Addressing the threat COVID-19 poses specifically for detainees and corrections employees is challenging governments as the pandemic sweeps across the globe. The problem has become increasingly urgent as a growing number of incarcerated individuals and prison workers test positive for coronavirus infection.
The United States incarcerates nearly 2.2 million people in jails or prisons—more than any other nation—and reports of detainees and jail and prison workers who have contracted COVID-19 are becoming increasingly frequent. In Chicago, for example, the Cook County Sheriff’s office noted that as of April 5, 234 detainees had tested positive, 14 of whom were hospitalized, and 78 employees had also tested positive. Last week, the New York Times reported that in New York City’s jails, including the Rikers Island complex, 167 inmates, 23 health workers, and 114 corrections staff (2 of whom have died) had tested positive.
Jail and prison populations are exceptionally vulnerable to COVID-19 for a variety of reasons, including older age and health status, as well as conditions such as overcrowding and limited access to or poor quality of health care while incarcerated. More than 10% of inmates of US state and federal prisons are 55 years or older, and many have chronic or life-limiting illnesses. Approximately 15% of inmates of state prisons reported ever having asthma and 10% reported ever having a heart disorder—conditions that put individuals at high risk for severe illness with COVID-19.
In addition to physical vulnerability, overcrowding and sanitation issues in many jail and prison settings heighten the risk of disease spread and are in stark contrast to the recommendations of public health officials for social distancing, frequent handwashing, and other practices for COVID-19 prevention.
According to a 2019 report on global prison trends, there are more than 10 million men, women, and children in jails and prison, and such facilities are overcrowded in at least 121 countries. Space for social distancing is inadequate or nonexistent. Limited access to soap and water may make frequent handwashing impossible, and hand sanitizer may be off limits because of its high alcohol content. Inmates in some facilities must pay for their own soap and personal hygiene items and may be charged copays for medical visits that they may not be able to afford.
Addressing the situation is crucial because of the risks COVID-19 poses not only to incarcerated people but also to the general population. Jails, which by their nature are transient facilities, have the potential to accelerate spread because of their enormous turnover, as people are locked up and then released again into the community. In an analysis of a database of county- and jurisdiction-level jail populations, the Marshall Project (a nonprofit news organization covering the US criminal justice system) and the New York Times found that, based on 2017 data, approximately 200 000 people typically flow into and out of jails every week.
In response to the growing number of quarantine and isolation cases in federal facilities, the US Bureau of Prisons announced that to mitigate COVID-19 exposure and spread, all 146 000 persons incarcerated in federal facilities would be under quarantine (that is, confined to their cells), effective April 1, for 14 days. The Bureau said that to “the extent practicable,” inmates would still have access to programs and services that are normally offered, such as mental health and educational services, and that they would be able to access communal areas (such as for showers and telephone and computer access).
However, Rep Jerrold Nadler (D, New York) and others urged more aggressive measures to address the problem, including releasing older and medically vulnerable or pregnant prisoners. Last Friday, US Attorney General William P. Barr directed the Bureau of Prisons to expand the group of inmates at federal prisons eligible for early release, particularly at correctional institutions in Louisiana, Connecticut, and Ohio, where the largest numbers of inmates and staff members have tested positive for COVID-19.
Facilities in California, New York, Ohio, Texas, and elsewhere have also granted early release to thousands of inmates, such as lower-level, nonviolent offenders and elderly or medically fragile individuals, from state and local facilities. In many cases, the released inmates are homeless, and authorities are scrambling for alternatives. California and New York City are leasing hotel rooms so homeless people released from jail don’t accelerate the pandemic.
Although the United States is unique with respect to the size of its incarcerated population, the threat COVID-19 poses to prison populations and staff is universal, and other countries are similarly working to mitigate risk. For example, jails and prisons in Australia, Canada, England, France, Ireland, Germany, Northern Ireland, Scotland, and Wales have released prisoners early or are considering doing so.
Guidelines released last month by the World Health Organization outline measures that prisons and other detention facilities (such as immigration detention settings) should take. These guidelines include considering noncustodial measures at all stages of the criminal justice process as well as screening all individuals upon admission for fever and lower respiratory tract symptoms—and possibly medically isolating them pending further evaluation.
“Efforts to control COVID-19 in the community are likely to fail if strong infection prevention and control (IPC) measures, adequate testing, treatment and care are not carried out in prisons and other places of detention as well,” the guidelines note.
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Joan Stephenson, PhD Joan Stephenson, PhD, is Consulting Editor for the Forum and JAMA and an award-winning independent writer and editor based in Chicago. She joined JAMA as a writer and editor for JAMA's Medical News & Perspectives department and subsequently served...