Research on the Risk of COVID-19 for Incarcerated Persons

Explanatory Note: Research here is understood broadly, to include testimony from various sorts of experts in the news, expert affidavits attached to legal briefs, petitions and letters from such experts to decisionmakers, and studies/analyses pitched at a wide audience. Some categories are highlighted --- Medical authorities (blue), Corrections / law enforcement authorities (yellow), Prosecutors / judges (red), Legal documents, like affidavits, briefs (green)

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Name (individual or organization)TitleType of authorityType(s) of researchTitle(s) of researchLocationKey quote / notesLink(s)Date
Physicians for Human Rights Senior Medical Advisor Dr. Ranit Mishori
Dr. Scott Allen (Brown University)
Eunice Cho (ACLU)
Gerald Staberock (World Organization against Torture)
Medical professionalWebinarCOVID-19 Threats to Detention Center/Prison Populations with Dr. Scott Allen, Eunice Cho, and Gerald StaberockNationalIn the sixth installment of our webinar series, PHR Senior Medical Advisor Dr. Ranit Mishori moderated a discussion on COVID-19 and detention center/prison populations featuring Dr. Scott Allen, Eunice Cho, and Gerald Staberock. They discussed the U.S. and international response to the danger of contagion in these densely populated environments, questions concerning access to care for inmates and staff, and how judgments being made today will shape the landscape of legal precedent going forward.
Dr Stuart Kinner (PhD)
Dr Jesse T Young (PhD epidem, MPH)
Dr Kathryn Snow (MS epidem, PhD)
Louise Southalan (JD, MA)
Dr. Daniel Lopez-Acuña (MD, MPH)
Carina Ferreira-Borges (PhD, MPH)
Éamonn O’Moore (MB, BCh, BAO, MPH)
Experts in public health and epidemiology (several from Melbourne)Medical professionalComment, the Lancet Public Health Journal"Prisons and custodial settings are part of a comprehensive
response to COVID-19"
NationalPrisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to healthcare services relative to that in community settings. Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19)
Public health experts in Louisiana (14)Medical professionalLetter to Governor EdwardsPublic health letter to Governor EdwardsLAAs you are taking crucial steps to prevent the spread of COVID-19 by ensuring Louisianans practice social distancing and stay home, we, as public health experts and concerned citizens, write to urge you to take immediate action to safeguard the lives of those involved in our statewide court system and the Louisiana Department of Public Safety and Corrections, including those who work or are detained in these facilities, their families, and their communities
Dr. Seth J. Prins (Ph.D. MPH)
Sandhya Kajeepeta (MSc)
Professor of epidemiology and PhD student in epidemiology, ColumbiaMedical professionalAnalysis"Why Coronavirus in Jails Should Concern All of Us"NationalSo, even when we are operating under normal conditions, the association between jail incarceration and infectious disease mortality persists. This finding reflects deaths due to flu, pneumonia, and acute bronchitis, for example. This is empirical evidence that jail incarceration is most likely a driver of infectious disease deaths at the population level.
Dr. Brie Williams, (MS MD)
Cyrus Ahalt (MPP)
David Cloud (JD, MPH)
Dallus August (Research Assoc)
Dr. Leah Rorvig (MD)
Dr. David Sears (MD)
UCSF affiliated public health professionalsMedical professionalArticle, Health Affairs Journal"Correctional Facilities In The Shadow Of COVID-19: Unique Challenges And Proposed Solutions"NationalIn this moment we must all remember that incarcerated people, and all those who work in prisons and jails, are part of our families and our communities. We have constitutional and ethical obligations to protect these populations and to take all appropriate actions needed to mitigate the effects of a potential outbreak in correctional facilities. Here are some practical ideas for where to start...1. Release some people from prisons and jails. Wherever possible, and in close coordination with public health officials in corresponding jurisdictions, we must decrease the number of people in jails and prisons immediately.
Dr Benjamin A. Howell (MD, MPH)
Dr Haiyan Ramirez Batlle (MD)
Cyrus Ahalt (MPP)
Dr Shira Shavit (MD)
Dr Emily A. Wang (MD, MAS)
Nickolas Zaller (PhD)
Dr Brie A. Williams (MS, MD)
UCSF / U Arkansas / Yale affiliated public health professionals; primary care doctors w/experience in correctional medicineMedical professionalArticle, Health Affairs Journal"Protecting Decarcerated Populations In The Era of COVID-19: Priorities For Emergency Discharge Planning"NationalA Roadmap For Emergency Discharge Planning During The COVID-19 Pandemic: Effective discharge planning calls for a mix of short-term strategies and policy changes to position reentering citizens for success. A comprehensive list of recommended solutions is included for reference in exhibit 1. In this post, we highlight short-term reentry strategies that correctional systems and community public health authorities should prioritize during the pandemic.
Dr. Anne C. Spaulding (MD, MPH)Professor, Epidemiology, Emory UniversityMedical professionalCOVID-19 presentation for law enforcement

COVID-19 Q&A for law enforcement

News report
"Coronavirus COVID-19 and the Correctional Facility"

"Understanding how to slow the spread of COVID-19 in corrections"

"No Escape From Virus Threat for 2 Million Crammed in Prisons"
NationalPresentation: "Prisons and jails are enclosed environments, where individuals dwell in close proximity. Incarcerated persons sleep in close quarters, eat together, recreate in small spaces. Staff are close by. Both those incarcerated and those who watch over them are at risk for airborne infections."

Bloomberg: “It’s considered a congregate setting. That’s one of the risks,” said Anne Spaulding, an associate professor at Emory University’s Rollins School of Public Health. “The propensity to incarcerate at such high levels can accelerate epidemics,” such as a recent outbreak of Legionnaires disease at a women’s work camp in Florida.
2/26/2020; 3/11/2020
Centers for Disease ControlMedical professionalHealth advisory"Interim Guidance on Management of Coronavirus Disease 2019 (COVID-19) in Correctional and Detention Facilities."National"There are many opportunities for COVID-19 to be introduced into a correctional or detention facility, including daily staff ingress and egress; transfer of incarcerated/detained persons between facilities and systems, to court appearances, and to outside medical visits; and visits from family, legal representatives, and other community members. Some settings, particularly jails and detention centers, have high turnover, admitting new entrants daily who may have been exposed to COVID-19 in the surrounding community or other regions."
Dr. Marc F. Stern (MD, MPH)Professor, School of Public Health, University of Washington; Former Asst Secretary for Health Care, WA State Dept of CorrrectionsMedical professionalLegal documents (declarations)

Guidance to law enforcement

News reports
Declaration of Marc Stern, Coleman v. Newsom, Plata v. Newsom

Declaration of Dr. Marc Stern

Declaration of Marc Stern, Dawn v. Asher

Washington State Jails Coronavirus Management Suggestions in 3 “Buckets”

"ICE Is Ignoring a Simple Way to Slow the Spread of Coronavirus: Let People Out of Detention"
CA, National, WA
CA declaration: I visited 10 of the California state prisons in 2009, and have observed many of the large open dormitories, housing groups ranging from a half dozen to scores of incarcerated people. Additionally, I have reviewed photographs taken in 2019 and provided to me by plaintiffs’ counsel of living areas and day rooms in four prisons: Central California Women’s Facility, California Institution for Men, California Medical Facility, and the Substance Abuse Treatment Facility at Corcoran. I also reviewed a CDCR Institutional Bed Audit dated March 23, 2020 that shows that many of the CDCR dormitories are very crowded. For example, at Avenal State Prison, all people are housed in dormitories designed to house 50-100 people. Most of those dormitories are currently at 150% capacity. At the Central California Women’s Facility, some of the dormitories are as much as 194% overcrowded.

National declaration: For detainees who are at high risk of serious illness or death should they contract the COVID-19 virus, release from detention is a critically important way to meaningfully mitigate that risk. Additionally, the release of detainees who present a low risk of harm to the community is also an important mitigation strategy as it reduces the total number of detainees in a facility. Combined, this has a number of valuable effects on public health and public safety: it allows for greater social distancing, which reduces the chance of spread if virus is introduced; it allows easier provision of preventive measures such as soap for handwashing, cleaning supplies for surfaces, frequent laundering and showers, etc.; and it helps prevent overloading the work of detention staff such that they can continue to ensure the safety of detainees.

WA declaration: As a correctional public health expert, I recommend release of eligible individuals from detention, with priority given to the elderly and those with underlying medical conditionsmost vulnerable to serious illness or death if infected with COVID-19.

Guidance: The following ideas are provided as suggestions to jails for managing the impacts of COVID-19. It is VERY important to note that they are not standards or rules and also that many of these suggestions are based on current CDC recommendations.

