By Drs. Scott Heysell and Rebecca Dillingham

In February, the Diamond Princess cruise ship, quarantined in the port of Yokahama, Japan, harbored the largest cluster of people with COVID-19, the disease caused by the novel coronavirus (SARS-COV-2), outside of mainland China.

As the global pandemic has spread, COVID-19 outbreaks have been associated with more than 25 additional cruise ship excursions. Features of a cruise ship — including crowded congregate areas, “high-touch” shared surfaces and passengers’ limited ability to disembark — create an environment where infectious diseases such as COVID-19 can be easily transmitted from person to person.

Yet last week, Cook County Jail in Chicago became the nation’s largest-known single source of COVID-19, exceeding that of any cruise ship or the outbreak on the U.S.S. Theodore Roosevelt.

Virginia currently detains around 60,000 people in conditions that, from the perspective of rapidly transmitting viruses like COVID-19, are similar to landlocked cruise ships. The people incarcerated in and working for the 41 state prisons, 72 local and regional jails and nine secure juvenile facilities are at serious risk of contracting and dying from COVID-19. This risk of transmission extends to the communities that support these correctional facilities.

Distinct from the ocean-going cruise ships that voyage with well-equipped medical personnel and ample supplies for cleaning and disinfecting, correctional facilities in Virginia are overcrowded and medical care is often substandard.

Infectious diseases in prisons and jails are notoriously difficult to diagnose. Measures to contain outbreaks such as isolating individuals in a single cell can constitute psychological torture, worsen other medical problems and do not eliminate infection risk given shared air supply as well as the necessity for food delivery and exchange of other items between prisoners and correctional staff. As a stark example, we were saddened to learn that a youth in the Bon Air Juvenile Correctional Center in Midlothian had tested positive for COVID-19, and we were further dismayed to learn that all residents of the facility were now living in “medical isolation,” which some youth have reported means room confinement up to 23 hours per day.

Correctional staff, unlike staff on cruise ships, work in shifts and return home to their communities each day. Under-resourced in personal protective equipment and training, these employees may act as critical transmission links from the correctional facility to their family and friends, thereby accelerating the spread of disease.

Indeed, of the 387 confirmed cases of COVID-19 in the Cook County Jail outbreak, 115 were staff members. Similarly, the Virginia Department of Health reports that amongst those people testing positive within the Department of Corrections fully half of the 42 people to suffer COVID-19 have been correctional staff. This is likely an underestimate given the limited availability of testing. To reason that a prison or jail is one of the safer places to be in a pandemic, as some have argued, is not only historically and epidemiologically false, but if applied to policy, simply dangerous.

To quell the spread of COVID-19 throughout the corrections system and into the communities that support those facilities, officials must urgently act to reduce the detained population. Gov. Ralph Northam recently announced that the Virginia Department of Corrections will begin releasing inmates with records of good behavior and with less than a year left of their sentence, but this decision awaits approval by the General Assembly and only when they reconvene on April 22.

As we approach the projected peak of new cases in Virginia by the end of the month, there is no time to wait. Governors of Colorado, Kentucky, and Michigan have already acted quickly to accelerate the release of thousands of inmates to curb the pandemic in their own states.

In their letter to Governor Northam, The Legal Aid Justice Center provides a comprehensive template of recommendations for more expansively and rapidly reducing the detained population. Courageous decisions by Governor Northam’s administration to close schools and businesses have likely contributed to slowing the spread of the virus in much of Virginia.

We therefore echo the center’s call for the governor to take another bold step to protect the health of the commonwealth and to examine all release mechanisms available to him under law, not only for prisons, but also for people incarcerated in localities not administered by the Department of Corrections and for youth detained in secure juvenile facilities.

These mechanisms include pardons, clemency and medical evacuation for older people or those with chronic medical conditions. Furthermore, we ask for health and sanitation inspections of immigration detention centers in Caroline County and Farmville, where detainees have undertaken a hunger strike over COVID-19 concerns.

Allowing some of the most vulnerable citizens of our commonwealth, those who are passengers of our landlocked correctional facilities, to disembark can be accomplished with haste and within a scientifically, ethically and legally supported framework.

This action will limit further transmission of COVID-19 in our communities and will save lives.

Scott Heysell MD, MPH and Rebecca Dillingham MD, MPH are both infectious disease physicians and global public health professionals at the University of Virginia. Together they have more than 30 years of experience focused on caring for people with infectious diseases as well as an equally strong commitment to community-engaged research that exposes and addresses health inequities.