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Prisons
Prisons
While COVID-19 puts the world’s population at risk, the disease is an ethical and logistical nightmare for inmates in prisons and jails, especially in the United States. Prison populations are extremely vulnerable for several reasons. First, studies have shown that the frequency of hypertension and asthma, among other health conditions, is higher in prison populations than the general population [1]. This puts prisoners at greater risk of developing severe SARS-CoV-2 infection. Furthermore, the racial composition of incarcerated individuals in the US means that many of the individuals infected in prisons will be African American [2]. This fact adds further complexity to the issue of racism surrounding the emergence of SARS-CoV-2. It is also worth noting that prisoners are especially vulnerable due to the constant influx of new prisoners and rotating guard systems. New prisoners are capable of bringing the virus into a location that has been previously virus-free, as are the guards that come to work and go back to their homes everyday. Moreover, some prisoners have reported that guards rotate around different parts of the prison, potentially spreading the virus across the vulnerable population [3]. Perhaps most important is the inability of prisoners to protect themselves and follow social distancing guidelines outlined by the federal government. Inmates can hardly stay six feet apart when they are packed into barracks and cafeterias, plus if they are handcuffed they may be unable to cover their mouth when they cough or sneeze. Additionally, alcohol-based hand sanitizers are prohibited as the alcohol can be separated from the gel, and soap and paper towels are scarce [4]. Towels and clothing are also washed infrequently. To some degree, prisoners may face the same level of confinement as nursing homes and cruise ships in which this virus has wreaked havoc, but the lack of autonomy of prisoners and access to basic sanitation puts these individuals at much greater risk. Together, these factors make prisons hotspots for viral transmission.
Figure 1. Prisoners are virtually unable to maintain social distancing measures. https://www.latimes.com/world-nation/story/2020-03-19/la-na-coronavirus-prisons-safety
As a result, prisoners and other officials are pleading with the Bureau of Prisons and governors to release prisoners and/or improve access to medical care inside prisons. While most prisons have halted visitor hours and some have moved more inmates to solitary confinement in an effort to prevent transmission, few have gone so far as to release significant numbers of prisoners. Those opposed to prisoner release argue that it puts citizens at risk to have inmates on the streets committing crimes (though crime rates have reduced drastically since social distancing measures became commonplace [5]). Supporters feel that releasing those who have committed non-violent crimes or have less than 180 days remaining on their sentence would help significantly reduce the burden that this virus has on America’s healthcare system. They also argue for the release of elderly prisoners and those with underlying health conditions that could put them at greater risk. (It is worth remembering that just as with the general population, if prisoners need serious medical care they will be taken to a local hospital, taking up limited beds and services.) Iran is an example of a country that took steps to reduce the prison population’s burden on the healthcare system by freeing 50 to 80,000 prisoners who were serving less than five years and tested negative for the virus [6]. The effects that this disease will wreak on the prison system is just beginning as of April 13th when over 1300 cases of COVID-19 could be linked to American prisons and jails, at least 500 in the Chicago Cook County Jail alone [7].
Officials face a difficult decision in terms of keeping their country’s population safe from criminals while trying not to deliver death sentences to vulnerable prison populations and their staff. Understanding the scale of a pandemic takes many forms, including modeling and prediction, but also consideration of how to best protect vulnerable populations, such as prisoners, so that transmission can be kept to a minimum.
College Students and Mental Health
College Students and Mental Health
The disruptions to daily life and uncertainty due to COVID-19 have immense repercussions on people’s mental health, particularly for young people (aged 18-25), who are more likely to report poor mental health than older age demographics and for whom rates of mental health disorders are higher than they have been in previous generations [8]. As college campuses closed last month, most students were sent back home, away from their friends and newfound independence to their childhood homes and parents’ rules. The college experience marks a significant developmental phase in many people’s lives. Students are missing out on celebrating milestones and developing their personal identities [9]. For those with pre-existing mental health disorders or who are looking to seek confidential help, access to campus mental health resources is limited [10]. Also, students may be experiencing heightened levels of stress due to the stability of their personal and family income, graduation into an economic crisis, sense of isolation, and fear of infecting older and/or immunocompromised adults, all on top of trying to finish the spring semester.
For students with pre-existing mental health conditions, the routines they built up as coping mechanisms and the on-campus resources they used are difficult to replicate at home. For example, those with body image and eating disorders may find it challenging to deal with less control over their food options at home, not having access to gyms, and being around family members. Furthermore, college might have been the first time that it felt safe for students to seek professional help, knowing they wouldn’t have to disclose their treatment to their parents. Without access to campus mental health services, it would be challenging for these individuals to get separate telehealth services under their parents’ insurance without them being notified. By law, mental health clinicians are only licensed to practice in the state their license is from [11]. Even the limited virtual services offered by colleges in response to students’ needs may not be feasible for students who lack spaces in their homes for privacy. Being in tight quarters with family can be detrimental to students’ well being in cases where there is a history of trauma, strict rules, insensitivity to issues of body image, or a general lack of open-mindedness.
In times of disasters, studies have shown that people report more symptoms of anxiousness, depression, and trauma during and years after the event [12]. However, there is a dearth of research on disaster mental health in young adults. Considering the pre-existing rise in mental health challenges faced by millennials and Gen Z, the stressors caused by COVID-19 should be studied in relation to those populations in order to best inform psychological interventions.
Figure 2. Managing one's mental health becomes especially difficult in quarantine and when socially isolated from one's community. https://coronavirus.dc.gov/page/public-resources
References
[1] https://jech.bmj.com/content/63/11/912.long
[5] https://time.com/5819507/crime-drop-coronavirus/
[6] https://www.bbc.com/news/world-middle-east-5172339
[10] https://www.thecrimson.com/article/2020/4/8/harvard-coronavirus-college-mental-health/
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