COVID-19 Preventive Measures in Northern California Jails: Perceived Deficiencies, Barriers, and Unintended Harms

Abstract

BackgroundCarceral facilities are high-risk settings for COVID-19 transmission. Little is known about the hidden burden of infection or practical barriers to infection control in these settings, especially in jails. There is also limited research on the mental health impacts of the pandemic among people living and working in carceral facilities.MethodsBetween July 8, 2020 and April 30, 2021, we performed SARS-CoV-2 rapid antibody testing and administered a questionnaire among residents and staff of four Northern California jails. We utilized multivariable logistic regression, adjusting for demographic and carceral characteristics, to analyze factors associated with prior infection, including perceived likelihood of prior infection and access to new masks. We additionally assessed the implementation of, perceptions toward, and impacts of COVID-19 policies in practice. We engaged stakeholder representatives, including incarcerated individuals, to guide study design, procedures, and results interpretation.ResultsWe enrolled 788 jail residents and 380 jail staff. Nearly half of residents and two-thirds of staff who were antibody-positive had not previously tested positive for COVID-19. Among residents without a prior COVID-19 diagnosis, antibody positivity was significantly associated with perceived likelihood of prior infection (adjusted OR = 8.9; 95% CI, 3.6–22.0). Residents who had flu-like illness in jail cited inadequate responses to reported illness and deterrents to symptom reporting, including fears of medical isolation and perceptions of medical neglect. Residents also disclosed deficient access to face masks, which was associated with antibody positivity (adjusted OR = 13.8, 95% CI, 1.8–107.0). Worsened mental health was pervasive among residents, attributed not only to fear of COVID-19 and unsanitary jail conditions but also to intensified isolation and deprivation due to pandemic restrictions on in-person visitation, programs, and recreation time.ConclusionCarceral settings present significant challenges to maintaining infection control and human rights. Custody officials should work diligently to transform the conditions of medical isolation, which could mitigate deterrents to symptom reporting. Furthermore, they should minimize use of restrictive measures like lockdowns and suspension of visitation that exacerbate the mental health harms of incarceration. Instead, custody officials should ensure comprehensive implementation of other preventive strategies like masking, testing, and vaccination, in conjunction with multisector efforts to advance decarceration.

COVID-19 and Influenza Infection Prevention and Control Measures in U.S. Jails, Prisons, and Detention Centers: A Scoping Review

“…Five results examined the impact of de-densification on infection rates (Chin, Ryckman, et al, 2021; Jimenez et al, 2020; Leibowitz et al, 2021; Liu et al, 2022; Vest et al, 2021). Vest et al (Vest et al, 2021), Leibowitz et al (Leibowitz et al, 2021), and Jimenez et al (Jimenez et al, 2020) investigated links between how full a prison is and infection rates.…”

“…All three studies concluded that decarceration may be an effective mitigation measure. Chin et al (Chin, Ryckman, et al, 2021), Leibowitz et al (Leibowitz et al, 2021), and Liu et al (Liu et al, 2022) demonstrated that having a smaller number of cellmates reduces the risk of COVID-19 infection for people who are detained in state prisons. Chin et al (Chin, Ryckman, et al, 2021) found that dormitory residents had higher infection rates than cell residents (adjusted hazard ratio, 2.51; 95% CI, 2.25-2.80).…”

“…Leibowitz et al (Leibowitz et al, 2021) found that for each 10-percentage-point increase in single cell units in facilities, the incidence rate decreased by 18% (95% CI, 0.73-0.93). Liu et al (Liu et al, 2022) used cross-sectional antibody testing to show that having eight or more cellmates was associated with an increased likelihood of previous infection relative to zero or one cellmate (OR, 1.8; CI, 1.0-3.3). All three studies used data from 2020 and early 2021.…”

“…Using antibody testing and a questionnaire administered to jail residents, Liu et al (Liu et al, 2022) investigated contributors to COVID-19 infection in four California jails. They found that having access to new masks more frequently (once a week compared with more infrequently than that) was associated with a decreased risk of infection (OR 13.8; 95% CI 1.8-107.0) (Liu et al, 2022).…”

“…Criminal-legal involved populations, including people who are detained and incarcerated in jails, prisons, and detention centers, are more likely to be infected with and die from viral respiratory infections. COVID-19 shined a spotlight on the structural conditions of carceral settings that facilitate the transmission of respiratory pathogens: overcrowding, a high number of visitors, poor ventilation, and inadequate access to soap, water, and personal protective equipment (Beaudry et al, 2020; Bick, 2007; Hammett et al, 2002; LeMasters et al, 2022; Liu et al, 2022; Montoya-Barthelemy et al, 2020; Norton & Heiss, 2020; Reinhart & Chen, 2020). The synergistic impact of an aging incarcerated population, higher rates of chronic diseases, including substance use disorder, and suboptimal access to healthcare in carceral settings leads to worse outcomes from COVID-19 (Dir et al, 2022; Hawks et al, 2020; Saloner et al, 2020; Strodel et al, 2021).…”