Nursing homes have been major sources for COVID-19 outbreaks and deaths. A nursing home is a perfect storm of congregant living, a highly infectious novel virus, asymptomatic infections and elderly individuals with chronic health conditions, the very people most at risk for serious coronavirus illness and death.
There is another congregant population with vulnerable individuals in crowded conditions, which is also a brew pot for COVID-19 outbreaks: correctional facilities. These outbreaks not only affect prisoners and staff but may also extend to communities and have the potential to overload our health care system. Aside from some high-profile individuals being released from prison due to coronavirus risk, the problem in correctional institutions has garnered relatively little attention.
At least 10 of the 15 largest coronavirus “clusters” have occurred in correctional facilities. For example, in Ohio, the Marian Correctional Institution generated more than 2,400 cases. In Indiana, the National Guard was deployed to Westville Prison during a COVID-19 outbreak. Although no Indiana data is available for jails, as of June, 323 state prison staff and 715 inmates have tested positive for coronavirus (with only 7% tested); two staff and 20 incarcerated people have died. Nationally, more than 44,000 infections and 462 deaths have occurred among prisoners and correctional personnel.
Most jails and prisons possess less-than-optimal health care services and are encumbered with an at-risk population, including older inmates and many with chronic diseases at rates much higher than the general population. Many are African Americans and other minorities who are disproportionately affected by the COVID-19 crisis. Prisons are also generally lacking in COVID-19 testing and mitigation resources. It is virtually impossible to social distance in prisons or jails.
Beyond improving medical care and living conditions, necessary reforms include reducing correctional facility admissions and increasing releases to decrease population density. Medically vulnerable prisoners and inmates with nonviolent offenses and other crimes that did not threaten public safety should be the focus. Older inmates and those with chronic diseases are more apt to get seriously ill and require more in-hospital services.
Because one-third of incarcerated people are in local jails with short stays, “jail churn” (the traffic of admissions and releases) promotes infection and spread to communities. Admission-reduction strategies include reclassifying non-public-safety-related misdemeanors to non-confining offenses, using citations rather than arrests for minor offenses and diversion to mental-health and substance-abuse treatment.
Similarly, reducing parole and probation revocations for “technical” violations, such as violating curfew or failing a drug test, would go a long way in reducing correctional populations. Home detention, furloughs, parole, community service or even commuting sentences are incarceration alternatives.
Indiana has yet to release a single inmate to help prevent coronavirus spread. Some states, including Kentucky, have developed release programs in response to COVID-19.
The public has little interest in prison health, and politicians don’t win elections based on advocacy for those who have offended society. But prisoners are not isolated from the community at-large, with inmates, staff, vendors and visitors entering and leaving and potentially serving as vectors for COVID-19 community spread.
How we treat prisoners is a measure of our society’s humanity. Action is warranted. If not for them, then we should do it for the common good.•
Feldman is a family physician, author, lecturer and former Indiana State Department of Health commissioner for Gov. Frank O’Bannon. Send comments to firstname.lastname@example.org.
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