Prisons and COVID-19 Spread in the United States

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


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

In This Article


We present the first empirical evidence that prisons are strongly correlated with COVID-19 case counts. The relationship is robust to multiple specifications and is increasing in prison capacity. Our results highlight public health concerns in suburban and rural America with respect to the presence and scale of prison facilities. Although economies of scale exist in general for prisons in terms of profitability and cost-effectiveness and for local policymakers in terms of job creation, we found evidence that public health risk is higher around larger facilities. These counties may also need proportional public health infrastructure to cope with potential adverse outcomes.

Our results suggest that coordinated responses, particularly closures, may be effective in slowing the spread of outbreaks in and around prisons. Prisons, in conjunction with small or underfunded local hospitals, may make rural outbreaks worse or unmanageable. Community leaders will want to consider the role of prisons when developing response plans for outbreaks of communicable disease. Such response plans should include the spatial distribution of personal protective equipment, equipment such as ventilators, and general prevention funds, making specific considerations for the safety of incarcerated individuals, prison employees, and their families. Coordination between prison and public health officials on mitigation strategies is vital to keeping these essential institutions functional.

Finally, this work speaks to structural vulnerabilities of the US health care system that are deserving of the focus of policymakers. The impact of COVID-19 in these facilities—and the impact of these facilities on their wider communities—underscores how unprepared US health care and carceral systems are for global health crises.