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Original Commentary

Approaches to Reducing Risk of COVID-19 Infections in Prisons and Immigration Detention Centers: A Commentary

Kate Kelly1 , Nai Soto1, Nadi Damond Wisseh1, and Shaina A. Clerget1

Abstract Although often left out of public health efforts and policy decisions, prisons, jails, and detention centers are integral to community health. With an average of 650,000 citizens returning home from prison each year in the United States, and thousands of correctional staff members returning home every night, there are millions of touchpoints between outside communities and carceral settings. For this reason, carceral communities should be central to planning and policy making in response to the spread of the COVID-19 illness. As social workers and clinicians, we are urgently concerned that efforts to prevent COVID-19 infections in prisons are underdeveloped and inadequate in the face of a fast-spreading virus. In this commentary, we outline a set of public health, policy, and clinical recommendations based upon the existing literature to mitigate various risks to the well-being of carceral communities.

Keywords prison, detention, immigration, public health, coronavirus

In the United States, there are 2.3 million people held in prisons, jails, juvenile facilities, and

immigration detention centers, overseen by a myriad of jurisdictions and agencies (Sawyer &

Wagner, 2020). The outbreak of coronavirus illness (COVID-19) has made these Americans

uniquely vulnerable, largely due to physical and bureaucratic conditions of U.S. carceral systems.

One of the foremost recommendations by the Center for Disease Control (CDC) to stop and slow the

spread of COVID-19 is to practice social distancing and maintain a prescribed distance. However,

incarcerated residents in many U.S. correctional settings face overcrowded living conditions that

1 School of Social Work, College of Public Health, Temple University, Philadelphia, PA, USA

Corresponding Author:

Kate Kelly, School of Social Work, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA

19122, USA.

Email: [email protected]

Criminal Justice Review 1-8 ª 2020 Georgia State University

Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0734016820957707 journals.sagepub.com/home/cjr

prevent the possibility of physical distancing. A spatial examination of cruise ships and nursing

homes (settings that have been observed to promote rapid viral spread) found that prison cells are

comparable sizes or smaller, often shared, and do not accommodate the 6 ft. of personal space

recommended by the CDC and World Health Organization (Kajstura & Landon, 2020). Although

the current overall occupancy rate of U.S. prisons is just over 103% occupancy, overcrowding varies widely by facility and state, with some prisons reporting occupancy rates up to 319% (U.S. Depart- ment of Justice, 2019). Unable to safely separate from each other, prisoners are more likely to be

denied access to personal protective equipment (PPE) and disinfectant—despite national reports of

prison labor being used to produce these items (Alexander, 2020; Michaels, 2020).

Emerging data show that COVID-19 disproportionately affects those who are over 65 years old,

are immunosuppressed, or suffer from common chronic illnesses (Mueller et al., 2020). This puts

occupants of carceral settings at increased risk on multiple levels. Due in part to past legal precedent

mandating longer sentences for narcotics offenses, U.S. prisoners are increasingly aging; people

over 50 now make up 16% of the state and federal prison populations, and the demographic is expected to continue growing (Skarupski et al., 2018). Furthermore, incarcerated people experience

an increased comorbidity burden; more than half of U.S. federal prisoners report suffering from

underlying conditions such as cancer, hypertension, diabetes, HIV, asthma, and/or heart disease,

conditions which may increase the risk of severe illness or death if COVID-19 infection occurs

(Maruschak et al., 2015; Skarupski et al., 2018).

While immigration detention facilities face the same risk factors as prisons, unique conditions

and challenges further threaten the health of 43,000 people in Immigration & Customs Enforcement

(ICE) custody nationally. In some regions, individuals arrested by ICE are held in local jails and

prisons, while other regions utilize designated, immigration-specific detention centers. These facil-

ities frequently lack medical infrastructure necessary for treating severe COVID-19 cases, and a

third of detainees are held in communities with one or zero hospitals that have intensive care units.

This suggests that outbreaks at detention facilities located in rural areas could contribute to wider

local infection that might overwhelm a small community’s medical services (Cooke, 2020). Further-

more, in a rapidly evolving pandemic, translation services in detention can quickly become inter-

rupted. This diminishes detainees’ access to information about their own health and personal risk,

effectively turning a language barrier into a comorbidity factor.

