No Escape From Virus Threat for 2 Million Crammed in Prisons

More than 950 cases of Covid-19 have been confirmed in the U.S. but none yet in any of the thousands of jails and prisons across the country. Epidemiologists expect it will only be a matter of time.

Conditions in correctional facilities are much the same as those on the cruise ships that were early incubators –- with confined populations, some people especially vulnerable to exposure and medical with confined populations, some people especially vulnerable to exposure and medical care with varying levels of availability and caliber.

“It’s considered a congregate setting. That’s one of the risks,” said Anne Spaulding, an associate professor at Emory University’s Rollins School of Public Health. “The propensity to incarcerate at such high levels can accelerate epidemics,” such as a recent outbreak of Legionnaires disease at a women’s work camp in Florida.

More than 2 million Americans are in custody on any given day, the most in any country and lockups have experience with airborne diseases, including influenza and tuberculosis, and those transmitted by blood, such as hepatitis C and HIV.

To protect inmates and staff from the highly contagious coronavirus, though, guards and health-care workers can’t do much beyond following guidelines from the U.S. Centers for Disease Control and World Health Organization: Monitor for signs of contagion. Cover your mouth when you sneeze or cough. Wash your hands. In many institutions, hand sanitizer isn’t allowed because of its alcohol content.

Inmate-rights advocates have raised the alarm that correctional facilities, particularly those that are overcrowded, may be unprepared. Some of the advocates have called for authorities to release low-level, nonviolent offenders to remove them from harm’s way and consider furloughs for the aging and ill and those behind bars because they can’t afford pre-trial bail.

“If the only reason that a person is sitting in jail and is essentially a sitting duck for this illness is that they can’t pay the amount of money needed to get themselves out of jail, then I think local authorities should be thinking, ‘Does this make sense?’” said Maria Morris, a senior staff attorney with the American Civil Liberties Union’s National Prison Project.

In Iran, the authorities freed 54,000 low-level offenders who tested negative for the virus, instructing them to return once the threat has passed.

Prisons can easily become flashpoints. In Italy, at least six people died in riots as thousands of inmates protested their treatment during the outbreak, including a decision by authorities to suspend family visits.

Though pop culture presents murder as a pervasive threat in the U.S. system, illness is by far the leading killer, causing 86% of deaths in 2016, according to federal Bureau of Justice Statistics.

“Prison is not the place to get sick, and if you do that’s most likely what will kill you,” said Paul Wright, who served 17 years for murder in Washington state and is now executive director of the Human Rights Defense Center and editor of Prison Legal News.

Epidemiologists view local facilities -- city and county jails where suspects are first taken after arrests –- as the most at-risk because people are coming in off the streets as the virus is starting to spread in the general population.

The federal system, which houses 175,000 inmates, is checking those who exhibit signs of infection and for whether they recently traveled to high-risk parts of the world, as recommended by the WHO and CDC. The federal courthouse in Manhattan is taking the temperature of inmates brought in for hearings and banning those at 100.4 and above, and also screening courthouse visitors for travel to high-risk countries within the last four weeks.

A group of U.S. senators asked for details about coronavirus planning Tuesday in letters to the prisons bureau and the three largest private-prison operators, citing the “particular vulnerability of the prison population and correctional staff.”

Officials in the biggest state systems -- New York, California and Texas -- said they are following their protocols for other airborne infections, particularly influenza, and adapting them for Covid-19.

In California, prisons have troubled histories with medical care. The system was put under the control of a court-appointed receiver in 2006 because of the number of preventable inmate deaths. The state has since regained jurisdiction over medical care in 19 of its 35 prisons.

According to state officials, California has triage and treatment centers in all of its institutions, procedures in place for quarantine and isolation and contracts with local hospitals for acute needs. They said the system is ready to follow protocols for other crises -- riots, for example –- to isolate prisoners from one another, such as serving meals in cells instead of open cafeterias.

In New York, state prison officials introduced new screening measures on March 9 for people visiting inmates, asking if they had traveled outside the U.S. in the previous month or had exposure to anyone diagnosed with the virus. The Texas Department of Criminal Justice said it has the capacity to distribute masks and shoe covers for its 14,000 inmates and also employees and to clean surfaces with 10% bleach solutions.

Aging Inmates

A main concern is the overall health profile of the U.S. inmate. Diets on the inside aren’t generally healthy, stress is high, more than half of the population has suffered from mental-health problems and more than a third have chronic medical conditions, according to research from the National Center for Biotechnology Information, a division of the National Institutes of Health.

And inmates are aging, with years of tough-on-crime sentencing laws pushing the share of the elderly to more than 10%, according to Pew Charitable Trusts. “You’ve got quite a graying prison population, lots of lifers who are old,” said Scott Burris, a professor at Temple University’s Beasley School of Law and director of its Center for Public Health Law Research. “That’s who’s vulnerable to the virus.”

Multiple studies have shown that even when a prison controls outbreaks on the inside, communicable diseases that aren’t caught before a person walks out of the gates spread quickly on the outside. That’s often because former prisoners are poor and don’t have access to medical care once they’re home, said Gregg Gonsalves, an assistant professor of epidemiology and co-director of the Global Health Justice Partnership at Yale Law School and the Yale School of Public Health.

“What gets into a prison gets out of a prison,” he said. “It goes both ways.”