Prisons and Pandemics

This Article focuses on how to balance public health, public safety, and incarcerated people’s legal rights when implementing a program for early release from confinement. Ethical, epidemiological, and legal arguments all point to a need for an immediate reduction in the incarcerated population. However, this leaves open several points of reasonable disagreement about how to manage early release. These include how to set priorities for processing and releasing individuals across the country. For example, officials could prioritize screening individuals who are housed in facilities that have been hit hard by infection; or by screening individuals who have a safe place to quarantine post-release; or individuals who are being held for violations of parole, lower level and nonviolent crimes, or prior to their trials; or individuals who are most vulnerable to coronavirus; or individuals who have already served most of their sentences; and so on. This Article discusses how to set priorities for safely and quickly returning incarcerated individuals to their communities during a life-threatening outbreak. In Part II, we establish why incarcerated people are especially vulnerable during a public health emergency. For a variety of reasons, incarcerated people are more likely than the general public to acquire and to experience negative outcomes from infectious diseases, putting their health and the health of surrounding communities at risk. In Part III, we discuss the pandemic response taken by federal and state prisons and local jails and explain why it has had little success. For the most part, releases have been slow and discretionary, meaning that whether an individual is released is “like the luck of the draw” because there are “wardens in certain prisons that will get right on it, and some that won’t release a soul.” We also outline some of the recommendations proposed by bodies like the ACLU and members of Congress. Careful consideration of these different plans for releasing incarcerated people from confinement is important in order to prepare for COVID-19 in the coming months and to look toward future pandemics. In Part IV, we summarize the moral, practical, and legal arguments for making the health of incarcerated people a priority during a pandemic. These arguments rely on the ethical principle that we are morally required to protect individuals who have been deprived of the liberty to protect themselves; empirical evidence indicating that high infection rates within correctional facilities have serious public health consequences for surrounding communities; and legal precedent that suggests that incarcerated people have a right to protection from infectious diseases. Taking these arguments together, it is reasonable to support a substantial reduction in jail and prison populations, irrespective of one’s general views about the ethics and purpose of mass incarceration. In Part V, we delve into the details of how to release incarcerated people. There have been several general recommendations outlining broad guidelines for doing so. However, the ethical priorities that underlie these different recommendations have not been made explicit and have not been considered together. In this Part, we identify the various ethical considerations relevant to early release, and we argue that five factors should be given special priority. These are (1) risk of recidivism for a violent offense, (2) presumption of innocence for the accused, (3) risk of mortality from coronavirus, (4) proportion of sentence served, and (5) responsibilities to third parties

Policies for Expanding Hepatitis C Testing and Treatment in United States Prisons and Jails

Hepatitis C virus (HCV) is highly prevalent in United States prisons and jails. In prisons and jails, rates of infection are ten to twenty times greater than national levels. And, more than thirty percent of all people living with HCV in the United States will spend time in prisons and jails in any given year. Rates are especially high among people who inject drugs (PWID), a population whose members are also likely to move between carceral settings and the community. Thus, addressing HCV among incarcerated populations would have a significant effect on the virus’s transmission both in and out of confinement and is a crucial part of any HCV elimination strategy. Safe and effective HCV treatment is available. Direct-acting antivirals (DAAs) offered in an eight to twelve week course of oral treatment cure HCV in more than ninety percent of cases. Widespread testing and treatment in prisons and widespread testing and treatment or linkage to community care in jails are essential public health approaches. But testing and treatment in confinement lags behind medical guidance and public health recommendations. People incarcerated in prisons and detained in jails are entitled to adequate health care, and the U.S. Constitution prohibits deliberate indifference to their serious medical needs. In recent years, lawsuits filed by people with HCV in carceral facilities across the country have alleged violations of federal law for failure to provide DAA treatment. Although litigation results have been mixed, settlement agreements in states across the country have expanded HCV testing and broadened access to DAA treatment. These settlement agreements reflect a growing understanding that widespread testing and treatment is cost-effective, avoid the harmful health consequences of disease progression, and meaningfully reduce community transmission. This paper recommends model policies for prisons and jails to expand HCV testing and DAA treatment. The policy recommendations draw from relevant settlement agreements and current medical guidelines, supplemented by input from public health experts, medical professionals, and advocates. The paper proceeds as follows: • Part I describes the HCV epidemic in United States prisons and jails, the recent sea change in treatment protocols, and relevant clinical guidance and public health recommendations. • Part II sets out the legal landscape, including governing federal law and judicial decisions interpreting that law in this context, and describes settlement agreements in class action lawsuits addressing DAA access. • Finally, Part III offers model policies for prisons and jails to expand testing and treatment and to support successful outcomes for people with HCV in their custody

