Image via Shutterstock Image via Shutterstock

“It seems inevitable that either a prisoner or a staff member is going to become infected.”

It sounds like the plot of a bad movie: an infectious disease spreads through an American prison, sickening inmates and staff. While it seems outlandish, this sort of event may not be isolated to the realm of fiction—especially as the growing coronavirus outbreak spreads across the United States.

In fact, it’s already a reality in China, where more than 550 prisoners have been diagnosed with coronavirus, and Iran, where 54,000 inmates have been released from prisons in order to combat the spread of the disease in the country’s crowded jails. 

The United States is certainly not China or Iran, but Amy Fettig, deputy director of the ACLU’s National Prison Project and director of the organization’s Stop Solitary campaign, believes it’s likely that the coronavirus outbreak will eventually spread to an American prison or jail.

“It seems inevitable that either a prisoner or a staff member is going to become infected,” Fettig told COURIER.

There are currently no known cases of coronavirus, or COVID-19, among the incarcerated population in the United States, but the proposition of an outbreak in a detention facility raises interesting questions: How exactly are jails and prisons preparing for an outbreak? And what would they do if the coronavirus outbreak—which has already sickened more than 110,200 people in 97 countries and killed at least 3,835—spreads through their facilities?

“Unconstitutional Levels of Care”

There are an estimated 2.3 million people locked up in jails and prisons across the United States. That’s equivalent to the entire city of Houston being behind bars.

Under normal circumstances, the American correctional system’s healthcare infrastructure is challenged at best. As the nation’s incarceration rate has surged over the past four decades, prisons and jails in the U.S. have failed to treat hundreds of thousands of patients with Hepatitis C, HIV, drug addiction, mental illness, and even tuberculosis. 

In recent years, facilities across the country have experienced outbreaks of MRSA, scabies, and pneumococcal disease. In February, a federal prison in Florida experienced a legionnaires outbreak. 

Prisons and jails are a petri dish for the spread of infectious disease, and Fettig believes their failure to prioritize health care makes outbreaks more likely. “The healthcare system in these institutions often are very, very broken and provide unconstitutional levels of care,” she said.

“The healthcare system in these institutions often are very, very broken and provide unconstitutional levels of care.”

Not taking basic preventative measures could make many inmates acutely vulnerable to contracting coronavirus, Fettig continued. “These institutions have a lot of people who have compromised health, a lot of people with chronic care issues, a lot of people with poor health care, with serious diseases that aren’t being treated adequately or accurately by the prison medical care system,” she said. “You’ve got a population that’s extremely vulnerable to infectious disease and you’ve got institutions that oftentimes fail to take very basic measures.”

Protocols and Procedures

For their part, prison and jail officials say they’re taking necessary precautions to guard against a coronavirus outbreak in their facilities. The Federal Bureau of Prisons (BOP), which manages federal facilities holding more than 175,000 inmates, is preparing for the possible spread of the virus by following guidelines from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).

“As with any infectious disease, the BOP uses a comprehensive approach to manage its response, which includes screening, testing, appropriate treatment, prevention, education, and infection control measures,” Nancy Ayers, a BOP spokeswoman, told COURIER via email.

Ayers also said that all federal facilities are equipped with the necessary products for practicing good hygiene and that the bureau has taken preventative steps to try and protect against an outbreak. “BOP has provided guidance to staff including information about COVID-19, risk factors, symptoms and preventive measures regarding good hygiene practices.”

This guidance outlines protocols for screening all newly admitted inmates upon their intake at institutions. The bureau also offers a “screening tool,” or questionnaire, in case existing inmates or staff members are exposed or symptomatic. The questionnaire asks the individual to share information about their contact history, travel history, and symptoms, Ayers said.

The BOP spokeswoman, however, did not address what federal facilities would do if inmates were diagnosed with the coronavirus or what quarantine or isolation procedures they might institute.

‘A Lot of Gobbledygook’

While any BOP preparations are critical, more than 57% of American inmates reside in state prisons. In California, which has the largest state prison population in the nation with more than 120,000 inmates, the California Department of Corrections and Rehabilitation and the California Correctional Health Care Services are also preparing for a possible outbreak. 

Dana Simas, press secretary for the CDCR, told COURIER via email that they already have “established infection control practices” in place. The departments were reviewing “current outbreak procedures and processes for quarantine, health care treatment, visiting, transportation, and other operational needs to ensure the department is fully prepared to address any potential exposures,” she added.

Simas did not, however, respond to follow-up questions seeking to clarify exactly what the department’s existing infection control practices and outbreak procedures were.

Fettig is skeptical of the CDCR’s efforts. “That sounds like a lot of gobbledygook,” she said. “What exactly are they doing?”

Fettig said she recently visited the Arizona State Prison Complex in Tucson. “One of the number one complaints I heard from very desperate prisoners was they weren’t getting enough soap to wash their hands. They were being denied soap,” she said. 

The Arizona Department of Corrections, Rehabilitation and Reentry (ADCRR) denied Fettig’s account, with spokesman Bill Lamoreaux calling it “completely false.”

Fettig stands by her story, adding that institutions across the country are “simply filthy and not providing basic hygiene.” USA Today and MSNBC’s Chris Hayes have also reported on the lack of soap and hand sanitizer available in many facilities, with Hayes noting that even correctional officers have complained about a lack of soap to no avail. 

