor the status of the pandemic in their
communities. As widespread vaccination efforts continue, ongoing use of
the full panoply of mitigation measures is nevertheless especially
important in congregate settings and remains key to slowing
introduction, transmission, and spread of COVID-19.
---------------------------------------------------------------------------
\58\ A vaccine breakthrough infection is defined as the
detection of SARS-CoV-2 RNA or antigen in a respiratory specimen
collected from a person >=14 days after receipt of all recommended
doses of an FDA-authorized COVID-19 vaccine. COVID-19 Vaccine
Breakthrough Infections Reported to CDC--United States, January 1-
April 30, 2021. MMWR Morb Mortal Wkly Rep 2021;70:792-793. DOI:
https://dx.doi.org/10.15585/mmwr.mm7021e3.
\59\ COVID-19 Vaccine Breakthrough Case Investigation and
Reporting, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html (last updated July 15, 2021).
\60\ Supra at note 55.
---------------------------------------------------------------------------
5. Impact on U.S. Communities and Healthcare Resources
COVID-19 cases are on the rise in nearly 90% of U.S. jurisdictions,
and multiple outbreaks are occurring in parts of the country that have
low vaccination coverage. A person's risk for SARS-CoV-2 infection is
directly related to the risk for exposure to infectious persons, which
is largely determined by the extent of SARS-CoV-2 circulation in the
surrounding community. Emerging evidence regarding the Delta variant
finds that it is more than two times as transmissible as the original
strains of SARS-CoV-2 circulating at the start of the pandemic. In
light of this, CDC recommends assessing the level of community
transmission using, at a minimum, two metrics: New COVID-19 cases per
100,000 persons in the last 7 days and percentage of positive SARS-CoV-
2 diagnostic nucleic acid amplification tests in the last 7 days. For
each of these metrics, CDC classifies transmission values as low,
moderate, substantial, or high. At the time of this Order's issuance,
over 70% of the U.S. counties along the U.S.-Mexico border were
classified as experiencing high or substantial levels of community
transmission.\61\ In areas of substantial or high transmission, CDC
recommends community leaders encourage vaccination and universal
masking in indoor public spaces in addition to other layered prevention
strategies to prevent further spread.
---------------------------------------------------------------------------
\61\ Of the 22 U.S. counties along the U.S.-Mexico border, 13
counties are experiencing high levels of community transmission (San
Diego County, CA; Hidalgo County, NM; Presidio County, TX; Brewster
County, TX; Terrell County, TX; Val Verde County, TX; Kinney County,
TX; Maverick County, TX; Webb County, TX; Zapata County, TX; Starr
County, TX; Hidalgo County, TX; and Cameron County, TX) and four
counties are experiencing substantial levels of community
transmission (Imperial County, CA; Pima County, AZ; Santa Cruz
County, AZ; and Luna County, NM;). Five counties are experiencing
moderate levels of community transmission (Yuma County, AZ; Cochise
County, AZ; Dona Ana County, NM; El Paso County, TX; and Hudspeth
County, TX). No counties along the border are experiencing low
levels of community transmission. COVID-19 Integrated County View,
Centers for Disease Control and Prevention, https://covid.cdc.gov/covid-data-tracker/#county-view (last updated July 28, 2021).
---------------------------------------------------------------------------
Between March and June 2021, rates of hospitalization due to COVID-
19 decreased dramatically, easing long endured pressures on the U.S.
healthcare system. However, in July 2021, with the rise of the Delta
variant, the seven-day average for new hospital admissions in the
United States increased 35.8% over the prior seven-day period.\62\
Rates of hospitalization are rising most sharply in areas with low
vaccination coverage.\63\ CDC recommends continuous monitoring of the
availability of staffed inpatient and intensive care unit beds, as data
on usage of clinical care resources to manage patients with COVID-19
reflect underlying community disease incidence. This information can
signal when urgent implementation of layered prevention strategies
might be necessary to prevent overloading local and regional health
care systems. Strains on
[[Page 42835]]
critical care capacity can increase COVID-19 mortality while decreasing
the availability and use of health care resources for non-COVID-19
related medical care.\64\ Increased hospital admissions are forecasted
in the coming weeks as the Delta variant continues to predominate.\65\
---------------------------------------------------------------------------
\62\ COVID Data Tracker Weekly Review, Interpretive Summary for
July 16, 2021, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/past-reports/07162021.html (last visited July 28, 2021).
\63\ COVID Data Tracker Weekly Review, Interpretive Summary for
July 9, 2021, Centers for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/past-reports/07092021.html.
\64\ Supra note 15.
\65\ COVID-19 Forecasts: Hospitalizations, Centers for Disease
Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/science/forecasting/hospitalizations-forecasts.html (last updated
July 21, 2021).
---------------------------------------------------------------------------
The rapid spread of the highly transmissible Delta variant is
leading to worrisome trends in healthcare and community resources.
Signs of stress are already present in the southern regions of the
United States.\66\ Ultimately, the flow of migration directly impacts
not only border communities and regions, but also destination
communities and the healthcare resources of both. In light of this, the
totality of the U.S. community transmission, health system capacity,
and public health capacity, as well as local capacity to implement
mitigation protocols, are important considerations when reassessing the
need for this Order.\67\
---------------------------------------------------------------------------
\66\ See COVID Data Tracker: New Hospital Admissions, https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions (last
updated July 22, 2021) (showing HHS Regions 4, 6, and 9,
encompassing all southern states, experiencing increased rates of
new admissions of COVID-19-confirmed patients).
\67\ See Implementation of Mitigation Strategies for Communities
with Local COVID-19 Transmission, Centers for Disease Control and
Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/community-mitigation.html (last visited May 6, 2021).
---------------------------------------------------------------------------
II. Public Health Reassessment
A. Immigration Processing and Public Health Impacts
Noncitizens arriving in the United States who lack proper travel
documents, whose entry is otherwise contrary to law, or who are
apprehended at or near the border seeking to unlawfully enter the
United States between POE are normally subject to initial immigration
processing by CBP in POE facilities and U.S. Border Patrol stations.
