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Pandemic Protocols for Missouri Jails and Prisons

By: Dr. Fred Rottnek, Chad Flanders, and Finola Prendergast

Everything seems amplified in correctional settings like prisons and jails: health disparities, institutional racism, trauma and toxic stress, food insecurity, and health conditions made worse by lack of access to care. Prisons and jails often lack consistency in health and hygiene practices. In particular, only a minority of jail facilities meet any minimum accreditation requirements—and even these requirements set only a minimum bar for safety. Too often, those who live and work in these settings are out-of-sight, out-of-mind populations.

Addressing Prison Conditions During COVID-19

COVID-19 hit U.S. correctional facilities hard. Early in the pandemic, COVID-19 case rates among people in prison and correctional staff rapidly outpaced rates in the general population. Many of the most significant COVID-19 outbreaks in the U.S. have occurred in correctional facilities. With every shift change, with every admission and discharge from these facilities, human beings become vectors for spreading the virus to the facility and the community. COVID-19 has magnified the public health impact of practices within correctional facilities—not only for the residents and workers in prisons and jails but also for those living in surrounding communities.

A prison cell

In October 2021, the nonprofit Missouri Appleseed released a co-authored report describing the COVID-19 response of Missouri’s prisons and jails. This report included the following: 

A spokesperson for the Missouri Department of Corrections has stated that their prisons are currently already enacting many of the Pandemic Protocol’s suggestions. Still, in most cases, neither we nor the public know what guidelines, if any, local jails are following. If adopted throughout Missouri, the Pandemic Protocol – divided into four parts: Divert, Decarcerate, Protect, and Vaccinate – has the potential to reduce both viral spread within correctional facilities and community spread traceable to correctional facilities.

The Pandemic Protocol

Divert: Dr. Hedwig Lee and Dr. Savannah Larimore’s analysis of COVID-19 case rates in Missouri counties with prisons, compared to rates in counties without prisons, showed higher community case rates in counties with prisons. The correlation between prison presence and higher community case rates suggests that COVID-19 in prisons may threaten people residing and working in prisons and surrounding communities. A similar study, published last June in Health Affairs, found connections between community case rates in Illinois and movement through Illinois’s Cook County Jail, suggesting that jails as well as prisons may be driving community case rates. Because movement through a correctional facility may be a risk factor for increased COVID-19 cases, the Pandemic Protocol suggests halting jail admissions for people accused of non-violent crimes and halting re-imprisonments for technical violations of parole.

Decarcerate: A 2021 study of the Texas prison system published in the Journal of Urban Health found lower rates of COVID-19 cases and deaths in prisons below 85% population capacity. This study suggests that the fewer people forced to live in a congregate correctional setting, the lower the risk of viral spread in that setting. The Pandemic Protocol suggests reducing population censuses in prisons and jails by releasing medically vulnerable individuals on furlough or electronic monitoring and releasing individuals near the end of their prison sentences. Dr. Hedwig Lee and Dr. Savannah Larimore’s analysis showed a correlation between the mere presence of a prison and higher community case rates. The Protocol also suggests closing prisons where possible while keeping each prison’s capacity below 85%.

Protect: For those people who continue to live or work in a correctional facility after implementation of Diversion and Decarceration, the Protocol suggests educating all correctional staff, incarcerated people, and visitors on the facility’s viral containment policies; implementing standardized PPE, hygiene, and social distancing policies; and implementing regular surveillance testing of people who live or work in correctional facilities to catch asymptomatic cases. More unusually, it also suggests giving correctional staff hazard pay for the duration of a given pandemic to prevent dangerous understaffing. It also asks for increased transparency from the state prison system and local jails about viral containment policies and cases, deaths, and vaccinations in correctional facilities, disaggregated by facility, staff or resident, and race. 

Vaccinate: Missouri vaccinated correctional staff in Phase 1B of its vaccine rollout but waited to vaccinate people residing in jails and prisons who were not otherwise eligible due to a medical condition until Phase 3 when the entire adult population became eligible. In future pandemics, when a vaccine becomes available, the Pandemic Protocol suggests vaccinating both correctional staff and residents of correctional facilities as soon as possible due to the increased infection risk inherent in living or working in a correctional facility. It also suggests making vaccination opt-out rather than opt-in for correctional staff and residents and eliminating any co-pays for correctional medical services related to vaccination to increase the convenience and desirability of vaccination.

A Practical Way Forward

The Pandemic Protocol is a practical way forward. It offers ways to protect those who live and work in jails and prisons. It also protects the families and communities throughout the state. Until we have better criminal justice systems, we are obligated to mitigate the negative outcome of the existing systems. Adopting this Pandemic Protocol provides reasonable measures to improve the health and well-being of all of us.

Dr. Fred Rottnek is Professor and Director of Community Medicine at St. Louis University School of  Medicine. Chad Flanders is Professor of Law at St. Louis University School of Law. Finola Prendergast, PhD, is Director of Research at Missouri Appleseed.