Jails, prisons, and detention centers in America are often overcrowded and unhygienic places. This is dangerous, even under normal circumstances. But with the coronavirus spreading rapidly, the nation’s addiction to mass incarceration could be disproportionately deadly for many incarcerated people — especially those 65 and older or those with pre-existing conditions — who often live on top of each other.
To discuss the risks that coronavirus presents to our correctional systems, I caught up with Dr. Homer Venters, a physician, epidemiologist, and the former chief medical officer of the NYC Correctional Health Services, where he played a leadership role during the H1N1 outbreak in 2009. He is the author of Life and Death in Rikers Island, a groundbreaking book that examines the severe impacts of mass incarceration on health. Currently, Dr. Venters serves as the senior health and justice fellow for Community Oriented Correctional Health Services.
Our conversation was edited for length and clarity.
Why do jails and prisons present such significant health risks to incarcerated people and to employees?
Jail and prison health systems in the United States have been designed to be very separate from the rest of the country’s community health systems. The government agencies that are crucial to managing the coronavirus response — like state departments of health, county departments of health, and the Centers for Disease Control and Prevention (CDC) — are essentially absent from jail and prison healthcare and health outcomes. As a result, jails and prisons struggle to provide even basic health services and lack most of the skills and resources to manage outbreaks.
In the broader response to coronavirus, we continue to hear about the need to think beyond the walls of a school or a house of worship, to think across a whole community, and to coordinate all our response efforts together. Meanwhile, 5,000 jails and prisons stand in stark contrast because people behind bars and the health services that they receive are so completely separate from the rest of our society.
What should jail and prison administrators do to ensure that incarcerated people and employees who work in these facilities stay safe?
One of the first steps is to make sure that jail and prison administrators are in the room with the community and public health leaders that are managing the community response to the coronavirus outbreak. You need to have leaders from these correctional settings at the table. Just as there are important implications for what happens in schools, in libraries, and in business, there are critical decisions that have to be made about jail health services. Jails, after all, cannot simply be shut down like schools.
The way jails and prisons are designed and administered promotes the spread of communicable disease. Generally speaking, these are unsanitary settings, and there is not ample access to handwashing. Most of the terms that we have learned in the last few days, like social distancing and self-quarantine, are completely not applicable in these settings. We have lots of staff and visitors coming and going, and we have to anticipate that as the coronavirus impacts the people who are detained or incarcerated, it will also impact staff. And it will mean fewer people to work in these places at just the time where the administration of these settings will actually require a very complex set of housing area decisions and other management responses.
New York Gov. Andrew Cuomo recently announced that incarcerated people will be making hand sanitizer. However, in most jurisdictions, including New York State, hand sanitizer is contraband. Should hand sanitizer and related items be more readily available and taken off the contraband list?
Given that this is a pandemic, it’s hard to envision how the small amount of alcohol in hand sanitizer poses a greater risk in prisons and jails than that of contracting coronavirus. But I would say that many places won’t get hand sanitizer, even if there is a policy decision permitting it. In fact, handwashing is one of the simplest and most important tools for preventing the spread of coronavirus. And 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. 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.
Some advocates are calling for an early release or medical furlough for incarcerated people who are sick or elderly. Should all jurisdictions do this?
We especially need to be concerned about everybody in a correctional setting with a chronic medical problem who is older than age 50 or 55. It is important to think about their path out of jail and prison.
I worry that as people who work in the courts get sick — such as judges, defense attorneys, and prosecutors — and as transportation becomes difficult, the path out of these places may become obstructed. We saw this dynamic during H1N1. We had patients who couldn’t get to court, and their path to court was their path home. That is another rationale for shrinking the size of the population of people in every prison and jail. Yes, we want to increase the likelihood that we can succeed in the management plan inside the jail or prison. But we also want to avoid blocking the path out of jail or prison and to avoid a scenario where people can’t go home because they can’t access certain types of court services.
Ultimately, this pandemic is going to impact people across a wide range of ages. And people who come into jails and prisons are a very high-risk population because they have high levels of both physical and behavioral health problems. So you have a much broader spectrum of patients at risk of contracting the virus, and many of them are at risk for really serious illness and death. Given how hard it is for those patients to access care, many of these deaths may end up being jail-attributable deaths.
In other words, I anticipate that people will die behind bars of coronavirus who would have survived if they were in the community. We know this happens with diabetes, with trauma, and with suicide. I think our lack of evidence-based systems in these places may also drive jail-attributable deaths from coronavirus.
To remedy this, I would start by looking at the path into jails and prisons or into incarceration. As the virus gets into these settings, one of the most critical tasks will be risk management. This raises questions such as: Where are the high-risk patients? How can we protect them from getting coronavirus? When they show signs of symptoms, how can we make sure we can get them higher levels of care if and when they need it? And once they develop symptoms, how are we keeping them separate from everybody else?
All of that requires the ability to use housing areas for relatively small groups of people and to cohort people into different groups for housing based on their health status. Cohorts help separate at-risk people with no symptoms from people who are in their early stages of symptoms and from people who have a diagnosis. I think this starts with reevaluating all of the points of entry in the prison system, from community policing to the courts and arraignments into the jail setting.
What worries you the most about coronavirus?
Right now, what worries me the most is the lack of communication with people who are incarcerated, with their families, and with the staff who work in these facilities, especially correctional staff. This was really a core issue during the H1N1 outbreak. Patients were terrified; correctional officers were terrified; and it was really hard for us in health services to build up a good pathway for communicating with those staff. I worry about all of the misinformation and fear that is already starting to build in jails and prisons and that it will spread like wildfire once the first few cases start happening.
The lack of information can lead to a very toxic mix, especially when you consider the power dynamic where patients don’t have autonomy while correctional officers who have lots of power don’t have information and are scared. That dynamic can contribute to very bad health outcomes and to poor conditions in jails and prisons, especially when the correctional staff and the patients or the incarcerated people have been left out of the loop. I think that is what has happened so far.
There is certainly much more information being shared between commissioners of health and the press or people perceived as their constituents than with people behind bars, both those who are held there and those who work there.
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