Absent CDC's issuance of an order under 42 U.S.C. 265 directing
otherwise, immigration processing takes place pursuant to Title 8 of
the U.S. Code. Although some number of inadmissible noncitizens present
at POE, the vast majority are encountered by CBP between POE.\68\ Upon
such encounters, Border Patrol agents conduct an initial field
assessment and transport the individuals to a CBP facility for intake
processing.\69\
---------------------------------------------------------------------------
\68\ Fiscal year to date, 96% (1,076,242 of 1,119,204) of
encounters of noncitizens occurred between POE.
\69\ CBP facilities include POE, U.S. Border Patrol stations,
and facilities managed by the Office of Field Operations.
---------------------------------------------------------------------------
CBP facilities are designed to provide this short-term intake
processing and are thus space-constrained.\70\ While undergoing intake
processing under Title 8 at CBP facilities, noncitizens are regularly
held in close proximity to one another anywhere from several hours to
several days. Depending on the outcome of intake processing, a
noncitizen is generally referred to the DHS' Immigration and Customs
Enforcement (ICE), where they are often subject to longer-term
detention.71 72
---------------------------------------------------------------------------
\70\ CBP facilities were designed for the immediate processing
of persons and are statutorily designated as short-term (less than
72 hours) holding facilities. 6 U.S.C. 211(m).
\71\ FMU transferred to ICE custody are generally held at a
Family Staging Center (FSC). Following intake processing, UC are
referred to the Office of Refugee Resettlement (ORR) within HHS'
Administration for Children and Families (ACF) for care.
\72\ While CBP policies regarding transfer and release decisions
are the same across the Southwest Border, implementation varies
based on local CBP capacity, and ICE capacity.
---------------------------------------------------------------------------
Compared to CBP facilities, ICE facilities have space allocations
similar to traditional long-term correctional facilities. Still, during
migratory surges, capacity constraints hinder CBP and ICE operations
and facilities alike. If downstream ICE operations and facilities reach
capacity limits, ICE may be unable to take custody of additional
noncitizens in a timely manner. When this movement of noncitizens from
CBP to ICE custody is impeded or delayed, noncitizens may remain in
CBP's densely populated, short-term holding facilities for much longer
periods. Of note, the United States is currently experiencing such a
migratory surge of noncitizens attempting to enter the country at and
between POE at the southern border.\73\ DHS has already recorded more
encounters this fiscal year to date than the approximate 977,000
encounters in the whole of FY 2019.\74\
---------------------------------------------------------------------------
\73\ According to data from DHS, encounters at the southern
border have been rising since April 2020 due to several factors,
including ongoing violence, insecurity, and famine in the Northern
Triangle countries of Central America (El Salvador, Honduras,
Guatemala).
\74\ Southwest Land Border Encounters, U.S. Customs and Border
Protection, available at https://www.cbp.gov/newsroom/stats/southwest-land-border-encounters (last visited July 28, 2021).
---------------------------------------------------------------------------
CBP has implemented a variety of mitigation efforts to prevent the
spread of COVID-19 in POE and U.S. Border Patrol facilities based on
the infection prevention strategy referred to as the hierarchy of
controls.\75\ CBP has invested in engineering upgrades, such as
installing plexiglass dividers in facilities where physical distancing
is not possible and enhancing ventilation systems. All CBP facilities
adhere to CDC guidance for cleaning and disinfection. Surgical masks
are provided to all persons in custody and are changed at least daily
and if or when they become wet or soiled. Personal protective equipment
(PPE) and guidance are regularly provided to CBP personnel. Recognizing
the value of vaccination, CBP is encouraging vaccination among its
workforce. All noncitizens brought into CBP custody are subject to
health intake interviews, including COVID-19 screening questions and
temperature checks. If a noncitizen in custody displays symptoms of
COVID-19 or has a known exposure, CBP facilitates referral to the local
healthcare system for testing. Finally, in the event CBP decides to
release a noncitizen prior to removal proceedings, the agency has
coordinated with local governments and non-governmental organizations
to arrange COVID-19 testing at release.\76\
---------------------------------------------------------------------------
\75\ Hierarchy of Controls, Centers for Disease Control and
Prevention, available at https://www.cdc.gov/niosh/topics/hierarchy/default.html (last visited July 6, 2021). The hierarchy of controls
is used as a means of determining how to implement feasible and
effective control solutions. The hierarchy is outlined as: (1)
Elimination (physically remove the hazard); (2) Substitution
(replace the hazard); (3) Engineering Controls (isolate people from
the hazard); (4) Administrative Controls (change the way people
work); and (5) PPE (protect people with Personal Protective
Equipment).
\76\ This is also true of ICE facilities.
---------------------------------------------------------------------------
In addition to these mitigation measures, enhanced physical
distancing and cohorting remain key to preventing transmission and
spread of COVID-19, particularly in congregate settings. To address
this, as the pandemic emerged, CBP greatly reduced capacity in their
holding facilities. While U.S. Border Patrol facilities along the
southern border currently have a non-pandemic total holding capacity of
14,553 individuals, implementation of mitigation measures led to a 50-
75% reduction in holding capacity depending on the design of a given
facility, resulting in COVID-constrained holding capacity of 4,706.\77\
However, the current surge has caused CBP to exceed COVID-constrained
capacity and routinely exceed its non-COVID capacity.\78\ From July 3
to July 24, 2021,
[[Page 42836]]
CBP encountered an average of 3,573 SA and 2,479 FMU daily, over a 21-
day period, even with the CDC Order in place. This extreme population
density and the resulting increased time spent in custody by
noncitizens presents a serious risk of increased COVID-19 transmission
in CBP facilities.
---------------------------------------------------------------------------
\77\ Similarly, the operational holding capacity for SA in ICE
facilities was reduced by 30% from a regular total capacity of
56,888 beds to 39,821 beds.
\78\ Non-COVID-19 holding capacity was exceeded as recently as
July 25, 2021.
