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Fighting Coronavirus in Rural Communities by Protecting Incarcerated People

Across the United States, rural counties with limited medical resources house large state prison populations that are vulnerable to Covid-19.

  • Kayla Abrams
  • Sunwoo Oh
May 18, 2020

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.