As COVID-19 spreads, public health officials are telling people to stay home if they feel sick. But in jails and prisons, that's not an option.
Robert Greifinger is a physician who spent 25 years working on health care issues inside the nation's prisons and jails, and he says the "social distancing" advice we're all hearing right now isn't so simple behind bars.
"There are crowding issues, ventilation issues, security issues where people have to be checked and monitored fairly frequently," Greifinger says. "So it's really hard to do."
If jails and prisons are complacent about the coronavirus, he says they run the risk of becoming "incubators" for the disease.
"Since jail and prison staff and prisoners tend to be younger, one thinks initially that it's not going to be a big problem," he says. "But remember that staffs work shifts, they come in and out of the facility, and they may be bringing that infection home to people who have compromised immune systems."
For weeks, Greifinger and other corrections health experts have been urging prison administrators to plan for the coronavirus. But when NPR first started asking jails and prisons about preparations, most pointed to existing plans for other infectious diseases, such as tuberculosis.
Now they're feeling more pressure to act. The Federal Bureau of Prisons on Friday announced a 30-day suspension for social visits by inmates' friends and family, to try to prevent the spread of the virus. Even attorney visits will be subject to approval on a "case-by-case" basis. The BOP is also suspending transfers of inmates between federal facilities.
Most of America's incarcerated population are in state prisons and jails, where responses continue to be more uneven.
In Arizona, a spokesperson for the Department of Corrections said employees and inmates were being encouraged to disinfect shared services. But a correctional officer told KJZZ's Jimmy Jenkins nothing new was being done, and said unsanitary conditions threatened the health care of staff and inmates. NPR isn't identifying the officer because speaking to a reporter could cost him his job.
The officer told Jenkins, "A lot of units have issues just getting soap and paper towels stocked in the restrooms." Jenkins says he's also been unable to get details on coronavirus preparation from the Maricopa County Sheriff's Office, which houses nearly 7,000 people on a daily basis.
But others are taking clear steps to prepare.
Near Seattle, the South Correctional Entity, or "SCORE," houses nearly 600 inmates. It's doing extra screening of new inmates, and it's not allowing visitors into the lobby, where family members usually communicate with inmates via video conferencing.
The same video-conferencing service is available to families who want to call from home, and SCORE executive director Devon Schrum has asked the company that runs it to offer that service to families for free, during the pandemic.
Inside the jail, she says they're doing what they can to keep the virus at bay.
"Four times a day we're wiping down the entire jail including the cells, and we're wiping down before and after inmates come in," she says. They're also orienting inmates on good hand hygiene, and she's considering giving them supervised access to hand sanitizer — it's usually contraband in jails, because of the alcohol content.
For inmates who eventually do test positive, the jail has identified holding areas with with separate air in-takes for their ventilation.
"We have 24/7 medical coverage, so at this point we're prepared to treat in place. And to minimize the risk to the rest of the population," Schrum says.
But jails and prisons can expect a subset of their COVID-19 cases to be serious, and many of those patients will be sent to local hospitals, potentially adding to the anticipated surge of demand for critical care.
Jose Saldana believes some of the most vulnerable prisoners should be sent home now, before they get sick. He's a former prisoner who now directs an organization called "Release Aging People in Prison Campaign."
"It's probably going to be deadly for some of the elderly people that I left behind," Saldana says. He'd like parole and clemency boards to consider which older, sick prisoners could be let out, because he believes they'd stand a better chance of surviving the pandemic at home.
"Let's look at it realistically, for what it is. To keep such men in prison, to die — knowing they're going to die! — is just pure revenge. It's not justice," Saldana says.
There may be other reasons to let some of them go. Marc Stern is a physician who used to be the top medical officer for the Washington State Department of Corrections, and he says jails and prisons should be planning for the possibility of not having enough staff.
"We don't want to be caught behind the ball," he says. "We don't want to find one day that a number of officers have called in sick, and we're having trouble managing the institution."
He's recommending corrections administrators communicate now with courts or parole systems about which inmates might be safely released early, in case things get to that point.
ARI SHAPIRO, HOST:
As COVID-19 spreads, public health officials are telling people to stay home if they feel sick. That's not an option in jails and prisons. As NPR's Martin Kaste reports, there's concern about protecting inmates, staff and the public.
MARTIN KASTE, BYLINE: Robert Greifinger's a doctor who spent the last 25 years working on health care issues inside prisons and jails, and he says this social distancing advice we're all hearing right now is not that simple behind bars.
ROBERT GREIFINGER: There are crowding issues, ventilation issues, security issues, where people have to be checked and monitored fairly frequently. So it's really hard to do.
KASTE: But he says if jails and prisons are complacent about coronavirus, they run the risk of becoming, as he puts it, incubators.
GREIFINGER: Since jail and prison staff and prisoners tend to be younger, one thinks initially that it's not going to be a big problem. But remember, that staff work shifts, they come in in and out of the facility, and they may be bringing that infection home to people who have compromised immune systems.
KASTE: When NPR first started asking jails and prisons what they were doing about coronavirus, most of them pointed to their existing plans for other infectious diseases, such as tuberculosis. But now some of them are taking extra, specific steps. One of the earliest to do so is the South Correctional Entity, or SCORE. It's a jail with almost 600 inmates near Seattle.
DEVON SCHRUM: Four times a day, we're wiping down the entire jail, including the cells, and were wiping down before and after inmates come that.
KASTE: Devon Schrum is the jail's director. She says they're orienting their inmates to practice good hand hygiene, and she's considering giving them supervised access to hand sanitizer. It's usually contraband in jails because of the alcohol content. She says they've also identified holding areas with separate air handling to house inmates when they do test positive.
SCHRUM: We have 24/7 medical coverage. And so at this point, we're prepared to treat in place and to minimize the risk to the rest of the population.
KASTE: Still, just like the outside world, there will be a subset of COVID-19 cases in jails and prisons that will be serious and which will end up adding to the burden of local hospitals. Jose Saldana spent 38 years in prison.
JOSE SALDANA: It's probably going to be deadly for some of the elderly people that I left behind.
KASTE: Saldana is director of an organization in New York called the Release Aging People In Prison Campaign. And he says this crisis is a good reason for clemency boards to be considering which older sick prisoners might stand a better chance of surviving all of this back home.
SALDANA: Let's look at this realistically, for what it is. To keep such men in prison to die, knowing that they're going to die, it's just pure revenge; it's not justice.
KASTE: Of course, there's no way of knowing right now how many older prisoners are actually at risk of dying, but there may be other reasons to let some of them go. Marc Stern used to be the top medical officer for the Washington State Department of Corrections, and he's now recommending that jails and prisons at least consider which of their inmates might be safely released early.
MARC STERN: I think we are at that point because we don't want to be caught behind the ball; we'd like to be ahead of the ball. In other words, we don't want to find one day that a number of officers have called in sick and we're having trouble managing the institution.
KASTE: He thinks it would be better to talk to judges and parole systems now about who could be released in case things get to that point.
Martin Kaste, NPR News, Seattle.
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