---------------------------------------------------------------------------
CBP faces unique challenges in implementing certain COVID-19
mitigation measures. All individuals encountered by U.S. Border Patrol
must be processed in CBP facilities. Not only does this involve close
and often continuing contact between CBP personnel and noncitizens, but
CBP is further constrained by requirements separate noncitizens within
its holding facilities according to specific permutations.\79\ These
cohorting requirements significantly complicate CBP's ability to
address COVID-19-related risks, as CBP facility capacity to accommodate
COVID-19 mitigation protocols may not always align with the makeup of
the incoming population of noncitizens and the categorical separations
required of DHS.
---------------------------------------------------------------------------
\79\ For example, criminal cases must be held separately from
administrative cases, SA must be separated by gender identity, FMU
and UC must be separated from SA, and all vulnerable individuals
must be protected from harm.
---------------------------------------------------------------------------
Immigration Processing Under Title 8 of the U.S. Code
The vast majority of noncitizens attempting to enter the United
States without proper travel documents are SA; SA account for 68% of
overall CBP encounters this fiscal year as of July 26, 2021. Under
normal Title 8 immigration processes, SA are transferred to ICE custody
pending removal proceedings. As noted above, absent expulsions directed
by an order under 42 U.S.C. 265, SA presenting at POE or attempting
entry between POE would be processed and held in CBP facilities while
awaiting transfer to ICE. Generally, CBP only releases SA into U.S.
communities as a last resort, due to severe overcrowding and when all
possible detention options have been explored.
A smaller percentage, 23%, of noncitizens encountered by CBP are
members of an FMU.\80\ As with SA, CBP has limited capacity to hold
FMU. Under Title 8, due to court-ordered restrictions that largely
prohibit the long-term detention of families, FMU are generally
released from DHS custody pending removal proceedings. Prior to
release, some FMU are transferred from CBP custody to Family Staging
Centers (FSC) operated by ICE. Only a limited number of FMU may be held
in an FSC, and time in custody for an FMU is generally about 2-3 days
before being released. FSC capacity is further limited by COVID-19
mitigation protocols.\81\
---------------------------------------------------------------------------
\80\ Thus far this fiscal year, as of July 26, 2021.
\81\ The total capacity for these FSCs is 3,230. However, due to
COVID-19 mitigation protocols and family composition limitations,
current operational capacity for the FSCs is approximately 2,400. In
July 2021, due to an influx of single adults at the SWB, ICE ceased
intake of family units at one of the FSCs and began to transition
the facility to hold single adults. With this transition, the
remaining COVID-limited FSC capacity for family units is
approximately 1,800. Additionally, ICE has procured 1,200 additional
beds at Emergency Family Staging Centers (EFSCs); this bed space is
not limited by family composition or COVID-19.
---------------------------------------------------------------------------
Releasing FMU to communities necessitates robust testing,
vaccination where possible, and careful attention to consequence
management (e.g., facilities for isolation and quarantine). DHS has
partnered with state and local agencies and non-governmental
organizations to facilitate COVID-19 testing of FMU upon release from
CBP custody. Pursuant to these arrangements, CBP generally transports
FMU to release locations where partner agencies and organizations are
on-site to provide testing and facilitate consequence management.
Although the implementing partners and their capacities (including for
consequence management such as housing) vary, the objectives are
constant. These resources, however, are limited. They are already
stretched thin, and certainly not available for all FMU who would be
processed under Title 8 in the absence of an order issued under 42
U.S.C. 265. DHS has committed to supporting and, where possible,
expanding these efforts, including exploring the incorporation of
vaccination into this model. CDC strongly supports DHS efforts that
include broad-based testing and vaccination.
Immigration Processing With an Order Under 42 U.S.C. 265
Following the issuance of the March and October Orders, covered
noncitizens apprehended at or near U.S. borders, regardless of their
country of origin, generally were expelled to Mexico or Canada,
whichever they entered from, via the nearest POE, or to their country
of origin. Where possible, SA and FMU eligible for expulsion based on
the March and October Orders have been processed pursuant to the Title
42 authority, unless a case-by-case exception was made by DHS.\82\
---------------------------------------------------------------------------
\82\ Some countries have put in place limitations that make
expulsion pursuant to Title 42 inapplicable. The October Order
excepted covered noncitizens ``who must test negative for COVID-19
before they are expelled to their home country'' and several
countries refuse to accept the return of SA and FMU and other
individuals unless DHS first secures a negative test result for each
individual to be returned. These noncitizens are thus not covered by
the prior Order and thus cannot be expelled pursuant to Title 42.
See 85 FR at 65807.
---------------------------------------------------------------------------
Even with the March and October Orders in place, a significant
percentage of FMU were unable to be expelled pursuant to the order,
given a range of factors, including, most notably, restrictions imposed
by foreign governments.\83\ For example, the Mexican government has
placed certain nationality- and demographic-specific restrictions on
the individuals it will accept for return via the Title 42 expulsion
process. With limited exceptions, the Mexican government will only
accept the return of Mexican and Northern Triangle nationals. Moreover,
along sections of the border, Mexican officials refuse to accept the
return of any non-Mexican family with children under the age of seven,
greatly reducing DHS' ability to expel FMU. In addition, many countries
impose travel requirements, including COVID-19 testing, consular
interviews, and identity verification that can delay repatriation.
These added requirements often make prompt expulsion a practical
impossibility. Conversely, DHS continues to be able to process the
majority of SA under Title 42.\84\ In those cases where Title 42
processing is not possible, SA and FMU are instead processed pursuant
to Title 8. Processing noncitizens and issuing a Notice to Appear under
Title 8 processes takes approximately an hour and a half to two hours
per person. Conversely, processing an individual for expulsion under
the CDC order takes roughly 15 minutes and generally happens outdoors.
---------------------------------------------------------------------------
\83\ Only 33% of FMU encountered fiscal year to date have been
expelled under Title 42 and this percentage has fallen over time. In
June 2021, only 14% of FMU were expelled under Title 42, an average
of approximately 300 per day.
\84\ Fiscal year to date, 89% of SA have been expelled under
Title 42. This percentage has fallen slightly as the constraints on
expelling individuals have increased. In June 2021, 82% of SA were
expelled under Title 42, an average of over 3,000 per day.
