In March 2020—as the first COVID-19 cases were reported in the United States—the Trump administration pressured the Centers for Disease Control and Prevention (CDC) to invoke Title 42, a little known provision of the U.S. Public Health Service Act of 1944 that would allow federal officials to ban people and goods from entering the United States when doing so is required in the interest of public health. Issued under the public health authority—not an immigration authority—this order barred individuals without documentation from entering the country, meaning that even those seeking asylum at U.S. borders were denied their rights to have their cases heard. In effect, under the guise of public health, the Trump administration shut down the U.S. asylum system.
Between March 2020 and March 2022, U.S. Customs and Border Protection (CBP) recorded more than 1.8 million expulsions under the Title 42 order. These expulsions had devastating consequences for individuals fleeing violence and danger. In fact, Human Rights First has tracked 10,250 instances of murder, kidnapping, rape, and torture to those turned away under Title 42 since February 2021.
The lack of evidence behind Title 42 in lowering COVID-19 cases across the country raises the question of its use as a public health measure.
Misusing public health authority
A public health justification for invoking Title 42 was tenuous even in the earliest days of the pandemic. Public health experts quickly decried this use of Title 42, saying it “fails to protect public health” and that such laws “should not be used as a pretext for overriding humanitarian laws and treaties that provide life-saving protections” to those seeking asylum. Even Dr. Anthony Fauci, the Biden administration’s chief medical adviser, said that “focusing on immigrants, expelling them or what have you, is not the solution to an outbreak” of COVID.
Last month the CDC—the agency responsible for renewing or terminating a Title 42 order—determined that the current use was no longer necessary given public health conditions. Enacting Title 42 is meant to protect public health interests. So what, then, have been the actual public health implications of Title 42 expulsions? Is there a relationship between Title 42 expulsions and the spread of COVID-19 in the United States? More specifically, does an increase in Title 42 expulsions decrease the number of COVID-19 cases? The data say no.
The data show there is no statistical relationship
Using a multivariate regression analysis, the authors looked at the statistical relationship between Title 42 expulsions and COVID-19 cases in the United States between March 2020 and February 2022.
If the current Title 42 order served public health purposes, we would expect an increase in the monthly number of Title 42 expulsions to be correlated with a statistically significant decrease in the monthly number of COVID-19 cases. However, the data show there is no statistically significant relationship between the monthly number of Title 42 expulsions and the monthly number of COVID-19 cases in the United States (p = .432).
This is true when analyzing the relationship between a specific month’s Title 42 expulsions and COVID-19 cases (also called contemporaneous) but also when comparing the lagged value—that is, comparing one month’s Title 42 expulsions with the following month’s COVID cases (p = .483). The logic behind lagging the monthly number of Title 42 expulsions is that Title 42 expulsions in one month may not show an effect on the monthly number of COVID-19 cases until the following month.
There is still no statistical relationship, even considering COVID-19 spikes
Because the monthly number of COVID-19 cases in the United States has varied from month to month during the pandemic, is it the case that outliers may be affecting our ability to see a relationship between Title 42 expulsions and the spread of COVID-19? Again, the answer is no. As Figure 1 shows, there are unexpected positive relationships between the natural log of the monthly number of Title 42 expulsions; the lagged value of the natural log of the monthly number of Title 42 expulsions; and the natural log of the monthly number of COVID-19 cases in the United States. This further makes clear that an increase in Title 42 expulsions has not decreased the number of COVID-19 cases. In Figure 1, the solid line shows the contemporaneous relationship, and the dotted line shows the lagged relationship.
Figure 1
There is no statistical relationship when considering additional factors
Does an increase in Title 42 expulsions decrease the number of COVID-19 cases in the United States when controlling for other factors? The answer is also no. When modeling the monthly number of COVID-19 cases in the United States, one need only to control for how many months into the pandemic we are; the month of the year to capture seasonal spikes; and the monthly number of COVID-19 deaths as a measure of severity to explain more than 90 percent of the variance in the monthly number of COVID-19 cases (R-squared = .911). As indicated in the methodological appendix’s second model, when adding the natural log of the monthly number of Title 42 expulsions to the model, the results show that Title 42 expulsions are once again statistically insignificantly related to the monthly number of COVID-19 cases (p = .292). In other words, in the multivariate analysis, there is no statistically significant relationship between Title 42 expulsions and the spread of COVID-19 in the United States. Model four in the methodological appendix shows a similar result when analyzing the lagged value of the natural log of the monthly number of Title 42 expulsions. In other words, no matter which way one cuts the data, there is no statistically significant relationship between Title 42 expulsions and the spread of COVID-19 in the United States.
Conclusion
The data are clear—there is no statistical relationship between Title 42 expulsions and the number of COVID-19 cases in the United States. This lack of relationship, then, raises serious doubts about the use of Title 42 as a public health measure to prevent spread of the virus. The harms caused by invoking Title 42 in March 2020 will extend beyond its termination. It is essential that public health is not weaponized to deny protection to those seeking asylum and that the country protect the legitimacy and trust in its public health institutions.
Methodological appendix
Analysis uses monthly Southwest land border encounters data from the U.S. CBP and monthly COVID-19 case data from the CDC COVID Data Tracker.
Appendix Table 1