Prisons and pandemic preparedness

Abstract

Historically, prisons have been incubators for infectious diseases 1 because of overcrowding in confined spaces, 2 3 poor ventilation, under-resourced healthcare, and the poor physical and mental health of those incarcerated. 4 Such conditions placed prisoners at a high risk of covid-19 and increased the threat of outbreaks among the communities to which they returned. 5 Early in the pandemic, public health experts advocated for "strategic decarceration" in prisons with high population densities to prevent outbreaks and deaths. 6 7 More than a dozen countries released people from prison in response, but globally such efforts were haphazard. 8 Instead, many prison health services opted to increase testing and use of personal protective equipment, quarantines, and, once available, vaccinations.Correctional services typically introduced measures to reduce the movement of prisoners, including long term "lockdowns" and stopping in-person visits. 9 10 The mortality and morbidity associated with these measures remains unknown for most countries. However, emerging evidence suggests that the effects are likely to have been grim, particularly in prisons in areas where community transmission was high.