Mother Jones: Marc Stern, who served as the health services director for Washington state’s department of corrections, explained that reducing detainee populations would slow the spread of the virus by creating more distance between people. In a recent memo making recommendations to Washington jails, Stern, now an assistant professor at the University of Washington’s School of Public Health, wrote that local officials should ask whether there are inmates who can be released on their own recognizance or whether they could employ alternatives to detention. Anne Spaulding, a medical doctor and correctional health expert in Emory University’s epidemiology department, has also recommended that jails consider detention alternatives such as electronic monitoring.
3/5/2020, 3/25/2020, 3/15/2020, 4/13/2020
Dr. Danielle Ompad (PhD)Professor of Epidemiology, NYUMedical professionalLegal document (declaration, including charts, graphics)Affidavit of Danielle C. Ompad, PhD regarding SARS-CoV-2 infection (otherwise known as COVID-19) in correctional settingsMAAffidavit, including charts, graphics: If COVID-19 enters correctional facilities, the likelihood that there will be severe cases is high. According to the Massachusetts Department of Corrections, 983 PWI (11.2%) were aged 60 and over in 2019 among 8,784 total PWI. As previously mentioned, older adults are at increased risk for severe COVID-19 complications as well as death. According to data from the 2011-2012 National Inmate Survey,11 there is a substantial burden of disease among correctional populations. Approximately half of state and federal prisoners and jail inmates have ever had a chronic medical condition (defined as cancer, high blood pressure, stroke-related problems, diabetes, heart-related problems, kidney-related problems, arthritis, asthma, and/or cirrhosis of the liver). Twenty-one percent of state and federal prisoners and 14% of jail inmates have ever had tuberculosis, hepatitis B or C, or sexually transmitted infections (excluding HIV or AIDS). Table 1 displays lifetime prevalence of specific chronic conditions with implications for COVID-19 severity and death among state and federal prisoners and jail inmates. Note that older prisoners were about three times more likely than younger persons to havehad a chronic condition or infectious disease in their lifetime.
Dr. Craig W. Haney (PhD)Professor of Psychology & UC Presidential Chair, UCSC; co-founder, UC Criminal Justice & Health ConsortiumMedical professionalLegal document (declaration)Declaration of Craig Haney, Coleman v. Newsom, Plata v. NewsomCAPrisons lack the operational capacity to address the needs of persons in custody in a crisis of this magnitude. These facilities are ill-equipped to provide incarcerated persons with ready access to cleaning and sanitation supplies, or to assure that staff sanitize all surfaces during the day. Most correctional facilities were already operating at or beyond the limits of their capacities to provide mental health or medical care. The demand for such services in this crisis will only grow, and already scarce treatment resources will be stretched even more.
Dr. Jamie Meyer (MD)Assistant Professor of Medicine, Yale School of Medicine; Assistant Clinical Professor of Nursing at Yale School of NursingMedical professionalLegal documents (declarations)Declaration of Dr. Jaimie Meyer, Velasca v. Wolf

Declaration of Jaimie Meyer in Support of Motion for Preliminary Injunction and Class Certification, Fraihat v. ICE
NationalVelesaca v. Wolf: I have worked for over a decade on infectious diseases in the context of jails and prisons. From 2008-2016, I served as the Infectious Disease physician for York Correctional Institution in Niantic, Connecticut, which is the only state jail and prison for women in Connecticut...As such, from a public health perspective, it is my strong opinion that individuals who can safely and appropriately remain in the community not be placed in ICE’s NYC-area jails at this time. I am also strongly of the opinion that individuals who are already in those facilities should be evaluated for release.

Fraihat v. ICE: The risk posed by infectious diseases in jails and prisons is significantly higher than in the community, both in terms of risk of transmission, exposure, and harm to individuals who become infected. There are several reasons this is the case, as delineated further below.
3/16/2020, 3/24/2020
Dr. Jonathan Louis Golob (MD)Professor, Infectious Diseases, Internal Medicine, University of MichiganMedical professionalLegal documents (declarations)Declaration of Dr. Jonathan Golob

Declaration of Dr. Jonathan Golob in Support of Petition, Ortuno v. Jennings
National, CADeclaration #1: Discussion of features of the virus, vulnerability of incarcerated population

Declaration #2: During the H1N1 influenza ("Swine Flu") epidemic in 2009, jails and prisons were sites of severe outbreaks of viral infection. Given the avid spread of COVID-19 in skilled nursing facilities and cruise ships, it is reasonable to expect COVID-19 will also readily spread in detention centers, particularly when residents cannot engage in proper hygiene and isolate themselves from infected residents or staff.
3/13/2020, 3/22/2020
Dr. Robert B. Greifinger (MD)Physician and former health care manager, NY and NYC corrections; 30 years of experience in correctional healthcareMedical professionalLegal documents (2 declarations, 1 with attached journal article)

News reports
Declaration Dr. Robert B. Greifinger, Dawson v. Asher

Declaration of Robert B. Greifinge, M.D. in Support of Petition for Habeas Corpus and Motion fro Temporary Restraining Order, Oruno v. Jennings

"Prisons And Jails Worry About Becoming Coronavirus 'Incubators'"

"Expert to Fulton jail: Release 800 inmates or risk ‘disaster’"
National, GADeclaration #1: The only viable public health strategy available is risk mitigation. Even with the best-laid plans to address the spread of COVID-19 in detention facilities, the release of high-risk individuals is a key part of a risk mitigation strategy. In my opinion, the public health recommendation is to release high-risk people from detention, given the heightened risks to their health and safety, especially given the lack of a viable vaccine for prevention or effective treatment at this stage.

Declaration #2: Risk mitigation is the only viable public health strategy available to limit transmission of infection, morbidity and mortality outisde of the detention centers, and to decrease the likely public health empact outside of the detention centers. Even with the best-laid plans to address the spread of COVID-19 in detention facilities, the release of a key part of a risk mitigation strategy.

NPR: 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."

AJC: A leading expert on infectious diseases inside detention centers said Wednesday that, barring immediate action, the number of Fulton County Jail inmates infected with COVID-19 “will overwhelm the county’s available hospital and intensive care beds...This is a preventable disaster that can be avoided, but only by acting with extreme speed,” said Robert Greifinger, who served as medical monitor during the federal government’s 11-year oversight of the jail ending in 2015.
3/14/2020, 3/22/2020, 4/1/2020
Dr. Farah M. Parvez (MD, MPH)
Dr. Mark N. Lobato (MD)
Dr. Robert B. Greifinger (MD)
Experts in correctional public healthMedical professionalCommentary in Journal of Correctional Healthcare"Tuberculosis Control: Lessons for Outbreak Preparedness in Correctional Facilities"NationalOutbreaks in correctional facilities can easily spread to the surrounding community. One TB outbreak in a prison led to extensive spread into the local community and another outbreak resulted in TB disease in three young children after an inmate was released with undiagnosed TB (Jones, Woodley, Fountain, & Schaffner, 2003; Sosa, Lobato, Hadler, Condren, & Williams, 2008). Similar to TB, other communicable diseases, such as H1N1 and avian influenza, severe acute respiratory
syndrome (SARS), and methicillin-resistant Staphylococcus aureus, have a two-way street between the community and institutional settings. As such, correctional facilities must remain vigilant for communicable disease outbreaks and should have prevention and control plans in place.
Amici Curiae Public Health Experts in Massachussetts (14)Medical professionalLegal document (amici letter to Clerk Marion S. Doyle)Re: Committee for Public Counsel Services and Massachusetts Association of Criminal Defense Lawyers v. Chief Justice of the Trial Court, No. SJ-2020-115MAAs a group of experts in epidemiology, infectious diseases, public health, and healthcare for incarcerated people, we write to urge this Court to act in the best interests of public health and safety and grant Petitioners’ request to safely release as many people as possible from confinement.
Dr Sarah Fortune (MD)John LaPorte Given Professor and Chair, Department of Immunology and Infectious Diseases, Harvard School of Public HealthMedical professionalOpen letterRe: the Threat of COVID-19 in Jails and PrisonsNationalOne of the goals of the criminal justice system is to protect public safety. At this time, the best thing that can be done within the criminal justice system for public safety is to get as many people out of jails and prisons as possible, and to minimize the number of new people getting arrested and cycling into these facilities. Anybody detained for a non-violent offense or who does not pose an immediate danger to themselves or others should be released immediately, before an outbreak occurs. This is especially true of medically vulnerable people, including elderly, immunocompromised, and pregnant individuals. The more people we have behind bars when the virus hits, the more people will die – including people who are not detained.
Created: 3/28/2020
John Hopkins public health faculty (200)Medical professionalLetter to Governor HoganJHU Faculty Express Urgent Concern about Covid-19 Spread in Prison
MDMore than 200 Johns Hopkins faculty in public health, bioethics, medicine, and nursing signed a letter delivered to Governor Larry Hogan today, expressing their urgent concern about the spread of COVID-19 in Maryland’s prisons, jails, and juvenile detention centers and calling on the state to protect the health of its incarcerated population and make 'efforts to reduce the state prison population as well.'
Massachussetts ER doctors (~30)Medical professionalLetter to Governor Baker, shared via social mediaMA...strongly urge you to release as many people as possible from jails and prisons...
Harvard public health faculty (~80)Medical professionalLetter to Governor Baker

