{"subscriber":false,"subscribedOffers":{}} What COVID-19 Means For America’s Incarcerated Population — And How To Ensure It’s Not Left Behind | Health Affairs

Health Affairs Forefront

What COVID-19 Means For America’s Incarcerated Population — And How To Ensure It’s Not Left Behind

Doi: 10.1377/forefront.20200310.290180

As the world grapples with the panic of COVID-19 spread and associated fatalities, emergency preparations for a pandemic are underway. Public health officials and correctional leaders in the United States need to protect the health and safety of the most vulnerable non-community residents: incarcerated individuals.

With nearly a quarter of the world’s prison population, the United States is home to an ailing prison health care system and its large aging subpopulation. Our nation’s experience with tuberculosis, HIV and the ongoing hepatitis C epidemic has taught us that correctional settings are reservoirs of infectious diseases. Prisons push people into the paths of epidemics.

Nationwide efforts are intensifying to elucidate COVID-19’s pattern of spread and implement strategies for containment among community members. Yet for those 2.4 million people under judicial custody, public guidelines and preparedness are lacking to curtail their burden of infectious diseases. We need greater leadership from the system trusted to care for this population. Six immediate actions are urgently needed across the country’s prisons and jails.

First, the scope of preparedness in correctional settings is unclear. We need immediate baseline assessment of the degree of preparedness in prisons and jails in the event of an uncontrolled outbreak. This includes infection control measures, access to appropriate protective gear and diagnostic kits for correction staff and those incarcerated. This can be done in partnership with local academic institutions or public health departments. Furthermore, tighter regulations on sanitary practices including hand washing in correctional facilities should be enforced.

Second, medical and public health guidance is lacking. Transparent means of communication are critical between correctional facilities and state health departments for immediate reporting, testing and coordination of care. Using the best-available evidence, guidelines tailored to prison health providers on prevention, diagnosis, and treatment of COVID-19 should be established and widely disseminated by the Centers for Disease Control and Prevention, and National Commission on Correctional Health Care.

Third, this moment is not one for passive monitoring. Responses to reported or observed symptoms must be timely and honest, as the rate of viral transmission can lead to fatalities in an enclosed setting. Correctional employees have been implicated in litigations citing deliberate and harmful denial of medical care for incarcerated individuals. This is an opportunity to regain public trust in regard to the correctional culture of clinical passivity and deliberate indifference to the protected dignity of those under judicial custody. 

Fourth, policing patterns should not continue at the status quo. Bringing more people into the correctional setting during this period creates additional risk. In the absence of more comprehensive judicial reform, law enforcement agents can consider limiting further incarceration to egregious crimes rather than populating our jails and prisons with individuals convicted of non-violent crimes. In response to the COVID-19 outbreak, the British government has set a precedent for this approach in preparation for a shortage of their police workforce. Similarly, Iran, which has recorded alarming death rates from COVID-19 has granted furlough to 54,000 incarcerated men and women to limit the spread in prisons. 

Fifth, transitions of care merit special attention. Recidivism in the correctional system should be closely monitored during this period of prioritizing public safety. In addition, correctional facilities and community-based organizations should increase their commitment to continuity of health care during the transition of those released back to the community during this crucial time in our nation’s history.

Finally, the people who serve in the country’s prisons are also at heightened risk of infection. Policy makers should prioritize the health and safety of our corrections staff as they serve as a conduit and possible carriers of COVID-19 while shuttling between the community and our prisons. Measures to protect corrections staff at the front line of health care for the most vulnerable should be implemented. In addition, to ensure public safety during this pandemic, we must urgently prepare for the possibility of a prison staff shortage in the event of an outbreak.

The heath of the local and global community is intimately linked with the health disparities in correctional facilities. One cannot be achieved without mitigating the other. The unmet needs of incarcerated people have long been ignored. This historic moment requires calculated steps and nationwide preparation for the unforeseen aftermath of COVID-19. We must remember the millions of incarcerated people who cannot plan for themselves yet remain inextricably tied to the core of our public health system.