How Prisons and Jails Can Respond to the Coronavirus

“To the extent that we don’t do a good job in jails and prisons,” Homer Venters, an epidemiologist, says, “we will certainly prolong the life of this outbreak
No one can predict exactly what will happen if the coronavirus starts to spread inside American jails and prisons, but Homer Venters can make some very educated guesses. Venters, the former chief medical officer on Rikers Island, trained as a physician and an epidemiologist, and, in 2009, he helped oversee efforts to contain the outbreak of the H1N1 virus inside New York City’s jails. He now oversees Community Oriented Correctional Health Services (C.O.C.H.S.), a nonprofit that works to improve health care in jails and prisons. As the question of how to contain an outbreak inside these closed institutions has become increasingly urgent, leaders of county jails, state prison officials, and advocates have been seeking Venters’s expertise. I spoke to him about the challenges of trying to control the spread of a pandemic among incarcerated people. Our conversation has been edited for length and clarity.

Why are prisons and jails especially dangerous places to be during a pandemic?

Jails and prisons are full of people who are at higher risk than the general public. We have filled them up with people who have high rates of serious health problems. We also, especially in the state prison systems around the country, have an increasingly older population of people. So we have lots of people who are at high risk for serious complications.

All of the new terms of art that everybody has learned in the last two weeks, like “social distancing” and “self-quarantine” and “flattening the curve” of the epidemic—all of these things are impossible in jails and prisons, or are made worse by the way jails and prisons are operated. Everything about incarceration is going to make that curve go more steeply up.

If you think about how a county jail works, the first thing upfront is that people—when they’re arrested in the precinct and then when they go to court and then when they get to jail—they’re in these court pens with lots of other people. You could have a dozen or even two dozen people in a small pen, where there’s not room to really sit down, where you’re sitting on the floor or you’re sitting on benches.

Every time we do much smaller investigations of outbreaks—if there’s a bacterial meningitis or if there’s a pulmonary TB case—those are the places we worry about and where we see transmission happening, very quickly, of communicable disease. The jails are built to operate this way: big pens, big groups of people coming in. Five, ten, fifteen, twenty at a time going in blocks through cells. They start out in one cell, then they go to a second cell. They might go through six or eight cells. They don’t really have hand-washing access built in. That is basically a system designed to spread communicable disease.

Once people get through that intake process, if you go to housing areas in jails and prisons today, whether it’s a cell or a dorm-housing area, if you go to the bathrooms, you would find that many of the sinks don’t work. Many of them don’t have soap, and many of them don’t have paper towels to dry your hands.

What is the main strategy that should be employed to try to manage the outbreak of something like the coronavirus in a prison or a jail?

There are different ways to do this, but basically the idea is that you want to have one area for people who are well and who have no symptoms. You may have another place for people who are well but have very high-risk conditions. But certainly you want to have a special place to put people who have developed symptoms.

For prison systems or jails that are full—or, let’s say, over seventy-five per cent capacity—this process may be almost impossible for them to do. They may not have room to spread out. So if you can’t do that, if you can’t effectively keep the people with symptoms away from the people without symptoms, then you have a brand-new way of promoting transmission, which is separate and apart from jails being dirty or not having soap or hand-washing capacity.

This pandemic could bring new scrutiny to the ways that health care is delivered behind bars. What are some of the shortcomings of these systems?

Many of these sheriffs and jails have a pretty minimal approach to care. I mean, one of the basic standards in many jails is that it’s O.K. to wait up to fourteen days to do a comprehensive assessment on a person who comes into jail. The practice in a jail might be just to have a quick interaction with a nurse on the way in and then wait to see a doctor up to two weeks. That approach to limiting care and limiting what you know about people is the exact opposite of the approach we want to take in an outbreak, where we want to know everybody who’s at high risk because it’s so important to find those high-risk patients and understand who’s at risk of dying if and when the virus arrives.

If the pandemic is brought under control in most communities, but it is still spreading rapidly inside our jails and prisons, what does that mean for everyone else?

To the extent that we don’t do a good job in jails and prisons, we will certainly prolong the life of this outbreak.

A group of doctors and public health officials working in New York City’s jails and hospitals have urged the city to consider releasing those individuals currently confined in the city’s jails who are more than sixty years old. What do you think of that idea?

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. I just have really grave concerns. And so, if fewer people are in these systems—and, in particular, fewer people who have risk factors for serious complications—the more likely we are to succeed.

Is there anything about the coronavirus’s possible impact inside jails and prisons that you have not heard people talking about that you feel they should be?

Nobody is talking to the people who are detained themselves. I told somebody yesterday the story about an evening—maybe a Friday or Saturday night—when we were out checking temperatures and doing symptom checks [on Rikers Island] during the first week of the H1N1 outbreak. I was in a housing area, and an officer walked in—and they had all gotten N95 masks—and the officer had written on his mask: “Welcome to death.”

We were in there trying to calm people and figure out who is sick and who is not sick—and this one act just sent a wave of agitation through everybody in the house. I am sure that officer was terrified, too, and that’s why he did that dumb thing. But I just think that the engagement with the correctional staff and people who are detained has to be a top priority, because we need them to help with the management. A big part of that is telling us when they are sick or when somebody is sick, and not coming to work sick or not ignoring symptoms.

During the outbreak of the H1N1 virus on Rikers, how much tension was there inside the jails? And how tense could things get in the months ahead?

We had many difficult conversations and more than one chair thrown our way when it came to isolating people in housing areas. It was healthy young kids [sixteen years and older] who were being told they could not move anywhere. If you add in people really getting sick or dying behind bars, and then in a lot of these systems you don’t have correctional staff coming in. The basic jobs aren’t getting done.

People still are going to be watching T.V. So they watch T.V., and they hear about the importance of hand-washing, but there is no soap for them. They hear about the importance of going to the hospital or the doctor when you have certain symptoms, but that is not available to them. That level of hypocrisy or double standard is really fodder for serious chaos behind bars.

Do you think it is possible that there will be mass deaths inside jails and prisons?

I fear that, in communities that have deaths from coronavirus, we will have a significant number of deaths in the local correctional settings—and that many of those deaths will have been preventable. My worry is that there will be two standards of care—that incarcerated patients with one set of symptoms may be denied access to hospitals, even though in the community people with the same sets of symptoms do go to the hospital. And then that will lead to different rates of deaths and certainly to different rates of preventable deaths among people who are behind bars.