This column was originally posted on Jeff Keller’s blog, Jail Medicine.
“We’ve got another one,” My nurse told me on the phone. “He says he was exposed to COVID.”
Ever since COVID-19 came to my town, many people being arrested have begun to say that they have COVID or have been exposed; the thought being that “If I have COVID, they can’t put me in jail.” Of course, it doesn’t work that way. They go to jail anyway.
Once there, they will be booked by a jail deputy wearing personal protective equipment (PPE). After booking (and after the fingerprint machine and everything else that could have been touched is cleaned) they will be put into a special isolation cell for COVID “maybes.” There, our patient will be seen by a jail nurse (also in PPE) who will drill down into the details of possible COVID exposure, symptoms and the need to quarantine and test.
But often, at this point, patients change their story: “I wasn’t exposed and I’m not sick. Can I go to the dorms?” Jail life in the dorms is much easier than jail life in isolation.
Herein lies the problem: A typical jail dorm consists of, say, 40-60 inmates housed together in one big room, where they eat, sleep and hang out together all the time, 24 hours a day. There is no way to accomplish “social distancing.” Jail dorms can be thought of as a big petri dish ideally designed for the spread of COVID-19 once it gets in there. I do not want to introduce COVID-19 into this environment.
Inmate risks
So how big of a risk is our newly booked inmate? He is not sick, has no fever and denies having a cough or shortness of breath. But since some patients with COVID have no symptoms and since other COVID patients can spread the coronavirus for a couple of days before they develop symptoms, I cannot be 100% sure that this inmate does not have COVID.
Unfortunately, I can’t test everyone who comes to the jail (at this time) even though I would like to and I do not have enough isolation cells in some jails to quarantine those who have no symptoms. I simply must make the best decision I can.
Correctional staff risks
In truth, though, the biggest risk for introducing COVID-19 into one of the teeming jail dorms is not newly booked inmates like this one, but rather jail employees like deputies, nurses and kitchen staff. Every day they come to work from possible community-based COVID exposure is another day they could potentially bring COVID to work with them. We screen each jail employee every day when they come to work but, again, screening is not perfect. We keep our fingers crossed.
There are many dorms and other housing areas inside the average jail, each separated from each other by thick walls and plexiglass. If COVID does get into one dorm, the next challenge for the jail would be to keep it out of all of the other dorms. An inmate who tested positive for COVID-19 would be transferred to a special COVID isolation unit, which is another, now empty dorm, designated for that purpose. All of the other inmates in their old dorm will have been exposed and so must be quarantined, observed and tested as needed. But unless they also test positive for COVID-19, they will stay in the same dorm. Of course, no new inmates can be assigned to that dorm for at least two weeks. Housing will then become tight!
Mental healthcare
Inmate mental health has to be considered also. The jail inmates are rightly concerned about being exposed to COVID-19 in jail. Some ask for the jail medical staff to release them from jail and have to be told that we do not have that power, only a judge can release a jail inmate. And the courts have already released around 30% of the jail’s pre-COVID population. The ones remaining are very unlikely to be released, even if they have substantial health problems. It certainly helps to talk to the inmates about what they can do to protect themselves and be responsive (not dismissive) of their questions and fears.
Dealing with COVID exposures
There is also the problem of how to handle an inmate who has COVID and who then posts bond or is otherwise released from jail. Do we just open the jail door and let this person walk out? I will need the Health Department to help me if and when that happens.
Dealing with staff exposures to COVID-19 carries its own problems. Staff who have been exposed to an inmate or another staff member with COVID-19 are supposed to stay home for 14 days on self-quarantine. But just like the inmates, the jail staff can’t practice social distancing while at work. If, say, a jail deputy is diagnosed with COVID, their entire shift would have been potentially exposed, as well as perhaps medical staff, jail administration and inmates in several pods. The sudden loss of that many employees could cripple jail operations even utilizing our best conceived alternative staffing plans. The best we can do is to have the staff wear PPE while at work and work with the Health Department on emergency staffing.
The specter of COVID-19 getting into my jails is a nightmare that some correctional facilities are already experiencing. Meanwhile, my call phone just rang again. “We’ve got another one,” says my nurse.
As always, what I have written here is my opinion, based on my training, experience and research. I could be wrong! If you think I am wrong, please say why in the comments!