COVID-19 Infections in Prisons and Immigration Detention Centers: A Call for Evidence-Based Recommendations

The issue of how to protect prisoners during a pandemic is an international quandary and has

resulted in a patchwork of policies varying by country, state, and municipality. Italy halted personal

prison visitation with hopes of preventing illness, an act that resulted in riots and escapes across the

country (Mahbubani, 2020). Faced with the pressure of mounting COVID-19 infections, Iran moved

to release 85,000 prisoners nationally, prompting expressions of concern from United Nations

officials (Nebehay, 2020). Absent federal recommendations, guidance, and resources to protect

incarcerated individuals, state and municipal justice systems adapted independently and were unable

to prevent infections from occurring in their facilities. New York City’s infamous Rikers Island jail,

long a symbol of the hazards of mass incarceration, saw rapid viral spread nearly 6 times the rate of

the larger city, as well as multiple early deaths among inmates and correctional officers (New York

City Legal Aid Society, 2020). As of August 4, 2020, of the largest reported clusters in the country,

with more than 1,000 confirmed COVID-19 cases in each setting, 13 of the 15 were correctional

facilities. Despite evident similarities in the risk factors for carceral settings, recommending and

implementing protective measures for prisoners is made enormously complex by differences across

local, state, and federal jurisdictions, as well as disparate conditions in facilities that are privately or

2 Criminal Justice Review XX(X)

publicly managed. Without further prioritization and intervention, carceral settings across the United

States may continue to see elevated transmission and morbidity rates.

There are multiple levels at which swift, decisive, and collaborative actions could reduce the risk

of infection for incarcerated individuals and immigrant detainees. At the macro level, the federal

government should protect public health by including carceral settings in comprehensive pandemic

response policy, offering guidance to states, designating funding to criminal justice agencies, and

prioritizing imprisoned peoples’ access to testing, vaccines, and treatment. At the mezzo level,

municipalities and state-level agencies should enact protective policy measures, including delayed

and reduced arrests, expanding eligibility guidelines for release, permanently decreasing incarcer-

ated populations, and safely and ethically utilizing electronic monitoring and remote supervision.

At the micro level, clinicians and advocates should assist in the equitable implementation of these

policies, coordinate translation services for speakers of languages other than English, and help

facilitate ethical releases through involvement in reentry planning.

Macro-Level Public Health Efforts Grounded in Collaborative Approaches

The justice system is reliant on legal precedent and has struggled to adapt to unprecedented cir-

cumstances created by the COVID-19 pandemic. Lacking experience with placing criminal justice

actions in a public health framework, municipalities have had to quickly revise and implement new

policies without past reference. This has resulted in delayed, intermittent efforts that have exacer-

bated underlying risks for incarcerated residents and correctional staff members. Facing the like-

lihood of future widespread outbreaks of COVID-19 infection, courts and prisons must establish this

protective precedent now to be implemented without hesitation in the future. Prosecutors, public

defenders, community members, social workers, judges, court staff, police, and prison commis-

sioners must coordinate and collaborate in their efforts to respond to emergent pandemics. Further-

more, successful legal adjustments should be shared nationally to assist other jurisdictions in

navigating an outbreak.

Accepting that carceral settings are integral to larger public health efforts, federal and state

governing entities must prioritize their access to PPE, as well as disease detection and treatment.

Already, the spread of COVID-19 has revealed an inequality in PPE and testing availability, raising

questions about who would have access to any future vaccines that may be developed (Twohey et al.,

2020). Comprehensive aid packages related to COVID-19 must include designated funding to

criminal justice settings, ensuring adequate supplies of PPE, tests, and treatment, in order to mitigate

access inequalities and protect inmates and staff. Federal- and state-level guidance should be given

on how carceral settings can coordinate with local medical services and participate in larger public

health education efforts.

Finally, federal officials and policy actors should acknowledge that current conditions in correc-

tional settings represent a significant barrier to health promotion and disease prevention, not only in

the current context of COVID-19 but also in the case of any future novel virus or pandemic illness.

Falling crime rates across the United States during the pandemic, including in cities that made

significant prisoner releases at the onset of the U.S. COVID-19 outbreak, suggest that physical

incarceration of justice-involved individuals may not be integral to public safety during a pandemic

(Coyne, 2020). Moving forward, continual efforts should be made at every level to explore alter-

native policies that keep carceral populations as low as possible, given the heightened risk to human

health in these settings. Specifically, we would recommend forming collaborative task forces at

local, state, and federal levels. These task forces should include representation from community

members, correctional officials, public defenders, police officers, health officials, and judges to

explore alternatives to incarceration and orient system practices toward public health.

