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Prisons are going to be an incredibly dangerous place in a pandemic

Prisons are just as much of a hotbed for transmission as cruise ships, but they often aren’t at the top of the agenda for public health officials during a pandemic.

Prisons are going to be an incredibly dangerous place in a pandemic
[Photo: Dmitrii_Guzhanin/iStock]

As the coronavirus outbreak has spread around the world, health officials have homed in on cruise ships, quarantining vessels as a way to ward off more cases of COVID-19. It makes sense; when it comes to potential contamination zones, cruise ships, with their close quarters and communal activities, are a hotbed for transmission. But there’s another type of facility that is particularly vulnerable to pandemic outbreaks: prisons.

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“If we have a jail down the road that has 3,000 people in it, it’s similar to a cruise ship with 3,000 people in it,” says Anne C. Spaulding, a professor of epidemiology at Emory University and a former medical director with the Rhode Island Department of Corrections. “We have certainly seen the role that cruise ships can do in an epidemic like this. . . . What you see in a ship, you can see in a prison.”

There are a few similarities between what happens on a cruise ship and what happens inside prisons and jails: People live together, eat together, and sleep in tightly packed arrangements. But whereas cruise ship containment is a priority for many local officials, inmates may be more of an afterthought to officials outside the corrections industry during pandemics.

If the infection is widespread in a community, the likelihood that it’s going to be showing up in the local jails is fairly high.”

Jails, which are short-term facilities mostly filled with people awaiting trial, are vulnerable to anyone coming off the street who may be exposed, Spaulding says. “If the infection is widespread in a community, the likelihood that it’s going to be showing up in the local jails is fairly high,” she says. To protect jails from COVID-19, there needs to be preventive action such as health screenings for those coming into the facilities—law enforcement and inmates alike—and the ability to house separately anyone showing symptoms consistent with coronavirus.

Prisons, which hold inmates for longer-term confinements, need to conduct health screenings as well, for new inmates as well as those who work in the prison. Spaulding suggests prisons encourage staff to stay home if sick, and to be cognizant of staff health during roll call. “Containment is the best thing,” she says. “It’s easier to nip it in the bud if you send the person home . . . so things won’t get worse later on.”

Those who are incarcerated—about 2.3 million people across the country—may be at the mercy of their facilities and the limited hygiene products supplied to them. Many prisons don’t allow inmates access to hand sanitizers, since the alcohol could be separated out. (In New York State, incarcerated people are now making hand sanitizer as a way to combat statewide shortages resulting from the coronavirus outbreak. The prisoners are only getting paid 65 cents an hour and still can’t use the product themselves.) Some also require that inmates purchase their own soap at the commissary. One thing prisons can do to prevent the spread of COVID-19, Spaulding says, is to distribute soap, and not make inmates pay for each bar.

The California Department of Corrections and Rehabilitation provides soap and hospital-grade disinfectant to its incarcerated population, a spokesperson confirmed to Fast Company, and as a precaution during the coronavirus outbreak it’s supplying extra cleaning supplies. CDCR and California Correctional Health Care Services are in communication with infectious disease control experts, preparing for a scenario in which COVID-19 would affect their operations.

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CDCR is creating fact sheets and posters to be distributed in its institutions statewide, ensuring that inmates that come into the system or are transported to a county jail to attend court hearings receive a health screening, and it’s also asking that visitors who feel sick with a fever, cough, or difficulty breathing not enter a CDCR institution until they no longer show symptoms. The department has no intention of closing visitation at this time but said it may be postponed if there is an impact on staffing.

Washington State Department of Corrections is asking visitors who display those symptoms not to come in person as well. Instead it encourages friends and family to keep contact with inmates through JPay, video visiting, telephone calls, and mail. JPay, a private service that partners with correctional facilities to provide emails, money transfers, video visiting, and more, costs money and has been criticized for how it profits off incarceration. At a time when workers, especially in the Seattle area, may be losing hours and pay because of the coronavirus outbreak, paying to visit a loved one in jail may not be possible.

After Italian prisons suspended family visits because of COVID-19, prisoners in Italy rioted, leading to multiple deaths. Though Spaulding doesn’t expect that to happen in the U.S.—partly because many prisons here already have no-contact visitation—she says it’s important that officials in these facilities keep a calm presence. “Sometimes not knowing what is going on can increase the stress level for people who are incarcerated,” she says.

Downsize the prison population: That could mean releasing people on their own recognizance or identifying a few crimes that local police forces will not arrest people for.

A lot is unknown at the moment, such as whether prisons will actually see outbreaks at all. To that question, Spaulding says that while she doesn’t think a COVID-19 outbreak is inevitable in prisons, she would not be surprised if it occurred. Another thing that could curb coronavirus in prisons would be to allow recreation in an outside yard rather than in a small gymnasium. During the Spanish Flu of 1918, San Quentin Prison provided entertainment options for inmates, such as movies in a small theater, which Spaulding says probably contributed to more people getting influenza; 500 of 1,900 prisoners fell ill.

“Descriptions of San Quentin in the 1918 influenza outbreak is an example of what we should not do when we have an airborne pathogen,” she says. Another great way to prevent the spread of COVID-19 in prisons? Downsize the prison population, as a memo from a University of Washington School of Public Health professor suggests. That could mean releasing people on their own recognizance or identifying a few crimes that local police forces will not arrest people for.

Coronavirus is certainly on prison staff’s radar, Spaulding adds, and educational presentations, which are frequently updated with more information about COVID-19, are being shared on the American College of Correctional Physicians website. Facilities do have their own medical staff, but this is something that local health departments must choose to prioritize. “I would love to see planning for congregate settings like jails and prisons be higher on the agenda in public health in ‘name the outbreak,’ ‘name the emergency,'” she says.  “I don’t think that this phenomenon of high incarceration that we’ve got in our country is really understood as far as community infection control strategies, and we need [that] to be on a higher place on the agenda.”

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