"FXB Center Director, More than 80 Public Health and Medicine Experts Call on Governor Baker to Stem the Spread of COVID-19 in Prisons, Jails, and Juvenile Detention Centers"MAWe are writing as faculty members of the Harvard Chan School of Public Health and Harvard Medical School to express our urgent concern about the spread of COVID-19 in Massachusetts prisons, jails, and juvenile detention centers. We are grateful for the robust stance you have taken to stem the spread of COVID-19, which is a highly contagious global threat. However, these steps will not suffice to protect those who are incarcerated, those who work in these settings, or the communities connected to them. Only reducing the size of the incarcerated population will achieve this. Now is the time to act.
Public health professionals, Duke & UNC (12)Medical professionalLetter to Governor CooperNCUnless you immediately address this threat, you are leaving North Carolinians vulnerable to a massive outbreak of COVID-19. But it is within your power to immediately release people from jails and prisons and thus work to mitigate the spread of this disease.To that end, we ask that you take the following urgent steps:
California public health experts (~40)Medical professionalLetter to Governor NewsomCA Public Health Experts Urge Gov. Newsom to Release Elderly and Medically Vulnerable Populations from PrisonCACalifornia prisons are designed for a maximum capacity of 85,000 people but have been over capacity for decades. With over 122,000 people currently held in CDCR custody, the state’s custodial facilities are not equipped to prevent the spread of a highly contagious respiratory infection like COVID-19; rather, they appear almost perfectly designed to facilitate its unchecked spread.
Doctors working in NYC hospitals (shared by NYC Council members)Medical professionalLetter to Mayor de BlasioDoctors in NYC Hospitals, Jails, and Shelters Call on the City to Take More Aggressive Action to Combat the Spread of CoronavirusWe call on the City to...Order the NYPD to stop making low level arrests for violations and misdemeanors, in order to prevent the spread of the virus through our jails, courts, and precincts. Order the courts to consider release for anyone in pretrial detention over 60. Administratively reschedule all criminal court proceedings for people who are not currently incarcerated. Reschedule all other court proceedings.
Dr. Homer Venters (MD)former Chief Medical Officer, NYC Correctional Health ServicesMedical professionalNews reports (interviews, radio report)



Legal documents (declarations)
"Former Physician At Rikers Island Exposes Health Risks Of Incarceration"

"How Prisons and Jails Can Respond to the Coronavirus"

"4 ways to protect our jails and prisons from coronavirus"

"Coronavirus: The Prison Population"

National Emergency Webinar on COVID-19 and Criminal Legal and Immigrant Detention System

Coronavirus Guidance for Prisons and Jails

"Chesa Boudin on His Incarcerated Father and the Threat of the Coronavirus in Prisons"

"How Coronavirus Could Affect U.S. Jails and Prisons"

"Locked up: No masks, sanitizer as virus spreads behind bars"

Declaration of Dr. Homer Venters, Fraihat v. ICE

Supplemental Declaration of Dr. Homer Venters, Fraihat v. ICE
NY / NationalNPR: "The closing of Rikers is absolutely necessary. It's not sufficient to transform the criminal justice system in New York City to become more humane, but it's necessary. The jails that are in operation are crumbling."

New Yorker 1: "From the standpoint of responding to this outbreak, one of the most important questions is: How can we have fewer people in these places—in jails and prisons? Because it’s going to be very, very difficult to deliver a standard of care either in the detection or the treatment of people who are behind bars."

The Hill: "The CDC, state departments of health, the Joint Commission and other bodies that promote evidence-based care in our hospitals, ambulatory care clinics and nursing homes are largely absent in these settings,” he continued.” As a result, management of this pandemic will be harder and less effective for incarcerated people, their families and staff in these institutions."

NPR: "Lauren Weber, midwestern correspondent for Kaiser Health News, Dr. Homer Venters, the former chief medical officer for New York City's Correctional Health Services and Amy Fettig, deputy director for the ACLU's National Prison Project joined us for our conversation on how prisons are responding to COVID-19."

@15:56, Webinar: "The things that promote quality healhcare are generally absent behind bars."

Vera Institute of Justice call

New Yorker 2: “I think what we’re going to find out is that the way we’ve set up our state prisons all over the country—concomitant with the fact that we have closed a lot of rural hospitals—creates a very horrible circumstance. As lots of patients get sick in rural detention settings, there is very little way for them to get into hospital-level care, which will, I think, contribute to a lot of preventable deaths.” He added, “It’s terrifying to think what it looks like when you’re incarcerated in a rural, far-flung place and have respiratory distress.”

AP: “America’s 7,000 jails, prisons, juvenile and immigration detention centers are completely unequipped to handle this pandemic,” he said.

Declaration #1: I have been inside multiple ICE detention facilities, both county jails that house ICE detainees and dedicated facilities. My experience is that the densely packed housing areas, the manner in which health services, food services, recreation, bathroom and shower facilities for detained people, as well as the entry points, locker rooms, meal areas, and control rooms for staff, all contribute to many people being in small spaces. One of the most ubiquitous aspects of detention, the sally-port, or control port, a series of two locked gates that bring every staff member and detained person past a windowed control room as they stop between locked gates, provides but one example of this concern. The normal functioning of detention centers demands that during shift change for staff, or as the security count approaches for detained people, large numbers of people press into sally-ports as they move into or out of other areas of the facility. This process created close contact and the windows in these sally ports that are used to hand out radios, keys and other equipment to staff ensure efficient passage of communicable disease from the control rooms into the sally port areas on a
regular basis.

Declaration #2: ICE protocols and guidance fail to address the key recommendation of the CDC on the need for adequate intake screening of detainees. CDC guidance makes clear that everyone arriving in a detention facility should be screened for signs and symptom of COVID-19, but ICE protocols rely on questions about travel or other known contacts as a precursor to temperature checks and other sign and symptom checks. ICE protocols and guidance also fail to clearly mandate that all symptomatic patients be immediately given a mask and placed in medical isolation, and that all staff who have further contact with that patient wear personal protective equipment, as set forth in the CDC guidelines. The ICE protocol also fails to address the now-standard CDC advice that everyone who cannot engage in social distancing wear a face covering.
3/2019 - 4/9/2020
Dr. Ross McDonald (MD)Chief Medical Officer, Correctional Health Services, NYCMedical professionalNews report"‘A Storm Is Coming’: Fears of an Inmate Epidemic as the Virus Spreads in the Jails"NY"We will put ourselves at personal risk and ask little in return. But we cannot change the fundamental nature of jail. We cannot socially distance dozens of elderly men living in a dorm, sharing a bathroom. Think of a cruise ship recklessly boarding more passengers each day."
Dr. Tyler Winkelman (MD) Doctor and researcher, Hennepin County Medical Center and U MinnesotaMedical professionalNews report"A coronavirus outbreak in jails or prisons could turn into a nightmare"National"We can learn what works in terms of mitigation from other countries who have seen spikes in coronavirus already, but none of those countries have the level of incarceration that we have in the United States,” Tyler Winkelman, a doctor and researcher at the University of Minnesota focused on health care and criminal justice, told me...“All of these mitigation strategies — of closing schools, stopping conferences, decreasing travel — are to slow the speed at which people get the virus so that we don’t overwhelm our health care system,” Winkelman said. “If Covid spreads in a large, thousand-person facility, and within five days you have a thousand people with multiple chronic conditions who just got the virus, that has the potential to really overwhelm a health care system.”
Dr. Gerald Valleta (MD)Primary physician, Garner and Manson Youth InstitutionMedical professionalNews report"With COVID-19 threat looming, state prisons and jails are on edge"CT“We’re going to be required to treat them as best we can, with what’s available,” said Dr. Gerald Valletta, the primary physician at Garner and Manson Youth Institution in Cheshire. “If they get seriously ill — and a percentage of these patients will get seriously ill or die — they’re going to require hospital-level care."...“The more people get sick and call out, the more burdened staff will be. We were already facing a huge shortage,” he said.
Dr Frederick Altis (MD)Professor, Yale School of Public HealthMedical professionalNews report"With COVID-19 threat looming, state prisons and jails are on edge"CT“One case that gets loose in a prison and it will burst the seams,” said Frederick Altice, a professor of infectious diseases at the Yale School of Public Health who works with incarcerated populations. “People are transmitting one to two days before they become symptomatic. There’s still a level of overcrowding that is a major problem.”
Dr. Robert Cohen (MD)NYC Board of Correction; oversaw medical care for prisoners in FL, OH, NY, MI, CTMedical professionalNews report"Coronavirus in US prisons: Releases positive, but 'more needed'"NYEven as the city's jail population reaches historic lows, "[c]ollectively we think the mayor should be doing more", said Dr Robert Cohen, a member of the New York City Board of Correction, a nine-person, nonjudicial oversight board that regulates, monitors and inspects the correctional facilities in the city. Releasing more inmates who have committed violations such as parole violations - and more closely considering who qualifies for at-risk groups - could help, Cohen told Al Jazeera. "The fewer people there are in jails and prisons ... the slower the virus will spread in those populations, and the slower it will spread" outside through staff who go home at night, Cohen added. Those who have been released thus far are "basically persons who have city sentences for minimal crimes", Cohen explained.
Dr. Burton Bentley II (MD)Emergency medical physicianMedical professionalNews report"US jails and prisons are 'fertile grounds for infectious disease' and preventing the spread of coronavirus behind bars will be a challenge, say experts"National"They're unique because these people are in tight confines, often tightly packed, and that's a fertile ground for infectious disease," said Dr. Burton Bentley II, an emergency medicine physician and founder of the consulting firm Elite Medical Experts. "Anytime you have populations that are tightly condensed, the spread of communicable diseases … is obviously elevated and accelerated."
Dr Gregg Gonsalves (PhD)Professor, Yale School of Public HealthMedical professionalNews report"Elderly prison population vulnerable to potential coronavirus outbreak"CTAs of March 1, roughly a quarter of the people incarcerated in state prisons were older than age 45. That’s concerning because the risk of death from COVID-19 increases with age. "You can think of our prisons as sort of nursing homes with bars,” said Gregg Gonsalves, an assistant professor at Yale School of Public Health. “If we’re talking about a similarly aging population in our jails here, you’re talking about a carceral version of the same situation as you have in Washington State,” where the virus is spreading through elderly care facilities.
Debra CruzNurse, Cheshire Correctional InstituteMedical professionalNews report"Elderly prison population vulnerable to potential coronavirus outbreak"CTDebra Cruz, head nurse at Cheshire Correctional Institution, said she and other medical staff are concerned about staffing shortages. Although the union contract states they can be mandated to work up to a 16-hour shift and “after 16, we can go home,” it’s unclear what will happen if medical staff finish 16 hours of work and their replacement doesn’t show up.
Dr Fred Rottnek (MD) + 16 health care professionalsProfessor of medicine, St. Louis UniversityMedical professionalNews report"‘Ticking time bombs’: Missouri doctors, advocates call for release of prisoners"MOIn an accompanying letter, Fred Rottnek, St. Louis University medical professor, said doctors were worried about the thousands of people behind bars in institutions they believe can’t comply with Centers for Disease Control and Prevention guidance. He noted correctional facilities are often poorly ventilated and share heating, ventilation and air conditioning systems, which “accelerates the spread of disease through droplets.” Rottnek’s letter, which included signatures from 16 other health care professionals, recommended prison and jails evaluate the release of any inmates and detainees considered medically vulnerable, 55 or older or unable to pay a cash bond. It also suggested releasing enough inmates to accommodate the CDC’s social distancing guidelines.
Dr. Christopher DiGiulio (MD)Chief of medicine, Oregon corrections departmentMedical professionalNews report"Advocates And Sheriffs Worry Prison, Jails Could Be Incubators For COVID-19"ORDr. Christopher DiGiulio, the corrections department chief of medicine, acknowledged in an interview last week that it’s simply a matter of time before the agency has an inmate who contracts the virus in one of its facilities. “We’ve developed a vulnerable list, and should we have a case of COVID, what we would do is absolutely make sure that we cohort those vulnerable patients together and separate them from the incident case as much as possible,” DiGiulion said.
Dr. Ross MacDonald (MD)Chief doctor, Rikers IslandMedical professionalNews report"Coronavirus spread at Rikers is a 'public health disaster', says jail's top doctor"

