Health, Safety, and Education

People who are confined in jails, prisons, and immigration detention centers are particularly vulnerable to the outbreak of the novel coronavirus due to their close proximity to others and limited access to protective equipment and adequate health care. The safest and most effective way to reduce the spread of COVID-19 is release, which is addressed in Section I of this Report. Section II summarizes measures that incarcerated individuals can take to reduce their risk of exposure to COVID-19 while incarcerated. Advocacy and resources to increase access to soap, protective equipment, and social distancing is crucial. Greater communication and transparency to inform families and the public about what people are experiencing in prisons and jails will help support those efforts. In the meantime, because the virus that causes COVID-19 spreads easily from person-to-person and is potentially fatal, it is vital that people who are incarcerated have the wherewithal to follow recommended guidelines and seek treatment if they start exhibiting symptoms. 

While access to vital resources is currently woefully inadequate to protect and treat incarcerated individuals, there are small things individuals can do to protect themselves and others during this public health crisis. Our aim here is to provide a coordinated information source for those who are currently incarcerated or who have been released after a period of incarceration and are concerned about COVID-19 exposure. This section also provides information that will be helpful in advocating for necessary resources, medical care, and release. 

COVID-19: Reducing Risk of Exposure While Incarcerated

COVID-19 is a new coronavirus that emerged and began spreading in December 2019. On March 11, the World Health Organization declared COVID-19 a pandemic. Although the majority of people who are infected recover, COVID-19 has the potential to cause severe illness and pneumonia, which can lead to death. Older adults and people with underlying health conditions or compromised immune systems face higher risk of severe illness or death from this virus. People who are incarcerated are at a heightened risk of exposure, and the disease has already started spreading through jails, prisons, and detention centers in New York and across the nation.

1. Transmissions and Symptoms 
   • How the virus spreads: The CDC has issued guidance on how the COVID-19 virus spreads, and how to protect yourself and others. Although people who are incarcerated face restrictions on their access to these protections, they need access to information about how the virus spreads and available means for washing hands and social distancing. They can use this information to protect themselves where possible and to advocate for greater protection and for release based on the absence of those protections. CDC Guidance for Correctional and Detention Facilities recommends that corrections facilities post signage throughout the institution detailing the symptoms of COVID-19 and hand hygiene instructions. 
     1.  According to the CDC, a National Academy of Sciences Standing Committee on Emerging Infectious Diseases, and the World Health Organization, the COVID-19 virus is primarily transmitted between people through respiratory droplets that are most likely to spread when a person who is exhibiting symptoms (coughing/sneezing) is in close contact with another person. Recent research suggests that coronavirus can be spread by talking or possibly even just breathing. Transmission can also occur through indirect contact with surfaces in the immediate environment of an infected person. 

1. Symptoms: Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed COVID-19 cases. Infected people often develop a fever, cough, and difficulty breathing within 2-14 days of exposure. However, there are reports of asymptomatic cases, meaning that an individual may have been infected without displaying any of the most common symptoms. The CDC and other public health experts recommend that people who believe they may have been in contact with someone with COVID-19 take every possible precaution and seek treatment if they develop symptoms. Given the increased risk of exposure to anyone in prisons and jails, anyone incarcerated or working in a jail, prison, or detention facility falls within this category.

2. Vulnerable Populations
   • Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions are likely at higher risk for severe illness from COVID-19.
   • Prisons and jails “contain high concentrations of people in close proximity and are breeding grounds for uncontrolled transmission [of infection.” This situation puts anyone who is currently incarcerated at a heightened risk of exposure. According to a report issued by the Osborne Association, New York alone has 10,337 incarcerated older people and is among five states in the union with an incarcerated older population in excess of 10,000 people, including Texas (28,502), California (27,806), Florida (21,620), and Pennsylvania (10,214). According to data from the Marshall Project, in 2016 nearly 150,000 people incarcerated in state facilities were 55 or older. Similarly, 11 percent of the federal prison population—more than 20,000 people—is 56 or older. A letter on behalf of Federal Defenders reports approximately 10,000 individuals over the age of 60 presently in federal custody, with one third of all individuals in federal custody exhibiting preexisting conditions.
   • Additionally, people incarcerated in jails and prisons often have a higher prevalence of underlying health conditions than the non-incarcerated population, as the chart below demonstrates: 

