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Covid 19 Vector that is largely unsupported--our prison system

The United States prison system consists of Federal, State, Municipal, County jails and prisons. A common feature of most is that there very often are few to no physicians on staff, the full time staff for the most part consisting of Nurses, Nurse Practitioners or PA's, with a visiting physician As a result, other than beds there is no system set to provide ICU type treatment for those detained ---or prison staff.

Many of the facilities are isolated, and the hospitals that serve the communities local to the faility are often small and not equipped for a large number of Coronavirus patients. Add to their threat challenge or burden is the likely course of the virus, which is to say it will gradually spread in rural areas and may hit rural communities as a series of emergency room events.

If at that time the nearest hospital starts receiving patients from prisons, there will be a significant to extreme shortage of beds, machines, trained staff.

The CDC has a framework of analysis for systems and individual institutions to use but that compliance may well require extra staff, space, equipment and training. Preparedness staff may want to consider reviewing the document and assuring that each institution has a plan and that their needs are able to be met, and if not addressed, then there needs to be information sharing of the shortfalls. https://www.cdc.gov/coronavirus/2019-ncov/community/correction-detention/guidance-correctional-detention.html

What is needed is dedicated funding availabllity to state systems to route to county or other facilities that need equipment, and training of medical students and other volunteers with medical training to serve as a cadre that can be deployed to areas where there is a growing crisis that they will not be able to handle. This requires each system in each state have regular contact with a central coordinator.

Similarly, existing personnel patterns may not be set to cope with illness caused shortages of prison staff, or of those law enforcement who usually guard prisoners in transit. Security at the medial facility and nearby hospitals would be compromised, though for those prisoners with an acute Coronavirus event, their breathing would be so impaired that there could be lesser staff used.

Currently, plans appear to be individually created, with each institution and state assuming that it may handle things as other events though the implications from non-prison populations are that lack of centralized planning invites a crisis if not a total system failure.

For instance the website for Correctional Healthcare has no template plan nor any plan for projecting inmate infections, the number of cases that will require either specialized equipment or transport to an outside facility, nor evaluating nearby facilities for their ability to cope with a mass of cases from the prison population--both inmates and correctional staff. See, e.g., https://www.ncchc.org/blog/covid-19-coronavirus-what-you-need-to-know-in-corrections

While some states assume they will be able to centralize infected persons : https://ctmirror.org/2020/04/08/state-response-to-covid-19-prison-lawsuit-sheds-light-on-its-pandemic-plans-for-sick-inmates/ this assumes that the central faility will have necessary equipment and staff trained in that equipment, neither of which necessarily exist. https://ctmirror.org/2020/04/08/state-response-to-covid-19-prison-lawsuit-sheds-light-on-its-pandemic-plans-for-sick-inmates/

Those detained in facilities for immigration system detained persons present similar problems especially the lack of nearby hospitals for some of the facilities.

The concern is that because it's everyone's problem, it's nobody's. Needs have long gone unaddressed and the result is that you have in many facilities dormitory type beds which are proximate to each other. This creates an environment of anxiety and fear in addition to the level or stressors present in prison life. Lack of adequate mental health staff, combined with the removal of the outlets of group meetings, group worship, excercise, and opportunities for mutual and family support, and the internal violent event precursors are amplified.

At a minimum, each system should be able to know which if any of its faicilties do not meet CDC or other guidelines, what the plan is to meet them, what the funding stream is, and assuming there is no funding stream, what the plan is to let state agencies, the state executive, and legislators know, because if those needs are not met through a budget supplement then there can and will likely be a crisis.

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Idea No. 998