Prisons and COVID-19 Spread in the United States

Kaitlyn M. Sims, MSc; Jeremy Foltz, PhD; Marin Elisabeth Skidmore, PhD

Disclosures

Am J Public Health. 2021;111(8):1534-1541. 

In This Article

Abstract and Introduction

Abstract

Objectives: To empirically evaluate the relationship between presence of a state or federal prison and COVID-19 case and death counts.

Methods: We merged data on locations of federal and state prisons and of local and county jails with daily case and death counts in the United States. We used a selection-on-observables design to estimate the correlation between prisons and COVID-19 spread, controlling for known correlates of COVID-19.

Results: We found empirical evidence that the presence and capacities of prisons are strong correlates of county-level COVID-19 case counts. The presence of a state or federal prison in a county corresponded with a 9% increase in the COVID-19 case count during the first wave of the pandemic, ending July 1, 2020.

Conclusions: Our results suggest that the public health implications of these facilities extend beyond the health of employees and incarcerated individuals, and policymakers should explicitly consider the public health concerns posed by these facilities when developing pandemic-response policy.

Introduction

Prisons, meat-packing plants, nursing homes, and rural health systems have all been identified as structural vulnerabilities to US public health,[1] but our understanding of the role of prisons in COVID-19 spread is limited. As of November 30, 2020, at least 252 000 incarcerated individuals (incarcerated persons and detainees) and employees in US prisons and jails tested positive for the coronavirus, and 1450 died.[2] Incarcerated individuals are a highly vulnerable population whose barriers to timely health care include requiring incarcerated individuals to pay copays for health care, a practice that is legal in 35 states.[3–5] People of color are both disproportionately represented in prisons and disproportionately affected by COVID-19.[6–8] Finally, prisons are vital to the economy of many small and midsized towns in America.[9] Despite these issues and calls for increased public health interventions in prisons,[10] the statistical relationship between prisons and COVID-19 cases and deaths has not been adequately quantified.

Recent work has highlighted the structural vulnerabilities of prisons and the public health risk to the surrounding communities.[1,11] Incarcerated individuals and employees at prisons are at risk from "crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multi-person vehicles."[12] (p587) There have been numerous case outbreaks in prisons,[5,13] particularly during the first wave of the pandemic.[14]

Prisons are worthy of special public health scrutiny because closing prisons is politically and practically challenging compared with other institutional settings (such as meat-packing plants and schools) that have also been shown to foster COVID-19 outbreaks. Even when prisons are "shut down," incarcerated individuals and correctional employees remain on-site, and employees typically return to their homes after their shifts. In contrast, meat-packing plant closures have been somewhat successful in slowing outbreak growth, in part because meat-packing plant employees are not on-site.[15] The inability to close a prison suggests that containing and slowing an outbreak from a prison may pose a greater challenge. In this light, our finding that outbreak magnitude is increasing in proportion to prison population and capacity has important implications for local public health officials as well as prison facility planning and management.

The evidence we show that prisons are correlated with COVID-19 spread could be of particular use to researchers and policymakers working in rural and suburban contexts. Over 2.1 million people are incarcerated in the United States at any given time; following a surge of prison construction in the 1990s, a disproportionate number of prisons are located in nonmetropolitan areas.[9,16,17] There is a broad literature of community economic development on the impacts of prisons on the communities in which they are located.[18,19] The existing literature on the public health implications of prisons on the surrounding communities, however, focuses more on public health within the prison populations as opposed to potential spillovers from prisons to the health of the surrounding population. In light of the current pandemic and the salience of these facilities, our work provides vital insight on the intersection between prisons and short- and long-term public health outcomes.

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