COVID Behind Bars: Correctional Officers are Driving up Infection Rates

COVID Behind Bars: Correctional Officers are Driving up Infection Rates

Prisons and jails have hosted some of the largest COVID-19 outbreaks in the U.S. , with some facilities approaching 4,000 cases. In the U.S., which has some of the highest COVID-19 infection rates in the world, 9 in 100 people have had the virus; in U.S. prisons, the rate is 34 out of 100.

I study public health issues around prisons. My colleagues and I set out to understand why COVID-19 infection rates were so high among incarcerated individuals. 

Using data from the Federal Bureau of Prisons, we discovered the infection rate among correctional officers drove the infection rate among incarcerated individuals. We also found a three-way relationship between the infection rate of officers, incarcerated individuals and the communities around prisons.

No stranger to outbreaks

Prisons, jails and other correctional facilities routinely deal with infectious diseases. Hepatitis B and C as well as tuberculosis are all incredibly common in prison populations.

Because of that, prisons have established policies and procedures for handling infectious diseases. Many of those policies are the same as those for preventing the spread of COVID-19 – such as medical isolation of individuals with active infections, increased cleaning and surveillance of the disease. 

Public health experts have encouraged prisons to think about the role of correctional officers in infection spread for years and more recently have warned that correctional officers are a weak link for COVID-19 infections in prisons.

Even though prisons have policies for disease control, many of which include guidelines for correctional officers, prisons are at a disadvantage in stopping the spread of COVID-19. Current prison conditions – including poor ventilationovercrowdingand a lack of space for social distancing and isolation – make respiratory diseases like COVID-19 very difficult to control. 

For instance, before the start of the pandemic, the Federal Bureau of Prisons, along with nine state prison systems, has been operating at over 100% capacity. During the pandemic, even with massive early release and home confinement programs, many states remain at 100% prisoner capacity – or more

Additionally, U.S. prisons have been facing chronic staffing shortages. In the federal system, the issue is so severe that staff not trained as prison guards – including nurses – are being reassigned to guard the prison population. Short staffing makes the daily business of running a prison difficult during the best of times, not to mention during a pandemic. 

As early as March 2020, many prisons attempted to mitigate these conditions by granting early release and home confinement. Some also blocked all visitors and outside contractors. While helpful in some cases, ultimately these actions did little to stop outbreaks. 

Responding to COVID-19

Initially, public health organizations such as the Centers for Disease Control and Prevention went back and forth on the need for masks. Then mask mandates became a partisan issue. By midsummer 2020, 30 states mandated masking for correctional officers, prisoners or both. The Bureau of Prisons adopted a masking policy in late August, requiring correctional officers to mask when social distancing was not possible.

As the second and third waves of COVID-19 swept through the nation and the federal prison system, the mask mandate made only a small dent in slowing the uptick of infections among prisoners. 

Additionally, vaccine adoption rates among correctional officersand incarcerated people are low, weakening this line of defense. Across all states, incarcerated people have not been prioritized for the vaccine. Even when the vaccines are available, many incarcerated people are skeptical about receiving them due to mistrust of prison officials. 

Two-way vectors

We found the relationship between COVID-19 infections among correctional staff and incarcerated individuals is also shaped by the incidence of COVID-19 in the community surrounding the prison. Because correctional officers move between the prison and the community at the beginning and end of each shift, they can carry COVID-19 between these two spaces. 

Even when correctional officers test negative for COVID-19, they can still drive COVID-19 rates both inside and outside the prison via asymptomatic or pre-symptomatic spread. Our data showsthat when COVID-19 rates in the outside community get worse, so too do rates among the incarcerated population.

Prison policies aimed at stopping the spread of COVID-19 should be designed with an eye toward controlling the disease in the prison population, among correctional officers and in the community around the prison. 

For example, prison systems should be just as concerned with vaccination rates in the communities around prisons as they are with vaccination rates among correctional officers. Both rates will have an impact on the spread of COVID-19 within a prison.


Nurse of the Week Dr. Sandra Lindsay Says Vaccination “Should be Natural Choice” for Nurses

Nurse of the Week Dr. Sandra Lindsay Says Vaccination “Should be Natural Choice” for Nurses

Dr. Sandra Lindsay made headlines around the world (and in DailyNurse) for being the first person—and first nurse—in the US to hold out her arm for a vaccine that was regarded by many with uncertainty. How could they produce a vaccine at such a ferocious pace? (How? To paraphrase Samuel Johnson’s famous remark, when scientists fear that they or their loved ones will be killed by a virus, it concentrates their minds wonderfully). When people’s perspectives on the mRNA vaccines were clouded by fear and political biases coming from every angle, our Nurse of the Week stood up for non-immunocompromised nurses everywhere when she rolled up a sleeve and said, “I trust science .” The Jamaican-born nurse with many letters after her name is an important symbol and one that should be remembered. Nursing is about caring, but it is also about leadership, science, lots of hard work, and engaging in an endless war against ignorance.

