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How the CDC can get serious about the health of incarcerated people
Since the onset of COVID-19, the critical role of the Centers for Disease Control and Prevention (CDC) in saving lives and protecting people from health threats has been in full view. Incarcerated people have long been denied the expertise of the CDC and local health departments, but COVID-19 reveals a path to changing this feature of injustice in health.
Since March 2020, the CDC has issued several extremely helpful guidelines on how jails, prisons and immigration detention centers can prepare for and respond to COVID-19. By building on this work, the CDC can help local and state departments of health determine whether correctional settings are doing all they should, and identify gaps in resources, transparency and accountability to not only decrease COVID-19 infections and deaths but finally start to involve the CDC in promoting and protecting the health of incarcerated people.
I have spent the past eight months inspecting correctional facilities across the nation to see how well they are responding to COVID-19. The results have been alarming. Most facilities have implemented scores of new protocols and policies to screen staff every day, set up quarantine and medical isolation units and introduce new cleaning and disinfecting measures. These efforts are sometimes consistent with the guidelines outlined by the CDC, but quite often they are not.
Because correctional settings have long suffered from inadequate health services, and no oversight by the same groups that promote quality in hospitals and community clinics, correctional health services are operated to meet the expectations of sheriffs, wardens and commissioners of correction. During COVID-19, this manifests as lack of diagnosis or care when people become ill with COVID-19, officers often not wearing masks, incarcerated people being charged for soap, confusion about the use of quarantine and medical isolation, and swift retaliation against detained people who seek care when it has been denied or delayed. Despite clear guidelines from the CDC on most of these areas, there is little effort by local or state departments of health to make rigorous assessments about how well facilities are implementing their COVID-19 response. This is something the CDC can address immediately.
First, the CDC can create an office of correctional health that is led by people with lived experience of incarceration as well as correctional health experts. One of the clear deficiencies in the current COVID-19 response by the CDC has been the failure to elicit and respond to the realities faced by the more than two million people in detention settings. People routinely report COVID-19 symptoms only to be ignored. Even when identified as having COVID-19, people may be put into medical isolation units that function as solitary confinement, where they can deteriorate and die without regular health assessments.
Because many incarcerated people have risk factors for serious illness or death from COVID-19, these bad practices have fatal consequences, with approximately 180,000 cases and 1,400 COVID-19 deaths in prisons alone. This work by the CDC can start with anonymous phone surveys as well as in-person interviews during site inspections. Some of this work has been done by the Department of Justice and the CDC in isolated cases, but if the CDC is creating guidelines for appropriate responses in facilities, it can and should use its expertise to understand whether these guidelines are being followed and how effective they are.
Second, the CDC should create tools and support for local and state departments of health to begin the long overdue process of getting involved in the health of incarcerated people. The purposeful exclusion of incarcerated people from the rest of our nation's health care quality and transparency systems is an overt and significant part of racial discrimination in health. And the CDC has the stature to start addressing this by helping the nation's local and state health departments understand whether the COVID-19 responses are adequate.
Each of my COVID-19 assessments starts with three simple questions: Is the facility adequately detecting new cases, slowing the spread of the virus and protecting/releasing high-risk patients? This approach can be utilized by the CDC to provide templates for COVID-19 assessments to departments of health to understand access to care, testing, vaccines and infection control for COVID-19. But these links should grow to creating a role for assessing health services and outcomes across the spectrum of physical and mental health concerns for incarcerated people.
Finally, the CDC should include incarcerated people in its broad areas of health promotion and protection instead of limiting its interest behind bars to infectious diseases. For example, the CDC spends millions of dollars each year on education and prevention efforts around injuries and traumatic brain injury in youth sports, motor vehicle accidents and intimate partner violence. Our own work in the New York City jails documented that the rates of injury and head trauma to our patients while incarcerated were far higher than in the community, but these common sources of illness and death among incarcerated people have not been of interest to the CDC. This is an example of racial discrimination in health, and it can and must stop.
By thinking about incarcerated people as part of the community that deserves health protection and promotion, the CDC can do a better job with its COVID-19 response, as well as start to address the longstanding inequities in health for incarcerated people. These efforts will also help educate health officials and policymakers about the true costs of mass incarceration and bring their evidence-based perspectives to the discussion of how we can reform our justice systems.
Dr. Homer Venters is the former chief medical officer of the New York City jail system and author of "Life and Death in Rikers Island."