---------------------------------------------------------------------------
The March and October Orders permitted noncitizens to be promptly
returned to their country of origin, rather than being transferred to
ICE custody or released into the United States, resulting in
noncitizens spending shorter amounts of time in custody at CBP
facilities. However, as the number of noncitizens attempting to enter
the United States has surged and as individuals cannot be expelled
pursuant to Title 42 given the restrictions in place, the time in
custody at CBP facilities has increased for SA and FMU, even with the
October Order in place. As of July 29, 2021, the current average time
in custody at CBP facilities for SA
[[Page 42837]]
not subject to expulsion under the October Order is 50 hours. FMU
currently spend an average of 62 hours in CBP custody prior to release
or transfer to ICE. If the CDC Order were not in place, both SA and FMU
time in custody would likely increase significantly.
B. Public Health Assessment of Single Adults and Family Units
Implementation of CDC's March and October Orders significantly
reduced the length of time covered noncitizen SA and FMU are held in
congregate settings at POE and U.S. Border Patrol stations, as well as
in the ICE facilities that subsequently hold noncitizens.\85\ By
reducing congestion in these facilities, the Orders have helped lessen
the introduction, transmission, and spread of COVID-19 among border
facilities and into the United States while also decreasing the risk of
exposure to COVID-19 for DHS personnel and others in the facilities.
Implementation of the Orders has mitigated the potential erosion of DHS
operational capacity due to COVID-19 outbreaks. The reduction in the
number of SA and FMU held in these congregate settings continues to be
a necessary mitigation measure as DHS moves towards the resumption of
normal border operations.
---------------------------------------------------------------------------
\85\ For example, when processing noncitizens under Title 8,
prior to referral to ICE or release into the community, CBP
generally issues the noncitizen a ``Notice to Appear'' (also called
an I-862), which is a charging document that initiates removal
proceedings against the noncitizen and may include a court date or
direct the noncitizen to report to an ICE office to receive a court
date.
---------------------------------------------------------------------------
The availability of testing, vaccination, and other mitigation
measures \86\ at migrant holding facilities must also be considered.
While downstream ICE facilities may have greater ability to provide
these measures, CBP cannot appropriately execute consequence management
measures to minimize spread or transmission of COVID-19 within its
facilities. Space constraints, for example, preclude implementation of
cohorting and consequence management such as quarantine and isolation.
Covered noncitizens housed in congregate settings who may be infected
with COVID-19 may ultimately increase community transmission rates in
the United States, especially among susceptible populations (i.e., non-
immune, under-vaccinated, and non-vaccinated persons). Mitigation
measures, especially testing and vaccination, must be considered for
the noncitizens being held, as well as for facility personnel. On-site
COVID-19 testing for noncitizens at CBP holding facilities is very
limited and the majority of testing takes place off-site. For example,
if a noncitizen is transported to a community healthcare facility for
medical care, testing is provided based on local protocols. Once
transferred to ICE custody, testing for SA and FMU is more widely
available.
---------------------------------------------------------------------------
\86\ See Interim Guidance on Management of Coronavirus Disease
2019 (COVID-19) in Correctional and Detention Facilities, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html#correctional-facilities (last visited July 28, 2021).
---------------------------------------------------------------------------
Although COVID-19-related healthcare resources have substantially
improved since the October Order was issued, emerging variants and the
potential for a future vaccine-resistant variant mean the possible
impacts on U.S. communities and local healthcare resources in the event
of a COVID-19 outbreak at CBP facilities cannot be ignored. The
introduction, transmission, and spread of SARS-CoV-2--including its
variants--among covered noncitizens during processing and holding at
congregate CBP settings remain a significant concern to the
noncitizens, CBP personnel, as well as the community at large in light
of transmission to unvaccinated individuals and the potential for
breakthrough cases. Of particular note, POE and U.S. Border Patrol
stations are ill-equipped to manage an outbreak and these facilities
are heavily reliant on local healthcare systems for the provision of
more extensive medical services to noncitizens.\87\ Transfers to local
healthcare systems for care could strain local or regional healthcare
resources. Reliance on healthcare resources in border and destination
communities may increase the pressure on the U.S. healthcare system and
supply chain during the current public health emergency.\88\ Of note,
hospitalization rates are once again soaring nationally as the Delta
variant spreads and the vaccination rate of the public lags. Ensuring
the continued availability of healthcare resources is a critical
component of the federal government's overall public health response to
COVID-19.
---------------------------------------------------------------------------
\87\ See CBP Directive No. 2210-004, U.S. Customs and Border
Protection, https://www.cbp.gov/sites/default/files/assets/documents/2019-Dec/CBP_Final_Medical_Directive_123019.pdf (Dec. 30,
2019). Many of the U.S. Border Patrol stations and POE facilities
are located in remote areas and do not have ready access to local
healthcare systems (which typically serve small, rural populations
and have limited resources). 85 FR 56424, 56433. See also Abubakar
I, Aldridge RW, Devakumar D, et al. The UCL-Lancet Commission on
Migration and Health: the health of a world on the move. Lancet.
2018;392(10164):2606-2654. doi:10.1016/S0140-6736(18)32114-7.
\88\ See COVID-19 State Profile Report--Combined Set,
HealthData.gov, https://healthdata.gov/Community/COVID-19-State-Profile-Report-Combined-Set/5mth-2h7d (last updated July 28, 2021).
---------------------------------------------------------------------------
Given the nature of COVID-19, there is no zero-risk scenario,
particularly in congregate settings and with variants as transmissible
as that of Delta in high circulation in the country. The ongoing
pandemic presents complex and dynamic challenges relating to public
health that limit DHS' ability to process noncitizens safely under
normal Title 8 procedures. Processing a noncitizen under Title 8 can
take up to eight times as long as processing a noncitizen under Title
42. Importantly, longer processing times result in longer exposure
times to a heightened risk of COVID-19 transmission for both
noncitizens and CBP personnel. Amid the ongoing migrant surge, both the
COVID-19-reduced capacity and higher non-COVID holding capacity limits
have been exceeded in CBP facilities. Complete termination of any order
under 42 U.S.C. 265 would increase the number of noncitizens requiring
processing under Title 8, resulting in severe overcrowding and a high
risk of COVID-19 transmission among those held in the facilities and
the CBP workforce, ultimately burdening the local healthcare
system.\89\
---------------------------------------------------------------------------
\89\ Throughout the course of the COVID-19 pandemic, CDC has
observed numerous outbreaks in similar congregate settings. See FAQs
for Correctional and Detention Facilities, Centers for Disease
Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/faq.html (last visited Apr. 15,
2021).
