Institute of Government and Public Affairs Task Force on the Impact of the COVID-19 Pandemic POLICY SPOTLIGHT | JUNE 30, 2020 Authors Pandemic Behind Bars: Sage Kim, PhD, Associate Professor, Health Policy & Administration, School of Containing COVID-19 Outbreaks Public Health, University of Illinois at Chicago in Illinois Correctional Settings Tim Jostrand, MPH, Alumni, Health Policy & Administration, School of ll around the United States, prisons and jails have become Public Health, University of hotspots for COVID-19. Inmates and staff working at state Illinois at Chicago Acorrectional facilities, and those living in the surrounding communities, are all at heightened risk of contracting COVID-19.1 Ali Mirza, Wolff Intern, The Illinois Department of Corrections (IDOC) is grappling with Institute of Government localized COVID-19 outbreaks and is likely to face more outbreaks and Public Affairs, if proactive measures are not taken to bolster self-hygiene, social University of Illinois distancing, and testing availability. System Robin Fretwell Wilson, Director, Institute of Government and Public Affairs, University of Illinois System; Roger and Stephany Joslin Professor of Law, University of Illinois College of Law Contact: Robin Fretwell Wilson, Director, IGPA: (217) 244-1227 1 This Policy Spotlight documents the growing con- cern for the health of the incarcerated population and explores the implication of unabated prison and jail COVID-19 outbreaks for the health of Illinois communities where correctional facilities are located. It argues that jails and prisons are not isolated or removed from the community. Pre- venting COVID-19 transmission in jails and prisons requires steps to ensure that COVID-19 outbreaks within correctional settings do not spill over to the surrounding communities, and that infection does not enter into correctional facilities from the community. Meeting the public health and mental health needs of inmates is not only just, it is smart public health policy. OUTBREAKS IN ILLINOIS CORRECTIONAL FACILITIES As of June 22, the Cook County Jail (CCJ) had reported 558 people who had confirmed cas- es of COVID-19. Of these, 527 have recovered, seven have died and 24 were currently positive. This is across a population of 4,515 detainees,2 and together, these account for 12.3% of CCJ can help minimize the disproportionate impact of detainees. CCJ employees have been hit hard as COVID-19 on minority communities. well. By June 22, 446 cases had been confirmed among the CCJ staff: 36 employees were posi- In state correctional facilities, COVID-19 affects tive for COVID-19 on that date, an additional 407 both the inmate population and staff. At 12 of staff had recovered, and two correctional officers IDOC’s 24 correctional centers across Illinois, and one deputy had died due to COVID-19.3 This 274 inmates had tested positive for COVID-19, of represented roughly 14.9% of CCJ’s workforce of whom 225 had recovered as of June 22. The most approximately 3,000 employees.4 recent information publicly available indicates 13 had died as of June 9.8 On May 29, 2020, federal judge Matthew Kennelly denied Cook County Sheriff Thomas Dart’s request Staff are not immune to these risks. By June 22, to stay an April 2020 preliminary injunction in a 184 IDOC staff had tested positive, of whom 167 class action lawsuit over jail conditions. The judge had recovered across the 24 facilities.9 Notably, ordered the sheriff to implement a number of some of the staff infection was among people who measures to protect inmates from COVID-19 infec- worked at IDOC treatment facilities, such as the tion. These ranged from ceasing to use “crowded Elgin, Joliet, and Kewanee treatment centers. None bullpens” at intake to enforcing “social distancing of these facilities reported any inmate cases.10 in most of the Jail,” testing for symptoms, ensur- ing “actual” access to sanitation, and “enforcing COVID-19 cases are not equally distributed across cleaning and sanitation” throughout CCJ.5 IDOC facilities. By June 22, Stateville Correctional Center and its Northern Reception and Classifica- Mitigation measures in correctional facilities affect tion Center (NRC) in Will County accounted for not only the health of inmates but also that of the 68.2% of the total IDOC inmate confirmed cases public. A study published in the journal Health (187 of 274 confirmed IDOC inmate cases).11 Affairs documents that 15.9% of all confirmed COVID-19 cases in Chicago on April 19 were Additionally, 79 Stateville staff and 37 NRC staff associated with cycling through CCJ, meaning have contracted COVID-19, of whom 108 have that “arrest and pre-trial detention practices may recovered. Stateville and NRC confirmed staff cas- be contributing to disease spread.”6 Importantly, es comprise 63% of all 180 IDOC staff cases as of the