Coronavirus In Jails And Prisons

For the last six months, we’ve examined the impact of the coronavirus pandemic on people incarcerated in U.S. prisons, jails, and juvenile-detention facilities. Today, we’re wrapping up the project, though it certainly doesn’t mean the crisis is over. The map we’ve been updating weekly with new outbreaks (see below) shows active cases at more than 450 facilities. We have strong reason to believe that the actual number is much higher. 

This project has affirmed what we knew at the outset: too many people are locked up in overcrowded, unsanitary facilities where requests for medical care are routinely ignored. Despite the repeated urging of experts, officials have been reluctant to release even the most vulnerable people in their care, even as deaths mount. 

We conclude the project with a Q&A with Homer Venters, a physician, epidemiologist and expert in correctional health care. Venters was among the first to warn corrections officials that they would face a crisis if they didn’t take early action, and he continues to try to work with facilities to mitigate the ongoing risk COVID-19 poses to prisons and jails. 

The Appeal: Was there ever the possibility of avoiding, or at least mitigating, the large outbreaks we’re still seeing in correctional facilities?

Homer Venters: I think that there were, and still are, many lives that could be saved through more aggressive release efforts. There’s still a lot of ongoing work and a lot of opportunity to be more effective in that area, because so many systems really didn’t make meaningful progress.

There have been some effective interventions for conditions on the inside and many lives can be saved if those are more widely implemented. One of the things that’s taken a while to sink in is that the primary vector for the disease is staff. Addressing that requires a really aggressive approach—not just a daily screening of staff, but also testing routinely and doing evidence-based contact tracing when new cases appear. I continue to find facilities where there’s very little effort to implement contact tracing and where testing is not being conducted on a wide-scale basis. If you’re lacking in both those departments, if there is [a case] uptick in the community around the facility, it will make its way into the detention center.

One of the areas that remains completely unaddressed is the underlying failures of correctional health systems. I’ve been thinking a lot about how much of this is a manifestation of racism and systemic racial inequity. If the CDC comes up with guidelines for how people should be treated and if the local or the state health department has an idea or recommendation about what should happen with COVID care, but then neither the CDC nor the local or state department of health do anything to ensure those things actually happen for incarcerated people, that’s a real unit of racism in our health system.

All these detention settings have ‘sick call’ and that’s the primary way for people to report COVID symptoms and get care. But when you talk to incarcerated people, they routinely tell you that their sick call requests go unanswered, or they have to submit multiple sick call requests just to get a response, or they may get a response that says, ‘Here’s some Tylenol,’ but it isn’t really an assessment or care for COVID. In some cases, those sick call requests get thrown out. And so we have this group of people who, when they seek care for COVID-19, they must use this process to access care.

It’s a system that’s broken. There are lots of other representations of racism in health care in our country, but this is really striking. The voices of the people who are getting sick are being actively disregarded and dismissed. It’s ongoing and it’s systemic.

Early on we saw horrific outbreaks in prisons and jails, like Terminal Island, Lompoc, and Cook County, that got a lot of media attention. That attention has started to fade, but large outbreaks continue. It’s almost like we’ve become numb to those stories. What is it going to take to create real change?

I think there’s a high level of public acceptance for mortality and morbidity among people of color, but especially people who are incarcerated. It just doesn’t move the needle on policy. My hope is that, because we have this fleeting engagement with the CDC and with local and state health departments, [advocates] can force them to recognize how harmful incarceration is. And certainly COVID is a great example of this.

One near-term thing is to figure out whether CDC guidelines are being followed, because generally what happens is the CDC updates their guidelines and local jail or detention administrators say, ‘We’re following it,’ and that’s it. There’s no independent assessment of whether or not that’s happening. We wouldn’t accept that from a hospital. We wouldn’t accept that from a dialysis center. But somehow we think it’s OK to let a sheriff or a department of corrections tell us that they’re doing an adequate job—and my experience is that they’re not. My hope is that we can brow-beat the CDC and state and local health departments into some function that involves, in the short term, assessing the adequacy of the COVID response in these facilities. And, then, in the long-term really start to expand to all the other health problems that people experience during incarceration so that a health department that cares about diabetes outcomes in poor and underserved communities is also thinking about those same outcomes for people who are incarcerated.

Often local officials get angry when COVID-19 infection numbers from a jail or prison are included in a county’s total infection count and they’ll insist that those numbers be removed. Should public-health systems be including these numbers—not just COVID cases, but rates of diabetes, rates of heart disease, so jails are part of a community’s health report card?

I firmly believe that because the role of the health department is to promote health, then it should include people in places that are hard to reach or include outcomes that are harder to improve or control. If somebody is murdered behind bars, the local police show up. But for some reason, we’ve decided it’s OK for local health departments to just not pay attention to the health outcomes for people who are incarcerated.

We really have crafted this in such a way that it leaves [public-health systems] off the hook and leaves everybody who is incarcerated unprotected. If you’re a county health commissioner, or if you’re a state health commissioner, your goal should be to improve the health and understand the health risks for everybody in your community. And that means going into places where you’re probably not welcome, because that’s probably where people are being denied care.

