Interrupting COVID-19 in jails and prisons
At this crucial infection point we need 'all of the community' to help halt transmission in our corrections systems
By Tim Stephens, Don Hulick, Gary Maynard, Keith Neely and John Walsh, PhD
The incidence of COVID-19 in corrections has been more than five times higher than in the general population. One study estimates that 80% of COVID-related deaths in jails were of people who were not convicted.  The burden on the corrections system and concentration of disease is higher than in nursing homes.  In many of our cities and counties, the spread in jails and prisons accelerates and sustains the rate in the general community. 
This was predictable, and therefore preventable. In every recent infectious disease outbreak, jails and prisons have been epicenters of spread. This has been true of HIV, the 2009 H1N1 influenza and tuberculosis. Spread is predictable in these and other congregate settings because of the limited ability to move away from the source of the disease: other human beings.
During COVID there have been few successful interventions that have lowered these rates. Rates are going up again as we enter the winter and confront another wave of the pandemic.
Most corrections systems have had to develop early release programs; however, this one-off, short-term solution has not demonstrably “bent the curve.” Corrections facilities continue to be major COVID hotspots. If we cannot alter this trend and make conditions safer for inmates, corrections personnel and their families, then communities with corrections facilities will continue to see serious disease spread.
Medical facility deficits
Corrections systems have had serious deficits in medical facilities for a long time. They are the de facto mental health system: in 44 states hold more mentally ill individuals than their state psychiatric institutions.  They have been housing a sicker population over recent years. The number of elderly (and less healthy) inmates has risen dramatically ‒ 400% between 1993 and 2013.  Corrections administrators incur large, unplanned additional security costs to provide basic healthcare for lack of simple onsite capacity.
After 12 months of observation, it is now clear COVID is overwhelmingly spread from respiratory droplets, mostly indoors. Increased facility cleaning is insufficient, and fundamental changes to air-handling and lowering human-to-human contact is necessary. Most corrections systems lack the space and resources to make these changes.
Jails and prisons are cannibalizing their facilities: using classrooms for quarantine, opening old annexes, deploying tents to house inmates with no ability to segregate airflow and restricting access to common spaces. Systems are refusing transfers and extending lockdowns. This combination of actions is straining operational capacity and producing negative consequences for normal operations and the mental health of officers and inmates. In New York City the number of interventions to breakup inmate violence has nearly tripled in recent months. 
Use federal funds
We can and must break the cycle of COVID-19 in corrections. We must use the next round of federal funding to address this issue for all people, for those living and working inside the wire, and those outside.
Corrections must be part of the all-of-society effort to contain the spread of the outbreak. We recommend at a minimum:
- Corrections have specific, dedicated funding for decreasing the COVID outbreak;
- The entire corrections operation (visitations, home monitoring, corrections personnel health protections and behavioral health programs) be eligible for funding;
- The entire judicial process (intake, processing, court hearings and inter-facility transfers) be included to ensure transmission between the community can be managed.
The CARES Act was not designed to address community transmission at the levels and concentrations we have seen in corrections since early April. In early September, the U.S. Treasury had to issue updated guidance on “COVID-19-related expenses of maintaining state prisons and county jails.” This is insufficient.
For a start, we propose a dedicated $3B fund to address the built corrections environment and indoor air quality.
We recommend each state receive a base amount of $20M, and an additional $2B be distributed among the states based upon the 2010 census of state population. The exact distribution should include resources for the territories and tribal jurisdictions.
The appropriation should also include resources set aside to collect accurate data and research knowledge gaps related to the dynamics of infectious disease transmissions, development of effective control strategies, applied mitigation protocols, and population behaviors occurring in jails and prisons. We additionally recommend funds be distributed by the state administrative agents with a requirement that 50% or more of a state’s total allocation go to local jails, and at least 10% go to reducing exposures in courthouses.
This $3B is less than $10 per American, or the equivalent of two lattes at Starbucks.
For $3B we can, as a nation, start to address the stresses in our corrections systems and break the transmission cycle back and forth to our communities.
This program will lower COVID-19 rates in a population (inmates and corrections officers) that has been unduly exposed and produce additional positive outcomes:
- Lower security and operational costs for inmate transfer to hospitals for care;
- Return the orderly transfer of inmates to the appropriate security level fitting their offenses;
- Reduce the exposure of corrections officers in the conduct of their normal duties;
- Lower the burden of long-term lockdowns and the associated violent episodes.
As the COVID-19 outbreak accelerates across the nation we can expect it will be a larger threat to inmates, corrections officers and the wider community as it circulates into and out of jails and prisons. At this crucial infection point, we need “all of the community” to help halt transmission in our corrections systems.
5. Maruschak LM, Berzofsky M, Unangst J. Medical problems of state and federal prisoners and jail inmates, 2011-12, 2015.
About the authors
Tim Stephens, MA, is the CEO of SafeJail, a partnership of public health, facility designers, engineers and corrections experts focused on making jails safe. Tim has spent more than 30 years in developing population health innovations and public health preparedness programs. For 10 years he served as the Public Health Advisor to the National Sheriffs Association. Contact him at firstname.lastname@example.org.
Don Hulick served the Illinois Department of Corrections for 20 years, before retiring as warden of Menard Penitentiary. More recently he worked as a vice president of operations for Wexford Health Sources.
Gary Maynard has worked in corrections since 1970. He served in leadership roles in the Arkansas and Oklahoma prison systems, as the Director of Corrections in South Carolina and Iowa, and more recently as the Maryland Secretary of Public Safety.
Keith Neely, CJM, leads American Correctional Consultants, LLC. Keith oversaw the successful process for the Broward Sheriff’s Office, Department of Detention to maintain accreditation recognition from the American Correctional Association (ACA), Florida Corrections Accreditation Commission (FCAC), and the National Commission on Correctional Health Care (NCCHC). He served as a Commissioner for the FCAC from 2010–2016, and chaired the Nominating and Standards Review & Interpretation Committees.
John Walsh, PhD, is co-director of the Vanderbilt University Medical Center Program in Disaster Research and Training. He served a tour of duty in Vietnam as a marine before following his father into a career in corrections and law enforcement. He served as sheriff in Oklahoma and was the director of the Oklahoma Sheriffs Association. He is a co-author of the 2019 book "Three Seconds to Midnight," which describes how the United States is not prepared for a pandemic.