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS: A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.Supported by Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad, cofinanced by European Development Regional Fund “A way to achieve Europe”,Operative program Intelligent Growth 2014–2020 and grant PIE15/00079. This study received funding assistance from Gilead Sciences, Spain (IN-ES-337-2089), C/Vía de los Poblados, 3, 28033 Madrid, Spain, http://www.gilead. com/about/worldwide-operations/europe/spain; phone number: +34 913789830), who played no part in study design, data analysis, or in the preparation of the manuscript. All study investigators declare to be independent from funders

Hepatitis C in Prisons: Evolving toward Decency through Adequate Medical Care and Public Health Reform

Hepatitis C (HCV) in prisons is a public health crisis tied to current drug policy\u27s emphasis on the mass incarceration of drug users. Prison policy acts as a barrier to HCV care by limiting medical care for the infected, especially drug users, and by inhibiting public health measures addressing the epidemic. This Comment argues that courts mistakenly limit prisoners\u27 Eighth Amendment right to basic medical care when they defer to prisons that apply HCV policies as categorical rules of treatment. Where current standards of care mandate individualized patient evaluation for treatment, prison policies that eschew this principle exhibit deliberate indifference to prisoners\u27 medical needs. Additionally, this Comment looks beyond deliberate indifference to contemporary standards of adequate medical care and prisoner reentry, proposing that evolving standards of decency require greater care than existing Eighth Amendment standards articulated by the U.S. Supreme Court, and that prisoner reentry policy holds the potential for a shift toward public health reform of prisons. Ultimately, this Comment argues that HCV in prisons implicates a set of critical challenges calling for a fundamental rethinking of the prison as a medical provider, a public health institution, and a part of the community

Interventions to increase vaccine uptake among people who live and work in prisons : a global multistage scoping review

The objective of this study is to examine interventions implemented to increase vaccine uptake among people who live and work in prisons around the world. Peer-reviewed and gray literature databases were searched systematically to identify relevant information published from 2012 to 2022. Publications were evaluated by two researchers independently and underwent quality assessment through established tools. Of the 11,281 publications identified through peer-reviewed (2607) and gray literature (8674) search, 17 met the inclusion criteria. In light of limited data, the identified interventions were categorized into two categories of educational and organizational interventions, and are discussed in the text. The lack of availability of vaccination services and interventions to increase vaccine uptake among people who live and work in prisons, worldwide, is a serious public health concern. These interventions reported in this review can be adapted and adopted to mitigate the burden of infectious diseases among people who live and work in prisons

Arrested Adults Awaiting Arraignment: Mental Health, Substance Abuse, and Criminal Justice Characteristics and Needs

This Study is one of the first to look at the mentally ill during the pre-arraignment process. The pre-arraignment process is an excellent place to identify individuals with mental health and substance abuse problems, to examine those problems, to consider legal interventions, such as diversion or routing to specialized courts, for instance, drug and mental health courts, and to plan for community mental health, substance abuse, health, and social service interventions. Following a brief review of the literature on rates of substance abuse and mental health problems for ciminal justice populations, the process from arrest to arraignment in Kings County (Brooklyn) is described. This Study concludes with a discussion of the implication of results for practice, criminal justice intervention, and policy