BASILE, LouisianaBASILE, Louisiana (Reuters) - U.S. immigration officials say they have a plan if detention centers get hit with coronavirus outbreaks: They will transfer detainees with serious symptoms to hospitals with "expertise in high risk care."

But many centers - each housing hundreds of people, often in close quarters - are located in remote communities, far from hospitals able to handle a rush of patients with COVID-19. Detention center outbreaks in such areas could quickly swamp local hospitals, threatening their ability to treat local residents along with detainees.

About a third of the 43,000 immigrants in detention as of March 2 were housed at facilities that have only one hospital - or none - with intensive-care beds within 25 miles, according to a Reuters analysis of data from the American Hospital Directory and U.S. Immigration and Customs Enforcement (ICE). The seven sites with no such hospitals nearby held a total of about 5,000 detainees, according to the analysis, which examined centers that averaged 100 or more detainees.

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The shortage of available care is especially acute in Louisiana, according to interviews with local health workers, hospital administrators and current and former detention-center employees. The administration of President Donald Trump has quadrupled the number of detainees in the state - to nearly 7,000 - as part of a larger immigration crackdown. And Louisiana hospitals are already straining to handle one of the world’s fastest-growing coronavirus outbreaks.

The closest hospital to four of the Louisiana sites - which together house an average of 3,700 detainees - is Winn Parish Medical Center, which has just 46 beds and five intensive-care beds. Such tiny rural facilities would be forced to send patients to a handful of larger regional hospitals.

Doctors and nurses at both the small and larger hospitals said that a severe outbreak at even one detention center could overwhelm their ability to respond. One of the four centers, for example, is LaSalle ICE Processing Center in Jena, Louisiana - among the nation’s largest with a daily average of about 1,200 detainees. The nearest larger hospitals are about 40 miles away in Alexandria.

One nurse at Rapides Regional Medical Center in Alexandria said she worried about the threat of an outbreak at a prison or detention center when she recently saw a man flanked by two guards in the hospital’s COVID-19 unit.

"We don't have enough staff or equipment to handle something like that," the nurse said, noting that workers have been duct-taping the door frames of makeshift isolation rooms. "It's already chaotic.”

Six ICE detainees - five in New Jersey and one in Arizona - have tested positive for the disease, along with five ICE staffers, working in detention centers in New Jersey, Texas and Colorado, and two employees of privately run detention centers, according to ICE and the private operators. One of the employees worked at Stewart Detention Center in Lumpkin, Georgia, which housed more than 1,500 detainees as of early March.

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ICE spokespeople said the agency has a detailed pandemic response plan and is following the U.S. Centers for Disease Control protocols for testing and monitoring the disease. The agency said it would focus enforcement actions on the most serious criminals during the pandemic and seek alternatives to detention when appropriate. By the end of March, the number of immigrants in custody nationally had fallen to about 35,600, according to ICE, but the agency could not provide updated data by facility.

ICE spokesman Bryan Cox said that examining hospital resources near Louisiana detention centers is "speculative" because there are currently no confirmed COVID-19 cases at ICE facilities there. Cox and ICE spokeswoman Danielle Bennett said they did not know how many coronavirus tests ICE has administered, in Louisiana or nationally, and could not say whether the agency tracks that information.

OUTBREAK 'WOULD BE OVERWHELMING'

Public health experts say the risks to detention centers are serious. Carlos Franco-Paredes - an infectious disease doctor in Colorado who has worked in detention centers - said an outbreak in a population of 1,500 detainees could require between 150 and 175 intensive-care admissions.

The South Louisiana ICE Processing Center is near the town of Basile - population 1,700. About 40 minutes away is the Pine Prairie Processing Center, in another small community. Together, the centers house an average of 1,300 detainees. The two facilities, along with the Jena detention center, are run by Geo Group, a private company contracting with ICE.

About halfway between the two detention facilities is the Savoy Medical Center - with just 10 intensive-care beds and 6 ventilators, said chief executive Gene Burge.

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An outbreak "would be overwhelming for an area like this,” Burge said.

‘TICKING TIME BOMB’

ICE facilities have in-house medical care, but available services and equipment vary widely, said Scott Allen, a doctor and Department of Homeland Security consultant who has inspected detention centers.

Some rural centers have one person providing medical services, a problem if that caregiver gets ill, Allen said in a March 19 letter he wrote with another doctor to the U.S. Congress. Local hospitals would be unable to provide ventilators to both detainees and local residents, the letter warned, causing people from both groups to "die unnecessarily."

Five detainees inside the South Louisiana center, which houses more than 670 men and women, said in interviews that the conditions inside the center don’t allow them to protect themselves by, for instance, frequently washing their hands or maintaining social distance. They said they each only recently received a miniature bar of soap and have not been provided cleaning products.

Daimy Garcia, 28, an asylum seeker from Cuba, said more detainees have been recently transferred into her unit, making social distancing harder. She said her unit now holds more than 70 women from Cameroon, China, Brazil, Cuba, Mexico and Central America.

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"This is a ticking time bomb," Garcia said.

Pablo Paez, a spokesman for Geo Group said such allegations were "unfounded" and "being instigated by outside groups with political agendas." He said all the company's facilities provide access to regular handwashing and 24/7 access to healthcare. He referred questions about local hospital resources to ICE.

HIDING SYMPTOMS, SHARING BATHROOMS

The Catahoula Correctional Center near Harrisonburg, Louisiana houses a daily average of 500 detainees - just outside a town of 330 residents.

Four detainees at the center told Reuters that some immigrants have hidden symptoms of illness to avoid being isolated in the same solitary confinement cells the center uses for punishment.

Alfonso Diaz, a 58-year-old asylum seeker from Cuba with heart problems, said he shares a dorm with 100 other men, all sleeping in three-tier bunk beds and sharing four toilets and six showers. He said guards do not wear protective gear and told the detainees to ignore news about the virus.

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Scott Sutterfield, a spokesman for the private company LaSalle Corrections that runs Catahoula said that it has implemented a pandemic contingency plan at its facilities, which includes screening, testing, treatment and infection-control measures. Sutterfield did not respond to the specific concerns of the detainees interviewed by Reuters or answer questions about limited hospital capacity nearby.

The Catahoula facility is about 40 minutes away from River Correctional Center, another new ICE site housing detainees in Ferriday, Louisiana. The two locations average about 900 detainees combined.

The nearest hospital to both centers is the tiny Riverland Medical Center in Ferriday. The center has five intensive care beds but is only staffed for two critically ill patients.

Patients could also be sent to Merit Health Natchez, in nearby Mississippi, which had 15 intensive care beds as of last year, according to federal records. Natchez is also home to a facility that recently started housing 1,000 ICE detainees.

Blane Mire, a doctor at Merit Health, said on a March 26 call with town officials that his hospital was low on medicine and protective gear and full of coronavirus patients - three of them on ventilators. With hospitals in major urban centers also in need of supplies, he said, rural areas could be left behind. As Mire put it: "Natchez isn't going to be on the priority list."