Source: Prison Policy Initiative

3. Staying Safe While Incarcerated 
   • While there are ways to reduce the risk of COVID-19 exposure, much of the recommended hygienic and protective equipment is unavailable or difficult to obtain for those who are currently incarcerated. Reports indicate a shortage of toilet paper as well as a lack of alcohol wipes, hand sanitizer or soap in jails and prisons. According to the CDC, “many facilities restrict access to soap and paper towels and prohibit alcohol-based hand sanitizer and many disinfectants.” Additionally, protective measures like social distancing and self-quarantining are difficult or impossible to follow while incarcerated. 
     1. The CDC has issued guidance recommending that correctional facilities “provide a no-cost supply of soap to incarcerated/detained persons, sufficient to allow frequent hand washing. If soap and water are not available, CDC recommends cleaning hands with an alcohol-based hand sanitizer that contains at least 60% alcohol.” 
   • Staying at least six feet away from other people lessens chances of catching COVID-19. The CDC has provided guidance to correctional institutions recommending measures for social distancing within facilities, such as providing ready access to soap and cleaning supplies, reassigning bunks to provide more space between beds, providing for regular cleaning practices, and arranging for people to sleep head to foot. 
   • Where social distancing measures are difficult to follow, like in jails and prisons, the CDC recommends that everyone wears a cloth face covering to cover their mouth and nose. They can be made out of t-shirts or any spare cloth.
   • Even with these measures, public health officials and corrections experts agree “that immediate decarceration is necessary to avoid a humanitarian crisis in our prisons and jails.” A Public Defenders’ Letter to Attorney General William Barr documents the facial inadequacy of the Bureau of Prisons’ modified operations plan, as well as the failure of the BOP to put the plan into operation in the face of shortages in resources, staff, and space. 

4. Seeking treatment while Incarcerated
   • The CDC recommends that anyone who exhibits the following emergency warning signs seek treatment immediately: trouble breathing, persistent pain or pressure in the chest, new confusion or inability to arouse, and/or bluish lips or face. Incarcerated individuals are urged to report these symptoms immediately to a staff member. 
   • The National Alliance on Mental Illness (NAMI) has issued a report that includes guidance for if you or a loved one is incarcerated and concerned about exposure to COVID-19 and seeking treatment while incarcerated. NAMI is also keeping their hotline open from 10am-6pm Monday through Friday ((800) 950-6264)

Seeking Remedies For Failure To Provide Adequate Protection And Treatment While Incarcerated

1. The legal and advocacy community has secured release for some people who face increased risk of severe injury or death. If individuals do not have access to a lawyer, they may proceed on their own behalf. For an overview of these advocacy efforts, resources, and sources, see section I of this Report. 

Charges For Medical Services While Incarcerated

New York is one of 12 states that do not charge a copay for  physician visits, medications, and testing. “These charges are the equivalent of charging a free-world worker $200 or $500 for a medical visit,” and  “discourage medical treatment and to put public health at risk.” The Prison Policy Institute is tracking states’ co-pay policies in response to the COVID-19 pandemic.

COVID-19: Reducing Risk of Exposure After Release 

1. Precautions and Restrictions 
   • The CDC has provided guidelines on how people can protect themselves and others from COVID-19 exposure, including hygienic measures, social distancing, and finding or making a face mask. 
   • The Bard Prison Initiative has put together a resource page for people who have returned to the community. 
   • Public health sources with first hand knowledge of conditions in transitional facilities recommend the following best practices for transitional housing facilities:
     1. Establishing and operationalizing clear lines and modes of communication between administration, staff, and residents –which could do much to alleviate or at least reduce anxiety, especially for residents who share close living spaces with several or more individuals and are not able to self-quarantine;
     2. Providing sufficient training for building staff to communicate self-quarantine protocols to residents who are able to isolate;
     3. Building staff recognizing high-risk residents with a mental health disorder, history of isolation or self-harm, for whom the crisis can be debilitatingly frightening and/or triggering;
     4. Identifying residents with active substance abuse issues and connecting with remote support (this is particularly challenging because the use of drugs and alcohol is not permitted and self-reporting is avoided for fear of reprisals);
     5. Ensure that staff and residents have sanitizing and protective gear available while in common spaces;
     6. Keeping touch points consistently sanitized, i.e. doorknobs, light switches, handrails, bathroom surfaces and fixtures, trash cans, computer keyboards, desks and phones; and
     7. Ensuring an adequate number of staff appropriately trained to execute and administer EMP, including front desk and caseworkers.

