PROVIDENCE, R.I. [Brown University] — In the midst of the COVID-19 outbreak, public health officials are stressing the importance of social distancing to prevent the spread of the virus. But for millions of people in America’s jails and prisons, social distancing is not an option. And medical experts are sounding the alarm of an additional public health disaster waiting to happen. 

Dr. Josiah Rich, a professor of medicine and epidemiology at Brown University, is co-author of an essay published on April 2 in the New England Journal of Medicine urging immediate action to mitigate mass outbreaks of COVID-19 behind bars. Among the authors’ recommendations is the immediate release of prisoners who are unlikely to commit further crimes, as well as those who are elderly or ill. Doing so will free up precious space to enable facilities to better manage the remaining population in the event of an outbreak. 

Taking no action, Rich says, will not only endanger thousands of lives among incarcerated populations, but poses a dire threat to everyone by further overtaxing health care systems. Last Friday, the Rhode Island Supreme Court cleared the way for 52 prisoners in the Ocean State, but Rich says that further action nationwide is required.

“When these people get sick, they’re going to get sick all at once,” said Rich, who is a practicing infectious diseases specialist at the Miriam Hospital in Providence. “That means there’s likely to be a large spike in people coming from corrections to the surrounding health care facilities. We can ill afford to have local health care systems overrun by a wave of people coming from the correctional setting. The consequences of that are dire.”

Rich, who is the director of the Center for Prisoner Health and Human Rights, discussed the situation and proposals to address it in an interview. 

Q: First, can you provide a sense of the scope of the problem?

We have 2.3 million people incarcerated in this country. That’s 2.3 million people in a congregate setting, and that’s a huge problem. All of the maneuvering that we’ve been doing to slow the spread of this virus — the social distancing — is very challenging to do in congregate settings. We’re going to see rapid spread in those populations, much like we saw in China and like what’s happening now at Rikers Island. 

And incarcerated populations are particularly vulnerable to severe infection. Older people are at particular risk from COVID-19 and our prison population is aging due to things like mandatory minimum sentencing and three-strikes laws that were enacted decades ago. There’s also a high prevalence of underlying medical conditions that could complicate infections. About half of the people in jails and prisons have at least one chronic medical condition. That’s a problem for the people in those institutions when this gets in there and spreads. 

Q: You make the point that the risks here don’t stay inside prison walls. Can you explain that?

For one thing, we have to think about the staff who work at these facilities. They’re obviously at risk as well, and they could in turn put their families at risk. But the problem goes far beyond that. The big worry is about the surrounding health care facilities.

Having been taking care of patients sick with this disease for over two weeks now, I can tell you that there are almost no correctional facilities that are going to be able to keep people alive who are very sick with this disease. They will be transferred out to surrounding health care facilities. If the incarcerated population got infected at the same rate as everybody else, they’d just be another part of the burden on the health care system. But the reality is that, because of the congregate setting,  incarcerated populations are likely to get infected all at once. And they’ll be flooding into the health care system.