Solitary confinement can’t stop COVID-19 from spreading through prisons

In fact, it might make the public health crisis worse.
Prison cell with a sink and toilet behind bars
As COVID-19 spreads through too-dense prison populations, wardens are turning to lockdowns and non-medical isolation. Umanoide/

Robin Blades is a freelance science journalist and a clinical researcher at the University of California, San Francisco. This story originally featured on Undark.

In December, COVID-19 infections in prisons in the US hit a record 25,000 in one week. Among correctional staff that month, there were an additional 5,000 new infections a week, leading to spread in surrounding communities. According to a New York Times database, collectively, more than 580,000 people at correctional institutions have been infected. The prisoner death toll has now surpassed 2,000.

Eleven months into the pandemic, the US prison system has not gotten control of its rising caseload, which is likely still underestimated, according to The Marshall Project, a nonprofit journalism outlet focused on criminal justice issues. Doctors, attorneys, prison reform advocates, and public health researchers are increasingly concerned about one of the tactics that prisons are using to isolate symptomatic individuals: solitary confinement, the prolonged use of which is an internationally recognized form of torture denounced by the United Nations.

According to report published last June by Unlock the Box, a campaign to end solitary confinement, during the first COVID-19 peak in April, there was a reported 500 percent increase in solitary confinement. Distinct from medical isolation, where inmates may be housed with others who test positive for Covid-19 and have access to televisions, tablets, and ways to keep in touch with family and friends, solitary confinement usually involves restrictions or bans on these resources.

In prisons that have implemented unit-wide lockdowns to prevent the spread of coronavirus, some lawyers say inmates report being confined to their cells for at least 22 hours a day. Such isolation has become commonplace in many correctional facilities, where minimal ventilation, limited protective gear, and overcrowding create superspreader conditions. Colder temperatures this winter may also enhance spread.

And while prison reform advocates acknowledge that physical separation of prisoners is necessary to contain the virus, they say there are better ways to go about it. According to a 2020 analysis from Amend, a program at the University of California San Francisco that seeks to change correctional culture in the US using a public health and human rights framework, the use of punitive isolation “including indeterminate system-wide facility lockdowns where people cannot communicate with their families, exercise outside, participate in programming, or interact with health care professionals,” may even increase transmission because it deters prisoners from reporting symptoms and seeking treatment.

“If the consequence is ‘going down to the hole’”—a common term for solitary confinement—“people aren’t going to report their symptoms,” says Amend’s research director David Cloud. “People are going to refuse testing. People are not going to do the things that are most critical for fighting this pandemic.” The Federal Bureau of Prisons did not respond to multiple requests for comment from Undark, but according to a fact sheet on the agency’s website, staff conduct rounds and take inmates’ temperatures at least once a day. Still, infection is not always accompanied by a fever or any symptoms at all.

Despite attempts to decrease prison populations early in 2020 to curb the spread of COVID-19, according to the Prison Policy Initiative, a nonprofit research and advocacy organization focused on criminal justice, most of the reduction has been due to decreasing admissions, not releasing inmates early. That means that people who are currently incarcerated, including those with pre-existing medical conditions, remain vulnerable to the virus. A disproportionate number of those people—nearly 40 percent—are Black, though Black people comprise less than 13 percent of the US population. New strains of the coronavirus may also cause more infections. Public health researchers suggest that prisons should replace punitive solitary confinement with humane medical isolation to protect people both inside and outside correctional facilities.

Defense attorney Ashley Allen represents David Maglio, the first person to test positive for COVID-19 at the Wyatt Detention Facility in Rhode Island. According to Allen, Maglio developed symptoms in April, and an outbreak followed not long after. He became seriously ill and was isolated.

“He said ‘I felt like I was locked in a closet and I had to bang on the door to get any attention. People looked at me like I was a zombie,’” Allen recalls Maglio saying. In an email, Wyatt Detention Facility warden Daniel Martin wrote that while inmates may be placed in medical isolation or quarantine housing to reduce the spread of COVID-19, they “are not placed in solitary confinement.” During this time, he added, they are offered playing cards, radios, and tablets, among other items, and have the ability to communicate with family members.

Between April and July, Maglio lost contact with his family, according to Allen. His wife and young son had moved to California, but he was unable to transfer to a facility closer to them until July. At his new facility, Maglio wrote in an email to Undark, he has not been able to see his family in person, or even over Zoom.

More than 15 consecutive days in solitary confinement is defined under international law as torture under the U.N.’s Nelson Mandela Rules, because the cells used for solitary are designed to cause sensory and social deprivation. While they may be the only space available to medically isolate infected people in many prisons, solitary confinement units are often used as an extreme form of punishment.

In a press release announcing the publication of Unlock the Box’s report on solitary confinement last summer, steering committee member Brie Williams, founder and director of Amend at UCSF, as well as a physician, said that while “[s]eparating people who become infected with COVID-19 is a necessary public health measure to prevent the spread of COVID-19, particularly in prisons and jails,” using “the punitive practice of solitary confinement in response to the pandemic will only make things worse.”

Individuals who have spent any time at all in solitary are more likely to die in the year after release, especially from suicide, according to research by Lauren Brinkley-Rubinstein, an assistant professor of social medicine at the University of North Carolina at Chapel Hill. Solitary confinement has proven to have such negative impacts on mental health that the U.S. Department of Justice recommended restricting its use in 2016.

Even when repeated pandemic lockdowns have led to prolonged solitary-like restrictions not only for infected individuals, but also on whole prison populations, these measures haven’t been able to stop the virus’s spread.

