States are split on how the roughly 1.4 million Americans living behind bars fit into the vaccination plan. As the first vaccines reach healthcare workers, prisons continue to be outbreak hotbeds. According to a report published in early December by the Council on Criminal Justice, the average rate of COVID-19 cases among inmates is 4 times higher than the national average, and twice as deadly. Spread of the virus isn’t slowing down, and some states are seeing a new trend, with inmates testing positive for the virus a second time — health officials in Michigan have now counted 115 cases of reinfection among inmates in the state, where roughly half of all inmates and one-quarter of prison staff have had COVID-19, according to a December 12 article in the Detroit Free Press. “Prisoners are at an elevated risk for COVID-19, both because of the structural factors, such as poor ventilation and close quarters, and also the underlying health conditions that can be more prevalent in prison populations,” says Thomas Abt, director of the National Commission on COVID-19 and Criminal Justice at the Council on Criminal Justice. “With elevated risk comes elevated need and, as the CDC advisory panel has noted, we should make efforts to address the neediest people first.” The National Academies of Sciences, Engineering, and Medicine recommends that people who work or live in correctional facilities be included in phase 2, along with teachers and people living in homeless shelters. But that stands as a recommendation, not law. At the time of publication, a report published by The Prison Policy Initiative recorded that seven states — Connecticut, Delaware, Massachusetts, Maryland, Nebraska, New Mexico, and Pennsylvania — are including inmates in the first phase of vaccine distribution, which includes other high-risk Americans such as healthcare workers and elderly people living in long-term care facilities. Another three states are expected to include inmates in either phase 1 or phase 2. Nineteen states have confirmed that inmates will be covered in phase 2, and an additional four are expected to follow suit. Eleven states, including Texas, which has the largest prison population in the country, and Florida which has the third largest, according to the U.S. Department of Justice — have not specified inmates in any phase. RELATED: 10 Diabetes Care Tips During The Coronavirus Pandemic
Prisons Provide Limited Protection Against Illness
Regardless of where inmates stand in line for a vaccine, the Centers for Disease Control and Prevention (CDC) has outlined protocols that detention centers should be following to curb the spread of the coronavirus. The guidelines include contact tracing and quarantining. However, enforcing these guidelines across all jails and prisons has proven difficult. “We know there are three ways to prevent transmission — wearing a mask, washing your hands, and keeping at least six feet of distance. But people who are in prisons can’t always adopt these strategies. We need to get the vaccine to the people who are least able to protect themselves from transmission,” says Holly Taylor, MPH, PhD, a research bioethicist at the National Institutes of Health (NIH). Before the pandemic hit the United States, alcohol-based hand sanitizer was banned in prisons, says Homer Venters, MD, former chief medical officer of the New York City Jail System and author of Life and Death in Rikers Island, who has been auditing prisons across the country since March. Most of the facilities he has visited have made an effort to make hand sanitizer available, “But it may not be refilled or may be in places that are hard for everyone to access,” he says. Lack of soap and paper towels also contributes to the spread of COVID-19 in correctional facilities, says Dr. Venters. “I still encounter places that are charging inmates for soap and quite a few that don’t have paper towels, so even if people get soap, they may be given one general towel to dry off after showers, for cleaning up their cell, and after they wash their hands,” he says. According to Venters, a bar of soap typically costs $1.40 through a prison commissary, the only place inmates can purchase goods. But people in prison only make about 30 to 40 cents an hour if they work, meaning it takes many hours of work just to buy a bar of soap, says Venters. “A lot of places will say that they give out soap freely, but what I often find is that the facility may give out a bottle of some nondescript soapy solution. I also often find that in places where everybody shares just a small number of showers, there may be a bucket of soap chips that’s always wet and that everyone shares. That’s an example of how a facility may say that everyone has access to soap, but when you are learning about this by speaking directly with inmates, the situation is much different,” says Venters, who notes that most inmates have been provided masks, an important safety measure, but that they aren’t always replaced with clean ones. Venters has observed similar holes in the way some prisons are adhering to CDC guidelines related to how to minimize spread after a known case. “When someone is diagnosed with COVID-19, the CDC says we should take care to disinfect the places that the person was. This is commonplace in nursing homes and even work places, but when someone behind bars has COVID-19, the people who clean the space and collect their belongings are often other inmates who don’t have special training or proper PPE, so they can get infected,” says Venters. Although most centers have suspended charges for healthcare visits related to COVID-19, inmates may still be charged for being seen for potential symptoms if they end up testing negative for the virus. In many places, it costs $5 to $10 every time you submit a request to be seen for a medical issue, says Venters. “And people who submit a request complaining of something such as a headache or bodyache, which could be a symptom of COVID-19, may end up with a charge if the health staff decide that that wasn’t related to COVID. It’s a barrier at a time when we want everyone to report every symptom they have,” says Venters. RELATED: How Obesity May Increase the Risk for COVID-19 Complications
A Moral and Scientific Issue
Dr. Taylor says that getting vaccines to prisoners is both an ethics issue and a matter of national public health. “People who are incarcerated are at a higher risk for comorbidities that put them at a higher risk of developing severe disease if they are infected,” she says. A November 2020 report by the University of Texas found that nearly 90 percent of Texas inmates killed by COVID-19 were eligible for parole. Nine had already been approved, but had not yet been released. “All humans have moral worth. If the whole town was on fire we wouldn’t just say, ‘Let the prison burn down with everyone in it,’” says Taylor. From an epidemiological perspective, which is driven by minimizing harm, incarcerated populations ought to be high on the list since they are high-risk, says Taylor. From an ethical perspective, she says she would opt to include people who are incarcerated in vaccination plans because to not do so would further disadvantage them. As the virus mutates, it’s becoming increasingly critical to control outbreaks that may be able to spread from areas of low vaccine uptake such as correctional facilities to communities on the outside. “We’ve learned the hard way that COVID-19 connects us all, and that even physical walls cannot stop the spread of the virus outside an institution. Wherever COVID-19 concentrates, it needs to be addressed, even if that is in jails and prisons,” says Abt.
