How COVID-19 Outbreaks in Prisons Are Making the Pandemic Worse for Everyone

• Researchers have found that the death rate from COVID-19 in prisons is three times higher than average.
• Crowding, poor sanitary conditions, and high rates of chronic illness among incarcerated people make it difficult to control the spread of infectious diseases in jails and prisons.
• Security measures designed to keep people in jails and prisons don’t effectively keep viruses or other infectious pathogens from traveling in and out of those facilities.

Jails and prisons are proving to be viral hot spots in the COVID-19 pandemic — and outbreaks there are putting the lives of incarcerated individuals and other community members at risk.

By July 21, at least 70,717 people in prisons across the United States had tested positive for the novel coronavirus, The Marshall Project reports.

Public health experts warn that the spread of the novel coronavirus in those facilities is endangering incarcerated people, correctional staff, and the wider public.

“Any national strategy to eradicate COVID-19 needs to focus aggressively on reducing outbreaks within prisons,” Brendan Saloner, PhD, an associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told Healthline.

“COVID-19 got into prisons in the first place through the outside world — such as staff or visitors — and it will never stay within prisons,” he said.

Case rates soaring

In a letter published this month in JAMA, Saloner and colleagues reported that the COVID-19 case rate is 5.5 times higher in state and federal prisons than in the general population.

When they made adjustments for age and sex, the authors of the letter found that the death rate from COVID-19 in prisons is three times higher than average.

The true case rate may be even higher, since testing for the novel coronavirus has been uneven across facilities. In select prisons that conducted mass testing campaigns this spring, infection rates exceeded 65 percent at some sites.

The novel coronavirus has also been making its way through local jails, where many people are awaiting trial or serving short sentences — often for petty crimes or nonviolent offenses.

Last week, the Mercury News reported that at least 40 incarcerated people had tested positive for SARS-CoV-2 within a roughly 24-hour period at Santa Rita Jail in Alameda County, California.

Most of those people were workers in the jail’s kitchen or laundry services, who work alongside other inmates and a third-party vendor who helps prepare food.

Spread to wider communities

The security measures that are designed to keep people in jails and prisons don’t effectively keep viruses or other infectious pathogens from traveling in and out of those facilities.

Staff members, visitors, and incarcerated individuals who contract SARS-CoV-2 inside of correctional facilities may pass the novel coronavirus on to other people after they leave.

In a study reported last month in Health Affairs, researchers found that the cycling of people in and out of Cook County Jail in Chicago, Illinois, may be significantly contributing to the spread of COVID-19 in surrounding communities.

“People are being arrested, cycled through high-risk infectious spaces in the jail where they are exposed to the virus, and then returned to their neighborhoods where they inadvertently infect their families and others,” Eric Reinhart, MA, lead author of the study and an MD, PhD candidate at the University of Chicago Pritzker School of Medicine in Illinois and the department of anthropology at Harvard University in Boston, Massachusetts, told Healthline.

“In fact, we found that jail cycling is far more significant than race, poverty, public transit use, and population density as a predictor of COVID-19 cases,” he added.

When Reinhart and his coauthor controlled for other factors, they found the arrest, booking, and release of people from the jail was independently linked to almost 1 in 6 cases of COVID-19 in Chicago and the wider state of Illinois.

Physical distancing is impossible

The rapid spread of COVID-19 through jails and prisons doesn’t come as a surprise to Sharon Dolovich, PhD, JD, a professor of law and director of the UCLA Law COVID-19 Behind Bars Data Project at the University of California in Los Angeles.

Crowding, poor sanitary conditions, and high rates of chronic illness among incarcerated people make it difficult to control the spread of infectious diseases in jails and prisons.

“Prisoners’ rights advocates have been saying we are just one pandemic away from a medical catastrophe in the prisons — and here we are,” Dolovich told Healthline.

Even in normal times, she said the amount of living space allotted to people in custody is inadequate to meet their physical and psychological health needs.

In the COVID-19 context, tight quarters and overcrowding make it impossible for incarcerated individuals to maintain adequate physical or social distance from one another.

Incarcerated people also have limited access to face masks and other protective equipment. Even basic sanitary supplies such as cleaning products can be hard to come by, especially for those who can’t afford to buy them from the commissary or the black market.

“You can’t socially distance, you can’t keep your hands clean, you can’t keep your environment disinfected,” Dolovich said, “and you’re lucky if you get a mask that you have to wear every day without being able to clean it.”

Chronic diseases heighten risk

If incarcerated individuals do contract the novel coronavirus, many of them have chronic health conditions that raise their risk of developing a severe infection and dying from COVID-19.

For example, a government report issued in 2016 found that prisoners were 1.5 times more likely than average to report a history of high blood pressure, diabetes, or asthma.

“Prison is hard on you anyway, and then the medical care is so grossly inadequate that you’re not getting preventative care and a lot of people have chronic conditions,” Dolovich said.

“So there’s a lot of comorbidities among people in prisons that you wouldn’t necessarily see in the same-age population outside,” she added.

Limiting the spread

To curtail the spread of COVID-19 in jails and prisons, public health experts and advocates are calling for increased access to testing, medical care, face masks, and sanitary supplies.

Many experts and advocates are also calling for fundamental reforms in how people in this country are policed and incarcerated.

“To effectively manage COVID-19 in the United States, it is vital that we address the ways in which America’s long-standing overuse of arrest and incarceration — which far exceeds that of any other country in the world — wreaks havoc on public health,” Reinhart said.

“We need to immediately implement changes to stop needless arrests and the dangerous practice of incarcerating people without any legitimate public safety justification,” he added.

Releasing a proportion of people who are already behind bars is another essential strategy for allowing people who remain in custody to physically distance from each other, Dolovich said.

Many people in custody are serving time for nonviolent or nonserious offenses, and releasing them would “pose no appreciable public safety threat,” she continued.

Keeping them in jail or prison exposes them and other community members to heightened risk of infection, complications, and death from COVID-19, she added.

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