Correctional housing units have minimal ventilation and limited access to protective equipment, says Alexandria Macmadu, an epidemiology Ph.D. candidate at the Brown University School of Public Health. Most facilities can’t provide six feet between incarcerated people and staff, or follow pandemic sanitation guidelines. “None of these facilities are built to actually allow for social distancing,” says Elizabeth Matos, executive director of Prisoners’ Legal Services of Massachusetts, a not-for-profit organization that offers legal representation and advocacy for inmates in the state.

The airflow through connected cells and dormitories also enhances risk of infection, says Lidia Morawska, a physicist and director of the International Laboratory for Air Quality and Health at Queensland University of Technology, which is a collaborating center of the World Health Organization.

Morawska worries that this winter, plummeting temperatures may cause even faster spread. “This kind of virus likes cold and dry conditions,” she says. Many facilities keep windows closed to prevent cold, which reduces ventilation and increases transmission.

These conditions make correctional facilities COVID-19 superspreaders. The US has the largest incarcerated population in the world, at roughly 2.3 million people. It is notoriously overcrowded, with an average occupancy level of 99.8 percent in 2017, according to the World Prison Brief, an online database hosted by the Institute for Criminal Policy Research at University of London. Some states operate at 150 percent capacity or more.

“That’s the elephant in the room with this pandemic,” says Cloud. “Just by virtue of 40 years of mass incarceration, you have so many people, so many humans, living in very small, terrible spaces. It’s just a perfect recipe for an outbreak to happen with staff coming in and out from the community.”

An initial push last spring to reduce prison populations ended with few lasting changes. Between January and August, state prison populations decreased by only 4 percent and the federal system by 10 percent for a total of about 70,000 people freed during that time period. Brinkley-Rubinstein analyzed COVID-19 spread in the Texas prison system and found that transmission is minimized at 85 percent capacity or less. More than 200,000 prisoners would need to be freed to hit that mark.

“As COVID continues to spread like wildfire across the country, we’ll see that amplified in prisons and jails,” Brinkley-Rubenstein says.

In a paper published last month, Stanford engineers collaborated with researchers at Yale University to model rates of transmission. They found that COVID-19 spreads faster in US jails and prisons than it did on the Diamond Princess cruise ship during the superspreader event that infected around 700 people early in the pandemic. As of September, more than 40 of the 50 largest clustered outbreaks in the US had occurred in prisons and jails, and they continue to fill the list of COVID-19 hotspots. The few facilities that have conducted mass testing found an infection rate of around 65 percent.

Adjusted for age and sex, the death rate for prisoners infected with the coronavirus is three times higher than for the general US population, according to the University of California Los Angeles School of Law’s COVID-19 Behind Bars Data Project. The COVID-19 outcomes are so poor for this population because many are already sick. “On average, they have at least one chronic condition,” Brinkley-Rubenstein says, “which puts people at risk of suffering more severely from COVID-19.”

These infections affect people outside of the system, too. “Prisons and jails are not an island. People go in and out of them each day. Not only the people who are incarcerated, but also the staff members who return each day to their families,” says Macmadu. In a December report, the Prison Policy Initiative estimated “that mass incarceration added about 566,800 cases—or roughly 13 percent of all new cases—over the summer of 2020 alone.”

“We’re in for a long, hard winter,” Brinkley-Rubenstein says.

While solitary confinement units may be the only way to medically isolate infected people in many prisons, some experts want prison administrators to rethink how the units are used. “We ought to transform those spaces into medical spaces rather than spaces of punishment,” Brinkley-Rubinstein says. The only thing solitary confinement and medical isolation need to share in common: physical separation from other people.

One way to distinguish solitary confinement from COVID-19 quarantine is to give isolated people access to materials that help pass the time and keep them connected to others. UCSF’s Amend program suggests increased access to telehealth consultations, books, radio, games, and, most importantly, communication with loved ones—as Martin says is the case at his Rhode Island facility. The researchers also recommend daily updates from health care staff and a maximum of 14 days isolation, in accordance with guidelines from the Centers for Disease Control and Prevention. These changes could help ease the mental health repercussions of isolation, while preventing further spread.

But humane quarantine hinges upon having sufficient testing and health care resources. While prisons need the help of public health officials to accomplish these aims, “our public health system itself doesn’t prioritize the millions of people that are behind bars or the people who work in those settings in our pandemic responses,” says Cloud. “It’s an afterthought, or it’s not thought of at all.”

Public health officials “have an imperative to pull a seat up to the table and help public safety institutions mitigate COVID-19 in their buildings,” says Brinkley-Rubinstein. This can be done, she adds, by aiding compassionate release, providing testing, and facilitating humane medical isolation.

Based on the Stanford-Yale jail models, each of these interventions reduces transmission by more than 50 percent. In combination, they will end an outbreak. Some advocates, like Cloud, see the new COVID-19 vaccine as another potential tool to stop spread. He argues that correctional facilities should be at the top of the priority list — not only to protect people in prisons, but those in surrounding communities.

Long-term, many advocates hope the pandemic will lead to a permanent decrease in prison populations. “More and more people are continuing to see decarceration is not only an apt approach to reduce the spread of COVID-19 in prisons and jails right now,” says Macmadu, “but also the ethical thing to do in light of the ongoing systemic racism and the ongoing disparities” that Black communities face.

Others are doubtful. The US prison system is built on traditions that are racist and structural in nature, says Brinkley-Rubenstein. “Once we emerge from this pandemic having not addressed the core sources of this system’s power, it makes me think that we’re probably going to go right back to the status quo,” she says.

However, she adds that the term “structural racism” seems to have become a part of everyday language. “People being versed in what that means does give me a little bit of hope, maybe.”