(Slide 1) As more and more people are attempting to keep themselves safe from COVID-19, it can be easy to forget about those who are removed from society via incarceration. Currently in the united states there are 2.3million people incarcerated. Additionally, there are around 600,000 people who enter prisons every year, with another 10.3 million cycling in and out of jails. Those who are incarcerated are currently being infected by COVID-19 at 5x the rate of the general population, and frequently have more difficulties in protecting themselves.

(Slide 2) The unites states holds about 25% of the worlds incarcerated population. Mass incarceration in the united states can be attributed to many factors, namely unfair sentencing practices, racial discrimination, the over criminalization of drug crimes.

(Slide 3) There are a number of reasons that incarcerated populations are at a higher medical risk for COVID-19 infections and having presenting more severely. First is that incarcerated populations are sicker than the average population. It is estimated that over a third of inmates have AT LEAST one chronic health condition. Frequently inmates are not engaged with primary care services outside of incarceration, and those that are can have a lag in treatment initiating once incarcerated. Frequently, treatments and medications are not continued at all behind bars. Secondly, around 25% of inmates have been diagnosed with at least one mental health condition. Frequently these can be severe such as bipolar, severe depression, schizophrenia and/or unspecified psychosis. This is compounded by a high tendency for incarcerated persons to have co-occurring substance use disorders. Lastly, incarcerated peoples are disproportionately people of color or from lower socioeconomic backgrounds with high occurrences of homelessness or housing instability.

(Slide 4) Looking at the diverse and frequently vulnerable population that make up US inmates, there are a number of factors that contribute to the inability to reduce the spread of covid-19. The first is physical structure in which they reside. The largest issue within correctional facilities is just the pure number of people within a facility. It is was found that half of states reported overcrowding within correctional institutions. This overcrowding results in inmates being unable to social distance, one if the first line defenses In preventing the spread of covid-19. Frequently there are not isolation spaces available to separate people who report feeling ill. Additionally, shared bathroom and living space make it difficult to contain infections. Adding to that are continued issues of poor or improper ventilation, lack of access to fresh air, and frequent risk to food contamination, and non-enforcement of proper hand hygiene. While COVID-19 is not directly a food borne illness, frequently workers who are sick are not removed from their duties, and frequent handwashing practices are not employed as strongly as they should be.

The second layer is personal protection for inmates. Again, living in a congregate setting already presents a risk factor for the spread of COVID-19. In many facilities, inmates do not have access to proper resources to disinfect their hands. Soap might not be free or readily available and hand sanitizer is frequently considered contraband. Masks are not always available to inmates, and currently only 15 states require inmates to wear masks at all, despite the CDC’s current recommendations. Accessing medical services can be difficult for many inmates they frequently require a disproportionately large copay. While originally implemented as a deterrent to prevent unnecessary medical visits, it is now becoming a barrier to early identification of sick individuals. Lastly, staff at correctional facilities can be frequent carriers of COVID-19. There are currently around half a million employees in the prison system alone, considered essential employees, staff frequently come into direct contact with inmates, work in under resourced facilities, lack access to appropriate PPE, and have the continual strain of increasing mental health burdens and burn out.

(Slide 5) So what can be done? The largest and simplest step to prevent the spread of COVID-19 within correctional facilities is to simply have less people incarcerated. There has been a recent push for release of those who have low level non-violent crimes, those who are elderly or medically fragile, and those who are already within 1 year of release. Additionally, within facilities, we can reduce the barriers to accessing medical services by reducing or eliminating costs, ensuring that inmates and staff have access to proper PPE and hand washing supplies, supporting mental health concerns of employees and inmates, and lastly partnering with outside institution to ensure that appropriate medical guidance, policies, and research is being done within facilities. Thank you for viewing this project and taking the time to learn about barriers that are disproportionately effecting those who are most vulnerable within society.