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You need a plan for coronavirus in your facility

This disease spreads most rapidly where people are enclosed together, like nursing homes, cruise ships and prisons


Illustration of the 2019-nCoV viewed through an electron microscope. Note the spikes that adorn the outer surface of the virus, which impart the look of a corona surrounding the virion.


This column was originally posted on Jeff Keller’s blog, Jail Medicine.

Unless you’ve been living under a rock, you have been hearing about the threat of the coronavirus. Every day, the news media provides an update of the number of new cases, the number of new countries affected and the number of new deaths.

You probably already know that the coronavirus originated in China. What you may not know, but you should if you work in corrections, is that Chinese prisons were especially hard hit. This disease spreads most rapidly where people are enclosed together, like nursing homes, cruise ships and prisons. If this disease gets a foothold in the United States, correctional institutions are likely to be impacted.

what is COVID-19?

When referring to the coronavirus, we are talking about what is officially known as COVID-19, which is the name of the disease, not the virus. The official name of the virus is SARS-CoV-2, more commonly known as novel coronavirus.

Coronavirus has been around forever; it is one of the viruses that cause the common cold, a nuisance but hardly a pandemic concern. However, viruses sometimes mutate, which is what this particular coronavirus did, becoming a new, or novel, coronavirus. The novel coronavirus makes people sicker than the old version and also is more easily transmitted from person-to-person. These two properties have turned the disease, COVID-19, into a global threat.

What are the symptoms of COVID-19?

Once exposed to the coronavirus, people usually begin to show symptoms 2-14 days later. COVID-19 is characterized by fever, cough, shortness of breath and body aches, so it can be confused with influenza. Most people who get COVID-19 have only a mild illness, but around 15% get very sick and around 2.5% die.

The ability of the coronavirus to spread quickly from one person to another is one of its most prominent features. This virus is transmitted in two ways: First, by a sick person coughing or sneezing droplets into the air and another person inhaling the droplets, and second, the virus gets on an inanimate object like a doorknob and is spread to the next person who touches the doorknob.

The virus is spread mainly by people with COVID-19 who are clearly sick and coughing, but also may be spread before an infected person knows they are sick. The best way to prevent transmission is to quarantine infected people, which the countries hardest hit by COVID-19 are trying to do.

There is no vaccine or antiviral drugs for COVID-19 at this time. Once someone gets sick with COVID-19, only supportive care is the only option. This means that preventing exposure is the single most important thing people can do.

How to protect against infection

Take the following precautions to protect yourself:

  • Get a flu vaccination. Since COVID-19 closely resembles the flu, it makes sense to try to eliminate this source of confusion.
  • Frequently wash your hands.
  • Clean surfaces you regularly touch.
  • Don’t wear a mask if you are not sick! According to the Centers for Disease Control (CDC), masks don’t help uninfected people.
  • If you get sick with a coughing/sneezing illness, don’t go to work.
  • If you get very sick, go to the doctor, where you may be tested for COVID-19.

Infection control planning for correctional facilities

Since COVID-19 is spreading so rapidly worldwide, there are fears it may become a pandemic. If COVID-19 gets to your region, there is a very good chance it will show up in correctional facilities. We need to be prepared in advance. I recommend the following:

  • Each correctional facility should assign one person to be responsible for COVID-19 preparedness. I’ll call that person the infection control supervisor. Their job is to coordinate a response to a COVID-19 epidemic (or any other epidemic, for that matter). If necessary, the infection control supervisor may appoint an infection control committee to assist in preparedness.
  • Meet with the district health department. If a COVID-19 epidemic hits, the health department will be in charge of the overall response. They need to know who to contact at the correctional facility and the infection control supervisor needs to know who to contact at the district health department.
  • Set up a meeting at your correctional facility to talk about COVID-19 preparedness. The infection control committee should be there (of course), but also a representative of facility administration, and ideally someone from the regional health department and a representative of the hospital where you will send your sickest inmates.
  • Create a plan on how you are going to handle COVID-19 at your facility. The plan should include obtaining any necessary equipment and supplies, when to begin screening (usually when the health department tells you to), how and where you are going to quarantine infected patients, how you will transfer the sickest to the hospital and how you will release infected patients into the community when they are released from jail.
  • The infection control supervisor should create COVID-19 educational materials for medical staff, detention staff and inmates. Education should emphasize facility cleanliness, the importance of handwashing and what to do when sick.

This planning will pay off if COVID-19 shows up in your community.

As always, what I have written here is my opinion, based on my training, experience and research. I could be wrong! If you think I am wrong, please say why in the comments.

Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of emergency medicine practice experience before moving full time into his “true calling” of correctional medicine. He is the medical director of Badger Medical, which provides medical services to several jails and juvenile facilities in Idaho. Dr. Keller is a Fellow of both the American College of Emergency Physicians and the American College of Correctional Physicians. He serves on the Board of Directors of the American College of Correctional Physicians.