To contain coronavirus, release people in prison

During hurricane Katrina incarcerated people were left for dead in Louisiana. Locked in their cells, they watched the water rising around them. Amidst the chaos of the flood, the state and municipal government ignored their cries for help waiting too long to implement an effective response. The water is rising again– but this time, the disaster is a tidal wave of new infections.

The question is not if people in the Connecticut prison system will be infected with COVID-19, the question is when the first case will be detected. The current Covid-19 response plan in place by the Connecticut Department of Corrections (CDOC) is ineffective at best and grossly negligent at worst. In order to best mitigate the harm of an impending outbreak, the Connecticut Department of Corrections (CDOC) and Gov.Ned Lamont must consider immediate measures to decrease rates of incarceration in the state of Connecticut and release those most vulnerable to the devastating effects of Covid-19 in Connecticut prisons.

Even in safer times, prisons are detrimental to public health. Close confinement in prisons coupled with often unsanitary conditions, unnecessary barriers to hygiene products, and limited access to healthcare services increases an individual’s risk of disease acquisition and transmission. A report prepared by the World Health Organization (WHO) identifies a number of factors that complicate effective intervention and make prisons uniquely dangerous hotbeds for disease transmission. Ultimately, the state’s ability to combat this urgent pandemic is dependent on prevention strategies specifically intended to protect its most vulnerable populations. Yet, the current response of the CDOC indicates that, as with Katrina, incarcerated people are being left behind without protection. Connecticut is failing to appropriately prepare for Covid-19, and both free and incarcerated residents will pay the price.

The pandemic response plan put forth by the CDOC is the same plan that it drafted for Influenza A in 2007. CDOC Spokeswoman Karen Martucci recently doubled down on the use of the outdated methods, explaining that “[COVID-19] isn’t new for us. We quarantine for the flu every year.” However, preventing Covid-19 requires different approaches than Influenza A. The disease characteristics differ significantly from one another: recent studies indicate that the new virus is significantly more infectious, can be transmitted by asymptomatic cases, and may even be airborne —meaning tiny droplets in the air or on surfaces could spread disease in the absence of an infectious individual. Additionally, each year many people are vaccinated for seasonal influenza, which reduces the force of infection in the community; with COVID-19, there is no vaccine and no natural immunity to this new pathogen. This means that the potential for spread is far greater than for seasonal flu, where partial herd immunity is in place each year.

There are some prevention methods for Influenza A addressed in the CDOC plan that may help to prevent the transmission of Covid-19 — e.g., provision of personal protective equipment (PPE), hand-washing and sanitizing requirements for prison staff, and improved disease education. However, these methods must be vastly expanded to face the new challenges posed by Covid-19. For instance, surgical masks, which are suggested in the CDOC response plan and protect against Influenza A, do not prevent transmission of airborne Covid-19 droplets.

The supplemental release of an operational response plan by the CDOC specific to Covid-19 does not meaningfully change the fact that their prevention strategy neglects key features of this novel coronavirus. The plan is focused predominantly on two interventions: (1) restricting outside access to prison facilities, and (2) minimizing contact among incarcerated individuals. Yet neither measure will, on its own, prevent transmission. For example, the CDOC states that all delivery personnel coming into contact with the facility will be screened via question-based monitoring (i.e., have you developed symptoms of disease in the last X number of days?). However, such a surveillance mechanism is unlikely to be effective for Covid-19, given that asymptomatic individuals are also infectious. Meanwhile, minimal efforts at social distancing within the facility without appropriate provision of environmental protective measures — such as increased access to sanitizer, soap and adequate ventilation — are unlikely to be sufficient to prevent an outbreak and subsequent disease transmission.

