The vast incarcerated population is uniquely vulnerable to the pandemic as experts urge release of cash bail prisoners and others

To curb the spread of coronavirus, doctors and advocates are calling on the US to temporarily forgive bail and to clamp down on other programs that keep low-risk offenders imprisoned.

Jails and prisons remain uniquely vulnerable to coronavirus outbreaks, experts say, potentially leaving a major hole in America’s defenses against the outbreak.

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In the US, home to 22% of the world’s prison population, incarcerated people are vulnerable to the coronavirus because of their limited access to basic hygiene measures and their high rates of existing health issues.

People being transported in handcuffs also cannot cough into the crook of their elbow. Hand sanitizer with alcohol, which is what health authorities recommend people use, is contraband at most US prisons because of its alcohol content (though prisoners in New York are making it for the state). Locked up, there is no way to self-quarantine.

“The more people behind bars, the more transmissions you are going to have,” said Josiah Rich, a Brown University epidemiologist.

In countries hard-hit by coronavirus, there have been mass prison releases and even jail riots in the wake of infections.

Three Chinese provinces registered more than 500 cases of coronavirus in prisons. Iran temporarily released 70,000 prisoners. In Italy, riots occurred in at least two dozen prisons and six inmates died after they broke into an infirmary and overdosed on methadone.

At the journal Health Affairs, public health experts outlined six urgent steps needed to address coronavirus in prisons, including limiting incarceration rates. “Prisons push people into the paths of epidemics,” the authors wrote. The Prison Policy Initiative called for the release of medically fragile and older adults.

These groups also highlighted that outbreaks in prisons can radiate to the outside through visitors, correctional officers and lawyers.

Rich said an easy fix to reduce the risks is to release people who are only incarcerated because of cash bail, a payment to the court required to leave jail while awaiting a hearing.

“They are not there because we need to keep society safe, they are there because they are too poor to afford bail,” Rich said. “If they were wealthy, they would have the means. So, do we think we should keep them in there in the face of this epidemic?“

If measures aren’t taken to reduce the risk in prisons, it could place a burden on the healthcare system, which is already under threat from the spread of coronavirus.

There are about 2.8 hospital beds per 1,000 people in the US, compared with 12 per 1,000 people in South Korea, which seems to have mitigated the impact of coronavirus.

People in jail and prison have underlying health conditions at higher rates than the general population, a risk factor for coronavirus. Both jails and prisons have a 1.3% prevalence of HIV compared to 0.4% in the US generally. In state prisons, 64.7% of people smoke and in federal prisons, 45.2% of people smoke, compared with 21.2% across the US.

Coronavirus death rates are the worst in people 60 and older and the US prison population has been ageing for the past two decades. From 1990 to 2012, the US prison population aged 55 or older increased by 550%.

“When this thing pops as we think it might, and really becomes deeply ingrained, we’re going to start filling up ICU beds,” Rich said. “This is about your parents or grandparents not being able to get into an ICU bed either because they have coronavirus beds or because they have something else.”

Rich said the number one change people can make to minimize this threat is simply to reduce the number of imprisoned people. Temporarily forgiving bail is one way. Another is to release low-level, older offenders, though it is unclear where they would be sent if they do not have close friends or family members to take them in.

“In the best of scenarios, we would only hope to delay this,” Rich, director of the Center for Prisoner Health and Human Rights, said. “And because we have so many ill people behind bars, it’s going to get there, it’s going to spread like wildfire.”