2. Restrictions On Movement: Shelter In Place

In response to the COVID-19 pandemic, many state and local governments are issuing restrictions on residents’ movement and activities. The New York state government has ordered all non-essential workers to work from home until further guidance is issued, and to maintain a 6 foot distance from others in public . Gyms, movie theaters, and casinos are closed. Bars and restaurants are open for take-out and delivery only.

3.  Seeking Testing and Treatment after Release

1. Testing is free to all eligible New Yorkers as ordered by a health care provider or by calling the NYS COVID-19 hotline at 1-888-364-3065. Individuals may also be screened and pre-register for testing on line.
2. Local health departments are the point of community contact for COVID19  concerns. Local health centers may not have currently have COVID-19 testing capability.  Individuals can call the nearest health center or their health department to learn about availability for screening and testing. Testing is free, regardless of insurance status. 
3. As of right now, only the following groups of people qualify for COVID-19 testing in New York: 
   1. Persons that had close contact (within 6 feet) of a known case of COVID-19;
   2. Persons who have travelled to a country with a CDC-designated level 3 travel health warning for COVID-19 or who meet CDC Level 2 high-risk traveler criteria (older adults and people of any age with serious chronic medical conditions) and have symptoms of fever, cough, and trouble breathing;
   3. Persons who are under quarantine as directed by the local health department, and have symptoms of fever, cough, and trouble breathing, persons who are ill with fever AND respiratory illness (e.g., pneumonia, ARDS) and without alternative explanatory diagnosis (e.g., influenza, legionella, streptococcal pneumonia, fungal infections) and patient also has negative results on a molecular respiratory viral panel;
   4. Persons whose healthcare provider, local health department and NYS Department of Health agree that testing is required (with or without a recent travel history).

If you meet any of the above criteria, you may call the New York Novel Coronavirus Hotline at 1-888-364-3065. 

1. The New York State Department of Health has also created an online screening tool for people who think they may have symptoms related to COVID-19. 
2. Coverage for costs of testing and treatment related to COVID-19

1. If you are in New York, you will not be charged a copay if you seek testing for COVID-19. 
2. Uninsured New Yorkers can apply for coverage through NY State of Health or directly to insurers during a special enrollment period that ends May 15, 2020. If you lost employer coverage, you must apply within 60 days of losing that coverage. Because of a loss of income, New Yorkers may also be eligible for Medicaid, the Essential Plan, subsidized Qualified Health Plans or Child Health Plus. You can enroll by calling 855-355-5777 or visiting New York State of Health. 
3. Individuals who are undocumented can enroll in Emergency Medicaid through the Marketplace. 
   1. Emergency Medicaid ordinarily covers emergency conditions only but is covering all testing, evaluation, and treatment for COVID-19.
   2. If you are under 65, you can enroll in Emergency Medicaid online or call 1-855-355-5777. Most people who are 65 or older or who have a disability will need to complete a different application. For help enrolling, call 347-396-4705.
4. Many private insurers will cover the cost of treatment for COVID-19. A list of providers and their COVID-19 coverage is available here. 

Mental Health Services 

The outbreak of COVID-19 is likely to be stressful for people generally, and particularly for people who have been exposed to the virus while incarcerated, who may experience  heightened feelings of anxiety, isolation, and helplessness. Incarceration and reentry can already be traumatic experiences, and resources are available for those who need emotional support: 

• The National Alliance on Mental Illness (NAMI) has issued a report that includes guidance for if you or a loved one is incarcerated and concerned about exposure to COVID-19. NAMI is also keeping their hotline open from 10am-6pm Monday through Friday ((800) 950-6264). 
• The Substance Abuse and Mental Health Service Administration’s Disaster Distress Helpline is available to anyone in need. To speak to someone, call 1-800-985-5990 or text TalkWithUs to 66746.  
• New Yorkers can call the COVID-19 Emotional Support Hotline at 1-844-863-9314 for free, immediate mental health counseling.
• Mental health services specific to reentry: 
  • The Center for Alternative Sentencing and Employment Services (CASES) has a mental health clinic located in Central Harlem that remains open to both existing and new clients. To make an appointment, visit www.nathanielclinic.org or call (212) 553-6708. 
  • Reentry programs continue to provide services virtually and, where needed, in person to existing and new clients returning to the community from prison.
    • Exodus Transition Services provides in person counseling and support for people transitioning from prison to the community. 
    •  The Fortune Society continues to offer services to existing and new clients, including mental health services at their Better Living Center. For more information, contact Andrew Tate at [email protected] or 929-487-9495.