"Top doctor at Rikers Island calls the jail a ‘public health disaster unfolding before our eyes’"
NYSpeaking in response to a letter from five New York district attorneys and a special narcotics prosecutor criticising the release of “high-risk” inmates following the outbreak of Covid-19, he wrote on Twitter this week: “The only part of the letter I can speak directly to is their failure to appreciate the public health disaster unfolding before our eyes."
Dr. Matthew Murphy (MD)Professor of Medicine, Brown UniversityMedical professionalNews report"Covid-19 Poses a Heightened Threat in Jails and Prisons"National“The new folks who are arriving every day tend to be of low socioeconomic status,” says Matthew Murphy, who studies infectious disease risk in the criminal justice involved population at Brown University. “Their incarceration might be one of the first times they are interacting with the health care system.” Even if the disease doesn’t arrive with a newly incarcerated person, the comings and goings of prison staff create a similar risk of exposure.
Dr. Gaven Yamey (MD, PhD, MA)Physician; Professor of Global Health and Public Policy, Duke University; Director, Center for Policy Impact in Global HealthMedical professionalOp-ed"We Must Act Now to Protect America's Most Vulnerable from Coronavirus"NationalSentences should be commuted, we argue, for elderly people, who very rarely commit crimes after release. Older people who become infected with SARS-CoV-2, the virus that causes COVID-19, are at higher risk of severe illness and death. Similarly, given the higher mortality risks facing people with conditions such as diabetes, heart and lung diseases, and cancer, sentences for the medically vulnerable population should also be commuted.
Dr. Lipi Roy (MD, MPH)former Chief of Addiction Medicine, NYC jailsMedical professionalOp-ed"Infections And Incarceration: Why Jails And Prisons Need To Prepare For COVID-19 Now"NationalAs the former Chief of Addiction Medicine for New York City jails including Rikers Island, I oversaw substance use disorder (SUD) treatment and recovery services for the 2nd-largest jail complex in the United States. Perhaps more evident than SUD was the high burden of disease among the men and women behind bars, both chronic and infectious.
Dr. Oluwadamilola T. Oladeru (MD)
Adam Beckman
Dr. Gregg Gonsalves (PhD)
Public health professionalsMedical professionalOp-ed

News report
"What COVID-19 Means For America’s Incarcerated Population — And How To Ensure It’s Not Left Behind""In response to the COVID-19 outbreak, the British government has set a precedent for this approach in preparation for a shortage of their police workforce. Similarly, Iran, which has recorded alarming death rates from COVID-19 has granted furlough to 54,000 incarcerated men and women to limit the spread in prisons. "
Dr. Brendan Saloner (PhD)
Dr. Sachini Bandara (PhD)
Professor and assistant scientist, Health policy and management, Johns Hopkins School of Public HealthMedical professionalOp-ed (joint)"To protect inmates and the nation from COVID-19, release offenders who pose no threat"National"Being incarcerated is a major threat to an individual’s physical and mental health. Infectious diseases like tuberculosis and influenza spread rapidly in confinement, and there is every reason to expect that COVID-19 will do the same. People behind bars are some of the most vulnerable in our society. So what can our criminal justice system do to protect them and, by extension, the communities they live in? Release — and better still don't incarcerate — people who pose no threat."
Noora Reffat
Joseph Gaylin
Arvind Venkataraman
MPH student, Yale School of Public Health; Criminal justice fellow, Yale’s Center for Social Justice and Public Service; Research Associate, Immunobiology, Yale School of MedicineMedical professionalOp-ed (joint)"To contain coronavirus, release people in prison: Do not let Covid-19 become Katrina in Connecticut."CTThe question is not if people in the Connecticut prison system will be infected with COVID-19, the question is when the first case will be detected. The current Covid-19 response plan in place by the Connecticut Department of Corrections (CDOC) is ineffective at best and grossly negligent at worst. In order to best mitigate the harm of an impending outbreak, the Connecticut Department of Corrections (CDOC) and Gov.Ned Lamont must consider immediate measures to decrease rates of incarceration in the state of Connecticut and release those most vulnerable to the devastating effects of Covid-19 in Connecticut prisons.
Dr. Brie Williams (MS MD)Professor of medicine, UCSF; Director, Criminal Justice & Health Program, UCSFMedical professionalOp-ed (joint)

News report

Open letter
"A Public Health Doctor and Head of Corrections Agree: We Must Immediately Release People from Jails and Prisons"

"Covid-19 Poses a Heightened Threat in Jails and Prisons"

COVID-19 in Correctional Settings: Immediate Population Reduction Recommendations
NationalThe Appeal: Because of this unsettling reality, it is only a matter of time before a COVID-19 outbreak in one of our nation’s jails or prisons has significant public health consequences in surrounding communities. Because COVID-19 is highly transmissible, including by asymptomatic carriers, the thousands of people each day who leave their homes, enter a correctional facility and interact in close proximity with colleagues and incarcerated people in these often overcrowded, chaotic environments are at considerable risk of transmitting the virus back to their families and into their communities when they return home.

The Wire: Wary inmates are far from the prison health care system’s only problem. It will struggle with the same shortages and difficult triage decisions that every medical center is dealing with or preparing for. Mental health care services, particularly those provided by outside resources, are a likely casualty. Sick prisoners also may not be dealing with a medical system that is equipped or staffed to meet their needs, particularly during a pandemic. “Prison infirmaries generally lack life-support equipment,” says Brie Williams, director of the criminal justice and health program at UC San Francisco. “They are only able to provide limited respiratory support for a limited number of people,” Williams adds. In California, most prisons are under medical receivership, which means that the federal government has deemed them incapable of providing adequate medical care to their inmates and has assumed oversight.