---------------------------------------------------------------------------
All of this is of particular concern as the Delta variant continues
to drive an increase in COVID-19 cases. While scientists learn more
about Delta and other emerging variants, rigorous and increased
compliance with public health mitigation strategies is essential to
protect public health.\90\ Reducing the further introduction,
transmission, and spread of these variants and future variants of
concern into the United States is key to defeating COVID-19. CDC has
concluded that SA and FMU should continue to be subject to the Order at
this time pending further improvements in the public health situation.
---------------------------------------------------------------------------
\90\ About Variants of the Virus that Causes COVID-19, Centers
for Disease Control and Prevention, https://www.cdc.gov/coronavirus/2019-ncov/transmission/variant.html (last updated Apr. 2, 2021).
---------------------------------------------------------------------------
C. Comparison to Unaccompanied Noncitizen Children
As discussed in the July Exception, UC are differently situated
than SA and
[[Page 42838]]
FMU. The Government has greater ability to care for UC while
implementing appropriate COVID-19 mitigation measures. ORR has
established a robust network of care facilities that provide testing
and medical care and institute COVID-19 mitigation protocols, including
vaccination for personnel and eligible UC. In light of these
considerations, there is very low likelihood that processing UC in
accordance with existing Title 8 procedures will result in undue strain
on the U.S. healthcare system or healthcare resources. Moreover, UC
released to a vetted sponsor or placed in a temporary or licensed ORR
shelter do not pose a significant level of risk for COVID-19 spread
into the community. UC are released only after having undergone
testing, quarantine and/or isolation, and vaccination when possible,
and their sponsors are provided with appropriate medical and public
health direction. CDC thus finds that, at this time,\91\ there is
appropriate infrastructure in place to protect the children,
caregivers, and local and destination communities from elevated risk of
COVID-19 transmission. CDC believes the COVID-19-related public health
concerns associated with UC introduction can be adequately addressed
without UC being subject to this Order. As outlined in the July
Exception and incorporated herein, CDC is fully excepting UC from this
Order. The number of UC entering the United States is smaller than both
the number of SA \92\ and of FMU. Whereas UC can be excepted from the
Order without posing a significant public health risk, the same is not
true of SA and FMU, as described above.
---------------------------------------------------------------------------
\91\ This situation could change based on an increased influx of
UC, changes in COVID-19 infection dynamics among UC, or unforeseen
reductions in housing capacity.
\92\ Note, the total number of SA encounters may include repeat
encounters with SA who attempt entry again following expulsion.
---------------------------------------------------------------------------
D. Summary of Findings
Upon review of the various public health factors outlined above and
in consideration of the circumstances at DHS facilities, it is CDC's
assessment that suspending the right to introduce covered noncitizen SA
and FMU who would otherwise be held at POE and U.S. Border Patrol
stations remains necessary as the United States continues to combat the
COVID-19 public health emergency. In making this determination, CDC has
considered various possible alternatives (including but not limited to
terminating the application of an order under 42 U.S.C. 265 for some or
all SA and FMU, modifying the availability of exceptions for individual
SA and FMU in an order under 42 U.S.C. 265, and reissuing an order
under 42 U.S.C. 265 for some or all UC); but for the reasons discussed
herein, CDC finds that the continued suspension of the right to
introduce SA and FMU under the terms set forth herein, combined with
the exception for UC, is appropriate at this time. This temporary
suspension pending further improvements in the public health situation
and greater ability to implement COVID-19 mitigation measures in
migrant holding facilities will slow the influx of noncitizens into
environments at higher risk for COVID-19 transmission and spread.
DHS has indicated a commitment to restoring border operations in a
manner that complies with applicable COVID-19 mitigation protocols
while also accounting for other public health and humanitarian
concerns. In light of available mitigation measures, and with DHS'
pledge to expand capacity in a COVID-safe manner similar to expansions
undertaken by HHS and ORR to address UC influx, CDC believes that the
gradual resumption of normal border operations under Title 8 is
feasible. With careful planning, this may be initiated in a stepwise
manner that complies with COVID-19 mitigation protocols. HHS and CDC
intend to support DHS in this effort and continues to work with DHS to
provide technical guidance on COVID-19 mitigation strategies for their
unique facilities and populations.\93\ CDC understands that DHS intends
to continue exercising case-by-case exceptions for individual SA and
FMU based on a totality of the circumstances as CDC transitions away
from this Order. CDC is also providing an additional exception to
permit DHS to except noncitizens participating in a DHS-approved
program that incorporates pre-processing COVID-19 testing in Mexico of
the noncitizens, prior to their safe and orderly entry to the U.S. via
ports of entry. Based on the incorporation of relevant COVID-19
mitigation measures in such programs, in consultation with CDC, CDC
believes such an exception is consistent with its legal authorities and
in the public health interest.
---------------------------------------------------------------------------
\93\ CDC has advised DHS on best practices with regard to
testing noncitizens at the point they are released to U.S.
communities to await further immigration proceedings. In addition to
enforcing physical distancing (as practicable), mask-wearing, and
testing for both noncitizens and personnel alike in POE and U.S.
Border Patrol stations, CDC advises vaccination of DHS/CBP personnel
to further reduce the risk of COVID-19 introduction, transmission,
and spread in facilities and communities and protect the federal
workforce. Widespread vaccination of federal employees and other
personnel in congregate settings at POE and U.S. Border Patrol
stations is another layer of the strategy that will lead to the
normalization of border operations.
