key: cord-301852-9nza3po0
authors: Sears, David; Ahalt, Cyrus; Augustine, Dallas; Williams, Brie
title: Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities
date: 2020-07-27
journal: Ann Intern Med
DOI: 10.7326/m20-4543
sha: 
doc_id: 301852
cord_uid: 9nza3po0

Coronavirus disease 2019 has swept through prisons in much the same way it has nursing homes: after being introduced by staff or newly arrived residents, it spreads efficiently, including to many with medical vulnerabilities. Yet, many correctional workers lack basic protections. The authors believe that ensuring community-standard occupational health for correctional staff during COVID-19 will protect prison residents, staff, and their communities.

C orrectional facilities (prisons and jails) are the second largest source of coronavirus disease 2019 (COVID-19) outbreaks in the United States, surpassing all other non-nursing home congregate settings combined (1) . The disease has swept through prisons in much the same way it has devastated nursing homes: after being introduced by staff or newly arrived residents, it spreads efficiently, including to many with medical vulnerabilities. As COVID-19 transmission continues unabated in these settings, protecting the health and safety of correctional workers is a moral imperative and an underappreciated requirement to mitigate the pandemic's effect on incarcerated persons and surrounding communities.

Public health experts agree that the most critical action governments can take to reduce the risk for catastrophic prison outbreaks is to immediately and dramatically address overcrowding through depopulation (via release) (2, 3) . Although few correctional systems have followed this guidance, most have taken secondary precautions to ensure that facilities are occupied almost exclusively by full-time staff and a stable resident population (for example, by limiting in-person visitation; decreasing population movements between facilities; reducing new admissions; and suspending activities of volunteers and nonessential, part-time, or transient staff) (3, 4) .

What has been too often lost in this conversation is the need for enhanced measures to safeguard the occupational health of correctional staff in ways that are commensurate with the risk they face while carrying out their duties. Tens of thousands of correctional workers interact with incarcerated persons and each other every day. This workforce includes correctional officers; clinicians; social workers; and janitorial, food service, administrative, and clerical staff. Most notably, uniformed correctional officers may come into close contact with hundreds of colleagues and incarcerated persons every day and are at disproportionately high risk for severe complications from COVID-19 because of high rates of chronic and behavioral health conditions (5) . Although occupational health interventions should focus primarily on correctional officers given their numbers and close, sustained contact with incarcerated persons, interventions should be adapted to reduce risk for infection for all staff. At the end of every shift, each of these workers risks introducing COVID-19 into their homes, families, and communities if infected at work.

Furthermore, incarcerated persons have a constitutional right to health care that meets community standards (6) . Community-standard infection control in con-gregate living and health care facilities includes efforts to ensure that those providing care, including nonmedical staff, are not ill and capable of spreading COVID-19 to their patients (7) . Patients in the community expect health care workers to be screened for infection, granted sick leave if infected, offered personal protective equipment, and evaluated for infection if they show symptoms. Yet, this community standard of occupational health is not met in many correctional facilities. Correctional officers are not universally guaranteed medical benefits or paid sick leave, and most access occupational health services via outside organizations. As a result, strategic workplace testing of asymptomatic correctional staff has not been the norm. In some states, labor agreements between correctional officer unions and departments of corrections even preclude correctional departments from requiring basic health screenings on facility entry or knowing the results of testing among these essential workers, some of whom come to work despite being infected if they have no sick leave available (8) .

The patchwork of policy and practice that is failing to meet the urgent occupational health crisis that COVID-19 presents in correctional systems should be of particular concern to correctional officers because their unique duties, coupled with the severe overcrowding of U.S. prisons, place them at a level of risk unmatched by an appropriate policy response to protect them. Officers escort patients with suspected or confirmed COVID-19 to medical appointments, implement housing movements for medical isolation or quarantine, help distribute medications, accompany hospitalized patients, and act as first responders to medical emergencies. Each of these activities may bring officers into close contact with the novel coronavirus, and none can be accomplished while physically distancing. In addition, because testing in correctional systems has thus far been extremely limited relative to the risk, staff members often return home at the end of each shift without knowledge of the extent of risk they or their families are facing. A growing number of COVID-19related deaths among U.S. correctional officers underscores the health perils and outsized risk for COVID-19 complications many face (9) .

Fortunately, effective policy to safeguard the health of staff working in comparably high-risk settings, particularly in health care, can guide departments of corrections and correctional officer unions faced with similar challenges. To protect correctional staff and ensure that community standards of care are afforded to incarcerated populations during the COVID-19 pandemic, prisons must:

This article was published at Annals.org on 27 July 2020.

1. provide staff with universal screening for COVID-19 symptoms and exposures before entry into the facility at each shift and recurrent universal testing in hot spots with widespread community transmission or in facilities with outbreaks (these measures will bring screening in line with guidelines for other congregate settings, such as nursing homes); 2. reorganize staff and residents into assigned cohorts that practice physical distancing from each other and comprise as few persons as is feasible on the basis of facility resources (10); 3. institute policies that promote a culture of health, including sick leave that requires workers to stay home when they are sick or have been exposed to infection; 4. provide access to and training in appropriate use of hand sanitizer, soap, and personal protective equipment, including universal masking and enhanced protection when in contact with infected residents or those suspected of being infected (such as N95 masks, face shields, gloves, and gowns); and 5. streamline workplace-based, no-cost clinical evaluation and diagnostic testing for staff who have COVID-19 symptoms, high-risk exposures, or known infection and are being evaluated for a return to work.

Many correctional workers lack these basic protections and continue to do their jobs, in some cases playing an essential role in ensuring that incarcerated patients receive prompt access to adequate care themselves. Prison residents and staff should not fear that each encounter is needlessly putting the other at risk, nor should the staff's families or those in their communities be subject to increased risk for infection because of inadequate occupational health protections. Ensuring community-standard occupational health for correctional staff during COVID-19 will protect us all.

latest map and case count. The New York Times

COVID-19 in correctional settings: immediate population reduction recommendations

Flattening the curve for incarcerated populations-Covid-19 in jails and prisons

Responses to the COVID-19 pandemic. Prison Policy Initiative

Mission critical: correctional employee health and wellness

Preparing for COVID-19 in nursing homes

Union files national grievance over alleged safety violations at federal prisons during coronavirus pandemic. Government Executive

The Marshall Project. A state-by-state look at coronavirus in prisons

Limiting COVID-19 transmission and mitigating the adverse consequences of a COVID-19 outbreak in correctional settings: RELEASE: COHORT: TEST