majority of CCJ detainees are racial or eth- June 22.12 nic minorities, which are populations that also are most affected outside jail by the COVID-19 The confirmed case rate in some correctional set- pandemic.7 Policies to reduce transmission in jail tings is significantly higher than the rate in Illinois’ Contact: Robin Fretwell Wilson, Director, IGPA: (217) 244-1227 2 general population as of June 22, which is a rate Stateville Correctional Center before IDOC report- of 1,082 per 100,000 persons.13 In the Stateville ed its first COVID-19 inmate death on March 30.16 Correctional Center, for instance, the confirmed The average incubation period after exposure case rate for inmates is estimated at 16,447 per to the virus is 5.1 days17 and the time to death is 100,000 persons (187 confirmed cases in an estimated to be 17.8 days.18 Thus the infection was inmate population of 1,137),14 while for the staff likely present and spreading within the Stateville the case rate is 6,049 per 100,000 persons (79 of Correctional Center in early- to mid-March. 1,306 employees).15 Confirmed cases are reported by facility but not Figure 1 provides a comparison of confirmed case the number of tests performed. This makes it dif- rate per 100,000 persons among Illinois, Chicago, ficult to gauge risk to the inmate population or to IDOC, and CCJ populations as of June 22. the communities surrounding correctional facil- ities where their workforces reside. A decline in Figure 1: COVID-19 confirmed cases may be due to declin- Confirmed case rate per 100,000 persons ing transmission or to a lack of testing. Confirmed case rate/100,000 Since June 22, IDOCConfirmed has reported case ra teonly/10 a0, handful000 of additional cases. Without sufficient testing, it Illinois population is difficult 60608to know the breadth of the infection among inmates. The Southern Illinoisan newspa- Chicago per in CarbondaleCCJ reported that less than 2% of population inmates were tested by early May.19 As of June IDOC 9, IDOC indicated that only about 900 inmates inmates had been tested60403 for COVID-19.20 Overall, however, IDOC does not report the number of tests per- IDOC formed inState eachville facility. Instead, IDOC’s COVID-19 sta supply inventory reports show the number of CCJ COVID-19 tests in each facility’s inventory. Just detainees over 2,900 tests60551 showed as available to all IDOC facilities on June 17 for more than 30,000 prison Stateville Sheridan inmates inmates.21 East Moline The number of tests is dwarfed by needs. Con- inmates sider East Moline61244 which reported an outbreak of Sheridan 28 casesEast among Moline inmates and four among staff inmates on June 22.22 The facility houses 1,055 inmates.23 0 2,000 4,000 6,000 8,000 1 12,000 14,000 16,000 18,000 0,0 0 2,000 4,000 6,000 8,000 1 12,000 14,000 Their inventory shows 110 tests since the May0, 19 24 000 00 report, up from 24 tests on April 30. Testing is an essential tool to preventing transmis- Sources: Population data on June 22. Illinois Department of Public sion between corrections and the general pop- Health, COVID-19 Statistics Website, https://perma.cc/F9BT-LQWM; ulation in surroundingConfirmed areas. cases It isin vitalZIP code to explore U.S. Census Bureau, “Quick Facts: Chicago,” https://perma.cc/ surrounding correctional facility RA4C-P6VL. Prison inmate populations as of April 22, 2020: Illinois ways to minimize risk of transmission between Department of Corrections, https://illinois.gov/idoc/facilities/pages/ corrections andConfirmed surrounding cases communities. in correctional Ade- facility covid19response.aspx. quate testing of inmates and staff is needed not only to contain transmission among detainees but also to prevent spread to staff who likely live Confirmed case rates at these IDOC facilities near the facilities. Of course, testing can also as- exceed case rates across Illinois. CCJ’s rate is sist local communities with early detection of an more than six times that of surrounding Chicago outbreak.25 (12,270 vs. 1,956 per 100,000 persons). The fact that the confirmed-case rates for certain facilities COVID-19 cases have been confirmed to have are at such high levels indicates that their con- occurred in 101 of the 102 Illinois counties, as of ditions have not allowed effective mitigation or June 22.26 Certain communities are sites of pris- containment. ons that are near or over capacity.27 This includes Graham Correctional Center in Hillsboro, State- There are good reasons to believe that coronavi- ville Correctional Center in Joliet, and the prison rus was spreading inside IDOC facilities such as in Dixon. COVID-19 outbreaks, if not contained, Contact: Robin Fretwell Wilson, Director, IGPA: (217) 244-1227 3 could spread through the community in which county, similar to prisons in other states, including officers and staff reside.