---------------------------------------------------------------------------
II. Legal Basis for This Order Under Sections 362 and 365 of the Public
Health Service Act and 42 CFR 71.40
CDC is issuing this Order pursuant to sections 362 and 365 of the
Public Health Service Act (42 U.S.C. 265, 268) and the implementing
regulation at 42 CFR 71.40. In accordance with these authorities, the
CDC Director is permitted to prohibit, in whole or in part, the
introduction into the United States of persons from designated foreign
countries (or one or more political subdivisions or regions thereof) or
places, only for such period of time that the Director deems necessary
to avert the serious danger of the introduction of a quarantinable
communicable disease, by issuing an Order in which the Director
determines that:
(1) By reason of the existence of any quarantinable communicable
disease in a foreign country (or one or more political subdivisions or
regions thereof) or place there is serious danger of the introduction
of such quarantinable communicable disease into the United States; and
(2) This danger is so increased by the introduction of persons from
such country (or one or more political subdivisions or regions thereof)
or place that a suspension of the right to introduce such persons into
the United States is required in the interest of public health.\94\
---------------------------------------------------------------------------
\94\ 42 U.S.C. 265; 42 CFR 71.40.
---------------------------------------------------------------------------
CDC has authority under Section 362 and the implementing regulation
to issue this Order to mitigate the further spread of COVID-19 disease,
especially as the need to prevent proliferation of COVID-19 disease
related to SARS-CoV-2 virus variants is heightened while vaccination
efforts continue. Section 362 and the implementing regulation provide
the Director with a public health tool to suspend introduction of
persons not only to prevent the introduction of a quarantinable
communicable disease, but also to aid in continued efforts to mitigate
spread of that disease.\95\
---------------------------------------------------------------------------
\95\ 85 FR 56424 at 56425-26.
---------------------------------------------------------------------------
The term ``introduction into the United States'' is defined in 42
CFR 71.40 as ``the movement of a person from a foreign country (or one
or more political subdivisions or regions thereof) or place, or series
of foreign countries or places, into the United States so as to bring
the person into contact with persons or property in the United States,
[[Page 42839]]
in a manner that the Director determines to present a risk of
transmission of a quarantinable communicable disease to persons, or a
risk of contamination of property with a quarantinable communicable
disease, even if the quarantinable communicable disease has already
been introduced, transmitted, or is spreading within the United
States.'' 42 CFR 71.40(b)(1). Similarly, the term ``serious danger of
the introduction of such quarantinable communicable disease into the
United States'' is defined as, ``the probable introduction of one or
more persons capable of transmitting the quarantinable communicable
disease into the United States, even if persons or property in the
United States are already infected or contaminated with the
quarantinable communicable disease.'' 42 CFR 71.40(b)(3).
In promulgating Sec. 71.40, CDC and HHS noted that
```introduction' does not necessarily conclude the instant that a
person first steps onto U.S. soil. The introduction of a person into
the United States can occur not only when a person first steps onto
U.S. soil, but also when a person on U.S. soil moves further into the
United States, and begins to come into contact with persons or property
in ways that increase the risk of transmitting the quarantinable
communicable disease.'' \96\ This language recognizes that many
quarantinable communicable diseases, including COVID-19, may be spread
by infected individuals who are asymptomatic and therefore unaware that
they are capable of transmitting the disease. Even when a communicable
disease is already circulating within the United States, prevention and
mitigation of continued transmission of the virus is nevertheless a key
public health measure. In this case, although COVID-19 has already been
introduced and is spreading within the United States, this Order serves
as an important disease-mitigation tool to protect public health. This
is particularly true as new variants of the virus continue to emerge.
By continuing to suspend the introduction of persons from foreign
countries into the United States, this Order will help minimize the
spread of variants and their ability to accelerate disease
transmission.
---------------------------------------------------------------------------
\96\ Id. at 56425.
---------------------------------------------------------------------------
Section 71.40(b)(2) defines ``[p]rohibit, in whole or in part, the
introduction into the United States of persons'' in Section 362 as ``to
prevent the introduction of persons into the United States by
suspending any right to introduce into the United States, physically
stopping or restricting movement into the United States, or physically
expelling from the United States some or all of the persons.'' See also
42 U.S.C. 265 (authorizing the prohibition when the danger posed by the
communicable disease ``is so increased by the introduction of persons
from such country . . . or place that a suspension of the right to
introduce such persons into the United States is required in the
interest of public health''). Pursuant to that provision, this Order
permits expulsion of persons covered by it, as did the prior Orders
issued under this authority.\97\ CDC recognizes that expulsion is an
extraordinary action but, as explained in the Final Rule, the power to
expel is critical where neither HHS/CDC, nor other Federal agencies,
nor state or local governments have the facilities and personnel
necessary to quarantine, isolate, or conditionally release the number
of persons who would otherwise increase the serious danger of the
introduction of a quarantinable communicable disease into the United
States.\98\ In those situations, the rapid expulsion of persons from
the United States may be the most effective public health measure that
HHS/CDC can implement within the finite resources of HHS/CDC and its
Federal, State, and local partners.\99\
---------------------------------------------------------------------------
\97\ See id. at 56425, 56433.
\98\ Id. at 56425, 56445-46.
\99\ Id. at 56425.
---------------------------------------------------------------------------
As stated in the Final Rule for 42 CFR 71.40, CDC ``may, in its
discretion, consider a wide array of facts and circumstances when
determining what is required in the interest of public health in a
particular situation . . . includ[ing]: the overall number of cases of
disease; any large increase in the number of cases over a short period
of time; the geographic distribution of cases; any sustained
(generational) transmission; the method of disease transmission;
morbidity and mortality associated with the disease; the effectiveness
of contact tracing; the adequacy of state and local healthcare systems;
and the effectiveness of state and local public health systems and
control measures.'' \100\ Other factors noted in the Final Rule are the
potential for disease spread among persons held in congregate settings,
specifically during processing and holding at CBP facilities, and the
potential for disease spread to the community at large.\101\
---------------------------------------------------------------------------
\100\ Id. at 56444.