• My Bronx Impact On Line is the Bronx's new search, referral and application website for connecting all people in need to the programs that serve them. 
• Alcoholics Anonymous is holding online meetings for all interested individuals. 

Food Security and Food Delivery

1. The New York City Department of Education is making three free meals available daily for any New Yorker at more than 400 meal hubs across the city. 
2. Any New Yorker in need of food can get three free meals a day at more than 400 Meal Hubs across the city. Meals can be picked up at all Meal Hubs from 7:30 am to 1:30 pm, Monday through Friday. Meals Hubs will operate for children and families from 7:30 am to 11:30 am, and for adults from 11:30 am to 1:30 pm. No one will be turned away. No registration or ID is required. Vegetarian and halal options are available. 
3. NYC Shut It Down is providing free home cooked meals and groceries to Black, Brown and Indigenous people in need for the duration of the COVID 19 crisis
   • For access to free meals, please visit their website
   • If you are healthy (symptom-free), have a car, and would like to help, please email [email protected]

Because of the new protective restrictions on movement and activity, there has been a dramatic increase in demand for food deliveries. Food couriers (people who deliver food to customers through an app like Postmates, UberEats, DoorDash, or Seamless) themselves face increased risk of exposure, and are encouraged to take precautions to protect themselves from exposure to COVID-19. Some services (like DoorDash) are providing their couriers with hand sanitizers and gloves. Most services also allow couriers to leave food at the customer’s door, eliminating contact between the customer and the courier. If this is an available option, it is strongly advised. Both DoorDash and UberEats will provide up to 14 days of financial assistance to any of their workers who are diagnosed with coronavirus and have to self-quarantine.

Immediate Action 

There are many ways advocates can help direct public health resources to vulnerable populations, including those who are currently incarcerated. 

• FWD.us is calling on elected leaders to direct more public health resources to vulnerable populations, including those experiencing incarceration. You can join their campaign here. 
• VOCAL-NY and other advocacy organizations have penned an open letter to Governor Cuomo and Mayor de Blasio, calling for emergency action to address the survival needs of homeless New Yorkers amid the COVID-19 pandemic. 
• Add your name to this letter to Congress drafted by Incarcerated and Formerly Incarcerated People regarding the urgent need for greater funding for those who are incarcerated or returning home.

Longer Term Advocacy 

As the current public health crisis has demonstrated, major changes must be made in the future in order to keep America’s incarcerated population safe. The following resources provide policy recommendations and solutions that advocates can incorporate into their work. 

• Practical Ideas for Addressing the COVID-19 Crisis in Prisons and Jails 
  • Health Affairs issued a statement detailing some practical solutions to the public health concerns posed by jails and prisons, including preventive measures like reducing facility populations and responsive measures such as the rapid deployment of healthcare providers in times of crisis. 
• A Just and Humane Response to Outbreak
  • The Prison Policy Initiative published five recommendations for prisons and jails in response to the ongoing public health crisis and joined dozens of advocacy groups in endorsing a comprehensive public health platform that includes decarceration.
• Call on the Government to Protect New Yorkers Without Access to Housing 
  • As the federal and state governments encourage people to practice social distancing measures and to self-quarantine in their homes, those experiencing homelessness remain the most vulnerable among us to COVID-19 exposure. Communities United For Police Reform and 120 other organizations have signed and circulated this petition calling on the New York government to protect the state’s homeless population and provide access to healthcare to everyone who needs it.
• A Comprehensive Approach to Healthcare Access
  • Mass incarceration poses long-term public health risks and expands existing health disparities that many advocates seek to mitigate beyond the current outbreak of COVID-19.
    • The Solomon Center for Health Law and Policy at Yale Law School has been issuing innovative health and legal policy recommendations as the government responds to the ongoing public health crisis. Some recommendations seek to increase widespread access to medical services, such as by easing restrictions on telehealth, while others seek to address the high population density in prisons and jails, which stymies public health efforts. 

In 2014, the Vera Institute of Justice published a report examining some of the health disparities exacerbated by incarceration and the failures of federal and state policy in addressing the needs of incarcerated people.