Uniquely Vulnerable During Disease Outbreaks, Prisons and Jails Brace for Coronavirus Cases

Large numbers of people living in close proximity, many of them elderly or living with chronic diseases. Limited access to hand soap and sanitizer. Insufficient infrastructure for medical testing and treatment. If ever there were a place designed for the rapid spread of coronavirus, it would be a prison.

Though no cases of Covid-19 have been confirmed in a U.S. prison or jail, officials say it’s only a matter of time—because it’s already happening around the world. In China, at least 500 cases have been traced back to four prisons, a scenario so alarming that Iran preemptively released 70,000 people from prison to mitigate the risk of something similar.

When coronavirus appears in a prison or jail in the U.S., it could be extremely difficult to contain. Corrections facilities are often older buildings with poor ventilation and cramped quarters, while trips to the bathroom for handwashing—a vital step to limiting spread of the respiratory illness—may be limited by prison rules. But that doesn’t mean prisons aren’t prepared, said Anne Spaulding, a professor of epidemiology at Emory University.

“People are definitely making plans and have been for weeks now,” said Spaulding, who previously served as the medical director for the Rhode Island Department of Corrections and the associate medical director for the Georgia Prison System. “It’s not like jails and prisons haven’t had experience with this before. A lot of jails and prisons did pandemic planning when we had H1N1 a decade ago.”

Peter Thorne, the deputy commissioner for public information at the New York City Department of Corrections, said that the office is working with other government agencies to manage any potential outbreak in the city’s jails, which house over 5,000 people. “The health and well-being of our personnel and people in custody is of paramount importance,” Thorne said in a written statement. “The Department is working in close coordination with the CDC, NYC Department of Health, and Correctional Health Services to identify and evaluate detainees with potential symptoms and refer them for testing as necessary.”  

At a Monday meeting of the Seattle City Council, Patty Hayes, the director of public health, said that the King County jail is monitoring people for symptoms at intake, but acknowledged that won’t be enough. “We know at some point … we will see somebody who has already been booked all of a sudden become symptomatic, just like happened in the nursing home,” Hayes said. “We’re actively setting up systems within the jail to make sure we can isolate and quarantine within there safely.”

While local leaders take action, the response from federal regulators has lagged. Hayes noted that the CDC, which last week issued guidance to long-term care facilities like nursing homes, has not provided any policy suggestions to jails or prisons. Lawmakers on the national stage led by Massachusetts Sen. Elizabeth Warren on Tuesday called on the Bureau of Prisons, which controls federal prisons, and private prison companies that manage many federal prisons, to release their plans for managing coronavirus outbreaks. 

The National Commission on Correctional Health Care said that correctional administrators should prepare for instances where coronavirus halts essential services, like cooking and cleaning, which are normally provided by incarcerated people. They also advise jails and prisons to encourage family members showing symptoms to skip their visits, or to implement non-contact visitation systems like video conferencing. 

Spaulding said many jails likely already have these systems in place. “Video visitation is fairly standard now in large jails, so that would be nothing novel,” she said. “Often when crises occur, there is a desire to keep traffic to a minimum, to buckle down and concentrate on health issues.”

The coronavirus outbreak has prompted some advocacy organizations, like the Prison Policy Initiative, to call for major reforms because health conditions that make Covid-19 more lethal, like asthma and cigarette lung damage, are far more common in prisons than they are in the general population. They suggest releasing elderly people who would need complex medical care before medical staffing rolls get stretched too thin, eliminating co-pays for prison medical care, lowering jail admissions by issuing citations instead of arresting people, and eliminating parole and probation revocations for technical violations like breaking curfew to reduce “jail churn.”

They also noted that some policy changes can’t be made by wardens or correctional officers, so lawmakers should act now before a pandemic possibly forces state legislatures to close.

Some jurisdictions are already considering measures like those suggested by PPI. San Francisco Public Defender Manohar Raju wrote to Sheriff Paul Miyamoto on Monday asking the department to take precautionary measures to ensure that the approximately 1,100 people in San Francisco’s jails stay safe. “The constant flow of both staff and detainees in and out of the jails—where large numbers of people are housed in close proximity—means that a powerful virus like COVID-19 can take over quickly and easily,” Raju wrote. In response, San Francisco District Attorney Chesa Boudin said his office is considering drafting emergency policies to expedite release for some people.

Spaulding said that correctional facilities are generally “eager to release people who need to be released” and may start significantly decreasing jail populations as sick staff are forced to stay home. She also said that some prisons may start being “more aggressive” with their release recommendations to parole boards for medically fragile people, meaning there might be more people managed under community supervision or electronic monitoring.

Some states, however, are taking advantage of their captive labor force to bolster their response to the coronavirus outside prison walls. This week, the New York state prison system began producing its own brand of hand sanitizer for state and local government use, a move that was lambasted by prison rights advocates because of the state’s choice of labor. They noted that incarcerated people are producing hand sanitizer with an alcohol content so high it would be considered contraband under state prison rules and, therefore, not be available to them. It’s not yet clear whether that rule will be changed amid coronavirus concerns. Thorne, with the New York City jail system, did not address a question about whether inmates in city jails could have access to sanitizer products.

The Legal Aid Society condemned the New York Corrections Department for using incarcerated people who make 65 cents an hour to combat a public health crisis. “This is nothing less than slave labor and it must end,” said Tina Luongo and Adriene Holder of the LAS. “From fighting dangerous forest fires to now mass producing vital hand sanitizer, government and big business continue to force the labor of incarcerated individuals—for pennies on the dollar—for a political purpose or to line their own pockets.”