Why US jails and prisons became coronavirus epicenters

Jails and prisons in the US are reporting coronavirus outbreaks. That’s bad for everyone.

America’s jails and prisons have become epicenters in the coronavirus pandemic.

At Illinois’s Cook County Jail (which serves Chicago), some inmates refused to eat noncommissary food to protest conditions they claimed enabled the spread of the coronavirus. The New York Times found earlier this month that the Cook County Jail outbreak, which has sickened nearly 400 detainees and almost 200 correctional officers, made it “the nation’s largest-known source of coronavirus infections.”

In Rikers Island in New York City, the jail’s top doctor called the coronavirus outbreak there — one of the largest in the country, with hundreds sick — a “public health disaster unfolding before our eyes.” As of April 20, the confirmed infection rate in New York City jails was more than 9 percent, compared to less than 2 percent in New York City more broadly, according to the Legal Aid Society.

Brian Cassella/Chicago Tribune/Tribune News Service via Getty Images

In Michigan’s Parnall Correctional Facility, 10 percent of prisoners and 21 percent of staff tested positive for the coronavirus as of April 15, according to the Detroit Free Press. When controlling for population, that makes the outbreak there even worse than Cook County’s or Rikers Island’s.

In Ohio, more than one in five of the state’s confirmed cases are in the prison system, the Columbus Dispatch reported. The Marion Correctional Institution, where 73 percent of inmates tested positive for the virus, makes up a majority of those cases.

The federal prison system hasn’t been spared either, with several deaths and and at least 100 inmates and staff members infected just in FCC Oakdale in Louisiana.

Jails and prisons are ideal environments for an infectious disease to spread. They are, by design, often packed as much as possible, thus limiting the possibility of social distancing. They also severely limit access to hygiene products — the sheriff in Cook County had to proactively let inmates use sanitizer, which is normally prohibited due to its alcohol content, and soap and water can be hard to get. Even among staff, personal protective equipment (PPE) such as masks remains difficult to access.

The outbreaks are concerning not just because of the impact they can have on inmates, staff members, and their families, but also because the events can spill over beyond the correctional facilities. Millions of inmates go in and out of prisons, and particularly jails, each year, returning to their communities. Staff members go home at the end of their shifts. Inmates’ family members can visit — although that’s become much harder, if not impossible, due to the pandemic.

And if there’s an outbreak in a jail or prison, it can strain nearby health care systems as inmates and staff are sent to local hospitals and clinics that are better equipped to treat Covid-19, the disease caused by the SARS-CoV-2 coronavirus, than correctional facilities.

So to get the coronavirus pandemic under control, experts say, the nation will need to get outbreaks in jails and prisons under control, too. This means releasing more vulnerable and less dangerous inmates early, as some jails and prisons have been doing. It means making sure inmates and staff have better access to hygiene products and PPE. It means a change in how jails and prisons fundamentally operate — allowing more room for social distancing and quarantining, or otherwise isolating inmates and staff when necessary.

Jails and prisons create a coronavirus threat to whole communities

Many countries are facing new challenges in their jails and prisons due to the coronavirus pandemic. But the US is unique, because mass incarceration has led to millions of people being incarcerated across thousands of jails, prisons, and other correctional facilities in the country — any of which could become hotbeds for disease.

The US locks up about 2.3 million people on any given day — the highest prison and jail population of any country in the world. With an incarceration rate of 655 per 100,000 people, the US incarcerates people at nearly twice the rate of Russia, more than five times that of China, more than six times that of Canada and France, nearly nine times that of Germany, and almost 17 times that of Japan.

“We can learn what works in terms of mitigation from other countries who have seen spikes in coronavirus already, but none of those countries have the level of incarceration that we have in the United States,” Tyler Winkelman, a doctor and researcher at the University of Minnesota focused on health care and criminal justice, told me.

It’s not just the number of people in jail and prison, but the number going in and out of them, too. Jails in the US alone admit upwards of 5 million unique people each year, releasing many of those same people back to the community within days or weeks. There are also visitors and correctional staff who interact — sometimes in very limited spaces — with inmates. Any of these people can bring the virus in and take it out.

“Jails pull together people from many neighborhoods, put them all together in cramped, unsanitary conditions, and then very quickly release them back to the same communities,” John Pfaff, a criminal justice expert at Fordham University, told me. “They’re a very powerful centralizing and diffusing vector of disease. That alone should grab people’s attention.”

No other country faces a risk quite like this. Even the states that incarcerate the least number of people in the US still lock up far more people than the vast majority of other countries: In 2018, the Prison Policy Initiative estimated that the incarceration rate of Massachusetts, the least carceral state, was more than double that of England and Wales, and nearly triple that of South Korea.

So a prison outbreak would present a potentially deadly risk to a relatively massive population, which, on top of everything else, disproportionately suffers from chronic illnesses and other health conditions that could exacerbate Covid-19.

There are also big racial disparities in jails or prisons, which, if those people are released back to their own communities, could further worsen already bad outbreaks in minority communities.

Jails and prisons present an elevated risk for other types of facilities and institutions. Winkelman, who works in the Hennepin County Jail and local homeless shelters, noted that there is a lot of overlap between jailed and homeless populations. Someone released from a jail, then, could infect people in a homeless shelter, or vice versa, causing an outbreak that could bounce back and forth between both places, infecting far more people than would be in a jail or homeless shelter alone.

But even if an outbreak is contained to a jail or prison, the effects could spill over outside.

