Institutional Responses to the COVID-19 Pandemic in American Prisons

We analyzed the prevalence of chronic illnesses, including mental illness, and access to health care among US inmates. We used the 2002 Survey of Inmates in Local Jails and the 2004 Survey of Inmates in State and Federal Correctional Facilities to analyze disease prevalence and clinical measures of access to health care for inmates. Among inmates in federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition. Among inmates with a mental condition ever treated with a psychiatric medication, only 25.5% (SE = 7.5%) of federal, 29.6% (SE = 2.8%) of state, and 38.5% (SE = 1.5%) of local jail inmates were taking a psychiatric medication at the time of arrest, whereas 69.1% (SE = 4.8%), 68.6% (SE = 1.9%), and 45.5% (SE = 1.6%) were on a psychiatric medication after admission. Many inmates with a serious chronic physical illness fail to receive care while incarcerated. Among inmates with mental illness, most were off their treatments at the time of arrest. Improvements are needed both in correctional health care and in community mental health services that might prevent crime and incarceration.

Despite growing inmate populations in the USA, inmates are excluded from most national health surveys and little is known about whether the prevalence of chronic disease differs between inmates and the non-institutionalised population. Nationally representative, cross-sectional data from the 2002 Survey of Inmates in Local Jails, 2004 Survey of Inmates in State and Federal Correctional Facilities and 2002-4 National Health Interview Survey Sample Adult Files on individuals aged 18-65 were used. Binary and multinomial logistic regression were used to compare the prevalence of self-reported chronic medical conditions among jail (n = 6582) and prison (n = 14,373) inmates and non-institutionalised (n = 76 597) adults after adjusting for age, sex, race, education, employment, the USA as birthplace, marital status and alcohol consumption. Prevalence and adjusted ORs with 95% CIs were calculated for nine important chronic conditions. Compared with the general population, jail and prison inmates had higher odds of hypertension (OR(jail) 1.19; 95% CI 1.08 to 1.31; OR(prison) 1.17; 95% CI 1.09 to 1.27), asthma (OR(jail) 1.41; 95% CI 1.28 to 1.56; OR(prison) 1.34; 95% CI 1.22 to 1.46), arthritis (OR(jail) 1.65; 95% CI 1.47 to 1.84; OR(prison) 1.66; 95% CI 1.54 to 1.80), cervical cancer (OR(jail) 4.16; 95% CI 3.13 to 5.53; OR(prison) 4.82; 95% CI 3.74 to 6.22), and hepatitis (OR(jail) 2.57; 95% CI 2.20 to 3.00; OR(prison) 4.23; 95% CI 3.71 to 4.82), but no increased odds of diabetes, angina or myocardial infarction, and lower odds of obesity. Jail and prison inmates had a higher burden of most chronic medical conditions than the general population even with adjustment for important sociodemographic differences and alcohol consumption.

Infection control instructions call for use of alcohol-based hand rub solutions to inactivate severe acute respiratory syndrome coronavirus 2. We determined the virucidal activity of World Health Organization–recommended hand rub formulations, at full strength and multiple dilutions, and of the active ingredients. All disinfectants demonstrated efficient virus inactivation.