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COVID-19 in Jails: Urgent Medical Response Needed

Mar 18th, 2020 | Category: Lead Article
COVID-19 Will Wreak Havoc in Texas Jails: Here Are Some Measures That Might Help

Jails are hot spots for Covid-19 virus

As the virus started to spread through the Harris County Jail, over 400 persons including guards were forced into quarantine. Though most people would experience only mild symptoms, some individuals were at risk for complications. This isn’t a theoretical scenario about the recent pandemic, but a Mumps outbreak that occurred in the jail during the summer of 2019. Mumps, caused by a virus, spread rapidly as jails are high risk locations for outbreaks of infections. County jails, with many people cycling in and back out to the community, become especially dangerous. Outbreaks of influenza and staphylococcal infections are common, but COVID-19, however, presents unprecedented risk for all of us.

There are 241 county jails spread across 254 Texas counties. In 2019, there were 110 reported custody deaths. Of the 487 total deaths reported since 2015, Harris, Bexar, Dallas and Travis counties lead with 61, 39, 27 and 23.*

Texas Jail Project (TJP) which works directly with families of incarcerated loved ones in county jails, reports that more than 80% of all the people who contact them are seeking help because their loved ones in jail are receiving inadequate medical care–or no medical care at all. Given the poor conditions and quality of medical care which have contributed to these fatalities in normal times, counties and judges must urgently take every possible measure to reduce the population in county jails, which totals nearly 68,000 on any given night. If they do not, they will be greatly increasing the risk of COVID-19 spreading inside the jail and outside into our community.

There are multiple factors behind the increased risk of infection in jails. Not a single CDC recommendation – social distancing, frequent handwashing, preventive quarantining – can be implemented in Texas county jails.

First, restriction on movement makes social distancing impossible. If the cell or block contains someone with an illness, a person cannot take measures to avoid the infected individual. While the CDC is recommending cancellation of events with more than 10 people, jails currently operate many times that number. Quarantining or isolating an individual after display of symptoms may already be too late given that it takes two weeks for the symptoms to develop. By that time, almost everyone in a pod or cell would have been infected

Second, sanitation practices are inadequate. Hand sanitizer and soap are often unavailable. Shortage of toilet paper is common. Toilets have no lids on them, and the aerosolized particles from flushing can spread various illnesses, such as the SARS-CoV-2 virus. Showers and cleanliness often are seen as nonessential, with no minimum enforceable standards for frequency of showers. Should an incarcerated person begin to show signs of illness, unless it’s an emergency, it can be days before that person is seen by medical staff.

Just yesterday our medical team discharged a young patient with a chronic, immunosuppressive illness from the hospital sent back to county jail. In another pretrial case received by TJP, a 37-year-old man suffering from rectal bleeding and diarrhea reports lack of medication and care in a small county jail. There’s no doubt in our minds that if either of them were to develop COVID-19, they would have significant complications, and it would almost certainly become life threatening. We can sanitize our hands as often as possible, avoid contact with others, and take our health into our own hands. They do not have that agency.

As infected patients can shed the virus before symptoms are pronounced, simply quarantining individuals when they become overtly symptomatic does not prevent the spread of the virus throughout the facility. The safest way to prevent COVID-19 from running rampant within jails and then spreading into the community, is to reduce the number of people inside the jail. The following recommendations designed in consultation with jail advocates such as TJP, would decrease the already taxed jail system and help mitigate, or even prevent, the spread of the pandemic within jails:

  1. Immediately release anyone charged with an offense that does not involve a serious physical safety risk to the community: More than 70% of those currently held in county jails are pretrial. In 2016, 40% of people arrested couldn’t make bail of even a few hundred dollars.
  1. Prioritize immediate release on personal bonds of populations that CDC has classified as vulnerable (pregnant women and patients with asthma, cancer, heart disease, lung disease, diabetes): Judges should issue personal bonds for medically fragile people, based upon recommendations by jail medical staff, lawyers, and pretrial services.
  1. Stop jail churn by ending the practice of jailing those who do not pose a serious safety risk: Sheriffs in Collin and Hays counties have already instructed police to cite and release non-violent offenders. This model should be followed throughout the state.
  1. Release all persons who are within 6 months of completing their sentence in a county jail.
  1. Waive infirmary fees and medical co-pays: To see a physician, patients in jails are typically charged a fee. This often disincentivizes ill patients from seeking necessary care or screening.
  1. Provide free and unlimited phone calls/video conferences/access to email: To counteract the psychological effects of further isolation from one’s family and the legal effects of not meeting with counsel, calls must be free, and people in jail should be provided with access to video conferencing and email wherever possible.
  1. Restrict isolation and solitary confinement: Correctional health experts such as Dr. Homer Venters, ex-medical director of Rikers Island, caution against overusing solitary confinement and preventive quarantines which are ineffective methods of stopping the spread of the virus in a correctional facility. These measures will put isolated individuals at risk of worsening illness due to less monitoring. These patients need as few barriers as possible between them and health care workers.

Speaking as a physician, we need bold, urgent measures to reduce the risk of jails becoming vectors for the spread of COVID-19. These may be difficult to do within our current jail infrastructure, but are necessary to protect our patients and communities.

Marc Robinson, MD

Co-President, Doctors for Change

Internal Medicine Physician

Krish Gundu

Co-founder, Texas Jail Project

*Texas Commission on Jail Standards data

Houston Area Physicians Petition Harris County Officials to prevent spread of COVID-19 in jail

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[…] a potential outbreak in a confined and often unsanitary place like the jail could be deadly, health professionals have […]

Mary E Perez

Why don’t the inmates have no hand sanitizer with everything that’s going on all over with this COVID-19

krystin relkin

My loved one is currently held at Pam Lychner State Jail in Humble Texas. It is the facility that has had one confirmed case of Covid-19 and currently has 20 others showing symptoms. My loved one has diabetes and high blood pressure as well as sleep apnea. He is up for parole in June and is a non-violent first-time offender. He is a very high risk if he contracts Covid 19. Is there anything we can do to get him released? House arrest? Anything at all? Please Help!

Monica A Davis

Who can I turn to for help my fiance is in the risk category, he has bad asthma.