Q&A: Without proper strategies, prisons could become COVID-19 ‘epicenter’
Compared with other countries affected by the COVID-19 pandemic, the United States generally has a higher incarceration rate, with more than 10 million people booked into jails each year. This specific setting poses “a unique set of challenges” when it comes to COVID-19 prevention that require action and attention, according to an editorial published in Clinical Infectious Diseases.
Lauren Brinkley-Rubinstein, PhD, assistant professor of social medicine and core faculty member of the UNC Center for Health Equity Research at the University of North Carolina at Chapel Hill, and colleagues explained that the jail setting poses a unique set of challenges for COVID-19 prevention, detection and management. Healio asked Brinkley-Rubinstein about recommendations for jail populations, including the correctional staff, and how to prevent COVID-19 in this group. – by Caitlyn Stulpin
Q: What makes inmates susceptible to COVID-19?
A: People who are incarcerated are susceptible to COVID-19 for many reasons. They tend to, on average, have a higher burden of chronic illness compared with their nonincarcerated counterparts. In addition, factors at the facility level can put people in these institutions at increased risk, too. In these settings, it is very difficult to engage in social distancing, soap and/or hand sanitizer are not widely available and there may be medical copays that act as a barrier to seeking help.
Q: Why is this an important issue in the U.S.?
A: This is an important issue in the U.S. because correctional facilities could become the epicenter of this pandemic. Riker's Island has a rate of infection that is nine times higher than that of New York City; day to day, there are new reports of cases across the country in jails and prisons. The health of people who live and work in correctional facilities are at risk, but so are people in the community. For jails in particular, there is a high turnover rate people coming in and out so rapid transmission in the jail will also affect community rates.
Q: What are your recommendations and what facilities do they apply to?
A: Our recommendations align with the guidance that the CDC and other agencies have provided. They apply to the macro and micro levels. First, jails and prisons should prioritize certain people for release. We've seen this begin to happen across the country. They should consider releasing people who are incarcerated only because of their inability to pay bail, otherwise known as pretrial detainees. They should also release people who have low-level offenses, are near release, are immunocompromised or are aged older than 50 years. Prisons should also consider releasing people who are older, have a high burden of chronic illness or are otherwise nearing their release date. Second, soap and hand sanitizer should be made available for free. Third, medical copays should be waived. Finally, robust rapid testing, done in 4 hours or less, should be implemented in every correctional institution.
Q: What about corrections staff?
A: Corrections staff are also at extreme risk for infection. They have little to no public health training and have not been, at least not yet, prioritized for testing like other first responders, but are still required to maintain close contact with people who are incarcerated. If they are exposed to COVID-19, they also risk bringing it home to their communities. They should be prioritized for testing and given personal protective equipment.
Disclosure: Brinkley-Rubinstein reports no relevant financial disclosures.