Kelly et al. 3

Mezzo-Level Policy Actions to Reduce Health Risk

Most incarcerated people in the United States are being held in state and municipal facilities,

representing an important level at which to intervene and enact collaborative, protective practices.

In line with the decarceration priority recommended above, in order to diminish local prison

populations, law enforcement agencies must agree to reduce inputs (arrests) and judges and attor-

neys must agree to increase outputs (releases) simultaneously. In cities like Philadelphia, agencies

seemed to gravitate toward this common goal and managed a small reduction to the jail population,

but the practices lacked explicit commitment. All criminal justice stakeholders, from the police to

prison commissioners to public defenders to the host communities, should be united and coordinated

in the common goal of creating safe conditions for incarcerated people.

There are numerous status quo carceral practices that must change in the new context of

COVID-19, from routine transfers and deportations to standard probationary procedure. Once a

viral outbreak is underway and local community spread has been identified, adding and transferring

new individuals to carceral settings introduces significantly higher health risks to inmates and staff.

During the flu pandemic of 1918, San Quentin State Prison experienced three separate waves of

infection, all thought to be introduced by new arrivals to the prison (Stanley, 1919). This speaks to

the need to halt routine transfers within detention systems as well as to delay and diminish the

number of new people being placed in custody. Furthermore, correctional staffing practices repre-

sent a significant risk of COVID-19 to be introduced to a facility or transmitted from within a prison

to their families and communities. Reducing the occurrence of procedures that require increased

staff-resident contact (such as transfers and intake) and providing adequate safety training and PPE

to correctional officers are essential practices.

Although some U.S. municipalities acted quickly to reduce inputs to their local prison systems

by delaying arrests for certain nonviolent crimes, ICE has proceeded with immigration raids,

detentions, and controversial deportations. In one instance, ICE deported COVID-exposed indi-

viduals to Haiti, a country ill-equipped to manage an outbreak of coronavirus illnesses (Del Valle

& Herrera, 2020). Immigration violations are classified as civil, noncriminal offenses, and undo-

cumented immigrants represent a low risk to public safety, suggesting these detentions are non-

essential in the context of a pandemic (Orrenius & Zavodny, 2019). To mitigate risk to people in

their detention facilities, ICE should halt deportations and release detainees so that they can safely

practice physical distancing in alternative housing while awaiting resolution of their immigration

cases.

Probation and parole services is another avenue to implement new practices that further reduce

interpersonal interaction and prevent COVID-19 transmission. The remote supervision model,

including phone check-ins and electronic monitoring, represents an interesting opportunity to pro-

tect public health. This prevents thousands of instances of individuals from leaving their homes or

residential programs, utilizing public transportation, and entering buildings with probation employ-

ees, activities that can increase the spread of COVID-19. As U.S. medical services migrate their

practice to telemedicine (digital, remote appointments in order to evaluate patients without risk of

COVID-19 exposure), probationary and parole agencies are considering a similar shift. However,

overreliance on electronic monitoring could result in a replication of harmful carceral conditions

outside of prison, expanding opportunities for punitive control into homes and neighborhoods

(Schenwar & Law, 2020). While a shift to remote probation would be beneficial to preventing the

spread of COVID-19, it must be undertaken carefully to mitigate unethical effects. Noncorrectional

social workers and case managers who work with people in reentry must also be aware of ethical

implications of remote service as well as disparities in technology access.

4 Criminal Justice Review XX(X)

Micro-Level Clinical Advocacy Based in Trauma-Informed Practice

Within larger criminal justice systems, social workers, clinicians, attorneys, and other advocates

have a valuable role to play in protecting the health of carceral communities through targeted,

trauma-informed interventions that promote health. “Trauma-informed” clinical practice entails

providing care under the assumption that individuals may have a history of trauma and with the

goal of preventing retraumatization (Knight, 2015). A widespread global pandemic has potential

negative mental health implications for all members of society, but incarcerated individuals may be

acutely affected, given that rates of personal trauma history among incarcerated people are high

(Jäggi et al., 2016; Wolff & Shi, 2012). As discussed by Hewson et al. (2020), prisoners may

currently face increased anxiety and uncertainty due to a lack of visitation, limited access to reliable

information, and indefinitely extended court dates. It follows that incarcerated people may need

increased clinical support and access to mental health treatment as a result of COVID-19 outbreaks

in their facilities and communities.

