Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities
Authors: David Sears, Cyrus Ahalt, Dallas Augustine, Brie Williams
Journal: Annals of Internal Medicine (2020)

Ideas and Opinions27 July 2020Occupational Health: A Key to the Control of COVID-19 in Correctional FacilitiesFREEDavid Sears, MD, Cyrus Ahalt, MPP, Dallas Augustine, MA, and Brie Williams, MD, MSDavid Sears, MDAmend at UCSF: Changing Correctional Culture and University of California, San Francisco, San Francisco, California (D.S., C.A., D.A., B.W.)Search for more papers by this author, Cyrus Ahalt, MPPAmend at UCSF: Changing Correctional Culture and University of California, San Francisco, San Francisco, California (D.S., C.A., D.A., B.W.)Search for more papers by this author, Dallas Augustine, MAAmend at UCSF: Changing Correctional Culture and University of California, San Francisco, San Francisco, California (D.S., C.A., D.A., B.W.)Search for more papers by this author, and Brie Williams, MD, MSAmend at UCSF: Changing Correctional Culture and University of California, San Francisco, San Francisco, California (D.S., C.A., D.A., B.W.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-4543 Annals Author Insight Video - David Sears, MD In this video, David Sears, MD, offers additional insight into the article, "Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities." (Duration 3:17) SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Correctional facilities (prisons and jails) are the second largest source of coronavirus disease 2019 (COVID-19) outbreaks in the United States, surpassing all other non–nursing home congregate settings combined (1). The disease has swept through prisons in much the same way it has devastated nursing homes: after being introduced by staff or newly arrived residents, it spreads efficiently, including to many with medical vulnerabilities. As COVID-19 transmission continues unabated in these settings, protecting the health and safety of correctional workers is a moral imperative and an underappreciated requirement to mitigate the pandemic's effect on incarcerated persons and surrounding communities.Public health experts agree that the most critical action governments can take to reduce the risk for catastrophic prison outbreaks is to immediately and dramatically address overcrowding through depopulation (via release) (2, 3). Although few correctional systems have followed this guidance, most have taken secondary precautions to ensure that facilities are occupied almost exclusively by full-time staff and a stable resident population (for example, by limiting in-person visitation; decreasing population movements between facilities; reducing new admissions; and suspending activities of volunteers and nonessential, part-time, or transient staff) (3, 4).What has been too often lost in this conversation is the need for enhanced measures to safeguard the occupational health of correctional staff in ways that are commensurate with the risk they face while carrying out their duties. Tens of thousands of correctional workers interact with incarcerated persons and each other every day. This workforce includes correctional officers; clinicians; social workers; and janitorial, food service, administrative, and clerical staff. Most notably, uniformed correctional officers may come into close contact with hundreds of colleagues and incarcerated persons every day and are at disproportionately high risk for severe complications from COVID-19 because of high rates of chronic and behavioral health conditions (5). Although occupational health interventions should focus primarily on correctional officers given their numbers and close, sustained contact with incarcerated persons, interventions should be adapted to reduce risk for infection for all staff. At the end of every shift, each of these workers risks introducing COVID-19 into their homes, families, and communities if infected at work.Furthermore, incarcerated persons have a constitutional right to health care that meets community standards (6). Community-standard infection control in congregate living and health care facilities includes efforts to ensure that those providing care, including nonmedical staff, are not ill and capable of spreading COVID-19 to their patients (7). Patients in the community expect health care workers to be screened for infection, granted sick leave if infected, offered personal protective equipment, and evaluated for infection if they show symptoms. Yet, this community standard of occupational health is not met in many correctional facilities. Correctional officers are not universally guaranteed medical benefits or paid sick leave, and most access occupational health services via outside organizations. As a result, strategic workplace testing of asymptomatic correctional staff has not been the norm. In some states, labor agreements between correctional officer unions and departments of corrections even preclude correctional departments from requiring basic health screenings on facility entry or knowing the results of testing among these essential workers, some of whom come to work despite being infected if they have no sick leave available (8).The patchwork of policy and practice that is failing to meet the urgent occupational health crisis that COVID-19 presents in correctional systems should be of particular concern to correctional officers because their unique duties, coupled with the severe overcrowding of U.S. prisons, place them at a level of risk unmatched by an appropriate policy response to protect them. Officers escort patients with suspected or confirmed COVID-19 to medical appointments, implement housing movements for medical isolation or quarantine, help distribute medications, accompany hospitalized patients, and act as first responders to medical emergencies. Each of these activities may bring officers into close contact with the novel coronavirus, and none can be accomplished while physically distancing. In addition, because testing in correctional systems has thus far been extremely limited relative to the risk, staff members often return home at the end of each shift without knowledge of the extent of risk they or their families are facing. A growing number of COVID-19–related deaths among U.S. correctional officers underscores the health perils and outsized risk for COVID-19 