Dr. Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC

So, what has Sandra Lindsay, DHSc, MS, MBA, RN, CCRN-K, NE-BC done in 2021? Well, she received her booster shot in January… We’re not certain about anything particular she did February through May, but she was probably preoccupied with her job as Director of Nursing at the Northwell Health Long Island Jewish Medical Center, waiting for the daily SARS-CoV-2 case rate to fall, and—because she really does trust science—preparing to add a Doctor of Health Sciences (DHSc) degree to her cv.

Then, this month, Dr. Lindsay responded to the request of a determined new grad, Tracey Smith, president of the Borough of Manhattan Community College (BMCC-SUNY) Nursing Students’ Association. Smith, who describes Lindsay as “the face of the Covid-19 vaccine,” was bent on getting the iconic nurse to speak at the pinning ceremony at the school, which is where she had earned her own first nursing degree in 1994 (and was valedictorian of her class, of course). “She can attest to the safety of the vaccine,” said Smith, who plans to earn a Master’s Degree in Pediatric Nursing. “She can help our new graduate nurses and the BMCC community at large to understand how this vaccine is working to protect us and the importance of mass vaccinations nationwide.”

After somehow finding time for her own new pinning, Lindsay spoke to Smith and the other BMCC nursing grads. She more than fulfilled Smith’s hopes: “It should be the natural choice for us to get vaccinated because it’s how we look out for each other. It gives us a chance to protect ourselves, our healthcare workers and our family and friends.  It’s an opportunity to grab onto a much brighter future after a very dark year.”

I believe in science. As a nurse, my practice is guided by science. And so I trust that. What I don’t trust is that if I contract COVID, I don’t know how it’s going to affect me or those I come in contact with. So, I encourage everyone to take the vaccine.

Dr. Sandra Lindsay, December 14, 2020

During commencement, Dr. Lindsay was also awarded the BMCC President’s Medal for 2021, “which expresses the College’s admiration and appreciation for extraordinary service and leadership.”

At the ceremony, Lindsay said of Covid-19, “It’s not gone. I was vaccinated back in December and here I am today, feeling well, doing well.  All BMCC graduates are role models. Nurses going out into the field are role models for patients who will look up to you as you model the behavior you want to see in the world.”

For more details (but not about Lindsay’s actions in February-May), see the NY Carib News story here.

Nurse of the Week Carla Brown is on a Mission to Vaccinate North Baton Rouge

Nurse of the Week Carla Brown is on a Mission to Vaccinate North Baton Rouge

Nurse of the Week, Carla Brown, RN, accompanied by a colleague clutching a clipboard to her chest, is standing outside a house in her North Baton Rouge, LA neighborhood. “You seem kind of impatient when you get to these doors to talk to these people…” a CBS reporter remarks . “Yes,” Brown replies, “Because I feel the urgency… Today I could see you, and tomorrow, you may not be here.”

Carla Brown does not have time for nonsense. These days, in addition to her work as an RN in a hospice, Brown has also donned the mantle of a community nurse. After experiencing her own tragic Covid loss, she’s managing her grief by doubling down on what nurses do best: helping people. Now, when not on duty at the hospice, Carla is on duty in her majority-Black North Baton Rouge area, pounding the pavement (nurses are also expert walkers!) and signing up neighbors for Covid-19 vaccination appointments. And when her elderly or disabled “patients” cannot reach a vaccination site, Brown swings by in her car and drives them there.

Her own loss was the nightmare of every frontline nurse. After Brown unknowingly contracted an asymptomatic case of Sars-CoV-2 at work, she came home and infected her family with the virus. The consequences were devastating. Carla’s husband, “the love of my life, David,” fell ill, as did her 90-year-old father, and 67-year-old brother. All three—husband, father, and brother—had to be hospitalized. Her spouse, David Brown, died in the hospital at age 67.

The grim statistics in the Baton Rouge vaccination efforts against Covid-19—that 64% of the white population has had at least one shot, while just 26% of the city’s Black community have had jabs—gave the bereaved Carla a new purpose: “All I can do now,” she says, “Is save somebody else.”

The vast discrepancy between white Baton Rouge and Black Baton Rouge has less to do with vaccine hesitancy than it does with our old familiar frenemy, structural racism. North Baton Rouge (NBR) has long been underserved by the local healthcare system, and the Covid vaccines have been strangely scarce in the area. Aside from a few ephemeral pop-up vaccination sites that have been hosted by Black churches, vaccines have been available at only four sites in the district.

To attack the vaccine scarcity problem, Carla employed some special artillery. Clad in her hospice uniform, the undaunted RN stepped into a popular neighborhood pharmacy—with a CBS reporter and camera crew in tow—and asked to speak with the owner. She told the proprietor that she could provide the completed registrations, insurance paperwork, and ID confirmations for NBR locals who have been won over by her urgent campaign. “We just need,” she said, “Somebody to supply us with the vaccine.”

