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Analysis

How Coronavirus Could Affect U.S. Jails and Prisons

People who come into jails and prisons are a very high-risk population for the virus, according to the former chief medical officer of the NYC Correctional Health Services.

March 13, 2020

This is part of the Bren­nan Center’s response to the coronavirus.

Jails, pris­ons, and deten­tion centers in Amer­ica are often over­crowded and unhygienic places. This is danger­ous, even under normal circum­stances. But with the coronavirus spread­ing rapidly, the nation’s addic­tion to mass incar­cer­a­tion could be dispro­por­tion­ately deadly for many incar­cer­ated people — espe­cially those 65 and older or those with pre-exist­ing condi­tions — who often live on top of each other. 

To discuss the risks that coronavirus presents to our correc­tional systems, I caught up with Dr. Homer Venters, a phys­i­cian, epidemi­olo­gist, and the former chief medical officer of the NYC Correc­tional Health Services, where he played a lead­er­ship role during the H1N1 outbreak in 2009. He is the author of Life and Death in Rikers Island, a ground­break­ing book that exam­ines the severe impacts of mass incar­cer­a­tion on health. Currently, Dr. Venters serves as the senior health and justice fellow for Community Oriented Correc­tional Health Services.

Our conver­sa­tion was edited for length and clar­ity.

Why do jails and pris­ons present such signi­fic­ant health risks to incar­cer­ated people and to employ­ees?

Jail and prison health systems in the United States have been designed to be very separ­ate from the rest of the coun­try’s community health systems. The govern­ment agen­cies that are crucial to managing the coronavirus response — like state depart­ments of health, county depart­ments of health, and the Centers for Disease Control and Preven­tion (CDC) — are essen­tially absent from jail and prison health­care and health outcomes. As a result, jails and pris­ons struggle to provide even basic health services and lack most of the skills and resources to manage outbreaks.

In the broader response to coronavirus, we continue to hear about the need to think beyond the walls of a school or a house of worship, to think across a whole community, and to coordin­ate all our response efforts together. Mean­while, 5,000 jails and pris­ons stand in stark contrast because people behind bars and the health services that they receive are so completely separ­ate from the rest of our soci­ety.

What should jail and prison admin­is­trat­ors do to ensure that incar­cer­ated people and employ­ees who work in these facil­it­ies stay safe?

homer-venters-qa-240
Dr. Homer Venters

One of the first steps is to make sure that jail and prison admin­is­trat­ors are in the room with the community and public health lead­ers that are managing the community response to the coronavirus outbreak. You need to have lead­ers from these correc­tional settings at the table. Just as there are import­ant implic­a­tions for what happens in schools, in librar­ies, and in busi­ness, there are crit­ical decisions that have to be made about jail health services. Jails, after all, cannot simply be shut down like schools.

The way jails and pris­ons are designed and admin­istered promotes the spread of commu­nic­able disease. Gener­ally speak­ing, these are unsan­it­ary settings, and there is not ample access to hand­wash­ing. Most of the terms that we have learned in the last few days, like social distan­cing and self-quar­ant­ine, are completely not applic­able in these settings. We have lots of staff and visit­ors coming and going, and we have to anti­cip­ate that as the coronavirus impacts the people who are detained or incar­cer­ated, it will also impact staff. And it will mean fewer people to work in these places at just the time where the admin­is­tra­tion of these settings will actu­ally require a very complex set of hous­ing area decisions and other manage­ment responses.

New York Gov. Andrew Cuomo recently announced that incar­cer­ated people will be making hand sanit­izer. However, in most juris­dic­tions, includ­ing New York State, hand sanit­izer is contra­band. Should hand sanit­izer and related items be more read­ily avail­able and taken off the contra­band list?

