Covid-19 Poses a Heightened Threat in Jails and Prisons

On Monday, Mo Korchinski drove to pick a woman up from prison. Korchinski is the project administrator for Unlocking the Gates Peer Health Mentoring Program, which provides support for formerly incarcerated people during the first 72 hours of their release. Korchinski had wasted the trip. The woman she had come to collect wasn’t able to leave custody. Due to extra security measures put in place during the global outbreak of Covid-19, she will have to wait a further 14 days before she can travel from prison to a post-correctional treatment facility, just in case she has been exposed to coronavirus while incarcerated. “It’s hard enough to find somewhere to go after prison any time,” Korchinski says. “Now with Covid-19, it’s way harder.” The woman will have to wait, and hope she doesn’t get sick.

While deferring long-awaited freedom is depressing, the idea of coming down with coronavirus in prison is even worse. “For the inmates I’m working with, there’s a lot of fear,” Korchinski says. In New Jersey, people detained by ICE have gone on hunger strike, demanding to be released rather than stare down a coronavirus outbreak they see as impending, inevitable. In Italy and Colombia, those fears have turned violent, sparking riots that resulted in the dozens of deaths. It isn’t only those who are incarcerated that have begun to worry about the enormous risk Covid-19 presents to the world’s incarcerated population, who, because of factors like being kept confined in close quarters, are unable to take many of the disease-prevention measures other people are now practicing. Many advocates and healthcare experts are calling for mass releases to prevent the potentially lethal outbreaks that may already have begun.

After weeks of anxious waiting, each day now brings news of new coronavirus cases among correctional officers and incarcerated people: in Los Angeles, in San Francisco, in Leesburg, Georgia, in Waupun, Wisconsin, in Oakdale, Louisiana. In most states, cases are in the low single digits, but in New York, especially on Rikers Island, numbers are beginning to climb. At least 38 people involved in the New York City correctional system have tested positive for Covid-19. (Convicted rapist Harvey Weinstein is currently incarcerated at Wende Correctional Facility in western New York state, but the disgraced Hollywood mogul has reportedly tested positive, and was previously being held at Rikers.) During a press conference on Sunday, President Trump was asked about the possibility of releasing nonviolent elderly federal prisoners who are at high risk of experiencing severe symptoms if they contract Covid-19. “We have been asked about that, and we’re going to take a look at it. It’s a bit of a problem,” Trump replied. “But when we talk about totally nonviolent, we’re talking about these are totally nonviolent prisoners. We’re actually looking at that, yes.”

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The widespread concern about coronavirus outbreaks inside prisons is well-founded. Covid-19 is dangerous anywhere, but the illness is poised to be especially destructive among the incarcerated population, for whom social distancing is impossible. “Prisons are crowded. In California, they’re at more than 130 percent of capacity,” says Lizzie Buchen, criminal justice project director for the ACLU of Northern California. While some inmates are housed two-to-a-cell, many are in open dormitories. “They sleep and live in very close proximity, sharing toilets, sharing showers,” Buchen says. “It is extremely unsanitary.” Many prisons are short on soap, and, even if they do have it, it’s not necessarily free. In many facilities, hand sanitizer is contraband due to its high alcohol content.

The steady influx of new people into prisons and especially jails makes an outbreak more difficult to prevent. According to Daniel Lopez Acuña, a public health physician who helped craft the World Health Organization’s guidance for managing Covid-19 outbreaks in prisons, new arrivals are a frequent vector for prison outbreaks. During the 1918 influenza pandemic, a single new prisoner precipitated a mass outbreak in California’s San Quentin prison. “The new folks who are arriving every day tend to be of low socioeconomic status,” says Matthew Murphy, who studies infectious disease risk in the criminal justice involved population at Brown University. “Their incarceration might be one of the first times they are interacting with the healthcare system.” Even if the disease doesn’t arrive with a newly incarcerated person, the comings and goings of prison staff create similar risk of exposure.

On top of the ease of spread, the incarcerated population also includes a large number of at-risk older adults due to the long sentences that are common in the US justice system. People in prison are also more likely to be in poor health to begin with. Incarcerated people experience higher rates of HIV infection, tuberculosis, and cardiopulmonary and immunocompromising conditions than is average. “People are reluctant to seek medical help,” Buchen says. “If you had the seasonal flu, you would be sent to solitary confinement.” It might be sound medical practice, but it must feel a lot like being punished for being sick.

Wary inmates are far from the prison healthcare system’s only problem. It will struggle with the same shortages and difficult triage decisions that every medical center is dealing with or preparing for. Mental healthcare services, particularly those provided by outside resources, are a likely casualty. Sick prisoners also may not be dealing with a medical system that is equipped or staffed to meet their needs, particularly during a pandemic. “Prison infirmaries generally lack life-support equipment,” says Brie Williams, director of the criminal justice and health program at University of California San Francisco. “They are only able to provide limited respiratory support for a limited number of people,” Williams adds. In California, most prisons are under medical receivership, which means that the federal government has deemed them incapable of providing adequate medical care to their inmates and has assumed oversight. “Medical staff are extremely stressed,” Buchen says. “They’re not equipped to handle a normal flu season.” Not every prison will have such a strained healthcare situation, but a few is already too many.

Illustrated woman, speech bubble, virus cell

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Some prison systems are already taking action to mitigate (or, hopefully, prevent) Covid-19 outbreaks before they burden their healthcare systems. “We’re operating under our contagious disease protocol,” says Jeremy Desel, the director of communications at the Texas Department of Criminal Justice. “Before they set foot in a unit, everyone fills out a questionnaire and gets temperature screened at the back gate.” If the person is running a temperature of 100.4 or higher, they will then be put in a mask and gloves, and medically isolated in the infirmary for further testing. Texas’ system is typical of screening efforts nationwide. All states have suspended normal visitation, and 15 have even banned legal visitation to further reduce chances of exposure to the virus.

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