On Friday, an inmate at Massachusetts Treatment Center, a prison in Bridgewater, tested positive for COVID-19. This case may be the tip of the iceberg, as other inmates and prison staff could have been exposed. As infectious diseases physicians and a sheriff working in Massachusetts jails and prisons, we urge the community and the Legislature to recognize the importance of prevention and mitigation in these enclosed environments. Action is urgently needed.
In 1690, Barnstable County built one of the nation’s first jails to punish crimes and improve public safety, and these tenets for incarceration still hold true. The correctional system’s physical and operational structure is built on confinement — a form of pandemic mitigation. Inmates sleep, eat, and interact in highly monitored and confined settings where social distancing is difficult, if not impossible. A perfect storm for the spread of COVID-19.
The state currently incarcerates about 7,600 people in long-term detention centers. This is an aging population with chronic illnesses such as HIV, diabetes, cancer, and heart disease. These underlying conditions heighten the risk of severe COVID-19 infection. County prisons and jails house a younger and healthier prison population but they also represent a high-risk group because they have high rates of substance use disorder, infections, and mental health disorders. Furthermore, jails and prisons need to have access to the supplies and equipment necessary to care for their staffs and those in their custody.
Since the advent of COVID-19, access to soap and hand sanitizer has dramatically increased in state prisons. In addition, the state has begun educational programs and screening for virus symptoms in people entering jail. The number of inmates has dropped — the result of a coordinated response from the custodial side and the courts to decrease overcrowding. Prisons and jails have terminated programs, visitation rights, court trips, work details, and prison transfers. We have seen concerted efforts from the key stakeholders to prepare. However, more action is necessary.
Although it might be inevitable, we must ensure that the thousands of people employed in the prison and jails do not introduce the virus into this community. Corrections officers, nurses, janitors, and kitchen staff are all integral to a jail’s safe functioning. But they are also at risk for infection and are the most likely source of imported infections. Staff members with symptoms should be encouraged to self-quarantine. Staff members should also agree to temperature checks upon entrance to each facility with every shift. This should be mandatory.
The state must ensure all employees have access to personal protective equipment to prevent key medical staff or correctional officers from getting ill. Contingency plans must be established immediately for this worst-case scenario. In the past, inmates have been released from overcrowded prisons.
We suggest stringent screening protocols with rapid turnaround tests for COVID-19 for inmates. Any barriers to rapid medical care must be suspended. Medical units should immediately see anyone feeling unwell. Testing for respiratory viruses, influenza, and COVID-19 should be available in every state institution. Institutions have already started rehabilitating unused units so that inmates can be isolated pending testing results. Grouping together people with unconfirmed COVID-19 should never be allowed, since influenza and other viruses are possible causes of infection as well. As much as possible, the number of people in rooms together should be limited. For example, meals should be capped at 25 people.
The risks and benefits of quarantining prisoners must be considered carefully. Supportive balancing measures must be initiated. We suggest considering increased phone time, telecommunication with lawyers, and increased recreation time.
Many incarcerated people are homeless. Increased funding is needed to set up respite programs for safe housing post-incarceration. Additionally, as addiction-related programming has decreased, linkage for substance use disorder treatment after release should not be forgotten.
It’s obvious that increased funding is needed to implement these measures. As the federal government releases relief money, jails and prisons must be a priority.
Our national values are reflected in how we treat the most vulnerable members of our society. We have worked with corrections administrators, corrections officers, and health care workers who have shown the highest level of care and compassion for incarcerated people with diseases such as AIDS. As COVID-19 moves through all populations at a rapid speed, we must take bold steps immediately in order to save as many lives as possible.
Dr. Alysse G. Wurcel is assistant professor of medicine at Tufts University School of Medicine and infectious disease physicians at Tufts Medical Center and Lemuel Shattuck Hospital. Dr. David R. Stone is associate professor of medicine at Tufts University School of Medicine and infectious disease physicians at Tufts Medical Center and Lemuel Shattuck Hospital. Peter J. Koutoujian is sheriff of Middlesex County.
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