Keeping viruses like COVID-19 from spreading in congregant living settings is a challenge. Prisons and jails face some particularly difficult obstacles.
Dr. Travis Schamber is corporate medical director of Peoria-based Advanced Correctional Healthcare, the largest county jail medical care provider in the United States. The company provides medical services to incarcerated populations ranging from 10 to 1,000 detainees.
Schamber said jail administrators started thinking proactively about COVID-19 long before the Centers for Disease Control and Prevention published their recommendations for correctional and detention centers earlier this month.
“Every year at flu season, that’s a big deal for us as a healthcare company partnering with jails” he said. “I don’t want to compare COVID-19 to the flu, but I will say that jails — having gone through the flu season over and over and over again — understand the importance of doing some of these basic things.”
He said the emphasis has been on screening all detainees, as well as staff and volunteers, for possible COVID-19 symptoms — keeping ill people out of the jails when possible or separating them from the rest of the population.
Schamber said the hardest aspect of mitigating illness in correctional facilities is controlling human behavior, especially in an already stressful environment.
“Getting a group of people who are in a confined space to follow yet another set of rules can be really difficult,” he said. “All it takes is one person not to follow the rules to make other people feel uneasy.”
Schamber said another difficulty is the frequent migration of people in and out of the jail. He said there are also some aspects of cleanliness that are harder to maintain.
“It’s more difficult in a correctional setting to have hand sanitizer, because it can be misused,” Schamber said. “Folks who struggle with substance use disorder may see that as an opportunity to have a source of alcohol.”
Similarly, Schamber said, most jails use cleaning supplies that have to be monitored by officers, as things like bleach can be toxic if ingested.
Schamber said most jails are equipped to keep a detainee in isolation, if they were to contract COVID-19. He said individual holding cells, often meant for security, can also be used for medical care. Some jails even have negative pressure rooms, like those found in hospital settings, to manage airborne infectious disease.
As long as the facility has room to quarantine an ill detainee, he said, the rest of treatment would be supportive care — things like checking vitals, ensuring the person gets enough fluids and nutrition, and symptomatically treating with pain relievers.
What some jails may be less prepared to handle is the mental toll of the COVID-19 crisis on detainees. Incarcerated people have the same fear and concern around the pandemic as the general population, Schamber said, especially those with family members who aren’t doing well.
“That is a very difficult situation. I don’t know how many times I’ve sat with an incarcerated patient who has just found out about the death of a loved one and they can’t be there at all. The odd part of what is happening with COVID-19 is that’s becoming a reality for lots of folks — where loved ones are dying alone in ICU beds, because they can’t go and visit them.”
Advanced Correctional Healthcare provides mental health services, in addition to staffing doctors and nurses. But not all counties choose to offer those services in their jail.
“Ultimately, the decision for staffing rests with the county,” he said. “Oftentimes, that has to do with the thing that no one likes to talk about in medicine but it’s always in the background, and that’s budget.”
Schamber said he encourages mindfulness practices and exercise routines to help people manage stress and depression while incarcerated. He said it’s also helpful for staff to watch detainees’ social interactions with others in the jail and whether they’re making phone calls to the outside, as these can be clues into how well that person is holding up.
Schamber said other COVID-19 mitigation efforts, like releasing some incarcerated people early or serving a notice to appear rather than booking someone in jail, should be left up to lawyers and lawmakers. But he said to rest assured that everyone involved takes the threat seriously.
“Even if people don’t come to an agreement about who should be going into the jail or staying out of the jail … I want people to understand that jails are really working hard to aggressively follow screening guidelines and keep this out of their facility,” he said. “There is no good end for anyone to have an outbreak of COVID-19 in a facility like this.”
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