As physicians with considerable combined experience and training in public health and epidemiology, we write to highlight the significant risks posed by prisons and jails in the COVID-19 pandemic. This arena has not been discussed in detail by Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, during his daily briefings about the status of the pandemic in Maine, but he wisely drew attention to the dangers posed by “congregate settings” and has pointed to those jails and prisons as being priorities for testing.

We agree, but also believe testing is not enough.   

Efforts must begin immediately to safely reduce the populations in correctional settings as much as possible. If such efforts are not undertaken, we risk the safety of not only prisoners but also staff and their families and entire communities. We believe a rapid, systematic approach to curbing the threat in prisons and jails is a key element to keeping all Mainers safe.

We are seeing how quickly this novel coronavirus can spread outside of the system. On March 19 there were 23 confirmed cases statewide. By March 26 there were 155 cases, and as we write this there are more than 340 confirmed cases and seven deaths across the state. These numbers likely don’t reflect the full picture of the coronavirus in Maine, as testing is limited, and there is no doubt they will continue to rise. But as quickly as the virus spreads under normal conditions, it will spread even faster in hotspots like jails and prisons.

That’s because maintaining 6 feet between people at all times — the physical distancing that is the most effective preventative for this disease right now — is all but impossible in jails and prisons. The single biggest risk to the spread of COVID-19 is crowding, and in prisons and jails COVID-19 can spread like wildfire, endangering prisoners, staff, and the community alike.

This is true even in the best of circumstances. Rikers Island Jail, in New York, has some of the best trained medical staff in the nation and has been following CDC guidelines since the earliest stages of this outbreak. Yet the rate of infection of Rikers Island Jail in New York City is seven times higher than the city-wide rate. Confirmed cases at Rikers went from one to 200 in under two weeks.

What some people may not know is that jails and prisons are generally not equipped to provide hospital-level care. That means that when incarcerated people become very sick, they rely on the same hospital beds and respirators as people who become sick outside of the system. Maine’s hospitals are already overburdened; we already run the risk of running out of beds, personal protective equipment for healthcare workers, and other resources without the added strain of hundreds more patients coming from the correctional system.

In light of these concerns, facilities across the country and the world have been releasing prisoners who don’t need to be locked up — enabling those individuals to physically distance in the community and reducing the threat to other prisoners and facility staff. Reducing jails and prisons is the only way the Maine Department of Corrections and county jails will be able to contain the spread of COVID-19 and decrease the threat to the greater community.

We understand that the DOC has begun this process on a case-by-case basis, which is a good start. But the pace cannot be constrained by case by case decision-making. We should set criteria for who can be safely released, and act until the numbers are low enough that every facility can maintain appropriate distancing for those who remain.   

We can start with those most at risk. Maine’s jails and prisons are full of people who meet the CDC’s definition of high risk because they have pre-existing conditions and/or are over the age of 65. And we should also look at people who have served their time and are due to get out soon. It is possible to let them out safely, and indeed it may be the safest thing we can do.

At times like this with so many challenges before us, it can be too easy to turn our backs on those who are incarcerated and hope for the best. But we cannot protect our community unless we protect all members and act across all systems. This unprecedented situation demands creative thinking and a willingness to imagine new solutions, including within the corrections system.

We know Maine officials are working hard to stop the spread of COVID-19 in our state, and we are so thankful for all that they have done and are doing. We hope they will not undermine their own good work by neglecting this crucial piece of the puzzle.

Sharon McDonnell of Yarmouth, BSN M.D. MPH, is a medical epidemiologist and public health physician. Lani Graham of Freeport, M.D. MPH, is a physician and the former director of the Maine Bureau of Public Health.

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