\101\ Id. at 56434. Strain on healthcare systems was also cited
as a factor in the Final Rule, specifically the additional strain
that noncitizen migrant healthcare needs may place on already
overburdened systems; the Final Rule described the reduction of this
strain as a result of CDC's previously issued orders. Id. at 56431.
---------------------------------------------------------------------------
As stated in 42 CFR 71.40, this Order does not apply to U.S.
citizens, U.S. nationals, lawful permanent residents, members of the
armed forces of the United States and associated personnel if the
Secretary of Defense provides assurance to the Director that the
Secretary of Defense has taken or will take measures such as quarantine
or isolation, or other measures maintaining control over such
individuals, to prevent the risk of transmission of the quarantinable
communicable disease into the United States, and U.S. government
employees or contractors on orders abroad, or their accompanying family
members who are on their orders or are members of their household, if
the Director receives assurances from the relevant head of agency and
determines that the head of the agency or department has taken or will
take measures such as quarantine or isolation, to prevent the risk of
transmission of a quarantinable communicable disease into the United
States.\102\
---------------------------------------------------------------------------
\102\ 42 CFR 71.40(e) and (f).
---------------------------------------------------------------------------
In addition, this Order does not apply to those classes of persons
excepted by the CDC Director. Including exceptions in the Order is
consistent with Section 362 and 42 CFR 71.40, which permit the
prohibition of introduction into the United States to be ``in whole or
in part.'' As explained in the Final Rule for section 71.40, this
language is intended to allow the Director to narrowly tailor the use
of the authority to what is required in the interest of public
health.\103\ Pursuant to this capability, CDC is therefore excepting
specific categories of persons from the Order, as described herein.
---------------------------------------------------------------------------
\103\ 85 FR 56424, 56444.
---------------------------------------------------------------------------
As required by Section 362, this Order will be in effect only for
as long as it is needed to avert the serious danger of the
introduction, transmission, and spread of COVID-19 into the United
States and will be terminated when the continuation of the Order is no
longer necessary to protect the public health. Finally, as directed by
42 CFR 71.40(c), the Order sets out the following:
(1) The foreign countries (or one or more political subdivisions or
regions thereof) or places from which the introduction of persons is
being prohibited;
(2) The period of time or circumstances under which the
introduction of any persons or class of persons into the United States
is being prohibited;
[[Page 42840]]
(3) The conditions under which that prohibition on introduction
will be effective, in whole or in part, including any relevant
exceptions that the Director determines are appropriate;
(4) The means by which the prohibition will be implemented; and
(5) The serious danger posed by the introduction of the
quarantinable communicable disease in the foreign country or countries
(or one or more political subdivisions or regions thereof) or places
from which the introduction of persons is being prohibited.
III. Issuance and Implementation of Order
Based on the foregoing public health reassessment, I hereby 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 under 42 CFR part 71,\104\ which authorize the CDC Director
to suspend the right to introduce 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
hereby replaces and supersedes the Order Suspending the Right to
Introduce Certain Persons from Countries Where a Quarantinable
Communicable Disease Exists, issued on October 13, 2020 (October Order)
\105\ and affirms and incorporates the exception for UC published in
the July Exception, such that UC are excepted from this Order.\106\
---------------------------------------------------------------------------
\104\ Control of Communicable Diseases; Foreign Quarantine:
Suspension of the Right to Introduce and Prohibition of Introduction
of Persons into United States from Designated Foreign Countries or
Places for Public Health Purposes, 85 FR 56424 (Sept. 11, 2020); 42
CFR 71.40.
\105\ Supra note 4.
\106\ Supra note 3.
---------------------------------------------------------------------------
This Order addresses the current status of the COVID-19 public
health emergency and ongoing public health concerns, including virus
transmission dynamics, viral variants, mitigation efforts, the public
health risks inherent to high migration volumes, low vaccination rates
among migrants, and crowding of immigration facilities. In making this
determination, I have considered myriad facts, including the congregate
nature of border facilities and the high risk for COVID-19 outbreaks--
especially now with the predominant, more transmissible Delta variant--
presented following the introduction of an infected person, as well as
the benefits of reducing such risks. I have also considered
epidemiological information, including the viral transmissibility and
asymptomatic transmission of COVID-19, the epidemiology and spread of
SARS-CoV-2 variants, the morbidity and mortality associated with the
disease for individuals in certain risk categories, as well as public
health concerns with crowding at border facilities and resultant risk
of transmission of additional quarantinable communicable diseases. I am
issuing this Order to preserve the health and safety of U.S. citizens,
U.S. nationals, and lawful permanent residents, and personnel and
noncitizens in POE and U.S. Border Patrol stations by reducing the
introduction, transmission, and spread of the virus that causes COVID-
19, including new and existing variants, in congregate settings where
covered noncitizens would otherwise be held while undergoing
immigration processing, including at POE and U.S. Border Patrol
stations at or near the U.S. land and adjacent coastal borders.
Based on an assessment of the current COVID-19 epidemiologic
landscape and the U.S. government's ongoing efforts to accommodate UC,
CDC does not find public health justification for this Order to apply
with respect to UC, as outlined in the July Exception. Although CDC
finds that, at this time, this Order should be applicable to FMU, CDC
notes that there are fewer FMU than SA unlawfully entering the United
States and many FMU are already being processed pursuant to Title 8
versus Title 42 given a variety of practical and other limitations on
immediately expelling FMU. DHS has indicated that it plans to continue
to partner with state and local agencies and nongovernmental
organizations to provide testing, consequence management, and
eventually vaccination to FMU who are determined to be eligible for
Title 8 processing. CDC considers these efforts to be a critical risk
reduction measure and encourages DHS to evaluate the potential
expansion of such COVID-19 mitigation programs for FMU such that they
may be excepted from this Order in the future. Although vaccination
programs are not available at this time, CDC encourages DHS to develop
such programs as quickly as practicable. While the migration of SA and
FMU into the United States during the COVID-19 public health emergency
continues and given the inherent risks that accompany holding these
groups in crowded congregate settings with insufficient options for
effective mitigation, CDC finds the public health justification for
this Order is sustained at this time.
DHS has indicated that it is committed to restoring border
operations and facilitating arrivals to the United States in a manner
that comports with CDC's recommended COVID-19 mitigation protocols.