Amend statement: Amend at UCSF is a health-focused correctional culture change program led by a team of experts from medicine (including geriatrics, infectious disease, and family medicine), public health, and correctional health and policy. As we confront a rapidly worsening COVID-19 epidemic, reducing population density inside correctional facilities is an urgent first-line public health measure. Failure to reduce populations smartly and safely will significantly increase the likelihood of disease transmission in these uniquely vulnerable settings.1 This document provides recommended immediate first steps towards purposeful and public health-oriented population reduction at Departments of Corrections with the goal of optimizing the health and safety of patients and staff.
Faculty, Tulane University School of Public Health & Tropical Medicine (20)Medical professionalOpen letterAn open letter regarding COVID-19 and jails in Orleans Parish, LouisianaLAWe strongly encourage the members of the New Orleans Criminal Justice Community to work to reduce the population of the jail immediately, before widespread infection takes hold in the jail. Further, we strongly encourage continuing to reduce the number of intakes into the Orleans Justice Center during this time of crisis.
Over 40 public health professionals (deans of schools of public health, medical academics, heads of medical centers...)Medical professionalPetition to Pres TrumpCOVID-19: PUBLIC HEALTH EXPERTS IMPLORE PRESIDENT TRUMP TO RELEASE PEOPLE IN FEDERAL PRISONS & ICE DETENTION CENTERSNational"As Americans are engaging in social distancing to limit the spread of COVID-19, we, as public health experts and concerned citizens, write to urge you to use your discretion to allow for the same to occur in federal prisons and immigration detention centers. These facilities contain high concentrations of people in close proximity and are breeding grounds for the uncontrolled transmission of SARS-CoV-2, the virus that causes COVID-19. The conditions in federal prisons and immigration detention centers present significant health risks to the people housed in them, the correctional officers, health care professionals, and others who work in them, and to the community as a whole. "
Laurie ReidFormer U.S. Public Health Service officer and correctional care nurse; liaison between the C.D.C. and the U.S. Marshals Service, 23 yearsMedical professionalQuoted in op-ed"Why Jails Are So Important in the Fight Against Coronavirus"NationalLaurie Reid, a retired U.S. Public Health Service officer and correctional care nurse, was a liaison between the C.D.C. and the U.S. Marshals Service for 23 years. Ms. Reid said the measures being recommended may be enough to curb the spread of the disease. But she worries that smaller jails may lack the needed masks, gloves, medical equipment, staff and — above all — room to separate people from one another. “Really, it’s going to come down to space,” she said. “I guarantee you smaller jails are just praying that nothing happens.”
Dr. Wan Yang (MS, PhD)Epidemiologist, Columbia UniversityMedical professionalQuoted in op-ed"Why Jails Are So Important in the Fight Against Coronavirus"NationalMedical experts say much more needs to be done to avert jailhouse equivalents of the plague. Wan Yang, an epidemiologist at Columbia, sees the grim numbers at Rikers Island as a warning to other jails. “With very quick turnover, it’s going to increase the risk,” she said. “Prevention is the key.”
Dr. Barun Mathema (MPH, PhD)Infectious disease epidemiologist, Columbia UniversityMedical professionalNews report

"Why Jails Are So Important in the Fight Against Coronavirus"

"Evaluating strategies for control of tuberculosis in prisons and prevention of spillover into communities: An observational and modeling study from Brazil."
NationalNYT: “Density is bad — we know that,” said Barun Mathema, an infectious disease epidemiologist at Columbia University who was part of a team that studied the spread of tuberculosis in a prison in Brazil. The team found that people entered the prison with low rates of infection. Within six months, their rates had shot up 30 times, and remained elevated for years after release. The prison drove the disease not only inside its walls, but also in the neighboring community, according to models of the general population.

Study: CONCLUSIONS: Our findings suggest that the prison environment, more so than the prison population itself, drives TB incidence, and targeted interventions within prisons could have a substantial effect on the broader TB epidemic.
3/31/2020, 1/2019
Dr. Rachael Bedard (MD)Senior director of geriatrics and complex care services, RikersMedical professionalInterview"A Rikers Island Doctor Speaks Out to Save Her Elderly Patients from the Coronavirus"NYI’m the senior director of the geriatrics and complex-care service. My specialty is taking care of people who are older and sick and then also coördinating with the courts to come up with creative solutions to get these folks out of custody as often as possible. I run a team of two other clinicians—a nurse and a nurse practitioner—social workers, and reëntry specialists...I walked around last week and talked to patients in our infirmary about covid, and we had these sort of dorm meetings. They are smart and logical and know how at risk they are. They said, “You’re coming in and out. Officers are coming in and out. How do we know you don’t have it?” And they’re right. We know that there is likely an asymptomatic spread of this disease. So when staff and officers and others are coming in and out, we just cannot make a commitment that we can protect them. It’s not a fortress.
Dr. Ricardo Ruiz (MD)Physician, Chesire Correctional Institute, CTMedical professionalNews report"Prison Doctors, Nurses Say Health Care Behind Bars Has Ruptured"CTDr. Ricardo Ruiz said he is the only physician for 1,500 inmates at the Cheshire Correctional Institution, a ratio, he said, that is “totally out of control...Even quarantining someone with chicken pox is an ordeal,” Ruiz said. “Access to care becomes a huge problem, getting seen, having follow-ups. We’ve got high infection rates in prison and a small window of opportunity to treat them, since most inmates are returning to the community. It would be devastating if the infections spread — it is a recipe for disaster,” Ruiz said.
Janet Short (RN)Registered nurse in corrections, CTMedical professionalNews report"Prison Doctors, Nurses Say Health Care Behind Bars Has Ruptured"CTJanet Short, a registered nurse, said the staffing shortage has driven up the amount of mandatory overtime. She said she has worked an eight-hour shift, and then has had to drive 20 miles to another prison and work a second consecutive shift. She said the fatigue can be overwhelming. “We’re in here saving lives — it’s irresponsible; this is [a] dangerous condition for staff and inmates,” Short said.
Lynne Munday (RN)Correctional head nurse, Bridgeport Correctional Center, CTMedical professionalNews report"Prison Doctors, Nurses Say Health Care Behind Bars Has Ruptured"CTLynne Munday, correctional head nurse at the Bridgeport Correctional Center, said that at one point, she found herself alone in the infirmary, with no backup available, and 26 inmates waiting for treatment. “These are IVs, dressing changes — they’re not just sitting there,” said Munday. “That would never be accepted on the outside.”
Lawyers for corrections staff (including medical staff), Cook County Jail, ILMedical professionalLetter to Sheriff Dart & Cook County Board of CommissionersILOver the past 48 hours, we have heard over a dozen first hand accounts from employees at Cook County Jail describing conditions reflecting an unconscionable disregard for human life at the jail amidst the COVID-19 pandemic. The accounts are from employees in a variety of critical jobs: correctional officers, nurses, paramedics, and mental health professionals...while conditions related to the pandemic are unrelated to our duties as counsel in that litigation [related to sexual harassment by inmates], it would violate our moral duties to stay silent about the grave crisis unfolding at the Jail.
Dr. John Walsh (MD)Director, Saint Joseph Medical Center (near Stateville Correctional Center, IL)Medical professionalNews report"Illinois prisoners sick with COVID-19 'overwhelm' Joliet hospitall"ILThe past few days, infected inmates at the Stateville Correctional Center have been taken to the closest hospital at Saint Joseph Medical Center for emergency treatment. The hospital's medical director, Dr. John Walsh, said they have been "overwhelmed" by inmates suffering from the effects of coronavirus. "This is a disaster," he said. "What I most fear, is that without some resolution, the number of patients coming in from Stateville will be excessive." Walsh said that the inmates are not isolated well.
Dr Daniel Lopez Acuña (MD, MPH)Former director, WHO Health Action in
Crises Recovery and Transition Programmes; faculty, Andalusian School of Public Health
Medical professionalNews & Analysis, Journal of the American Medical Association"The Challenge of Preventing COVID-19 Spread in Correctional Facilities"NationalThe Centers for Disease Control and Prevention (CDC) notes that people who are incarcerated or detained in a particular facility often come from a variety of locations, increasing the chance of introducing COVID-19. Plus, options to isolate people with COVID-19 are usually limited, and many facilities restrict access to soap and paper towels and ban alcohol-based hand sanitizers. In addition, incarcerated individuals are more likely than the general population to have underlying illnesses, such as cancer, diabetes, or substance use disorder, that increase their risk of developing severe COVID-19, said Daniel Lopez Acuña, MD, MPH, who helped craft new COVID-19 guidelines for prisons and jails for the World Health Organization (WHO)...One thing is clear, Lopez Acuña and other public health experts say: When it comes to the highly infectious virus that causes COVID-19, what happens in correctional facilities does not stay in correctional facilities, because staff members as well as incarcerated individuals come and go. That is why “it’s very important to keep the virus from entering the prisons,” and, if it does, to keep it from exiting, said Lopez Acuña, former director of the WHO’s Health Action in Crises Recovery and Transition Programmes. “If they are severe enough, you will have to send them to hospitals,” he said of incarcerated people with COVID-19. “If they are mild cases, you may have to have dedicated facilities for positives. This is not an outbreak of food poisoning. This is a really aggressive virus.”
Dr Stuart Kinner (Phd)
Dr Jesse T Young (PhD, MPH)
Medical professionalJournal Article, Epidemiological Review"Understanding and Improving the Health of People Who Experience Incarceration: An Overview and Synthesis"InternationalThe world prison population is growing at a rate that exceeds the rate of population growth. This issue of Epidemiologic Reviews comprises articles in which researchers summarize what is known about some of the key health issues facing people in prison, particularly in relation to human immunodeficiency virus and other blood-borne viral infections. A key recurring theme is that addressing the health needs of people in prison is important to reducing health inequalities at the population level—that prisoner health is public health...Prisoners are on average younger than the surrounding population; however, older people are one of the fastest growing demographics in many prison systems (46), notably including in the United States (47). This makes it challenging for service providers to fund and deliver appropriate health care.
176 medical and public health expertsMedical professionalLetter to Governor BakerCovid19 - Public Health Response
MAIncarcerated people are members of our communities. Protecting people who are incarcerated means protecting people who are parents, grandparents, spouses, friends and neighbors. A COVID-19 pandemic plan that prioritizes release from jails and prisons also protects staff and their families. Correction Officers and staff constantly enter and exit facilities, potentially exposing vulnerable populations to COVID-19 on both sides of the wall. People in our prisons and jails have higher rates than the general population of chronic illnesses, medically complex illnesses, and communicable disease, making them especially vulnerable to serious and fatal outcomes.[1] We must act now to disrupt infection.
Amend at UCSF -- public health professionals for changing correctional cultureMedical professionalBrief

News report
"The Ethical Use of Medical Isolation – Not Solitary Confinement – to Reduce COVID-19 Transmission in Correctional Settings"

"Louisiana prisoners held in notorious isolation unit are facing a 'slow moving disaster'"
NationalBrief: This brief clarifies the differences between “medical isolation,” “quarantine,” and “solitary confinement,” and describes the services and benefits that corrections officials should provide to people who are separated for medical isolation or quarantine so that they are not subjected to punitive and traumatizing conditions of solitary confinement. It is intended to provide guidance to departments of correction, prison and jail residents, advocates, and other key stakeholders to help ensure that using medical isolation or quarantine to mitigate the spread of COVID-19 in correctional facilities follow the highest standards of medical ethics.

