Coronavirus and the
Correctional Facility
For Correctional Staff Leadership
Anne C. Spaulding MD MPH
March 9, 2020
Emory Center for the
Health of Incarcerated Persons
Aspauld@emory.edu

Development of these slides was supported under cooperative agreement, the
Centers for Disease Control and Prevention’s (CDC’s) Collaboration with Academia
to Strengthen Public Health Workforce Capacity (grant no. 3 U36 OE000002-04
S05) funded by CDC, Office of Public Health Preparedness and Response, through
the Association of Schools and Programs of Public Health (ASPPH). Its contents
are solely the responsibility of the authors and do not necessarily represent the
official views of CDC, the Department of Health and Human Services, or ASPPH.
Please do not alter content without contacting authors.

What is Coronavirus? What is COVID-19?
You may have heard about “the new coronavirus”
Coronaviruses are named for the crown-like spikes on their surface.
This is a virus particle magnified a zillion times

There are many types of viruses out there. Most coronaviruses cause a mild cold.
The “new coronavirus” causes a disease called “COVID-19”. Some infections are
mild. Some people get a cough, fever and shortness of breath. A few need to be
hospitalized.
Some people are dying, but at a lower rate than with other epidemics like SARS.

The New Coronavirus Overview: Spread
• This virus spreads from person-to-person

• When people are in close contact, about 6 feet of each other or closer.
• The longer you are close together, the higher the likelihood of spread.

• When you cough or sneeze, droplets with virus particles spread in the air.
• Droplets can land in mouths or noses of people nearby.
• Droplets can be inhaled into the lungs.

• Sometimes a jail or prison will want to separate sick people and people who
don’t have the infection.

The New Coronavirus Overview: Spread
“Novel” is another word for new. Some people refer to this as “The Novel Coronavirus”

• The new virus can spread by touching with bare hands a surface or
object that has the virus particles on it, such as a used tissue.
• This is not the main way the virus spreads!

• The novel coronavirus can spread at different stages of sickness
• People are thought to be most contagious when they are sickest.
• People might be contagious before they even show symptoms,
but probably most people with COVID-19 did not catch
the virus from folks who are still well.

New Coronavirus Overview: Spread
• It started in China
• As of March 2020, it has spread to every continent.
• COVID-19 seems to be spreading easily in many communities.

Persons entering jails or prisons can bring it in with them.

• Keep up with your state and local health department to learn what’s happening
where your correctional facility is located.

If it’s in a community,
it’s likely to show up
in its local jail (or prison).

New Coronavirus Overview: Symptoms
• Many infected people have reported mild
symptoms or no symptoms at all
• Symptoms can appear soon or long after contact
with an infected person
• This could be 2 days, 2 weeks, or sometime in
between!

• Symptoms are listed here
• Symptoms sound similar to the flu…
• To prevent influenza, and possible unnecessary
evaluation for COVID-19: get a flu shot!

• Serious disease and death are most common in
• Older persons
• Those with underlying medical conditions

New Coronavirus Overview:
Prevention—Avoid Exposure!
• Avoid close contact with people who are sick.
• Avoid touching your eyes, nose, and mouth.
• Cover your cough or sneeze with a tissue.
• Throw the tissue in the trash.

• Wash your hands often with soap and water for at
least 20 seconds.
• As long as singing Happy Birthday song!

• Ask for a facemask if you have a cough; encourage
those who have a cough to ask for a facemask.
• Staff should stay off from work if they feel sick!
• Have a cough, fever and/or shortness of breath?

Stay home!
• If symptoms become worse, seek medical care; call
ahead before you go!

New Coronavirus Overview
To review, the common symptoms are : 1) fever, 2) cough, and 3) shortness of breath
To assess if incarcerated persons or staff member could be sick with COVID-19:
1. ASK where they have been within 14 days of the start of symptoms—
—Any place on current list of areas with local spread of disease??
2. ASK about contact with an infected person.
3. CHECK Symptoms—if person admits to 1 or more symptoms, refer to medical.

To check the CDC websites for areas of current activity:
Int’l: https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html
US: https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html

New Coronavirus Overview
To review, the common symptoms are : 1) fever, 2) cough, and 3) shortness of breath
To assess if incarcerated persons or staff member could be sick with COVID-19:
1. ASK where they have been within 14 days of the start of symptoms—
—Any place on current list of areas with local spread of disease??
2. ASK about contact with an infected person.
3. CHECK Symptoms—if person admits to 1 or more symptoms, refer to medical.