The result? Well, it is hard to dismiss nurse Brown even when she is not accompanied by a news team from a major national broadcasting network. In fact, after agreeing to order vaccine ASAP, the pharmacist implied he had little choice: “She’s an angel!” he said of Carla. “An angel in disguise.”

A tough angel, though. As Brown told a local station in Baton Rouge, “You want to go to your grave early, or you want to live? That’s been my sales pitch.” And when walking the streets and knocking on doors doesn’t get results, “Some [neighbors] I just physically took in my car and brought.”

See the full CBS video report on Carla Brown’s story and the health inequities in North Baton Rouge. She is also featured in a recent New York Times article.

Letter from Tennessee: Fed-Funded Local Clinics Focus on Covid Vaccine Equity

Letter from Tennessee: Fed-Funded Local Clinics Focus on Covid Vaccine Equity

Mary Barnett is one of about a dozen seniors who got a covid-19 vaccine on a recent morning at Neighborhood Health, a clinic tucked in a sprawling public housing development on the south side of downtown Nashville, Tennessee. 

“Is my time up, baby?” Barnett, 74, asked a nurse, after she’d waited 15 minutes to make sure she didn’t have an allergic reaction. Barnett, who uses a wheelchair, wasn’t in any particular rush. But her nephew was waiting outside, and he needed to get to work.

“Uber, I’m ready,” she joked, calling him on the phone. “Come on.”

Seniors of color like Barnett are lagging in covid vaccinations, and the Biden administration plans to redirect doses to community clinics as soon as next week to help make up for the emerging disparity. Tennessee is one of a few states allocating vaccines to the network of clinics known as FQHCs, or federally qualified health centers.

In most of the states reporting racial and ethnic data, a KHN analysis  found that white residents are getting vaccinated at more than twice the rate of Black residents. The gap is even larger in Pennsylvania, New Jersey and Mississippi.

“Equity is our north star here,” Dr. Marcella Nunez-Smith said at a briefing Tuesday, announcing vaccine shipments to the federally funded clinics. “This effort that focuses on direct allocation to community health centers really is about connecting with those hard-to-reach populations across the country.”

Nunez-Smith, who leads the administration’s health equity task force, said federally funded clinics — at least one in every state — will divvy up a million doses to start with, enough for 500,000 patients to get both doses. Eventually, 250 sites will participate.

The administration said roughly two-thirds of those served by FQHCs live at or below the poverty line, and more than half are racial or ethnic minorities. 

Seeking People Out

In Nashville, more than a third of eligible white residents have gotten their first shot, compared with a quarter of Hispanic residents and fewer than one-fifth of Black Nashvillians.

Unlike many local health departments, Neighborhood Health is not fending off crowds. They’re seeking people out. And it’s slow work compared with the mass vaccination campaigns by many public health workers and health systems.

Nashville is a key site in Black history. Pictured here in 1960, a young John Lewis at the city jail after his arrest at a downtown drugstore lunch counter, with O.D. Hunt, left, and Dennis Gregory Foote, students at Tennessee A&I State University. Staff photo by Jimmy Ellis (The Tennessean).

Barnett lives in a public housing complex that gathered names of people interested in getting the vaccine. She was lucky to have her nephew’s help to get to her appointment; transportation is a challenge for many seniors. Some patients cancel at the last minute because a ride falls through. Often, the clinic offers to pick up patients. 

Aside from logistical challenges, Barnett said, many of her neighbors are in no rush to get their dose anyway. “I tell them about taking it, they say, ‘Oh, no, I’m not going to take it.’ I say, ‘What’s the reasoning?’”

Usually, Barnett said, they don’t offer much of a reason. Her own motivation is a sister with kidney disease who died of covid in July. 

“You either die with it or die without it,” her brother told her in support of getting the vaccine. “So if the shot helps, take the shot.”

Same Story, Next Chapter 

People of color have made up an outsize share of the cases and deaths from covid nationwide. And, predictably, the same factors at play driving those trends are also complicating the vaccine rollout.

Rose Marie Becerra received an invitation to get the vaccine through Conexión Américas, a Tennessee immigrant advocacy nonprofit. A U.S. citizen originally from Colombia, she’s concerned about those without legal immigration status.

“The people who don’t have documents here are nervous about what could happen,” she said, adding they worry that providing personal information could result in immigration authorities tracking them down.

And unauthorized immigrants are among those at the highest risk of covid complications.

Even with 1,300 total community health centers around the country, Neighborhood Health CEO Brian Haile said his 11 clinics in the Nashville area can’t balance out a massive health system that tends to favor white patients with means. 

Haile said everyone giving vaccines — from hospitals to health departments — must focus more on equity.

“We know what’s required in terms of the labor-intensive effort to focus on the populations and vaccinate the populations at the highest risk,” Haile said. “What we have to do as a community is say, ‘We’re all going to make this happen.’”

This story is from a partnership that includes NPRNashville Public Radio and KHN.

Republished courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.