Decarcerating Correctional Facilities during COVID-19 Advancing Health, Equity, and Safety (2020) / Chapter Skim
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2 Correctional Facilities and COVID-19: Context and Framing
2 Correctional Facilities and COVID-19: Context and Framing
Pages 21-44
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prisons and jails and discusses the data limitations that challenge research efforts necessary to inform ongoing pandemic and public health responses. THE BASIC EPIDEMIOLOGY OF COVID-19 Epidemiologists study the spread of infectious diseases by dividing the population into distinct categories (or compartments)
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. The second summary measure is the effective reproduction ratio, or Re, which is the number of new infections that result from a new infection at a given point in time after the initial infection.
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Finally, the correctional health care system is largely siloed from public health and emergency preparedness planning and not resourced to manage pandemic outbreaks. Box 2-1 describes how these five features may have contributed to a COVID-19 outbreak at San Quentin Prison in California.
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In late May, a number of individuals were transferred from this prison to other facilities of similar prison population, San Quentin and Corcoran. It was later discovered that some of those transferred tested positive for COVID-19 (McCoy et al., 2020)
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Movement throughout all correctional facilities is common as staff and incarcerated people move in and out of housing, dining, recreation, and programming areas. 3 The SEIR model discussed above by Anderson and May (1991)
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Between 26 and 44 percent of people incarcerated were held in an overcrowded jurisdiction.4 Applying similar measures to jails, the average daily incarcerated population exceeds capacity in all but two states, Virginia and West Virginia (Minton and Zeng, 2015)
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She also finds significant pockets of incarceration outside of major urban areas, in small towns. This latter finding is consistent with other recent reports of rising jail populations in small towns and rural areas (Vera Institute of Justice, 2017)
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After controlling for other risk factors, incarcerated people have been found to have higher rates of many chronic conditions than the general population -- including hypertension, asthma (Binswanger, Krueger, and Steiner, 2009; Maruschak, Berzofsky, and Unangst, 2016) , and certain types of cancer (Binswanger, Krueger, and Steiner, 2009)
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The higher clinical severity among incarcerated people could reflect late reporting of symptoms or a higher threshold for or difficulties referring COVID-19 patients from a correctional facility to the hospital than that from the community. Either way, these data indicate unique issues for managing COVID-19 in correctional facilities.
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There is also evidence of aging in the jail population. From 1996 to 2008, the number of people incarcerated in jail aged 55 or older increased by 278 percent, compared with a 53 percent increase in the overall jail population (Beck and Berzofsky, 2010; Darrell and Beck, 1997; Greene et FIGURE 2-1 Age distribution of males and females held in state prisons in 2018 compared with the U.S.
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. Correctional Health Care All states have a constitutional obligation to provide adequate health care to incarcerated people.
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When COVID-19 outbreaks occur, many correctional facilities will likely turn to communitybased health resources and hospitals for assistance and treatment of those infected, which in turn will further stress these community health systems during the pandemic. THE SCOPE OF THE OUTBREAK To accurately describe the full extent of the COVID-19 pandemic in correctional facilities is difficult given the large variability in testing practices, testing rates, and data reporting and transparency across the country.
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With these caveats, higher transmission rates in prison appear to be reflected in the COVID-19 case rates among incarcerated people and staff compared to the general population: see Figure 2-2. (The case rate is the number of people testing positive for the SARS-CoV-2 virus that causes COVID-19 divided by the total population in question, such as the prison population, the staff population, or the general population.)
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SOURCE: Data from COVID Prison Project (2020)
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Improving the quality and availability of data on COVID-19 testing and cases, as well as information on facilities' mitigation strategies, is a significant research priority for understanding the different outcomes across correctional facilities during the pandemic. TABLE 2-2 COVID-19 Cumulative Prevalence, Test Positivity Rate, and Mortality Rate of Incarcerated People, by State and Federal Jurisdiction, as of August 31, 2020 Cumulative Prevalence Test Positivity Mortality Rate Case Fatality Jurisdiction (per 1,000)
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SOURCE: Data from COVID Prison Project (2020)
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By this measure, the health of prison staff is closely related to the well-being of the incarcerated population (COVID Prison Project, 2020)
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Testing capabilities and frequency vary across states and facilities. SOURCE: Data from COVID Prison Project, 2020.
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NOTE: Testing capabilities and frequency vary across counties and facilities. SOURCE: Data from COVID Prison Project (2020)
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. By the end of September 2020, there were 1,170 reported deaths among people in prison or ICE detention as a result of COVID-19 and 83 reported COVID-19–related deaths among prison staff across 19 prison systems (COVID Prison Project, 2020; UCLA Law COVID Behind Bars Data Project7)
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better data on testing and methods are needed in order to accurately monitor the relative risk of incarcerated populations compared with the general population. MITIGATING TRANSMISSION IN CORRECTIONAL FACILITIES There have to date been very few studies on how to best mitigate COVID-19 transmission in correctional facilities, although a number of papers have examined similar settings, such as homeless shelters, or how prisons have managed highly infectious respiratory diseases in the past (Beaudry et al., 2020; Mosites et al., 2020)
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Vest and colleagues used data from 103 state prisons of the Texas Department of Corrections to identify "latent class profiles," or groups of facilities which are similar based on the outcomes of incarcerated resident COVID-19 cases, staff COVID-19 cases, and incarcerated resident COVID-19 deaths. Three distinct groups of Texas prisons were identified: a low outbreak profile, a high outbreak profile, and a high death profile.
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The high rates of ad mission and release and overcrowding in facilities that are often inadequately ventilated exacerbate virus transmission. Incarcerated people are in relatively poor health, disproportion ately burdened by chronic conditions, and more susceptible to severe complications if infected.
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, the spatial concentration of incarceration predominantly in low-income communities of color, the health vulnerabilities of the incarcerated population, and the underresourced correctional health system. While the data from jails, prisons, and other facilities are far from complete, the available information points to cumulative COVID-19 cases and mortality rates among incarcerated people that are significantly higher than in the general population.
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