If COVID-19 is not being transmitted in your area:
1. As arrestees enter: correctional officers can ask these questions at door, and
refer to medical if yes to any. Put surgical mask on any coughing arrestee.
• Non-medical staff can ask the questions, does not require a nurse.
2. At start of each shift, ask staff these questions, and consider sending home if
any answered in affirmative.

New Coronavirus Overview—in established areas
To review, the common symptoms are : 1) fever, 2) cough, and 3) shortness of breath
To assess if incarcerated persons or staff could be sick with COVID-19:
1. ASK about contact with an infected person.
2. CHECK Symptoms—if person admits to 1 or more symptoms, refer to medical.

If COVID-19 is being transmitted in your area:
1. As arrestees enter: correctional officers can ask these questions at door, and
refer to medical if yes to any. Put surgical mask on any coughing arrestee.
• Non-medical staff can ask the questions, does not require a nurse.
2. At start of each shift, ask staff these questions, and consider sending home
if any answered in affirmative.
3. May consider temperature checks via non-contact thermometer.

New Coronavirus Overview
To review, the common symptoms are : 1) fever, 2) cough, and 3) shortness of breath
When bringing persons to medical staff, or awaiting medical staff to come to you—
• Place on the person with symptoms a surgical mask
especially anyone who is coughing.
• Place person in a room with a closed door while awaiting medical exam.
What supplies are recommended for at-risk facilities:

Simple surgical face masks for those who are sick (not for person conducting
questioning at the door.)
Facemasks are to prevent sick people from spreading disease, NOT to protect
healthy people from getting disease!!!
 Usual disinfectant: wipe down surfaces frequently
 Personal hand sanitizer OR access to handwashing station.
Personal protective equipment are for staff present during medical exam.
 Gloves, gowns, N95 masks, etc.

New Coronavirus: Incarceration
• Prisons and jails are enclosed environments where incarcerated persons
sleep in close quarters,
recreate in small spaces,
eat together,
and may be at increased risk for airborne infections due to close contact.
If incarcerated persons are at risk, correctional custody
staff are also at risk.
Following correctional healthcare direction for managing
incarcerated persons with diagnosed or suspected
coronavirus could lead to decreases in cases of disease
among both inmates and staff, and in the community.

New Coronavirus:
Implications for Correctional Custody Staff
• Plan on future absenteeism of correctional
officers who are sick.
• Discourage sick staff members from coming
to work, and possibly infecting other staff
members and inmates.
• Consider restriction of movement in and out of
the facility (visitors, non-essential vendors,
tours).
• Expect that supply chains (medicines, food, etc.)
may become disrupted.

New Coronavirus:
Implications for Correctional Custody Staff
1. Together with you medical staff, work with your local health department in prevention,
identification, and management of infectious disease
*The health department should consider how the presence of
disease in a jail and prison, and movement of citizens in and out
of the facility, impacts the health of the public.
* Even if your facility contracts with an outside medical vendor,
the health department still has a need to work with you.
Reminder you are in their jurisdiction!
2. Work with your medical staff on planning now: Determine
How many negative pressure rooms do you have?
How many medical rooms with closed doors (not just bars)?
What cell block(s) can be used for cohorting ill persons?

New Coronavirus:
Working with your jurisdiction’s law enforcement
(judges, prosecutors, etc.)
• Consider alternatives to incarceration, in
order to keep stock population down
(diversionary courts, community corrections).
• Consider measures other than detention (athome electronic monitoring).
• Ask who you can release on their own
recognizance?

New Coronavirus:
Caution for Correctional Facilities
Photo: Fox News

• A prison or jail is a self-contained environment, both those incarcerated and
those who watch over them are at risk for airborne infections.

• Cautionary tale #2: Hundreds of cases
diagnosed in Chinese prisons.

Photo: S. China Post,
from Weibo

• Some make an analogy with a cruise ship.
• Cautionary tale #1: think of the spread of
COVID-19 on the Diamond Princess Cruise Ship, January 2020.

Resources
• https://www.cdc.gov/coronavirus/2019-ncov/index.html
Many correctional systems have developed pandemic flu plans. These
plans can be readily adapted to COVID-19 and readapted as we learn more
about this new pathogen, e.g., incubation period, transmission, and
morbidity factors. The BOP plan is available online:
• https://www.bop.gov/resources/pdfs/seasonal_influenza_guidance.pdf
• Questions? Aspauld@emory.edu
• Emory Center for the Health of Incarcerated Persons, Atlanta GA

• Acknowledgments: I am grateful for constructive criticism from Allison
Chamberlain, Newton Kendig, Ank Nijhawan, Dianne Rechtine, Marc
Stern, and countless colleagues who are government employees.
3/9/2020