The Appeal: Advocates worry that fears of being placed in isolation at Camp J will deter incarcerated people across Louisiana from reporting symptoms—and thus increase their risk of spreading COVID-19 to others. Amend, a correctional health program at the University of California, San Francisco, notes: “Separating people who become infected is a necessary public health challenge, particularly in prisons and jails. But turning to the punitive practice of solitary confinement in response to the COVID-19 crisis will only make things worse.”
4/9/2020, 4/17/2020
Public health experts, Drexel University, University of Pennsylvania, Temple University (13)Medical professionalLetter to Governor WolfPublic Health Experts Letter to Governor Wolf - PA
PAThis “social distancing” has been difficult to accomplish in our society generally, but is impossible to achieve in our state correctional facilities, jails and youth detention centers as things currently stand. Almost 88,000 people are incarcerated in these facilities. Prisons and jails contain high concentrations of people in close proximity, with people housed cheek-by-jowl, in tightly-packed and poorly-ventilated dormitories; they share toilets, showers, and sinks; they wash their bedsheets and clothes infrequently; and often lack access to basic personal hygiene items.These facilities lack the ability to separate sick people from well people and to quarantine those who have been exposed. These facilities also currently lack the necessary medical equipment, specifically ventilators, necessary to treat this illness. There are currently only four ventilators available for the nearly 50,000 incarcerated in the state facilities
LA County Dept of Public HealthMedical professionalGuidance for facilitiesNovel Coronavirus (COVID-19): Los Angeles County Department of Public Health Guidance for Correctional and Detention FacilitiesCACorrectional and detention facilities pose unique challenges to communicable disease control. Incarcerated/detained persons commonly live in congregate settings, increasing the risk for COVID-19 to spread once introduced to the facility. Additionally, the high turnover in certain types of correctional environments, such as jails, coupled with the frequent traffic of staff and incarcerated/detained persons between facilities and outside systems (courts, medical appointments), heightens the threat of community spread...Collaborate with Legal and Judicial Systems to Adopt Policies to Reduce the Overall Population While Prioritizing High-Risk Persons
Dr Josiah Rich (MD)Epidemiologist, Brown University; Center for Prisoner Health and Human RightsMedical professionalNews reports

"Calls mount to free low-risk US inmates to curb coronavirus impact on prisons"

"We must release prisoners to lessen the spread of coronavirus"

"A Doctor on ICE’s Response to the Pandemic: 'You Could Call It COVID-19 Torture'"
NationalGuardian: Rich said the number one change people can make to minimize this threat is simply to reduce the number of imprisoned people. Temporarily forgiving bail is one way. Another is to release low-level, older offenders, though it is unclear where they would be sent if they do not have close friends or family members to take them in.

WaPo Op-Ed: It is essential to understand that, despite being physically secure, jails and prisons are not isolated from the community. People continuously enter and leave, including multiple shifts of corrections staff; newly arrested, charged and sentenced individuals; attorneys; and visitors. Even if this flow is limited to the extent possible, correctional facilities remain densely populated and poorly designed to prevent the inevitable rapid and widespread dissemination of this virus.

Mother Jones: As a contract employee of the Department of Homeland Security’s Office of Civil Rights and Civil Liberties, Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University, is particularly qualified to assess ICE’s COVID-19 response. Rich and Dr. Scott Allen, an expert medical adviser for Physicians for Human Rights and fellow DHS contract employee, came forward as whistleblowers last month, warning in a letter to Congress of a “tinderbox scenario” if the new coronavirus started spreading in immigration detention centers. (Rich spoke to us in his capacity as a whistleblower being represented by the Government Accountability Project; not on behalf of DHS.)
3/13/2020, 3/17/2020, 4/13/2020
Dr Josiah Rich (MD)
Dr Ross MacDonald (MD)
Epidemiologist, Brown University, Center for Prisoner Health and Human Rights;
Chief doctor, Rikers Island
Medical professionalNews report"Americans Most Likely to Be Infected: the Faithful, Jailed or Old"National“The immediate problem is you’re going to overwhelm medical services,” said Josiah Rich, a doctor who is director and co-founder of the Center for Prisoner Health and Human Rights in Providence, Rhode Island. Longer term, “the infection will continue to smolder and smolder and hamper our efforts to contain a resurgence."...
“It is possible that our efforts will stem this growth, but as a physician I must tell you it is unlikely,” Ross MacDonald, the chief doctor at Rikers tweeted. “I cannot reassure you of something you only wish to be true.”
Dr. Matthew J. Akiyama (MD)
Dr. Anne C. Spaulding (MD, MPH)
Dr. Josiah D. Rich (MD)
Professor, Albert Einstein College of Medicine; Professor, Epidemiology, Emory University;
Epidemiologist, Brown University, Center for Prisoner Health and Human Rights
Medical professionalArticle, New England Journal of Medicine"Flattening the Curve for Incarcerated Populations — Covid-19 in Jails and Prisons"
National"Therefore, we believe that we need to prepare now, by “decarcerating,” or releasing, as many people as possible, focusing on those who are least likely to commit additional crimes, but also on the elderly and infirm; urging police and courts to immediately suspend arresting and sentencing people, as much as possible, for low-level crimes and misdemeanors; isolating and separating incarcerated persons who are infected and those who are under investigation for possible infection from the general prison population; hospitalizing those who are seriously ill; and identifying correctional staff and health care providers who became infected early and have recovered, who can help with custodial and care efforts once they have been cleared, since they may have some degree of immunity and severe staff shortages are likely."
Dr Scott Allen (MD, FACP)
Dr Josiah Rich (MD)
Professor Emiritus, UC Riverside School of Medicine;
Epidemiologist, Brown University; Center for Prisoner Health and Human Rights
Medical professionalLetter to Congress

News report
Letter From Dr. Scott Allen and Dr. Josiah Rich to Congress re: Coronavirus and Immigrant Detention

"Doctors warn of 'tinderbox scenario' if coronavirus spreads in ICE detention"
NationalCNN: "As local hospital systems become overwhelmed by the patient flow from detention center outbreaks, precious health resources will be less available for people in the community," the letter says. "To be more explicit, a detention center with a rapid outbreak could result in multiple detainees — five, ten or more — being sent to the local community hospital where there may only be six or eight ventilators over a very short period."
3/19/2020, 3/20/2020
Dr Geoffrey R Swain (MD, PhD)Former Medical Director, City of Milwaukee Health
Department; retired medical school faculty
Medical professionalLetter to DA John Chisholm, MilwaukeeWIThis is not just about the health (or the life and death) of inmates, and not even only about the health and life and death of staff and their families. The decisions we make now will make a significant difference in the lives of every Wisconsinite who needs hospitalization for any reason during the coming months. This is because the drastic social-distancing measures that we are all undertaking aim to lower the infection rate to no more than 20% over four months. But even with that, our state’s 10,784 hospital beds and 1,913 ICUs beds (estimated from Wisconsin Hospital Association data) will likely be operating at full capacity for months. With a saturated healthcare system, every effort to reduce additional infection becomes even more essential to all patients needing any hospital care. Without rapid decarceration and adequate social distancing, once the virus makes its way into a jail or prison, it will be impossible to keep infection rates anywhere near 20% over 4 months in that population (including staff and their families). With no action, a conservative estimate would be that the peak in these settings will likely be about 60% infections over 4 months.
Dr Carlos Franco Paredes (MD, MPH, DTMH)Professor of medicine, Division of Infectious Diseases, Dept of Medicine, U ColoradoMedical professionalLegal document (declaration)

News report
Declaration of Dr Carlos Franco Paredes, Fraihat v. ICE

"A Doctor on ICE’s Response to the Pandemic: 'You Could Call It COVID-19 Torture'"
CADeclaration (incl helpful list of those most vulnerable to COVID-19, wrt immigration detention centers): As an infectious disease clinician with a public health degree in the dynamics of infectious disease epidemics and pandemics and twenty years of clinical experience, I am concerned about the treatment of immigrants inside detention centers which could make the current COVID-19 epidemic worse in the U.S. by having a high case fatality rate among detainees and potentially spreading the outbreak into the larger community.

