brie.williams@ucsf.

edu
http://amend.us

COVID-19 in Correctional Settings

General remarks – press conference, New York.

Amend at UCSF and the Criminal Justice & Health Program at UCSF

March 22, 2020

Brie Williams, MD, MS

Professor of Medicine, UCSF Division of Geriatrics
Director Criminal Justice & Health Program at UCSF
Director, Amend at UCSF

Thank you for inviting me to share some of the public health perspectives on this issue, I want to
cover a few basics on why this is an emergency in prisons and jails and some important next steps
that we must take. The possibility for accelerated transmission and poor health outcomes of patients
with COVID-19 in prisons and jails is extraordinarily high for several reasons.

1. Medical vulnerability. It may seem like a strange analogy, but just like cruise ships, prisons
and jails are communities enriched with very medically vulnerable people (especially people of
older age or with serious medical conditions). These individuals are eating, working and living
together in close quarters. This translates in increased risk spread of disease. These
populations also have the highest risk of acute illness when infected with COVID-19. This risk is
compounded by the frequent occurrence in many facilities of inadequate sanitation coupled
with little space, making effective social distancing in many facilities virtually impossible.

2. Medical treatment capacity is not at the same level as it is in a hospital. Correctional

healthcare centers can only treat relatively mild types of respiratory problems for a very limited
number of people. This means that people who become seriously ill while in prisons and jails
will be transferred to community hospitals for care. Which leads to the next point,

3. Prisons and jails are not actually isolated from our communities. UNLIKE cruise ships,
prisons and jails are not sealed off from the outside world. COVID-19 will not respect the walls
of a prison, and hundreds of thousands of correctional officers and correctional healthcare
workers enter these facilities every day, returning to their families and to our communities at
the end of their shifts, bringing back and forth to their families and neighbors and to
incarcerated patients any exposures they have had during the day. For this reason,
correctional health is public health. Decreasing risk in prisons and jails decreases risk to
our communities.

So how do we decrease risk?

1. First, we have to understand that in this moment we cannot practice business as usual, for this
moment, public health and public safety are entwined in a unique way.

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 brie.williams@ucsf.edu
http://amend.us

2. Instead, we have to take a public health approach which includes taking several immediate
steps:
• From a public health perspective, We have to decrease institutionalization (basically,
decarcerate) anyone and everyone possible. This means that we should:
o Create an emergency multidisciplinary taskforce to assess all people who are
older and/or with serious conditions for their suitability for release, including access
to a healthcare plan on outside and non-institutionalized housing
o SECOND: we should use this multidisciplinary taskforce to also identify anyone
(even those not ill) who is suitable for release – including those with a place to go
and who are within several months of release or who are deemed not to be an
immediate threat to the community. Reducing the overall population will help
medical professionals spread their clinical care services throughout the remaining
population more efficiently.
o THIRD: with a smaller population healthcare and correctional leadership will be
more able to institute shelter in place and quarantine protocols for those who
remain. This will serve to better protect the health of both residents as well as
correctional and healthcare staff.
o FOURTH: those facilities that have not yet done so should immediately begin
integrating a plan for the care of those who become seriously ill with COVID-19 in
their facility into their community’s emergency public health response plan. This
includes developing an emergency credentialing plan for healthcare providers to
work in prisons and jails in case the usual workforce become ill and unable to work.

Ultimately, coordinated, preemptive, thoughtful and decisive action around decreasing the
population in prisons and jails with public health at its center will save lives in prisons, jails and in
our communities. Business as usual will not.