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Prevent and Combat COVID-19 and Contagious Diseases in Corrections

by Dr. Anne Spaulding

Hi, I'm Ann Spalding and I am a public health physician. I've been trained in internal medicine and infectious disease. I have a Master's in Public Health from Johns Hopkins and I've been working in corrections since the mid-1990s.

Let's talk about prevention of COVID-19 in your correctional facility. So we've heard a lot of talk about the new Coronavirus. It is a Type B, which is more dangerous than the type A of Coronavirus that causes colds. The type B is like MERS and SARS and it causes much more severe disease. Let's talk about preventing this new disease from getting into your facility.

What's important about COVID-19 is screening and isolating. As we're talking about screening, we want to make sure that not only people who are coming into custody, but also people who work in a correctional setting will not be transporting this new virus into your facility.

There are three things that we'll be doing every day:

1. Make sure your staff is not coming in sick with fever, shortness of breath or cough. If somebody is sick as they report to work, they need to go home. You don't want somebody who should be at home on the job making everybody else who's working that day sick, making your population sick.

2. Screen offenders who are coming into custody to ensure they're not with fever, cough, and shortness of breath. Depending on your circumstances, you can take a temperature best. It's to have a no-touch means of taking a temperature. If the temperature is over a 100.4, you need to worry about the person.

3. Know about exposures of individuals before they come or have they been in an area where there is transmission ongoing in the community? Have they been exposed to cases on the outside prior to coming in?

A correctional facility, especially a small correctional facility with a small staff does not need to have medical be present 24x7 to ask important screening questions. Have you had a significant exposure? Are you sick? As people come in and they're sick for staff that can't get out of the building immediately for people who are in custody, you want to put a mask on that person and the type of mask we're talking about is a surgical mask, not an N95 (respirator). The sick person wears a surgical mask. There may be a time when we will be running out of masks. If somebody who's coughing is without a mask, have them cough into their elbow. Make sure you don't have people coughing without covering their nose and mouth. The other thing you want to do immediately is to get that person out of the general flow going into your population.

The best way to isolate somebody who is sick is to have them in a negative pressure room. If you don’t have a negative pressure room, or there’s no negative pressure bed space available, the next best is a closed room. If there's a trap on the door, keep it closed rather than open. You want to keep air inside and not coming out infecting others.

Who should be transported out? Inmates who are unstable. Inmates who are going to fare worse with this disease are those who are older, and those inmates who have underlying medical conditions such as diabetes, high blood pressure, and heart disease. Inmates with underlying medical conditions and people who are older can go downhill fast.

If community resources are not tapped out, rescue can be called. EMT could be called if those resources are not available. The safest way to have somebody be transported is to make sure that the people who are doing the transporting have both distance and barriers.

The people who are doing the transporting should have a mask and ideally it would be an N95 mask that would prevent particles, prevent droplets from coming in. But even a surgical mask would be better than nothing. Also, the inmate who is ill should be wearing a surgical mask. If the windows are down, it's going to be safer than if the windows are up. So consider making sure there's air circulation in that vehicle. We want to keep people spaced as far apart as possible in order to keep our population healthy.

This is the time to be thinking about video arraignment at the correctional facility rather than packing people into a van and taking them. If you are able to have people have telemedicine evaluations rather than bringing them to a healthcare facility on the outside, that would be another time when people who are not sick now are not going to be around people who are potentially sick.

Let's talk about keeping your facility clean. We want to clean high touch surfaces in our jail, so the handles of doors, things that people push, the bars that people are holding onto clean those frequently. We want to use cleaning material that can destroy this virus. If you look at cleaning material such as hospital-grade disinfectants on the back, it will say this has been tested against Coronaviruses and it will destroy Coronaviruses. We also have some evidence to make us believe that a household bleach will also work (diluted per instructions). You do not want to mix bleach with ammonia.

One other question that comes up is how do you clean a room after somebody with COVID-19 or high suspicion of it has been in the room. We want to have some time where that room has air exchanges before we put somebody else in that room.

The room should not be immediately available for another person to use. As of now, wait at least two hours before another person is placed in that room.

We should encourage people who are working in correctional facilities to stay on top of the news. We're in a people business where we're dealing with individuals all the time and be aware of what's going on nationally, what's going on in your community.

The bottom line for these times is to realize who we are. We're in corrections and we deal with threats all the time. We deal with risk all the time and we stand up to the challenge and we do well. We've done well with this before. We can continue our good work. We can be thoughtful, we can be proactive and we don't need to panic.