What about efforts to change the physical layout of jails and prisons?

There are some more progressive communities that are trying to have smaller jails where people are spread out and where there’s more space dedicated to meaningful programs and activities. All of that involves fewer people in a larger space. My concern is that where we’re at now, with thousands of deaths [among incarcerated people], most places have made remarkably few changes to facility operations.

I’ve been to prisons, particularly in the South, where you’re still at between 80 and 120 percent of capacity and really not much has been done in a meaningful way to prevent the spread of infection. Some of these states are trying to lower the age at which you can become a correctional officer, or they’re trying to raise the salary of correctional officers to compete with, like, the dollar store. So I don’t really hold out hope for better facility development that improves infection control. My primary recommendation has always been for places to consider high-risk people for release to protect them from dying.

At San Quentin prison, they’ve been talking about moving people from the open-air cells and dorms and putting them into cells with solid doors. Prisoners are saying they don’t want to be moved, even if it could prevent them from being infected. What are your thoughts on this?

I certainly see that. People routinely tell me that they don’t want to report COVID symptoms because they’re going to be put into solitary confinement or be punished or have their property taken away. Those are real concerns. This, again, goes back to the idea that these are systems built generally to be punitive and where there’s a wide tolerance for physical and sexual abuse and medical neglect. So the idea that you can sprinkle in some evidence-based infection control principles is really an illusion. It’s a delusion, actually, because to really be effective at implementing infection control behind bars, it takes trying to engage with the people there. And that’s an uphill battle if, prior to that point, you haven’t bothered to engage with them. In the New York City jail system, which was a very brutal and difficult setting, a lot of our success came from ideas patients gave us. One of the things I usually recommend in my COVID inspections is for health staff to go into housing areas and give an update on what’s going on, but also hear from incarcerated people on what’s working and what’s not working. We still have such a one-way street that’s mostly built on authority and discipline. It makes many infection-control ideas very difficult to implement.

Have any facilities embraced your recommendations?

A lot of these inspections have come with a court order. There are some cases where inspections have led to settlement agreements. My concern is that even when those changes happen, they really aren’t going to be long-lasting. So that’s why I think it’s inexcusable that local and state departments of health and the CDC don’t have a role in figuring out, on an ongoing basis, the adequacy of health care and health responses to COVID, but also other health outcomes behind bars.

In March, Jennifer Gonnerman interviewed you for The New Yorker. Her last question was, ‘If the pandemic is brought under control in most communities, but it is still spreading rapidly inside jails and prisons, what does that mean for everyone else?’ And you said, ‘To the extent that we don’t do a good job in jails and prisons, we will certainly prolong the life of this outbreak.’ Do you still feel that’s the case?

Yeah, definitely. Because we knew that when these outbreaks occur, they can quickly overwhelm local emergency rooms and hospitals. We’ve seen it now multiple times where, when a facility becomes overrun, it really pushes to the brink a local hospital or even a group of hospitals. And there are a lot of places just sitting out there that are targets for COVID.

➤ LaCrosse Independent reporter Ben Prostine takes a look at the recent COVID-19 outbreaks in Wisconsin prisons, which he describes as “not an accident, but a crisis by design.” There are roughly 21,000 people currently in the Wisconsin prison system, nearly 3,300 more than it was designed to hold. Facilities that have seen some of the largest outbreaks, like the prisons in Green Bay and Racine, are more than 33 percent over capacity, Prostine writes.  

➤ San Quentin may see “a second, or even a third surge” in COVID-19 cases if its population isn’t reduced significantly and quickly, KTVU’s Lisa Fernandez reports. On Tuesday, lawyers filed a petition on behalf of 300 people incarcerated in the Northern California prison, which has struggled to control the spread of the virus after a massive outbreak in June that sickened 2,239 incarcerated people and killed 29. More than 300 employees were also infected, and one died. Last month, a state appeals court found that corrections officials acted with “deliberate indifference” by ignoring the advice of medical experts in the early days of the outbreak. The court concluded that San Quentin remains “unsafe” until it reduces its population by half. 

➤ Two men incarcerated at the Jacksonville Correctional Center in Illinois died this week. One was only 35 years old, making him one of the youngest incarcerated people to die from the virus. Officials have not released his name. 

➤ A judge has ordered the federal Bureau of Prisons to explain what steps it’s taking to stop the spread of COVID-19 at Fort Dix, a federal prison in New Jersey. The order follows a petition filed by Robert Edward Whiteside, who is incarcerated there. In the filing, Whiteside claimed people who had tested positive for COVID-19 were moved into his housing unit. As of Thursday, 228 Fort Dix prisoners and 10 staff members had contracted the virus, making it the largest current outbreak at a federal prison.

Each dot on the map represents a correctional facility that’s currently reporting at least two active infections (hover your cursor over a dot to see the facility’s name).