“What we know from healthcare officials is that one of the number one ways to prevent the spread of coronavirus is washing your hands,” Fettig said. “We’ve got people who are locked down and unable to get soap to take basic preventative measures.”

She added that many prisons are not transparent and are “very closed institutions that don’t want to let sunshine in.”

The Importance of Working With Public Health Officials

To prepare for a possible coronavirus outbreak, Fettig said it’s imperative prisons and jails work with public health systems to ensure inmates have adequate hygiene supplies and to identify inmates who might be at risk of contracting coronavirus. 

“They’re going to need public health officials to come into these institutions and help them,” she said. “They’re going to have to communicate freely and openly with other government agencies, in order to ensure that they’re protecting prisoners, their employees, and the public. Because, frankly, what happens in jail and prison impacts our health in the community.” 

Given their track record of feeling that “they’re above the law or that they aren’t accountable to the public,” Fettig added, she is skeptical about how prisons and jails are managing these widespread health concerns. 

“Our experience with institutions across the country is they are extremely secretive when they have, for example, scabies outbreaks or other infectious diseases. They frequently don’t report incidents to the public health system like they are supposed to, and as a result, they often have outbreaks that get out of control and harm many more people than they should have,” Fettig said. “That simply can’t happen here because they are putting all of us at risk.”

In Arizona, Lamoreaux said the Arizona Department of Corrections, Rehabilitation and Reentry was in contact with the Arizona Department of Health Services and was “prepared to handle potential cases.”

The Bureau of Prisons is also “proactively encouraging communication with local health authorities for reporting and management procedures of suspected cases and identifying resources and supplies as needed,” Ayers, the BOP spokesperson, said. 

How the Largest Jail System in the World is Preparing

Los Angeles County is by far the most populous county in the nation, with more than 10 million residents. It is also home to America’s largest county jail population, with an average of more than 17,000 daily inmates. In fact, Los Angeles County Jails is the biggest jail system in the world.

All healthcare staff at Los Angeles County Jails are employees of the Los Angeles County Department of Health Services—the sort of direct integration Fettig recommends. Jackie Clark, director of correctional health for the Los Angeles County Jail system, said her department is doing everything it can to guard against a possible coronavirus outbreak. 

“We’re working closely with the department of public health leading the efforts here in L.A. County,” Clark said. They’re also working alongside the Los Angeles Sheriff’s Department to go over coronavirus-related protocols and procedures. 

Clark’s department is screening all new inmates for any type of infectious disease and conducting questionnaires to determine whether an inmate may be contagious with coronavirus or other infectious diseases such as the flu or tuberculosis.

“Because of the number of patients that are housed in these types of facilities, the spread of a communicable disease could be catastrophic if we had some type of episode like that, so we do a lot of screening on the front end,” Clark said. 

These preparations could take on a newfound urgency after Los Angeles County declared a health emergency last week. The number of coronavirus cases in the county has now risen to 14

“What happens in jail and prison impacts our health in the community.”

Clark’s department is also explicitly asking inmates who say they’ve had a cough or recent flu-like symptoms if they’ve traveled to other countries or one of the regions in China associated with the coronavirus. They’ve also ensured that the central jail and every station jail in the county are stocked with procedure masks as well as the more protective N95 masks, in case of an outbreak. 

And what happens if an L.A. County inmate has traveled to an affected area and is symptomatic?

“We provide the person a procedure mask and we have isolation rooms if we need to isolate them,” Clark said. “We would then do the test for the coronavirus, contact the public health lab where those tests are being sent to, and take precautions until we get results back.”

In the case of a widespread outbreak affecting dozens of patients, they would take over a wing of the jail and place the patients there.

“We would stop movement of those patients, because again, we would not want them to interact with other parts of the population,” Clark said. “A few years ago there was concern of measles … so we [isolated] people to limit movement in or out … We would do the exact same thing if that happened here with the coronavirus.”

The department has also advised staff to stay at home and avoid coming into work if they’re feeling any symptoms associated with the virus.

“We’ve been providing these bulletins out to staff for the past three or four weeks,” Clark said. “I haven’t had any staff here in the jail that has been home isolated because they have coronavirus or suspect they have it.”

Clark and her department have also put up posters throughout their jails to provide information to inmates. They aren’t, however, taking any proactive steps to protect inmates who might be more likely to contract coronavirus due to their age or pre-existing medical conditions.

“If we identify a case, we would follow the procedures,” Clark said, “but there’s nothing that we’re doing or is recommended at this point for our vulnerable population.”

The Bureau of Prisons, California Department of Corrections and Rehabilitation, and Los Angeles County Jail System all said they would continue to work closely alongside law enforcement and public health partners, in conjunction with CDC guidance. 

It’s too early to tell if they’re doing enough to prevent an outbreak, but the ACLU’s Fettig has her concerns. She wants facilities to be more proactive about determining which inmates are at greater risk and what precautions they can take for those inmates.

“They need to come up with an actual emergency plan,” Fettig said. “Because it might not happen this week, it might not happen next week, but there’s going to be an outbreak some place and they need to be prepared.”