Since the early stages of the Covid-19 pandemic, advocates have asked federal lawmakers to take action to protect incarcerated people by directing the Bureau of Prisons to reduce the number of people in federal prisons and assist states to do the same. However, there is another critical step that will require federal leadership. Congress should ensure that the next stimulus package includes funding for medical equipment and widespread testing for rural communities, where many prisons are located.
Covid-19 cases have been reported in state prisons across 41 out of 50 states as of May 15, and the pandemic has already reached many rural counties. Additionally, the high concentration of state prisons — along with underfunded healthcare systems — make rural communities especially vulnerable to coronavirus.
In the United States, nearly 70 percent of prisons are located outside of metropolitan areas while 40 percent are located in counties with less than 50,000 residents, with an average of 2.5 ICU beds per county. In some areas, prison populations comprise up to 36 percent of the total county population. Approximately 8.6 million people live in towns located more than thirty 30 minutes away from an emergency room, while some of the communities with large prisons have zero ICU beds. Research from the Brennan Center illustrates, by state, how many prisons are located in rural counties and the limited number of ICU beds the counties have.
Some states have released people from prison to curb the spread of the virus behind bars. However, these releases represent a small fraction of the states’ overall incarcerated populations. California, for example, has released 3,500 individuals, or less than 3 percent of its prison population. In Oklahoma, which has the second highest rate of incarceration in the country, the governor has commuted the sentences of approximately 450 prisoners — less than 2 percent of people behind bars in that state. Across the country, hundreds of thousands of people are still incarcerated in state facilities, many of which are in rural counties. The risk of an outbreak in these crowded settings poses a serious threat to public health systems.
Confined and overcrowded, prisons are a breeding ground for the virus. Seven out of ten of the largest Covid-19 outbreaks in the United States to date originated in a jail or prison. Moreover, the rate of spread in prisons is an estimated 150 percent higher than in the general population, infecting correctional officers and incarcerated people alike. But most prisons do not have hospital infrastructure, and most “prison hospitals” are more accurately described as infirmaries or clinics. As a result, a Covid-19 outbreak behind bars could overburden the already-depleted healthcare systems in rural counties.
Correctional systems rely on local medical resources for ventilators or ICU beds, which could quickly become overwhelmed in the event of a correctional outbreak. Of the 24 state prison systems that responded to a Marshall Project inquiry, only Texas reported having ventilators in its prisons. And even in Texas, as is the norm in other states, prisoners who need acute care typically need to be stabilized at a community hospital, which could exhaust the limited medical resources serving rural areas. Additionally, the U.S. prison population is aging. In 2016, the population in state prisons over the age of 55 surpassed the number of incarcerated young adults between the ages of 18 and 24. The growing older population faces a greater risk for contracting Covid-19 and other chronic illnesses.
Prisons do not operate separately from society. Families, staff, service providers, and justice-involved people enter and leave these facilities, return home, and interact with people in their communities. If there is a Covid-19 outbreak inside a rural state prison, it can quickly spread beyond its walls. For example, Marion County, Ohio has had one of the worst outbreaks in the country. As of May 14, nearly 80 percent of the prison population at the Marion Correctional Institution was infected with Covid-19 and about one-third of the workforce has tested positive.
Outbreaks in rural areas with a limited number of hospitals could prove deadly for incarcerated people, staff, and the surrounding community. More than half of rural hospitals have fewer than 26 regular beds, requiring patients to drive even farther for treatment, making it difficult to contain the virus. Louisiana’s first correctional death from the coronavirus involved an incarcerated individual at the Louisiana State Penitentiary (also known as Angola Prison) in West Feliciana Parish, where incarcerated people make up 36 percent of the county’s population — and the county has no ICU beds. Since then, 181 people in the parish have tested positive and a correctional officer has died.
Other states are similarly battling Covid-19 in prisons while facing a shortage of hospitals. Georgia state prisons have reported 275 confirmed cases among incarcerated individuals and 88 cases among staff. In fact, out of the 34 counties in Georgia with state prisons, 20 counties do not have a single ICU bed. Meanwhile, the Cummins Unit Prison in Lincoln County, Arkansas has had one of the worst outbreaks in the country. Incarcerated people comprise nearly 28 percent of the population of the county, which has zero ICU beds.
Federally funded medical preparedness with testing, ventilators, and ICU equipment will help limit the spread of the virus throughout the rural counties and better respond to outbreaks behind bars — as will efforts to reduce rural incarceration. To relieve crowding in prisons, state department of corrections officials should exercise emergency furlough powers to release as many vulnerable people as possible who do not pose a threat to public safety. Officials should also provide reentry planning and assistance for those facing housing uncertainty. Simultaneously, the federal government should provide aid to bolster rural medical infrastructure to address future outbreaks.
The pandemic threatens rural America and its prisons. In response, Congress should prioritize the provision of medical relief to rural communities in its next stimulus bill. Neglecting this responsibility will jeopardize the health and lives of incarcerated people in rural counties — and of the people who work and live near rural prisons across the country.