California's San Quentin State Prison. Inmates in facilities across the U.S., such as at California's San Quentin State Prison, pictured, are at high risk for COVID-19, experts say. File Photo by Terry Schmitt/UPI | License Photo
April 28 (UPI) -- Controlling spread of the new coronavirus inside jails and prisons is a unique challenge, public health experts argue in a commentary published Tuesday in JAMA Internal Medicine.
Prisons are designed to keep criminals away from the general public, but if inmates become infected with COVID-19 they face serious potential health consequences, and walls and barbed wire won't contain the virus.
People outside prison gates need to be concerned, they say, because it's easy for a virus to get out and affect the surrounding communities.
"Over-crowded prisons and jails are incubators for COVID-19 because social distancing is virtually impossible," co-author Dr. Stephanie Woolhandler, a primary care physician and a professor at the City University of New York's Hunter College, told UPI. "Guards and other prison staff enter and exit from the community daily. And when prisoners require care, they often must be cared for in an outside hospital."
"Prisoner health is community health," she added.
Although there is no specific data on the number of prisoners in the United States that have been diagnosed with COVID-19, the disease caused by the new coronavirus, SARS-CoV-2 -- but the numbers available are grim.
More than 1,000 inmates and 300 staff and guards at federal prisons have been infected, according to figures from the Federal Bureau of Prisons, and state and local jails across the country have reported high levels of disease spread as well.
More than 3,000 inmates across four states -- Arkansas, North Carolina, Ohio and Virginia -- have tested positive for the virus, according to reports, while more than 1,000 prisoners in Arizona alone have also been infected.
The outbreak has proved particularly problematic across prison systems, according to the new commentary, because the facilities, by their nature, are designed to be confined spaces.
In the commentary, experts use the analogy of the Diamond Princess cruise ship -- hardly a prison -- but with 3,700 people effectively trapped on board for four weeks, were not surprised that 700 became infected with the highly contagious virus.
America's prisoners also have several risk factors for serious illness from COVID-19, the authors said. More than 130,000 are 55 years of age or older, according to the most recent estimates, and about half have at least one chronic condition, like heart disease or asthma.
"Medical ethics dictates that inmates must be treated with the same care and respect as other patients, but many U.S. prisons force prisoners to make co-payments before seeing a doctor, and these co-payments are often prohibitively expensive for prisoners who earn just pennies per hour when they work," Woolhandler said.
"Prisons, especially those run by for-profit firms, often try to obstruct prisoners from going to outside hospitals, even when medically necessary, because the hospital bills take away from the firm's profits," she said.
While applauding efforts to ensure testing and availability of personal protective equipment at jails, the authors of the commentary note that the most effective way to avoid an outbreak is "to drastically reduce the populations of jails and prisons." This includes reducing what the writers call unnecessary admissions, such as for non-violent offenders, and by expediting the release of prisoners who have completed sentences or qualified for parole.
The commentary highlights Baltimore, which has deferred the prosecution of all drug possession and other minor crimes to keep jail populations down until the pandemic has been contained. Older patients, they added, should also be considered for early release, given that they are less likely to re-offend.
In addition, once prisoners are released, support services need to be made available to help them successfully re-integrate into their communities, while maintaining their physical and mental health.
"There are prisoners serving excessive sentences for non-violent offenses, inmates who have never been convicted but remain in jail for pre-trial detention because they are too poor to post bail and inmates re-incarcerated for technical parole violations," Woolhandler noted. "Releasing such inmates is the only way to reduce overcrowding and make social distancing possible."