Given that this is a pandemic, it’s hard to envi­sion how the small amount of alco­hol in hand sanit­izer poses a greater risk in pris­ons and jails than that of contract­ing coronavirus. But I would say that many places won’t get hand sanit­izer, even if there is a policy decision permit­ting it. In fact, hand­wash­ing is one of the simplest and most import­ant tools for prevent­ing the spread of coronavirus. And if you spend even just a couple of minutes in any jail or prison area, you would quickly find that many of the sinks there for hand­wash­ing don’t work, or that there are no paper towels or no soap. In other words, hand­wash­ing, the most basic tool that incar­cer­ated people have, won’t be consist­ently avail­able. Jail and prison admin­is­trat­ors should be think­ing right now about how they can put more infec­tion control meas­ures into place very quickly. 

Some advoc­ates are call­ing for an early release or medical furlough for incar­cer­ated people who are sick or elderly. Should all juris­dic­tions do this? 

We espe­cially need to be concerned about every­body in a correc­tional setting with a chronic medical prob­lem who is older than age 50 or 55. It is import­ant to think about their path out of jail and prison.

I worry that as people who work in the courts get sick — such as judges, defense attor­neys, and prosec­utors —  and as trans­port­a­tion becomes diffi­cult, the path out of these places may become obstruc­ted. We saw this dynamic during H1N1. We had patients who could­n’t get to court, and their path to court was their path home. That is another rationale for shrink­ing the size of the popu­la­tion of people in every prison and jail. Yes, we want to increase the like­li­hood that we can succeed in the manage­ment plan inside the jail or prison. But we also want to avoid block­ing the path out of jail or prison and to avoid a scen­ario where people can’t go home because they can’t access certain types of court services.

Ulti­mately, this pandemic is going to impact people across a wide range of ages. And people who come into jails and pris­ons are a very high-risk popu­la­tion because they have high levels of both phys­ical and beha­vi­oral health prob­lems. So you have a much broader spec­trum of patients at risk of contract­ing the virus, and many of them are at risk for really seri­ous illness and death. Given how hard it is for those patients to access care, many of these deaths may end up being jail-attrib­ut­able deaths.

In other words, I anti­cip­ate that people will die behind bars of coronavirus who would have survived if they were in the community. We know this happens with diabetes, with trauma, and with suicide. I think our lack of evid­ence-based systems in these places may also drive jail-attrib­ut­able deaths from coronavirus.

To remedy this, I would start by look­ing at the path into jails and pris­ons or into incar­cer­a­tion. As the virus gets into these settings, one of the most crit­ical tasks will be risk manage­ment. This raises ques­tions such as: Where are the high-risk patients? How can we protect them from getting coronavirus? When they show signs of symp­toms, how can we make sure we can get them higher levels of care if and when they need it? And once they develop symp­toms, how are we keep­ing them separ­ate from every­body else?

All of that requires the abil­ity to use hous­ing areas for relat­ively small groups of people and to cohort people into differ­ent groups for hous­ing based on their health status. Cohorts help separ­ate at-risk people with no symp­toms from people who are in their early stages of symp­toms and from people who have a diagnosis. I think this starts with reevalu­at­ing all of the points of entry in the prison system, from community poli­cing to the courts and arraign­ments into the jail setting.

What worries you the most about coronavirus?

Right now, what worries me the most is the lack of commu­nic­a­tion with people who are incar­cer­ated, with their famil­ies, and with the staff who work in these facil­it­ies, espe­cially correc­tional staff. This was really a core issue during the H1N1 outbreak. Patients were terri­fied; correc­tional officers were terri­fied; and it was really hard for us in health services to build up a good path­way for commu­nic­at­ing with those staff. I worry about all of the misin­form­a­tion and fear that is already start­ing to build in jails and pris­ons and that it will spread like wild­fire once the first few cases start happen­ing.

The lack of inform­a­tion can lead to a very toxic mix, espe­cially when you consider the power dynamic where patients don’t have autonomy while correc­tional officers who have lots of power don’t have inform­a­tion and are scared. That dynamic can contrib­ute to very bad health outcomes and to poor condi­tions in jails and pris­ons, espe­cially when the correc­tional staff and the patients or the incar­cer­ated people have been left out of the loop. I think that is what has happened so far.

There is certainly much more inform­a­tion being shared between commis­sion­ers of health and the press or people perceived as their constitu­ents than with people behind bars, both those who are held there and those who work there.