To develop a higher standard of control and care for Covid-19, the CDOC should not use Influenza A to model their response. Tuberculosis (TB) is a far more appropriate model for this outbreak. Unlike Influenza, TB is airborne and nearly as infectious as Covid-19. Additionally, the overall prevalence of TB among incarcerated individuals and staff at correctional facilities is exponentially greater than its prevalence in the population at large. Given the high rate of TB infection among incarcerated individuals, it is a well-studied infectious disease within the prison system.

Perhaps the most important of the preventative measures recommended by the WHO on control of TB in prisons deals with overcrowding. To whatever extent possible, the density of incarcerated individuals must be kept at a minimum. This intervention is not unique to prisons: in the past few days, Connecticut governor Ned Lamont has strongly urged residents to avoid large gatherings and follow CDC guidelines that encourage social distancing, a preventative public health intervention that has been embraced by municipalities, school systems, civil society organizations, and businesses throughout the state.

To be abundantly clear, social distancing within the state prison system should not be equated to solitary confinement or facility-wide lockdowns. Aside from infringing upon the rights of incarcerated individuals, there is limited-to-no epidemiologically sound research to suggest that these measures are effective in curbing the spread of infectious disease within prisons. Moreover, facility-wide lockdowns would simply substitute one public health crisis, Covid-19, with another, the prolonged use of solitary confinement. Instead, in order to address this looming crisis, CDOC should implement Covid-19 targeted response measures and the governor must immediately consider opportunities to dramatically reduce the state’s prison population.

Gov. Ned Lamont enacted both civil preparedness and public health emergencies, a decision that, in part, vests the governor’s office with the responsibility to “take appropriate measures for protecting the health and safety of inmates of state institutions.”(Conn. Gen. Stat. § 28-9-5). We now urge him to fulfill that responsibility by reducing the state’s prison population. Through broad powers delegated to the governor during a civil preparedness or public health emergency, which gives the governor discretion to appropriately revise Connecticut general statutes in order to protect public safety, Gov. Lamont is both empowered and obligated to release prisoners and halt prison population growth.

Through executive discretion already triggered through the declaration of a public emergency or through his power to grant temporary reprieves, the governor should focus on diverting any and all individuals from contact with the justice system. These diversionary measures could include directing the Division of Criminal Justice to divert as many cases as possible that would result in new admissions to the CDOC as well as suspending all non-essential parole meetings and conducting any necessary parole check-ins via phone. The governor could also use his emergency powers to release all medically fragile individuals from prison, all elderly people 60 years or older, all people who are nearing the end of their sentence or are eligible for parole, all people incarcerated for technical violations of parole, and all people in pre-trial detention. Due to the increased volume of returning citizens, the Commissioner of Correction should request all necessary resources from the Governor’s office to temporarily manage reentry services.

For those who remain on the inside, the CDOC should implement environmental controls and respiratory protections on par with the strongest recommendations made by the CDC to prevent the spread of TB. The CDOC should ensure that all facilities are adequately ventilated and should install HEPA air filters where possible; all incarcerated people, symptomatic or not, must be guaranteed free hygiene supplies and receive appropriate and timely access to health services.

If the goal of a criminal justice system is to ensure public safety, the Connecticut state government should address a public health crisis among all populations. As we are coming to terms with the devastating impacts of mass incarceration, we should take note that locking someone up and throwing away the key is not an effective public safety intervention. Likewise, diseases are not contained by prison walls; they are fueled by them. As we’ve seen with TB, an outbreak in a prison risks becoming an outbreak in the surrounding community. When the flood of Covid-19 comes for Connecticut, we want to know that we did everything in our power to protect our most vulnerable communities, and by extension ourselves. Do not let Covid-19 become Katrina in Connecticut.

Noora Reffat is a second year Master of Public Health student in the Epidemiology of Microbial Disease department at the Yale School of Public Health. Joseph Gaylin is a Criminal Justice Fellow at Dwight Hall, Yale’s Center for Social Justice and Public Service. Arvind Venkataraman is a Research Associate in the Immunobiology Department at the Yale School of Medicine, where he works on HSV-1 Vaccine Development.