• Overcrowded jails harbor some of the most virulent COVID-19 clusters and act as hubs for outbreak spillovers throughout carceral facilities and communities.
  • Communities with high Black and Latinx populations experience disproportionate rates of incarceration and SARS-CoV-2 infection.
  • Northwestern University and the Toulouse School of Economics link decarceration and public health mandates with lower COVID-19 caseloads.

A study covering 1,605 counties in the United States found that public policy interventions might have helped curtail the onslaught of COVID-19 in many communities.

Researchers at Northwestern Medicine, IL, the Toulouse School of Economics in France, and the French National Centre for Scientific Research believe that anti-contagion efforts are essential for controlling the epidemic and mitigating racial health inequities.

Prior research links high incarceration rates in Milwaukee with increased community health risks. According to the authors of this new paper, this is the first study to associate decarceration with public health benefits.

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Anthropologist, physician, and psychoanalyst Dr. Eric Reinhart authored this study. Reinhart is the Lead Health and Justice Systems Researcher at the Data and Evidence for Justice program at The World Bank. He is also a resident physician at Northwestern University Feinberg School of Medicine.

Co-author Dr. Daniel Chen, J.D., Ph.D. is a senior researcher at the French National Center for Scientific Research and the Toulouse School of Economics.

Their article appears in the Journal of the American Medical Association (JAMA).

Constant flow

Approximately 200,000 detainees enter U.S. jails each week, and about 55% of detainees are released weekly. There are also over 220,000 full-time employees working at correctional and detention facilities, which increases the population significantly.

Inadequate social distancing, isolation, and quarantine options for confined individuals make detainees more susceptible to COVID-19 transmission. Weaknesses in the healthcare infrastructure in jail settings further heighten the risk of exposure to the virus.

As of September 2020, correctional facilities made up 90 of the top 100 COVID-19 clusters in the country.

The study reports: “Incarcerated individuals have faced 5.5 times higher risk of contracting [SARS-CoV-2] than those in the general US population and […] 3 times the COVID-19 mortality rate.”

Jails vs. prisons

In an interview with Oncology Overdrive, Dr. Reinhart noted that U.S. jails and prisons “house more criminal detainees than any other country in the world.”

However, he said that it’s important to distinguish between the two institutions.

Prisons detain sentenced individuals for long periods. Jails typically keep pretrial detainees for a few days or weeks.

In this interview, Dr. Reinhart commented: “And if we are subjecting people to significant infectious risk by processing them through these facilities, we are in turn subjecting our own communities to this as well.”

“They shouldn’t be first”

The incarcerated have also faced limited vaccine opportunities. Some communities resisted efforts to prioritize detainees in the early vaccination effort.

Dr. Georges C. Benjamin is an author, speaker, and Executive Director of the American Public Health Association.

In an interview with Medical News Today, he said that this pushback stemmed from “the argument that these people had committed a criminal act and therefore were not deserving of being vaccinated, at least [not] early.”

Epidemic spurs releases

COVID-19 expedited the release of 208,500 inmates from March to June 2020. In response to the pandemic, occupied bed space in jail facilities fell from 81% in 2019 to 60% in 2020.

Dr. Benjamin applauded this as a positive move for public health and justice for nonviolent offenders. In the MNT interview, Dr. Benjamin stated:

“At the end of the day, we want to make sure that we maintain public safety. But, in most of these cases, these people were not a threat to public safety […] Unfortunately, these tend to be People of Color, just because we disproportionately arrest People of Color in our country, or at least, the rest are charged or put into the criminal justice system in a variety of ways.”

The study’s methods

Reinhart and Chen used county-level data from January to November 2020. They analyzed COVID-19 cases, jail censuses, and anticontagion policies to determine associations with daily COVID-19 growth rates.

Their sample of 1,605 counties represents 60% of the U.S. jail population, 51% of U.S. counties, and 72% of the total U.S. population.

The researchers noted changes in jail populations and the practice of policies including:

  • closures of schools and nonessential businesses
  • nursing home and prison visitation suspensions
  • mask mandates
  • stay-at-home orders

The study’s results

The panel regression model estimated that reducing U.S. jail populations by 80% would correlate with a 2% reduction in daily COVID-19 case growth rates.

In densely populated counties, this policy “was associated with 8 times larger reductions in COVID-19 growth rates” compared to lower-density population areas.

Other public health mandates likely led to the following COVID-19 caseload declines:

  • 7.3% decrease by suspending visiting at nursing homes
  • 4.3 % decrease by closing schools
  • 2.5% decrease by implementing mask mandates
  • 1.2% due to prison visitation bans
  • 0.8% decrease due to stay-at-home orders

Causality and consistency challenges

One of the study’s limitations is that, as a panel regression model, it could not determine causality.

The authors faced a lack of consistency among county-level data as well.

They also had to infer daily jail cycling figures because they could not directly identify daily detainee turnover.

Decarceration is key

The study suggests that large-scale decarceration would have a positive effect on communities and significant public health benefits.

The evidence suggests that reducing reliance on jails to handle minor offenses could improve mental health, economic opportunities, and public safety.

Dr. Benjamin cautioned that infection anywhere puts everyone at risk every day. He joined several leading advocates in a virtual town hall exploring incarceration and the COVID-19 pandemic in racialized communities.

Drs. Reinhart and Chen conclude:

“This study is thus consistent with existing expert consensus that public investment in a national program of large-scale decarceration and re-entry support is an essential policy priority for reducing racial inequality and improving US public health and safety, pandemic preparedness, and biosecurity.”

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