To help mitigate health risks and anxieties, carceral clinicians should play a forefront role in

distributing PPE to incarcerated people and should lead efforts to provide education about the virus

and prevention measures. Prison social workers and medical staff also have a professional impera-

tive to advocate for adequate treatment of COVID-19 illness in prisoners to protect the lives of

infected individuals as well as the wider community. To overcome language barrier risks to the

health of people in immigration detention centers, clinicians in these settings should ensure that

information is provided in individuals’ native languages to ensure comprehension and adherence to

prevention efforts. One model that has already emerged in this area is the Crisis Translators Network

(n.d.), an association of volunteer translators who have responded to the pandemic by coordinating

trauma-informed language services in hospitals, detention centers, and community settings.

Clinical intervention would benefit not only the health of incarcerated individuals but also the

health of those in reentry. Prior to the emergence of COVID-19, individuals released from prison

faced heightened barriers in obtaining housing, employment, medical care, and mental health

treatment, challenges which may be further exacerbated by pandemic conditions (Semenza & Link,

2019). Individuals released from Rikers Island in the midst of New York’s rapidly rising COVID-19

infections reported receiving no instructions or information related to disease prevention upon their

release (Al-Hlou et al., 2020). The protective benefits of releasing people from incarceration are

nullified if individuals lack housing, food, or essential health information. To ensure releases are

ethical and beneficial to public health, social workers and advocates should be closely involved in

reentry planning.

Conclusions

It is clear that carceral communities can no longer be excluded from comprehensive planning to

prevent COVID-19 outbreaks. Structural limitations, comorbidity factors, and resource disparities

create heightened risk within correctional facilities and the wider communities with which they

interact. Furthermore, protecting incarcerated individuals during a pandemic is not only a matter of

public health, it is a matter of civil rights and racial justice. Mass incarceration has long been

acknowledged to have a disproportionate effect on communities of color, and emergent data suggest

that across the United States, Black, Latinx, and Native individuals are being infected with

COVID-19 and dying from the disease at higher rates than White people. To mitigate these injustices

and protect wider public health, justice officials should work to permanently reduce carceral popu-

lations, provide protective resources, and enact the clinical recommendations outlined above.

Kelly et al. 5

Acknowledgments

First, we would like to acknowledge and thank the essential workers at the forefront of the pandemic,

including health workers, farmworkers, grocery workers, social workers, public defenders, and

community organizers. We also acknowledge and thank Omar Martinez, JD-MPH, as well as Josh

Lachewitz and our peers in the Social Welfare Policies & Services II Spring 2020 course at Temple

University, for providing feedback on earlier versions of this commentary. We acknowledge our co-

author Nai Soto for leading the research on immigration detention centers, and for creating visua-

lizations of our recommendations for dissemination.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/

or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this

article.

ORCID iD

Kate Kelly https://orcid.org/0000-0002-5155-0518

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Author Biographies

Kate Kelly is a second-year master of social work student at Temple University. She received a bachelor’s

degree in strategic communication and political science from Temple University. Her current field placement is

with the Defender Association of Philadelphia’s Adult Social Services Unit. She is interested in the biopsy-

chosocial effects of mass incarceration on individuals and communities, as well as the related policy

implications.

Nai Soto is a second-year master of social work student at Temple University. She received a bachelor’s degree

in early childhood education from Temple University. Her current field placement is with Temple’s Tuttleman

Counseling Services, where she facilitates trauma-informed yoga and meditation groups. She is interested in

utilizing mindfulness-based interventions to heal physical manifestations of trauma in the body.

Kelly et al. 7

Nadi Damond Wisseh is a second-year master of social work student at Temple University. She received a

bachelor of arts in psychology from Temple University. Her current field placement is at the Juvenile Law

Center, where she works with justice-involved youth advocates. She is interested in disparities within the

criminal justice system and their effects on minority communities.

Shaina A. Clerget is a second-year master of social work student at Temple University. She received a

Bachelor of Arts in English and International Studies from Indiana University. Her current field placement

is with the Defender Association of Philadelphia’s Adult Social Service Unit. She is interested in the decri-

minalization of sex work, ending mass incarceration, and liberatory social work practice.

8 Criminal Justice Review XX(X)