The mortal threat that COVID-19 represents to health and well-being is no longer in dispute. A month ago I wrote about four critical areas in which we needed to act in our jails, prisons and immigration detention centers to save the lives of the people who are held and work in these institutions, and to prevent these places from driving the outbreak curve higher and longer. COVID-19 has now arrived in these institutions, with a growing list of facilities being affected. Here are four more things we must do in the coming two weeks to stave off preventable deaths and shorten the coronavirus outbreak.
- People with risk factors for serious complications and death cannot be protected inside jails, prisons and immigration detention centers. Coronavirus is confirmed inside multiple correctional settings, and to think it won’t spread like wildfire denies everything we know about how it has spread elsewhere. Brave sheriffs and physicians who work on the inside of these institutions are making this point as they come to grips with the reality of the impossible job of preventing the spread coronavirus in places designed and run to spread communicable disease. Some local and state governments are listening, but very few.
- Create pathways for hospital care. Every state should explicitly plan the pathways for incarcerated patients to receive life-saving level of care. This is a daunting challenge, especially in rural counties with many jails, prisons and immigration detention centers and few hospitals. The way that most incarcerated patients get to a hospital involves two armed correctional officers taking them to the hospital and keeping a rotation of this security escort 24/7.Coronavirus will impact scores of patients inside these settings, as well as correctional staff, and there won’t be enough officers to escort sick patients or hospital beds for them. One potential solution is for states to plan their emergency response so hospitals can set up secure treatment units that don’t rely on a 2:1 ratio of correctional officers to patients. These units can be created alongside the new coronavirus units already being contemplated. Without them, patients who remain in these institutions will suffer preventable deaths.
- Don’t use lockdowns as a health response. Jails, prisons and immigration detention centers are designed and run to punish, especially in response to a health crisis. Being suicidal in jail often results in solitary confinement, which drives suicide as the leading cause of death. Outbreaks often stir a desire to lock people away in cells, with the notion that germs won’t spread if people are sealed in individual cells. Nothing could be farther from the truth. Lockdown units often require more staff than regular units, because of the need to handcuff and physically escort people to and from the shower, in and out of the cell for health care, and numerous other basic operations. All of this means more staff and more physical contact. Also, being placed in solitary confinement causes extreme distress, and inside the brutal and filthy solitary units I’ve observed around the nation, this practice drives violence and fractures engagement between health staff and people who are sick just when we need it most.
- Create Correctional Health Coordinator positions in every state emergency response, as well as the Centers for Disease Control and Prevention and the Department of Health and Human Services. We don’t have any reliable data on which jurisdictions are taking these first three steps and how it’s going. These coordinators must quickly assemble a national profile of data, including how many people are in these facilities, how many have symptoms, their test results and how many need and are receiving hospital level care. We need that information so we can divert resources to clusters behind bars and prevent these places from driving a resurgence of COVID-19 just when we’re achieving success elsewhere.
There is no part of American society that is less prepared for coronavirus or graver a threat to health than jails, prisons and immigration detention centers. But it’s not too late for us to act in a way that prevents death and shortens the outbreak for the entire nation.
Dr. Homer Venters is the former chief medical officer of the New York City Jail System and president of Community Oriented Correctional Health Services (COCHS).