Mother Jones: Dr. Carlos Franco-Paredes, a professor in the University of Colorado School of Medicine’s infectious diseases division, emphasized that crowded, enclosed spaces are the opposite of social distancing. By the time ICE quarantines a symptomatic detainee, that person will have likely have already infected others, he said. Those infected people will transmit the virus to others.
3/24/2020, 4/13/2020
Dr Todd William Schneberk (MD, MHPM)Emergency medical physician; Professor, Keck School of Medicine, USCMedical professionalLegal document (declaration)Declaration of Dr Todd William Schneberk, Rodriguez v. WolfCAIn light of the late onset of symptoms for COVID-19 and the lack of tests in the United States, detention facilities like Adelanto are already behind the curve to mitigate a devastating outbreak of COVID-19 among its staff and detained population. 18. Infectious diseases spread rapidly in congregate settings like jails, prisons, and detention facilities,
Dr Allen S Keller (MD)Professor, NYU School of Medicine; Attending Physician
Bellevue Hospital, NYC
Medical professionalLegal document (declaration)Declaration of Dr Allen S Keller, Ortuno v. JenningsCAPlans for separating suspected COVID-19 exposed or infected individuals within a given facility or by transferring to specialized quarantine facilities is neither effective nor feasible as a response to the threat of infection or infectious spread within a detention facility. As per CDC guidelines, when individuals become symptomatic and considered “at risk” of being infected with/contagious to others for COVID-19, they are supposed to self-isolate, not isolate within groups. Putting individuals with symptoms in a group-like isolation setting risks to those who were not infected with COVID-19, despite having similar symptoms to those who may be infected. In other words, for individuals who did not have COVID-19 before being placed in group isolation, many may contract COVID-19. This is exacerbated by substantial and increasing limitations on access to testing, even for those who have symptoms of COVID-19, because of a major shortage of testing materials. It would be unlikely that in these immigration detention facilities, all who are symptomatic could be tested prior to any form of group isolation.
Dr Allen S Keller (MD)
Benjamin D Wagner
NYU public health expertsMedical professionalJournal article, the Lancet Public Health"COVID-19 and immigration detention in the USA: time to act"NationalOvercrowding, poor sanitation, inadequate healthcare, and difficulty containing contagious diseases are well documented in ICE's immigration detention system. Most facilities are run by private prisons or county jails through lucrative ICE subcontracts. Distancing and other necessary measures to prevent SARS-CoV-2 from spreading are not possible in immigrant prisons. These congregate detention facilities pose a great contagion risk: already, several staff at different immigrant detention centres have tested positive for COVID-19 and detainee infections are being reported as well.
Dr Sandra R. Hernández (MD)President & CEO, California Health Care Foundation; physician and surgeonMedical professionalLegal document (declaration)Declaration of Sandra Hernández, Ortuno v. JenningsCADetention facilities do not have the ability to promote or permit adequate social distancing, to isolate people who are symptomatic consistent with COVID-19 infections, to diagnose who might be infected (whether they are symptomatic or asymptomatic), and to provide the acute respiratory support for individuals who manifest severe respiratory distress due to the infection. 22. Prisons, jails and detention facilities are not isolated from the community. They are part of and rely on the broader community. People from the community – including staff, contractors and vendors – come and go for various reasons. Detainees also need to be transported to and from facilities to attend court hearings, for specialized medical care, or for other reasons. There can also be rapid turnover of individuals in the facilities. With each entry and exit, individuals can bring infectious disease into or out of the facilities.
Sandhya Kajeepeta (MS)
Caroline G. Rutherford (BA)
Katherine M. Keyes (PhD)
Abdulrahman M. El-Sayed (MD, DPhil)
Seth J. Prins (PhD)
Public health faculty and students, Columbia UniversityMedical professionalJournal article, American Journal of Public Health"County Jail Incarceration Rates and County Mortality Rates in the United States, 1987–2016"NationalResults. A within-county increase in jail incarceration rates from the first to second quartile was associated with a 2.5% increase in mortality rates, adjusting for confounders (risk ratio [RR] = 1.03; 95% confidence interval [CI] = 1.02, 1.03). This association followed a dose–response relationship and was stronger for mortality among those aged 15 to 34 years (RR = 1.07; 95% CI = 1.06, 1.09).
Conclusions. Within-county increases in jail incarceration rates are associated with increases in subsequent mortality rates after adjusting for important confounders.
Theodore M. Hammett (PhD)
Mary Patricia Harmon (AB)
William Rhodes (PhD)
Abt Associates Inc, Cambridge, Mass; Harvard Graduate School of EducationMedical professionalJournal article, American Journal of Public Health"The Burden of Infectious Disease Among Inmates of and Releasees From US Correctional Facilities, 1997"NationalResults. During 1997, 20% to 26% of all people living with HIV in the United States, 29% to 43% of all those infected with the hepatitis C virus, and 40% of all those who had tuberculosis disease in that year passed through a correctional facility.
Conclusions. Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for infectious diseases. Such interventions stand to benefit not only inmates, their families, and partners, but also the public health of the communities to which inmates return.
Dr James Hamblin (MD)Lecturer, Yale School of Public HealthMedical professionalOp-ed"Mass Incarceration Is Making Infectious Diseases Worse"NationalThe penal system remains a source of diseases that spread among prisoners at rates far exceeding those in the communities from which they came. Of more than 10 million incarcerated people in the U.S. alone, 4 percent have HIV, 15 percent have hepatitis C, and 3 percent have active tuberculosis. These diseases are part of our criminal justice system, then, metered out and sanctioned implicitly by the state. The penal system is also a primary reason that these diseases can’t be eliminated globally, and the problem goes well beyond condoms, according to Chris Beyrer, the Desmond Tutu Professor of Public Health and Human Rights at Hopkins, who edited the Lancet research series. He spoke with me by phone from South Africa, where he is co-chairing the International AIDS Conference in Durban. He sounded distraught over the fact that HIV infections stopped declining years ago in the United States, and are now stable around 45,000 every year.
Peter Scharf (Ed.d. Human Development and Sociology)Professor of public health, Louisiana State University New Orleans School of Public HealthMedical professionalNews report"Report from Inside Angola Prison Paints a Troubling Picture As Coronavirus Grips Louisiana"LA“This is a public health disaster in the making. Most jails and prisons are not built for social distancing, or things like hand-washing, being away from people. They eat together, the guards come in and out,” said Peter Scharf, professor of public health at the Louisiana State University New Orleans School of Public Health. “Guards are as freaked out as the inmates. The number of pathways of contagion in prison are difficult to control. The chance of someone bringing it to the population is basically a certainty.”
Dr. Chris Beyrer (MD, MPH)Professor of Epidemiology, Johns Hopkins Bloomberg School of Public HealthMedical professionalLegal document (declaration)

News report
Declaration for Persons in Detention and Detention Staff COVID-19

"A Doctor on ICE’s Response to the Pandemic: 'You Could Call It COVID-19 Torture'"
NationalDeclaration: Pre-trial detention should be considered only in genuine cases of security concerns. Persons held for non-payment of fees and fines, or because of insufficient funds to pay bail, should be prioritized for release. Immigrants awaiting decisions on their removal cases who are not a flight risk can be monitored in the community and should be released
from immigration detention centers. Older inmates and those with chronic conditions predisposing to severe COVID-19 disease (heart disease, lung disease, diabetes, immune-compromise) should be considered for release.

