The most effective way to avoid the lethal spread of COVID-19 is to “drastically” cut jail and prison populations at high risk of infection, says the nation’s leading medical journal.
The Journal of the American Medical Association (JAMA) recommended in an Internal Medicine Viewpoint that authorities reduce “unnecessary” jail admissions and expedite the release of prisoners serving time for nonviolent crimes or technical parole violations as well as those with underlying medical conditions.
“In prisons and jails, social distancing is typically a physical impossibility,” said the Viewpoint.
The authors of “COVID-19 in Prisons and Jails in the United States,” Dr. Laura Hawks, Dr. Steffie Woolhandler, and Dr. Danny McCormick, drew on historical comparisons to underscore the unique risks faced by the incarcerated during the nation’s current health emergency.
“Prior viral epidemics have wrought havoc in carceral settings,” said JAMA.
It cited an account from San Quentin prison detailing the impact of the Spanish influenza of 1918, which estimated that half the 1,900 inmates incarcerated at the time contracted the disease. During the first wave of that epidemic, sick calls increased from 150 to 700 daily.
At San Quentin, a single incoming prisoner initiated each wave of the 1918 epidemic, according to the Viewpoint. Once introduced, the disease spread rapidly as a result of the inmates’ close confinement and an inability to isolate the sick.
The authors analyzed the COVID-19 outbreak on the Diamond Princess cruise ship for a more contemporary analogy.
“With about 3,700 passengers and crew held onboard in separate but close quarters, about 700 people became infected and 12 died over a 4-week period,” they wrote.
:The rapid spread was attributed to a small number of kitchen workers housed together on Deck 3, who were responsible for feeding the quarantined passengers.”
Most prisons and jails are similarly conducive to spreading disease.
Last month, the first case of COVID-19 was diagnosed at Riker’s Island. Within two weeks, more than 200 cases were diagnosed within the facility, despite efforts to curb its spread.
“People who are incarcerated will be at higher risk of exposure, as correctional officers and other staff frequently leave the facility and then return,” said JAMA.
The elderly, and persons with underlying illnesses, are at high risk of severe illness and mortality from COVID-19, said JAMA.
As a result of longer sentences (mostly for non-violent offenses), the average age of the prison population has increased. In 2013, state prisons housed 131, 500 persons older than 55, a 400 percent increase since 1993.
Many incarcerated persons older than 55 years have chronic conditions, such as heart and lung diseases, said JAMA.
About half of the people incarcerated in state prisons have at least one chronic condition; 10 percent report heart conditions, and 15 percent report asthma—“percentages far greater than those for the population at large, even when comparing similar age groups.”
The authors also urged that aggressive steps be taken to protect those being rapidly released.
“In the two weeks following release from incarceration, people are at increased risk of death, particularly from drug overdose and cardiovascular disease,” said JAMA.
” If more people are to leave prisons and jails, correctional officials and community members should take steps to mitigate these risks. Pharmacologic treatment for opioid use disorder is now available via telemedicine, and all prisoners who might benefit from such programs should be referred to them.”
Also, older prisoners and those with chronic health conditions should have pre-arranged primary care follow-up, as well as the means–such as a computer or smartphone–to engage in “telehealth” visits, said the Viewpoint.
Those who are released from prison and are at risk for homelessness require additional measures and resources, said JAMA.
“In Connecticut, a widespread effort to provide housing for the homeless in hotels has emptied shelters, which are high-risk environment. Additionally, streamlining access to and broadening eligibility criteria for safety net programs including Medicaid and food stamps are important.”
To read the Viewpoint, click here.
This summary was prepared by TCR Deputy Editor Nancy Bilyeau