COVID-19 and Mass Incarceration: Action Needed Now to Stem the Epidemic

In prisons and jails around the country, COVID-19 infections and deaths are occurring at lightning speed among both inmates and the staff who enter and leave the prison each day. In a commentary published today in JAMA Internal Medicine, physicians from Harvard Medical School and City University of New York's Hunter College explain why COVID-19 is nearly impossible to contain in such settings, and recommend urgent measures to reduce the loss of life.

To illustrate the devastating effects of COVID-19 among persons detained in close quarters, the authors cite the 1918 influenza pandemic, when nearly half of all prisoners at California's San Quentin jail fell ill. They also point to the recent case of passengers held on a luxury cruise ship, resulting in 700 COVID-19 infections and 12 deaths. They warn that prisons and jails today are even more crowded than San Quentin was in 1918 -- and much less-resourced than a cruise ship -- which will accelerate the COVID-19 epidemic both within prison walls and in nearby communities.

The authors suggest urgent changes within carceral settings. These include better access to testing and treatment, medical isolation when necessary, and ensuring that inmates can access medical care without copayments. However, the top priority should be enabling social distancing by immediately shrinking the number of incarcerated persons. "Decarceration - getting people out of prison - is the way to prevent a catastrophe," said senior author and associate professor at Harvard Medical School Dr. Danny McCormick. "Local governments and justice departments have made some changes, but too many people have been left in harm's way."

The paper also provides recommendations to protect inmates after release. "The two weeks after release are a high-risk time," said Dr. Laura Hawks, lead author and research fellow at the Cambridge Health Alliance. "Re-entry planning and support for housing, health care, food, and re-entry into the workforce are critical. Evidence shows that many prisoners can be safely returned to the community - and right now there's a humanitarian imperative to do so."

Study co-author Dr. Steffie Woolhandler, who is a Professor at CUNY's Hunter College and co-founder of Physicians for a National Health Program added, "We believe that health care is a human right, as is freedom from cruel and unusual punishment. Both of these rights are being trampled in our prisons and jails."

"COVID-19 in Prisons and Jails in the United States," Laura Hawks, M.D.; Steffie Woolhandler, M.D., M.P.H.; and Danny McCormick, M.D., M.P.H. JAMA Internal Medicine.

Published online first, April 28, 2020. doi:10.1001/jamainternmed.2020.1856

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