Mother Jones: Over Zoom, Dr. Chris Beyrer, the Desmond M. Tutu Professor of Public Health and Human Rights at Johns Hopkins University, raised a principle named after another South African champion of civil rights. The Nelson Mandela Rules, adopted by the United Nations in 2015, require that people in detention have access to the same quality of health care as the surrounding community. He applied the Mandela principle to ICE’s group quarantines. “Are people being provided that minimum standard of public health protection, which we have asked all Americans who have to liberty to embrace as a way to control this virus?” Beyrer asked. “I would say the answer is a clear no.”...For Beyrer, it’s essential that the public understand that most ICE detainees could be released without threatening public safety. In criticizing ICE’s coronavirus response, he described in stark terms the conditions for people forced to remain in group quarantines. “Cruel and usual punishment,” he said. “That level of anxiety, that level of stress…It’s a form of torture, you might say. A new form of torture. You could call it COVID-19 torture.”
3/16/2020, 4/13/2020
Dr. Kathleen R. Page (MD)
Dr. Maya Venkataramani (MD)
Dr. Chris Beyrer (MD, MPH)
Dr. Sarah Polk (MD, MHS)
Public health experts, Johns Hopkins Schools of Medicine and Public HealthMedical professionalArticle, New England Journal of Medicine"Undocumented U.S. Immigrants and Covid-19"NationalFinally, the Trump administration must address dire conditions in immigration detention centers. Under public pressure, ICE announced on March 18 that its “highest priorities are to promote life-saving and public safety activities,” and that it will therefore focus detention efforts on those posing a public safety risk and “delay enforcement actions until after the crisis or utilize alternatives to detention, as appropriate” ( opens in new tab). To promote “lifesaving” activities, ICE should release low-flight-risk detainees who are in custody. According to ICE, protocols are in place to screen and isolate detainees with Covid-19 symptoms. But infections transmitted through droplets, like influenza and SARS-CoV-2, are particularly difficult to control in detention facilities, since 6-foot distancing and proper decontamination of surfaces are virtually impossible.
World Health OrganizationMedical professionalInterim guidancePreparedness, prevention and control of COVID-19 in prisons and other places of detention Interim guidance InternationalPeople deprived of their liberty, such as people in prisons and other places of detention, are likely to be more vulnerable to the coronavirus disease (COVID-19) outbreak than the general population because of the confined conditions in which they live together for prolonged periods of time. Moreover, experience shows that prisons, jails and similar settings where people are gathered in close proximity may act as a source of infection, amplification and spread of infectious diseases within and beyond prisons. Prison health is therefore widely considered as public health. The response to COVID-19 in prisons and other places of detention is particularly challenging, requiring a whole-of-government and whole-of-society approach, for the following reasons...People in prisons and other places of detention are not only likely to be more vulnerable to infection with COVID-19, they are also especially vulnerable to human rights violations. For this reason, WHO reiterates important principles that must be respected in the response to COVID-19 in prisons and other places of detention, which are firmly grounded in human rights law as well as the international standards and norms in crime prevention and criminal justice...
Joan Stephenson (PhD)PhD biology; consulting Editor, JAMA Health ForumMedical professionalArticle, Journal of the American Medical Association"COVID-19 Pandemic Poses Challenge for Jails and Prisons"NationalJail and prison populations are exceptionally vulnerable to COVID-19 for a variety of reasons, including older age and health status, as well as conditions such as overcrowding and limited access to or poor quality of health care while incarcerated. More than 10% of inmates of US state and federal prisons are 55 years or older, and many have chronic or life-limiting illnesses. Approximately 15% of inmates of state prisons reported ever having asthma and 10% reported ever having a heart disorder—conditions that put individuals at high risk for severe illness with COVID-19. In addition to physical vulnerability, overcrowding and sanitation issues in many jail and prison settings heighten the risk of disease spread and are in stark contrast to the recommendations of public health officials for social distancing, frequent handwashing, and other practices for COVID-19 prevention.
Dr. Brie A. Williams (MD)
James McGuire (PhD)
Rebecca G. Lindsay (MS)
Jacques Baillargeon (PhD)
Irena Stijacic Cenzer (MA)
Dr. Sei J. Lee (MD)
Dr. Margot Kushel (MD)
Public health experts of UCSF, University of Texas, SF VA Medical CenterMedical professionalArticle, Journal of General Internal Medicine"Coming Home: Health Status and Homelessness Risk of Older Pre-release Prisoners"NationalOlder pre-release prisoners had a high burden of medical and mental illness and were at risk for post-release homelessness regardless of veteran status. Reentry programs linking pre-release older prisoners to medical and psychiatric services and to homelessness prevention programs are needed for both veterans and non-veterans.
Melissa Garrido (PhD)
Austin B. Frakt (PhD)
Public health experts, Boston Veterans Health Administration and Boston University School of Public HealthMedical professionalArticle, Journal of American Medical Association"Challenges of Aging Population Are Intensified in Prison"NationalMany of these older inmates receive inadequate health care and symptom management. Correctional facilities, by definition, are not health care facilities; their institutional focus is security. Limited access to clinicians with geriatric expertise means that diagnoses may be missed. Dental health needs, including the need for dentures, may be overlooked, leading to pain and inadequate nutrition. Institutional menus are counterproductive to the management of diabetes and obesity. Other gaps in care arise from suspicion of prisoners’ motives or attitudes. Pain medication may be restricted due to concerns that pills will be misused. Unusual behavior that occurs with dementia may be misconstrued as deliberate belligerence.
Dr. Alysse G. Wurcel (MD, MS)
Emily Dauria (PhD MPH)
Nicholas Zaller (PhD)
Dr. Ank Nijhawan (MD)
Dr. Curt Beckwith (MD)
Kathryn Nowotny (PhD)
Lauren Brinkley-Rubinstein (PhD)
Public health experts, Tufts Medical Center, UCSF Weill Institute for Neurosciences, SF General Hospital, University of Arkansas for Medical Sciences, University of Texas Southwestern Medical Center, Miriam Hospital & Rhode
Island Hospital, University of Miami, UNC Chapel Hill Center for Health Equity Research
Medical professionalLetter to journal editor, Clinical Infectious Diseases"Spotlight on Jails: COVID-19 Mitigation Policies Needed Now"NationalSocial distancing to reduce the rate of disease transmission is not feasible in jails, where people are confined to small living spaces and institutions are often over-capacity. Handwashing can be undermined by policies limiting soap access or requiring individual purchase of soap (at a marked up price). Many jails restrict access to hand sanitizer, which contains alcohol, fearing individuals will ingest it. Along with structural barriers to disease prevention, there are administrative challenges – largely driven by lack of financial resources – that impede timely access to healthcare professionals when sick. This is especially concerning because jails have a high proportion of people with underlying health conditions, making them more susceptible to severe COVID-19 infection.8 There are several reasons why people who are infected may be reluctant to self-identify symptoms, including unknown duration of detainment, fear of being isolated, or losing privileges (e.g., television, phone calls) in a medical unit.10 Further, increased risk of COVID-19 exposure in jails confers higher risk of transmission in the community upon release, with challenges surrounding then notifying those exposed who have limited access to stable housing or phones.
Dr Joseph A. Bick (MD)California Medical Facility, CA Dept of Correc and Rehab, and UC Davis School of MedicineMedical professionalArticle, Clinical Infectious Diseases journal"Infection Control in Jails and Prisons"NationalAt the end of 2005, ∼7 million people (or 1 of every 33 American adults) were either in jail, in prison, or on parole [1]. Compared with the general public, newly incarcerated inmates have an increased prevalence of human immunodeficiency virus infection, hepatitis B virus infection, hepatitis C virus infection, syphilis, gonorrhea, chlamydia, and Mycobacterium tuberculosis infection [2]. While incarcerated, inmates are at an increased risk for the acquisition of blood-borne pathogens, sexually transmitted diseases, methicillin-resistant Staphylococcus aureus infection, and infection with airborne organisms, such as M. tuberculosis, influenza virus, and varicella-zoster virus. While incarcerated, inmates interact with hundreds of thousands of correctional employees and millions of annual visitors [2]. Most inmates are eventually released to interact with the general public. Tremendous opportunities exist for infectious diseases specialists and infection-control practitioners to have an impact on the health of correctional employees, the incarcerated, and the communities to which inmates return. This article presents a brief review of some of the most important infection-control challenges and opportunities within the correctional setting.
Spokesperson for Adirondack HealthMedical professionalNews report"The Situation Here is Dire: How an Upstate New York Prison Failed to Contain a COVID-19 Outbreak"NYMatthew Scollin, a spokesperson for Adirondack Health, a local hospital, told The Appeal that it has a total of 12 ICU beds and nine ventilators, and the hospital has treated three COVID-19-positive patients so far. “Regardless of FCI Ray Brook,” he said, “we’re already trying to plan for numbers that would outstrip what we have on hand day to day anyways.” The region’s largest hospital, in Plattsburgh, where the correctional officer was admitted, did not respond to questions about their capacity.
Dr Shamsher Samra (MD, PhM)Faculty, School of Medicine at UCLA; attending, Harbor-UCLA Medical Center, LA County JailMedical professionalWeb conference

Module on health implications of incarceration
Covid 19 and Incarceration: What is Happening/What are the Key Questions/What Is to Be Done?

Module 13. Incarceration. Objectives:
1. Understand the health implications of incarceration and the Prison Industrial Complex.
2. Understand the rights of detained patients in the emergency department.
3. Understand the right to access care for patients.
Dr Lello Tesema (MD)Director, Population Health, LA County Correctional Health Services; assistant professor, General Internal Medicine, USC; Gehr Fellow, Gehr Family Center for Health Systems ScienceMedical professionalWeb conferenceCovid 19 and Incarceration: What is Happening/What are the Key Questions/What Is to Be Done?
Dr Laura Hawks (MD)
Dr Steffie Woolhandler (MD, MPH)
Dr Danny McCormick (MD, MPH)
Physicians and public health academics, Cambridge Health Alliance; Harvard Medical School; Hunter College, CUNYMedical professionalJournal article, JAMACOVID-19 in Prisons and Jails in the United StatesNationalEven before COVID-19 cases were detected in prisons and jails, clinicians and advocates for incarcerated persons proposed measures to ameliorate the anticipated harms, such as the wide availability of protective equipment, testing and medical care, and the elimination of co-payments and other policies that may deter inmates from seeking care. Although these actions are essential, the most effective way to avoid an imminent outbreak, is, as others have argued, to drastically reduce the populations of jails and prisons.6 Criminal justice systems can accomplish this by reducing unnecessary jail admissions and expediting prison release. Some prosecutors are already adjusting prosecutorial standards to reduce jail admissions and the length of stays. In Baltimore, prosecution of all drug possession and other minor crimes is being deferred. In San Francisco the district attorney has ordered the release of all persons in pretrial detention (who would be eligible for bail if they could afford it).7 These steps may reduce crowding in some jails, but many other jails—and most prisons—are minimally affected.
Dr Frederick Altice (MD)Professor of medicine and epidemiology, Yale School of MedicineMedical professionalJournal article, the LancetPrisons are “in no way equipped” to deal with COVID-19International“Prisoners share toilets, bathrooms, sinks, and dining halls. They are mostly sleeping in bunk beds; in some countries they sleep crammed together on the floor”, explains Frederick Altice of the Yale School of Medicine (New Haven, CT, USA). “These settings are in no way equipped to deal with an outbreak once it gets in.” If an institution is already operating at far beyond its capacity, it is going to be very difficult to find areas where prisoners with suspected COVID-19 can be isolated. “If a prisoner knows he is going to be put in solitary confinement if he admits to being sick, which is usually a punishment, then there is a heavy disincentive to seek medical attention”, adds Patton.