“All of these mitigation strategies — of closing schools, stopping conferences, decreasing travel — are to slow the speed at which people get the virus so that we don’t overwhelm our health care system,” Winkelman said. “If Covid spreads in a large, thousand-person facility, and within five days you have a thousand people with multiple chronic conditions who just got the virus, that has the potential to really overwhelm a health care system.”

One problem is that jails and prisons notoriously do a bad job of providing health care to inmates. As a CNN investigation last year revealed, these facilities often deny or delay even basic medical care, causing preventable complications and deaths. In the context of Covid-19, those kinds of delays could mean more time for a sick inmate to infect others.

This is in part by design: To get to prison doctors and nurses, inmates usually have to go through guards who often have different priorities.

“The system of care that exists around any given person, whether they’re incarcerated or not, is not just doctors or nurses, but it’s also the people who are in their immediate vicinity and taking care of them on a day-to-day basis,” Wanda Bertram, communications strategist for the Prison Policy Initiative, told me. “That’s why it really matters when those people are family members as opposed to when those people are correctional staff, who think of you as a threat.”

People in jail or prison also have less access to things people might otherwise take for granted that help prevent the spread of infection.

“If you spend even just a couple of minutes in any jail or prison area, you would quickly find that many of the sinks there for handwashing don’t work, or that there are no paper towels or no soap,” Homer Venters, former chief medical officer for New York City Correctional Health Services, told the Brennan Center, a criminal justice reform group. “In other words, handwashing, the most basic tool that incarcerated people have, won’t be consistently available. Jail and prison administrators should be thinking right now about how they can put more infection control measures into place very quickly.”

Jails and prisons are taking action — but they could do much more

Some jails and prisons are already taking steps to prevent the spread of the coronavirus. They’ve banned visits. They’ve released inmates early. They’ve tried to separate inmates out more; in Cook County, for example, detainees are now mostly placed in single cells instead of with a cellmate.

But problems remain. In Washington, DC, for example, inmates sued over conditions in jail, including a lack of soap and paper towels. The correctional officers union — typically at odds with inmates — joined the lawsuit against DC’s Department of Corrections. A judge ultimately denied inmates’ requests for an early release, but did order better protections against Covid-19, including more social distancing and improved tracking of symptoms.

Jonathan Newton/The Washington Post via Getty Images

“Mostly what we’ve seen are more grudging efforts,” Pfaff said. “I don’t think any place is doing great.”

But with coronavirus outbreaks now happening across the US, this is something, experts argue, that all jails and prisons should at least be preparing for, if not taking concrete steps to prevent.

“Jails and prisons should really have a sense that they’re almost overreacting,” Winkelman said, echoing what other experts have said about dealing with Covid-19 in general. “That’s probably going to be what the right move is.”

To that end, Winkelman said that guidance from the Washington Association of Sheriffs and Police Chiefs, released early in the US’s Covid-19 outbreak when Washington state was among the first hit, still holds up.

One recommendation: release some inmates. “Are there people you can release on their own recognizance? Do you have a priority list (who do you release if you need to downsize by 5%? 10%? etc.)?” the guidance asked. “Are there alternatives to arrest for certain crimes, or, in dire situations, are there crimes for which your patrol division will not arrest?” Another possibility is a furlough, in which some inmates are released temporarily, particularly those who are older and have health conditions that could make Covid-19 more dangerous.

Some jails and prisons are taking steps along these lines, but experts caution that this is something, again, that all jails and prisons should consider. If a key measure to beating the spread of Covid-19 is physical distancing, then making sure that jails and prisons aren’t as packed should help. One poll by Data for Progress suggested, too, that a majority of likely voters backs early release of at least some inmates to deal with the coronavirus outbreak.

Part of the challenge may be that early release isn’t only up to jails and prisons, Pfaff said: “The leniency requires every step of the process to buy into it. If you have the sheriffs on board, but the judges don’t agree, it’s going to be hard to get people out. If the judges are on board, but the sheriffs aren’t, it’s going to hard to get people out. You need everyone to come together to get people out — and it’s often very hard to get that unified response.”

Jails and prisons could also aggressively test to gauge the scope of their outbreaks and catch early warning signs of an epidemic. They could make soap and hand sanitizer easier to obtain. They could move visitations to phone and video conferences. They could guarantee paid sick leave to staff — helping ensure that staff stay home when they’re sick — and encourage staff to work from home when possible.

“If you’re going to keep people contained, at least make it possible for them to clean their hands and give them face masks or something they can wear,” Pfaff said.

At the same time, it’s important for jails and prisons to not get too carried away, including with inmates who prove to be sick.

“Inmates in isolation should have ample access to comfort, entertainment, and activity-related materials allowed by their custody level,” the guidance from the Washington Association of Sheriffs and Police Chiefs explained. “An important reason for this suggestion is that you want to do everything possible to encourage inmates to notify medical staff as early as possible if they experience symptoms of infection. Fear of being placed in an overly-restrictive cell may delay their notification, which is counterproductive.”

Above all, though, jails and prisons should take the coronavirus as a serious threat — not just to themselves, but to the greater public, too — and work with public health officials accordingly.

“It’s an exaggerated version of what we talk about all the time when we talk about the public health impact of mass incarceration — when we say that this is not just something that puts incarcerated people in danger but something that puts whole communities in danger,” Bertram argued. “You’re creating hotbeds of illness, and you’re creating damage that’s eventually going to have to be borne by these people and their families once they’re released. So it’s really a concern for everyone.”

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