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COVID-19 in Prisons and Jails

America's response to the COVID-19 pandemic in prisons and jails was a failure. Its response to what comes next doesn't have to be.

With more than half a million infections behind bars and over 3,000 deaths, America’s response to COVID-19 in prisons and jails has been a failure. Federal, state, and local governments ignored public health guidance, refused to implement even the most basic mitigation strategies, and failed to reduce their incarcerated populations to the level necessary to avoid these catastrophes.

As we enter the third year of dealing with the virus, public health experts increasingly agree that eliminating it completely is unrealistic; instead, they say COVID-19 will become endemic, meaning the disease will continue to impact the U.S. population for the foreseeable future, with new variants springing up, acute outbreaks, and ongoing threats to public health. They warn that the country needs to learn to live with the virus. However, learning to live with the virus doesn’t mean accepting that prisons and jails have to be Petri dishes where the virus — along with widespread illness and death — is left to run wild.

Successfully navigating this new normal will require deep reductions in prison and jail populations and concerted efforts to improve carceral healthcare. Governments have the tools and strategies to do this; what is needed is the will of leaders to use them.

The United States got the pandemic response wrong in prisons and jails, but it isn’t too late to get the endemic response — and future pandemics — right.

Prison and jail crowding has deadly consequences

The most effective way to mitigate the devastation of endemic COVID-19 in prisons and jails is to reduce the number of people behind bars. The United States locks up a larger portion of its population than any other nation in the world. While it is true that the incarcerated population is lower than it was at the beginning of the pandemic, it is still far too high and trending back up.

When the pandemic struck, it was instantly obvious what needed to be done: take all actions possible to “flatten the curve.” This was especially urgent in prisons and jails, which are very dense facilities where social distancing is impossible, sanitation is poor, and medical resources are extremely limited. Public health experts warned that the consequences were dire: prisons and jails would become Petri dishes where, once inside, COVID-19 would spread rapidly and then boomerang back out to the surrounding communities with greater force than ever before. There were widespread calls for governments to decarcerate. Unfortunately, these calls went unanswered.

Despite initial hopes that leaders would respond to the pandemic by releasing people, on the whole prisons released almost no one. Only three states — New Jersey, California, and North Carolina — released a significant number of incarcerated people from prisons. Parole boards also approved fewer releases in the first year of the pandemic than the year before. The response of governments was so bad that, in total, 10% fewer people were released from prisons and jails in 2020 than in 2019. As a result, at the end of the first year of the pandemic, 19 state prisons systems were at 90% capacity or higher. Even states that reduced prison populations didn’t necessarily reach “safe” population levels (if any prison can be called “safe”). At the end of 2020, 1 in 5 state prison systems were at or above their design or rated capacity. And there is plenty of evidence that these numbers have gotten worse since then.

Jails were particularly ill-prepared to respond to the pandemic. People generally don’t stay in jails for extended periods. There is a constant churn of people entering and leaving, creating a significant public health threat to people on both sides of a jail’s walls. Much like prisons, jails also saw an initial decline in their populations due to reduced admissions. As the pandemic drug on, though, jails populations slowly approached their pre-pandemic levels.

So, if governments failed to undertake the large-scale releases necessary to confront a pandemic, how is it possible that the incarcerated population is lower now than it was in 2019?

Reductions in the number of people in our nation’s prisons were not the result of goodwill for incarcerated people, concern for their health and safety, or a concerted effort to end mass incarceration. Instead, they were primarily an unintended consequence of court delays and suspension of transfers from local jails early in the pandemic. Many of the same factors that snarled our nation’s supply chain and made it more difficult to get appointments for various services also slowed down the process of sending people to prison.

These delays have already begun to ease. As governments adapted to the new normal, they quickly returned to business as usual, and prison and jail populations began creeping back up.

Since the start of the pandemic, we've tracked prison and jail populations across the nation. While populations decreased in the early months, they were never as low as they need to be, and have been creeping back up.

The failure to reduce incarcerated populations had ripple effects that worsened the pandemic far beyond the prison walls. At the onset of the pandemic, areas with higher incarceration rates experienced significantly higher COVID case rates. Our analysis showed that in the summer of 2020, mass incarceration resulted in half a million more cases nationwide. The study revealed that not only do prisons not improve public safety, they also harm public health.

The changing nature of the fight against COVID-19 demands that our nation abandon its addiction to mass incarceration. The virus is going to remain an ongoing threat. The criminal legal system must change to ensure that a short stint in jail or prison does not become a de facto life sentence.

Because the United States has locked up so many people behind bars, it has many strategies at its disposal to reduce its prison and jail populations relatively quickly, including:

• Expanding the use of early-stage diversion programs to keep people out of the criminal legal system in the first place;
• Increasing the use of “good time” credits;
• Reducing admissions for technical violations of probation and parole; and
• Expanding the use of clemency powers by governors.