Given the recent migrant surge, DHS believes that an incremental
approach is the best way to recommence normal border operations while
ensuring health and safety concerns are addressed. To this end, DHS
will work to establish safe, efficient, and orderly processes that are
consistent with appropriate health and safety protocols and the
epidemiology of the COVID-19 pandemic, in consultation with CDC.
CDC's expectation is that although this Order will continue with
respect to SA and FMU, DHS will use case-by-case exceptions based on
the totality of the circumstances where appropriate to except
individual SA and FMU in a manner that gradually recommences normal
migration operations as COVID-19 health and safety protocols and
capacity allows. DHS will consult with CDC to ensure that the standards
for such exceptions are consistent with current CDC guidance and public
health recommendations. Based on this incorporation of relevant COVID-
19 mitigation measures, CDC believes it is consistent with the legal
authorities and in the public health interest to continue the use of
case-by-case exceptions as a step towards the resumption of normal
border operations under Title 8. Additionally, DHS is working in
coordination with nongovernmental organizations, state and local health
departments, and other relevant facilitating organizations and entities
as appropriate to develop DHS-approved processes that include pre-entry
COVID-19 testing. Additional public health mitigation measures, such as
maintaining physical distancing and use of masks, testing, and
isolation and quarantine as appropriate, are included in such
processes. DHS has documented these processes and shared them with CDC.
CDC has consulted with DHS to ensure that the processes appropriately
address public health concerns and align with relevant CDC COVID-19
mitigation protocols. Based on these plans and processes, CDC believes
it is consistent with legal authorities and in the public health
interest to permit an exception for noncitizens in such DHS-approved
processes to allow for safe and orderly entry into the United States.
[[Page 42841]]
A. Covered Noncitizens
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 POE or U.S. Border Patrol
station at or near the U.S. land and adjacent coastal borders subject
to certain exceptions detailed below; this includes noncitizens who do
not have proper travel documents, noncitizens whose entry is otherwise
contrary to law, and noncitizens who are apprehended at or near the
border seeking to unlawfully enter the United States between POE. For
purposes of this Order, I refer to persons covered by the Order as
``covered noncitizens.''
B. Exceptions
This Order does not apply to the following:
U.S. citizens, U.S. nationals, and lawful permanent
residents; \107\
---------------------------------------------------------------------------
\107\ 42 CFR 71.40(f).
---------------------------------------------------------------------------
Members of the armed forces of the United States and
associated personnel, U.S. government employees or contractors on
orders abroad, or their accompanying family members who are on their
orders or are members of their household, subject to required
assurances; \108\
---------------------------------------------------------------------------
\108\ 42 CFR 71.40(e)(1) and (3).
---------------------------------------------------------------------------
Noncitizens who hold valid travel documents and arrive at
a POE;
Noncitizens in the visa waiver program who are not
otherwise subject to travel restrictions and arrive at a POE;
Unaccompanied Noncitizen Children; \109\
---------------------------------------------------------------------------
\109\ As excepted pursuant to the Public Health Determination
Regarding an Exception for Unaccompanied Noncitizen Children from
Order Suspending the Right to Introduce Certain Persons from
Countries Where a Quarantinable Communicable Disease Exists. 86 FR
38717 (July 22, 2021).
---------------------------------------------------------------------------
Noncitizens who would otherwise be subject to this Order,
who are permitted to enter the U.S. as part of a DHS-approved process,
where the process approved by DHS has been documented and shared with
CDC, and includes appropriate COVID-19 mitigation protocols, per CDC
guidance; and
Persons whom customs officers determine, with approval
from a supervisor, should be excepted from this Order based on the
totality of the circumstances, including consideration of significant
law enforcement, officer and public safety, humanitarian, and public
health interests. DHS will consult with CDC regarding the standards for
such exceptions to help ensure consistency with current CDC guidance
and public health recommendations.
C. APA, Review, and Termination
This Order shall be immediately effective. I consulted with DHS and
other federal departments as needed before I issued this Order and
requested that DHS continue to aid in the enforcement of this Order
because CDC does not have the capability, resources, or personnel
needed to do so.\110\ As part of the consultation, DHS developed
operational plans for implementing this Order. CDC has reviewed these
plans and finds them to be consistent with the language of this Order
directing that covered noncitizens spend as little time in congregate
settings as practicable under the circumstances. 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 noncitizens
involved, and the likelihood that covered noncitizens do not have homes
in the United States.\111\
---------------------------------------------------------------------------
\110\ 42 U.S.C. 268; 42 CFR 71.40(d).
\111\ 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
noncitizens.
---------------------------------------------------------------------------
This Order is not a rule subject to notice and comment under the
Administrative Procedure Act (APA). Even if it were, 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 delayed effective date. Given the public
health emergency caused by COVID-19, it would be impracticable and
contrary to public health practices and the public interest to delay
the issuing and effective date of this Order with respect to all
covered noncitizens. In addition, this Order concerns ongoing
discussions with Canada and Mexico on how best to control COVID-19
transmission over our shared borders and therefore directly
``involve[s] . . . a . . . foreign affairs function of the United
States;'' \112\ thus, notice and comment and a delay in effective date
are not required.
---------------------------------------------------------------------------
\112\ 5 U.S.C. 553(a)(1).
---------------------------------------------------------------------------
This Order shall remain effective until either the expiration of
the Secretary of HHS' declaration that COVID-19 constitutes a public
health emergency, or I determine that the danger of further
introduction, transmission, or spread 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, whichever occurs first. At least every 60 days, the CDC shall
review the latest information regarding the status of the COVID-19
public health emergency and associated public health risks, including
migration patterns, sanitation concerns, and any improvement or
deterioration of conditions at the U.S. border, to determine whether
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. I retain the authority to modify or
terminate the Order, or its implementation, 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.
Dated: August 3, 2021.
Sherri Berger,
Chief of Staff, Centers for Disease Control and Prevention.
[FR Doc. 2021-16856 Filed 8-3-21; 4:15 pm]
BILLING CODE 4163-18-P
