I was a prison doctor for 30 years and battled a different virus at the start of my career in 1987. It was HIV, and killed many young men before we had any drugs that worked. COVID-19 can kill more and medical and custody staff can bring it into their homes and the community, which is why what we do now matters.
If you have ever worked in a prison you know that "social distancing" will not work. How do you do that when 120 men sleep in one room, share 10 toilets, one urinal and 12 showers (when they are all working, which is rare.)
We know that washing hands and using bleach to clean surfaces is recommended. The prison can promote washing hands, but what happens when an inmate can’t afford to buy his own soap? He is handed a bar of soap that is three inches long and less than two nickels thick. Inmate sanitation teams can use bleach to clean surfaces, but bleach is a popular commodity in prison and may end up being sold instead of used for cleaning.
We also know that if you are older you have a greater chance of dying. Did you know that inmates are medically 10 years older than their chronological age because of their lifestyle choices? They also have more heart and lung problems. Before smoking was banned in the prison, 90% of my inmate population smoked.
Stress, poor nutrition and lack of quality sleep are common in a prison and they all affect the inmates ability to fight the virus. Do you see why I’m worried about the inmates as well as the staff who are responsible for them? It can be a perfect storm.
Measures taken by Nevada Department of Corrections
What are the measures that a prison can take to reduce the chance of inmates and staff getting the virus, transmitting it and dying from it? The CDC has given guidance for prisons, such as making soap free for inmates. The National Commission on Correctional Health Care is putting out recommendations on a weekly basis. Both organizations say the same three things: Prepare for it, try to prevent it from coming in and manage it when it occurs.
The Nevada Department of Corrections, where I worked, has prepared by working with local and state public health officials. According to their website, they added COVID-19 to their regulation on communicable diseases in February to guide custody and medical staff and update it when new information comes in.
They stopped all visitors coming into the prison March 7 based on CDC’s recommendations. They are also providing eligible inmates two free phone calls a week to decrease the impact of not being able to stay connected with their families.
On March 20 they activated emergency operation centers at each prison to distribute the most current information and instructions up and down the chain of command. They are screening anyone coming in and out of the prison for symptoms or fever and I’m glad to say that hand soap is now available at every facility for free.
Potential for resource-sapping domino effect
These are important practices, but what happens when an inmate is suspected of having the virus or gets sick? Each prison only has a limited number of medical beds. I worked at Northern Nevada Correctional Center, which is the only facility that has a regional medical facility. It has 60 medical beds and 60 psychiatric beds for a state population of about 13,000 inmates. It cannot take care of inmates who need a ventilator or ICU care.
Any inmate who needs that type of care would need to be sent to an outside hospital with two custody officers in attendance. Custody officers tend to be in short supply, and if they get sick or are told not to come into work because they show symptoms, security can quickly become compromised.
Virus won't stop at the fence line
Prison leaders need to get their information and advice from the medical community and work with them. The CDC recommends that every state have a prison health authority that gives an update to them every day. The NCCHC is the best organization for standards in correctional health care and they will be giving updates every week.
Not dealing with COVID-19 in a preventive, uniform, strategic way has caused spread of the virus, deaths and uncertainty in the United States. Given the current crisis, many may ask why we should focus on those imprisoned when hospitals are ill-prepared to deal with so many citizens who are already acutely ill. The reason is that if we do not decrease the spread of the virus and the crowding and conditions in prisons and jails, they will become hotbeds of infection. And the virus will not stop at the fence line. Medical and custody staff, and anyone coming in and out of the prison can become infected and bring it into the community.
Pandemics show us how interconnected we all are and give us opportunities to rethink how we approach complex problems and what we consider important in our lives. We should address this threat in our prisons because it is the humane thing to do. But perhaps this moment will wake us up not just to the dangers of a plague, but also to the plague of mass incarceration.