Correctional healthcare must change to respond to permanent COVID-19

The most important thing governments can do to stop the spread of COVID-19 is reduce the number of people behind bars. However, they must also take steps to ensure those they continue to incarcerate are safe. That will require dramatic improvements to health care protocols in prisons and jails.

Health care in prisons and jails is notoriously bad. It is plagued with poor care, inaccessible treatment, and mistrust. Recognizing that COVID-19 will be an ongoing threat, cities, states, and the federal government must address these deficiencies head-on. Here are a few ways they can do that.

1. Ensure access to vaccinations and vaccine education
   Vaccinations are the single most effective tool to combat COVID-19. They reduce a person’s risk of being infected, and if they are infected, make it much less likely that they will become seriously ill or die.
   
   Unfortunately, in the initial vaccine rollout, far too few states prioritized incarcerated people to receive the shots, despite their increased risk. And in many states, vaccination rates among incarcerated people have consistently lagged behind the non-incarcerated population.
   
   Vaccination efforts should include an educational component that allows incarcerated people to get the information necessary to feel comfortable taking the vaccines. Information about the safety and efficacy of vaccines is limited for people behind bars. Additionally, the relationship between people in prisons and the medical staff of that prison is often defined by mistrust. Governments should bring in outside medical experts and community leaders that will have the trust of the people who are incarcerated and give them multiple opportunities to ask questions and voice their concerns. Now that vaccines are readily available in the United States, prisons should also give people the option to get the immunization of their choice.
   
   It is crucial to remember vaccination standards are likely to change over time. Data increasingly show that people will need to get periodic vaccinations to maintain ongoing protection from the virus. Prisons must ensure incarcerated people can maintain an up-to-date vaccination status.
2. Eliminate medical copays
   Unaffordable medical copays in prisons and jails can lead to increased spread of disease in and around correctional facilities and postpone access to medical treatment, often resulting in worsening ailments/illnesses. With a highly infectious virus posing an ongoing threat, this can have deadly consequences. A person with undiagnosed and untreated COVID-19 is more likely to infect others and become seriously ill themselves.
   
   Forty states still charge incarcerated people copays to seek medical treatment. While some states suspended these fees during the pandemic, many have already reinstated them.
   
   With COVID-19 posing a perpetual public health threat, prison systems should end medical copays permanently.
   
   

   Our research on the state of copays during the pandemic

   Table last updated: February 3, 2022. States that have revised their policies can notify us at virusresponse@prisonpolicy.org. *Accord to the Delaware Department of Corrections, its co-pay policy has consistently not charged copays for “diagnostic and treatment of contagious/communicable diseases,” including COVID-19.

   States that do not charge copays	States that suspended all copays for incarcerated people in response to the pandemic	States that suspended all copays for respiratory, flu‑related, or COVID‑19 symptoms	States that rolled back previous suspensions and now charge medical copays on non‑COVID‑19 related symptoms	Governments that rolled back previous suspensions and now charge all medical copays	States that suspended some or all copays in response to the pandemic, but it is unclear if those suspensions are still in place	States did not suspend copays in response to the COVID‑19 pandemic
   California Illinois Missouri Montana Nebraska New Mexico Oregon Vermont Virginia Wyoming	Connecticut Massachusetts New Jersey Rhode Island West Virginia	Alaska Colorado Delaware* Florida Hawaii Indiana Iowa Michigan New Hampshire North Carolina North Dakota Pennsylvania South Carolina Utah Wisconsin	Idaho	Alabama Federal Bureau of Prisons Minnesota Texas	Arkansas Arizona Georgia Kansas Kentucky Louisiana Maine Maryland Michigan Mississippi Ohio Oklahoma South Dakota Tennessee Washington	Nevada

   
   
3. Establish metrics to identify outbreaks and protocols to respond to them
   Public health experts advise that endemic COVID-19 will be defined by waves of increased infections, often driven by new variants. Prisons officials must recognize the threat posed by the virus could dramatically increase quickly. They should have established processes to monitor the threat the virus poses and, when appropriate, plans to impose more rigorous interventions — such as masking, increased testing, and enhanced hygiene practices — to stop its spread.
   
   Prison officials should recognize the importance of contact with loved ones outside of the prison’s walls and only suspend visits from family and friends as a last resort. They should also permanently eliminate fees to make phone and video calls; this is particularly important when incarcerated people are cut off physically from their loved ones.

The United States’ response to COVID-19 in prisons and jails was a failure. The refusal to reduce jail and prison populations resulted in unnecessary illness, suffering, and death, both inside and outside prison walls. Abysmal prison and jail medical systems failed to distribute vaccinations effectively and did little to detect and address outbreaks when they occurred.

The damage and death already caused by these failures cannot be undone, but as the world realigns its approach to COVID-19, government leaders have an opportunity to change course to prevent future death and suffering among incarcerated people.

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