complications many face (9).Fortunately, effective policy to safeguard the health of staff working in comparably high-risk settings, particularly in health care, can guide departments of corrections and correctional officer unions faced with similar challenges. To protect correctional staff and ensure that community standards of care are afforded to incarcerated populations during the COVID-19 pandemic, prisons must:1. provide staff with universal screening for COVID-19 symptoms and exposures before entry into the facility at each shift and recurrent universal testing in hot spots with widespread community transmission or in facilities with outbreaks (these measures will bring screening in line with guidelines for other congregate settings, such as nursing homes);2. reorganize staff and residents into assigned cohorts that practice physical distancing from each other and comprise as few persons as is feasible on the basis of facility resources (10);3. institute policies that promote a culture of health, including sick leave that requires workers to stay home when they are sick or have been exposed to infection;4. provide access to and training in appropriate use of hand sanitizer, soap, and personal protective equipment, including universal masking and enhanced protection when in contact with infected residents or those suspected of being infected (such as N95 masks, face shields, gloves, and gowns); and5. streamline workplace-based, no-cost clinical evaluation and diagnostic testing for staff who have COVID-19 symptoms, high-risk exposures, or known infection and are being evaluated for a return to work.Many correctional workers lack these basic protections and continue to do their jobs, in some cases playing an essential role in ensuring that incarcerated patients receive prompt access to adequate care themselves. Prison residents and staff should not fear that each encounter is needlessly putting the other at risk, nor should the staff's families or those in their communities be subject to increased risk for infection because of inadequate occupational health protections. Ensuring community-standard occupational health for correctional staff during COVID-19 will protect us all.References1. Coronavirus in the U.S.: latest map and case count. The New York Times. 12 June 2020. Accessed at www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html on 12 June 2020. Google Scholar2. Williams B, Ahalt C, Sears D, et al. COVID-19 in correctional settings: immediate population reduction recommendations. Accessed at https://amend.us/wp-content/uploads/2020/03/Amend-3.30.20-Population-Reduction-Guidance-for-DOCs_COVID-19.pdf on 20 June 2020. Google Scholar3. Akiyama MJ, Spaulding AC, Rich JD. Flattening the curve for incarcerated populations—Covid-19 in jails and prisons. N Engl J Med. 2020;382:2075-2077. [PMID: 32240582] doi:10.1056/NEJMp2005687 CrossrefMedlineGoogle Scholar4. Responses to the COVID-19 pandemic. Prison Policy Initiative. 14 July 2020. Accessed at www.prisonpolicy.org/virus/virusresponse.html on 17 July 2020. Google Scholar5. Spinaris CG. Mission critical: correctional employee health and wellness. American Jails. 2020:8-14. Accessed at https://desertwaters.com/wp-content/uploads/2020/05/2020_Spinaris_Correctional-Employee-Health-and-Wellness.pdf on 22 June 2020. Google Scholar6. Estelle v. Gamble, 429 US 97 (1976). Google Scholar7. Centers for Disease Control and Prevention. Preparing for COVID-19 in nursing homes. Accessed at www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html on 17 July 2020. Google Scholar8. Bublé C. Union files national grievance over alleged safety violations at federal prisons during coronavirus pandemic. Government Executive. 20 April 2020. Accessed at www.govexec.com/workforce/2020/04/union-files-national-grievance-over-alleged-safety-violations-federal-prisons-during-coronavirus-pandemic/164755 on 17 July 2020. Google Scholar9. The Marshall Project. A state-by-state look at coronavirus in prisons. Accessed at www.themarshallproject.org/2020/05/01/a-state-by-state-look-at-coronavirus-in-prisons on 17 July 2020. Google Scholar10. Williams B, Ahalt C, Sears D, et al. Limiting COVID-19 transmission and mitigating the adverse consequences of a COVID-19 outbreak in correctional settings: RELEASE: COHORT: TEST. Accessed at https://amend.us/wp-content/uploads/2020/05/RELEASE-COHORT-TEST.Amend_.UCB_.pdf on 20 July 2020. Google Scholar Comments 0 Comments Sign In to Submit A Comment David Sears, MD, Cyrus Ahalt, MPP, Dallas Augustine, MA, Brie Williams, MD, MSUniversity of California, San Francisco, San Francisco, California13 January 2021 Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities This article was helpful to control COVID-19 in large facilities. Author, Article, and Disclosure InformationAuthors: David Sears, MD; Cyrus Ahalt, MPP; Dallas Augustine, MA; Brie Williams, MD, MSAffiliations: Amend at UCSF: Changing Correctional Culture and University of California, San Francisco, San Francisco, California (D.S., C.A., D.A., B.W.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4543.Corresponding Author: David Sears, MD, University of California, San Francisco, 350 Parnassus Avenue, Suite 908, San Francisco, CA 94143; e-mail, david.sears@ucsf.edu.Current Author Addresses: Dr. Sears: University of California, San Francisco, 350 Parnassus Avenue, Suite 908, San Francisco, CA 94143.Mr. Ahalt, Ms. Augustine, and Dr. Williams: University of California, San Francisco, 3333 California Street, Suite 380, San Francisco, CA 94143.Author Contributions: Conception and design: D. Sears, C. Ahalt, B. Williams.Analysis and interpretation of the data: D. Sears, D. Augustine.Drafting of the article: D. Sears, B. Williams.Critical revision of the article for important intellectual content: D. Sears, C. Ahalt, D. Augustine, B. Williams.Final approval of the article: D. Sears, C. Ahalt, D. Augustine, B. Williams.Administrative, technical, or logistic support: D. Augustine.This article was published at Annals.org on 27 July 2020. PreviousarticleNextarticle Advertisement Annals Author Insight Video - David Sears, MD In this video, David Sears, MD, offers additional insight into the article, "Occupational Health: A Key to the Control of COVID-19 in Correctional Facilities." 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