Spotlight on Jails: COVID-19 Mitigation Policies Needed Now.

TO THE EDITOR—In response to the coronavirus disease 2019 (COVID-19) pandemic, healthcare institutions and public health experts are mobilizing to develop mitigation protocols [1] based on the experiences of other countries, including China, South Korea, and Italy. Compared to these countries, the United States has a higher incarceration rate, with 10.6 million people booked into jails each year [2]. Jails pose a unique set of challenges to COVID-19 prevention, detection, and management mitigation that deserves immediate attention.

Social distancing to reduce the rate of disease transmission is not feasible in jails, where people are confined to small living spaces and institutions are often over capacity [3, 4]. Handwashing can be undermined by policies limiting soap access or requiring individual purchase of soap (at a marked-up price) [5, 6]. Many jails restrict access to hand sanitizer, which contains alcohol, fearing individuals will ingest it. Along with structural barriers to disease prevention, there are administrative challenges—largely driven by lack of financial resources—that impede timely access to healthcare professionals when sick [7]. This is especially concerning because jails have a high proportion of people with underlying health conditions [3, 8], making them more susceptible to severe COVID-19 infection [7]. There are several reasons why people who are infected may be reluctant to self-identify symptoms, including unknown duration of detainment [9], fear of being isolated, or losing privileges (eg, television, phone calls) in a medical unit [10]. Furthermore, increased risk of COVID-19 exposure in jails confers higher risk of transmission in the community upon release, with challenges surrounding then notifying those exposed who have limited access to stable housing or phones [11].

We have developed a list of recommendations to facilitate and augment COVID-19 mitigation polices in jails (Figure 1). At the most basic level, funds should be allocated to purchase soap, hand sanitizer, and personal protective equipment (eg, gloves, masks). Educational materials, in multiple languages, should be disseminated to people who are incarcerated and personnel designated to address any questions or concerns that arise. All corrections staff should receive training on identifying signs of coronavirus and preventing disease transmission. This starts with updating intake forms in detention settings to screen for people who meet criteria for COVID-19 testing and access to rapid (< 24 hours) testing results. Partnership with local academic centers to access rapid testing is encouraged. There should be dedicated spaces within jails for isolation of persons with confirmed or suspected COVID-19 who are not ill enough to warrant hospital transfer, with a plan in place for transporting patients when necessary. Ensuring the well-being of law enforcement and correctional officers is key to any mitigation strategy, and there should be policies that compensate staff who become sick with COVID-19.

Figure 1.

Recommendations to local county jails for coronavirus disease 2019 (COVID-19) mitigation response.

An evidence-based approach, grounded in public health principles, is needed to contain the outbreak without further isolating an already vulnerable population. The unintended consequences of these mitigation policies must be considered, for example, the deleterious impact of halting mental health treatment programs in jails. The recent riots in Italy’s correctional facilities [12] revealed the potential for negative psychological impact of emergency policies aimed at curtailing the spread of COVID-19 (eg, suspending family visitations). It is time for reexamination of policies, such as cash bail or holding people pretrial (ie, without a conviction), to decrease the jail population [13, 14].

Thoughtful and deliberate planning for COVID-19 mitigation in corrections institutions—especially jails—is imperative. We need action now, starting with engagement of key stakeholders to identify the current and future needs of jails to combat this pandemic. The health of our communities will only be as good, or as poor, as the health of the most disadvantaged among us. Now is the time to prioritize the healthcare of people who are incarcerated.