Care for Incarcerated Patients Hospitalized with COVID-19

Abstract

The COVID-19 pandemic has reshaped health care delivery for all patients but has distinctly affected the most marginalized people in society. Incarcerated patients are both more likely to be infected and more likely to die from COVID-19. There is a paucity of guidance for the care of incarcerated patients hospitalized with COVID-19. This article will discuss how patient privacy, adequate communication, and advance care planning are rights that incarcerated patients may not experience during this pandemic. We highlight the role of compassionate release and note how COVID-19 may affect this prospect. A number of pragmatic recommendations are made to attenuate the discrepancy in hospital care experienced by those admitted from prisons and jails. Physicians must be familiar with the relevant hospital policies, be prepared to adapt their practices in order to overcome barriers to care, such as continuous shackling, and advocate to change these policies when they conflict with patient care. Stigma, isolation, and concerns over staff safety are shared experiences for COVID-19 and incarcerated patients, but incarcerated patients have been experiencing this treatment long before the current pandemic. It is crucial that the internist demand the equitable care that we seek for all our patients.

The Risk of COVID-19 Infection in Prisons and Prevention Strategies: A Systematic Review and a New Strategic Protocol of Prevention

“…This study is, to date, the first systematic review that highlights the main aspects of COVID-19 in prisons, showing the incidence, morbidity, and mortality within these structures and providing the most important prevention techniques to reduce the risk of infection in prisons. Through this review, a preventive strategy for the risk of contagion is provided through the application of general measures to be implemented in prisons (improvement of environmental hygiene, appropriate use of PPE, release for minor crimes, mass screening, vaccination), and local measures in cases of a positive COVID-19 subject occurring within the prison (Figure 2a,b) [72][73][74]77]. Due to the fragility of people in prison and the precarious clinical condition of many prisoners, COVID-19 vaccination should be a priority in this population [17,80].…”

“…Specifically, a 73-year-old man with heart failure, chronic kidney failure, and diabetes mellitus was admitted to a hospital near the prison due to COVID-19 related pneumonia. Throughout the hospitalization, the prisoner was intubated and remained chained to the bed; after a few days he died in complete solitude, chained, losing his human rights [ 77 ].…”

COVID-19 vaccine for people who live and work in prisons worldwide: A scoping review

“…Exclusion was based on various factors including increased vulnerability, ethical and recruitment challenges, and lack of participation in design of studies. 52,54,61 Several papers raised the ethical arguments of need for informed consent, avoiding coercion, and minimising harm, recommending that oversight boards monitor trials and obtain input from these populations to enable their participation. 61,62 Publications raised further relevant issues for the prison population, including real and perceived pressure from authorities to participate in trials, pressure to participate to receive the care they cannot afford, uncertain risks of vaccines being trialled, limited or non-existent on-site clinical support, and the absence of an agreement that people in prisons would benefit from the vaccines if they were found to be safe and effective.…”

“…45 Most included studies were published in countries of the Global North. More than half (n=25, 57%) were published in the United States; [36][37][38][39][40][41][42][43][44][45][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] five were published in the United Kingdom; [63][64][65][66][67] two were from Brazil; [68][69] and there was one publication each from Africa, 70 Canada, [71][72][73] and South Korea. 46 An additional nine papers focused on various world regions.…”

Evaluating the effectiveness of problem-solving courts at preventing fatal and non-fatal opioid events: preliminary findings from Indiana

“…The COVID-19 pandemic exacerbated drug misuse and created barriers to treatment, especially for those who are incarcerated. 37 Prison costs are escalating, leaving fewer available resources to provide constitutionally protected treatments, therapies and services.…”