Prisons and jails have become hot spots for SARS-CoV-2 transmission. The cause might seem obvious—lots of people living in close quarters—but there’s a lot more to it. According to a physician who has worked with incarcerated patients for the last 20 years, it’s a community issue.

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An Ethics Talk videocast from the AMA Journal of Ethics® (@JournalofEthics) features an interview with Brie Williams, MD, MS, professor of medicine and director of Amend, a program to change correctional culture, at the University of California, San Francisco. In her conversation with the journal’s editor-in-chief, Audiey Kao, MD, PhD, Dr. Williams discusses both why prisons and jails are so vulnerable to a contagious disease like COVID-19 and what can be done to protect people who live and work in and around correctional facilities.

More broadly, the AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 pandemic. Learn more at the AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™ and AMA Journal of Ethics, and consult the AMA’s physician guide to COVID-19.

Prisons and jails might seem like remote and contained operations, but they are not—especially during a public health emergency such as a pandemic. Dr. Williams noted these keys to keep in mind about correctional facilities.

“Prisons and jails are communities with very medically vulnerable people,” Dr. Williams said, noting that prison and jail populations—including prison workers—tend to be “people of older age or with serious or at least chronic medical conditions, and these people are literally eating and working and recreating together … in dorms that hold 20, 40, 100, 200 people.”

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Correctional health care centers were never built to be acute care hospitals. They are designed to stabilize people; if patients can’t be stabilized, they will be sent to outside hospitals.

“Unlike cruise ships in the middle of the ocean,” Dr. Williams said,  “jails and prisons are not actually sealed off from the outside world. … Hundreds of thousands of correctional officers and health care staff enter and exit the facilities every week.”

Changing correctional culture will take time, but there are steps that policymakers can take to immediately ameliorate the situation in America’s prisons and jails. Dr. Williams recommended these steps.

Develop emergency multidisciplinary task forces that assess people for suitability for release. This means “having an access-to-health-care plan on the outside [and] having a home or at least a non-overcrowded institution, like a halfway house, where they can practice social distancing and follow local shelter-in-place mandates,” Dr. Williams said.

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Even those who aren't ill are candidates for release. This includes anyone who is not an immediate threat to the community. Reducing the overall patient population means that medical professionals inside prisons and jails can more efficiently spread their clinical services and more effectively physically distance among the remaining population.

Create physical distancing plans for the people who remain. “One idea that our team has is to develop many communities where basically we have eight-to-10-person groups that almost function like a household, and there's correctional staff that are specifically assigned to that group,” Dr. Williams said, “Having this group allows officials to identify and isolate and then immediately quarantine a small group if there is a confirmed case, so that they can keep the rest of the prison moving and not locked down.”

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