How effective are the virus prevention policies in Missouri’s prisons? We asked experts.

The Missouri Department of Corrections has a number of policies to help prevent the coronavirus from entering its prisons or stop it from spreading once it’s inside. But are they enough to address the threat of COVID-19?

To get further insight, the Missouri Information Corps talked to two experts about Missouri’s policies:

Here’s what they said.

Best practices

The best ways to combat the spread of COVID-19 in prisons are to drastically reduce the state’s prison population and follow the Centers for Disease Control and Prevention’s COVID-19 guidance for correctional centers, according to the experts.

“In my view, the single best thing that corrections administrators can do is to reduce the population density in their facilities to allow people who remain inside to be socially distanced,” Dolovich said.

Dolovich said as we’ve learned more about the virus, it has become clear that staying 6 feet apart in small, enclosed spaces where people stay for long periods of time is not sufficient protection. This means prison populations must be reduced even more than previously thought, she said.

“I can tell you that Missouri’s not doing enough, but … it’s just that no place is doing enough,” she said.

So far, Missouri has been unwilling to release incarcerated people, even as reported cases of COVID-19 rise in state prisons.

Spaulding said it’s important for state correctional facilities to adhere to the CDC’s interim guidance, which was updated on July 14. Since guidance was first issued in late March, understanding of COVID-19 has advanced significantly, she said.

Still, Dolovich said having great policies is not enough. 

“Written policies and practice are two totally different things,” she said. “To say that you have a great policy does not mean that you’re implementing that policy, so that only gets you part of the way there.”

Testing 

Missouri is currently mass testing incarcerated people and staff at every prison in the state. Of 20 adult institutions, mass testing has been completed at most of them. The prison system is also testing: 

  • Prisoners who are symptomatic.
  • Prisoners who may have come in contact with an infected person.
  • Prisoners upon intake into the prison system.
  • Prisoners about a week before release.
  • All prisoners and staff in a housing unit any time an outbreak is suspected.

The state is reporting the number of positive cases at each prison. Some prisoners have reported, however, that despite showing symptoms of COVID-19 the state has refused to test them.

If it follows through on the stated testing policy, Dolovich said Missouri is “doing a lot better than many states.” Intermittent mass testing at every prison should be a baseline, she said.

“As a first step, testing and transparency about the findings are crucial,” Dolovich said.

Spaulding also said these testing measures were good. She said mass testing could help address “unappreciated and undetected outbreaks.” 

But she said if a prison is repeatedly having a reintroduction of COVID-19, mass testing “may not be a feasible, ongoing measurement” of the virus in prisons.

Karen Pojmann, spokesperson for the Department of Corrections, said next week the department will also begin sample testing at all facilities. This will involve testing 10% of the population at each prison to gauge the presence of the virus.

As of Aug. 7, 23,095 Missouri prisoners have been tested, and 403 prisoners have active cases of COVID-19.

Isolation

But testing is only the first step. Both experts said what happens after prisoners are tested is just as important. 

Prisoners who show symptoms of COVID-19 or test positive are isolated, according to Pojmann.

“The moment they start having signs or symptoms, they need to be isolated in a unit by themselves and get a PCR test — a nasal swab — for infection,” Spaulding said. “And if the nasal swab comes back positive that means they’ve been exposed and infected and they need to be in isolation from persons who have either tested negative or whose status is unknown.”

She also said people who have tested positive for COVID-19 can be isolated together.

Dolovich said that on paper, the policies sounded good, but she wondered how well they are followed. It’s very hard to isolate people in prisons, she said. 

“You have to be really vigilant about it,” she said.

Masks and face coverings

Staff and people in prison are required to use an N95 and other personal protective equipment when in isolation units, which house people who have tested positive for COVID-19, and during any interaction with someone who has tested positive.

Cloth face coverings, which have been given to all prisoners and staff, are required:

  • In visiting rooms
  • In prisons’ front entries
  • In medical units
  • In infirmaries
  • In specialty units, including units that house elderly people or those with additional care needs and
  • During transport.

At facilities where large outbreaks have recently been identified — including Chillicothe Correctional Center, Eastern Reception, Diagnostic and Correctional Center and Missouri Eastern Correctional Center — face covers are now “required inside any building when social distancing cannot easily be maintained.”

Missouri’s eight neighboring states require prison staff to wear face coverings at all times when inside prisons. People in prison have also said that staff does not always wear the required face coverings in quarantine units.

Spaulding said it makes sense to require face coverings for people even when cases of COVID-19 aren’t reported. A large percentage of people “who can spread infection are asymptomatic, so the mask makes sense even if no cases are found,” she said.

But people in prisons shouldn’t have to wear masks when they’re alone in a cell or room with a closed door, Spaulding said.

While she’s not an epidemiologist or public health expert, Dolovich said data shows how effective masks are at preventing the spread of COVID-19. 

“To have a policy of only requiring universal masking in facilities that have serious outbreaks is getting it the wrong way around,” Dolovich said. “You wear the mask to prevent the outbreak.”

She also said masks must be laundered or replaced regularly to ensure that they’ll remain effective.

Suspension of some transfers

Regular transfers of prisoners have been suspended. But Missouri continues to transfer people “in extenuating circumstances.” 

In practice, this means the state transfers prisoners out of reception and diagnostic centers to make space for more people as they’re brought into the system. The reception and diagnostic centers are where people enter the system. Sometimes, people are also transferred if they have specialized care needs, Pojmann said.

“You can’t keep everyone in the reception and diagnostic centers forever or else you’re going to have a log jam,” Spaulding said. “If people are transferred in small groups, I think that’s a necessary function that will have to go on.”

Dolovich said it is necessary to test individuals before they are transferred.

“Before they move anybody from the reception center to the place they’re going to reside, they should make sure they don’t have COVID,” Dolovich said. 

She said she knows this is incredibly challenging for prison officials who are doing what they can to prevent the spread while knowing prisons are so vulnerable to the virus. 

“To say you have to test people before you move them out of reception centers isn’t to malign someone … because you forgot this one key thing,” Dolovich said. “The tragedy of it is, if you forget a key thing, it could be really devastating for lots of people.”

Spaulding also said that it is important to think about the status of COVID-19 at the prisons involved in the transfer.

“I think transferring large groups of individuals from a prison that’s having a bad outbreak to prisons that don’t have COVID is a bad idea, even if you think you are transferring vulnerable people out of that prison,” Spaulding said. “That is what led to a massive outbreak in California.”

People who have tested positive for COVID-19 are not being transferred, Pojmann said. She added that in most cases, people who are transferred are kept in quarantine, away from the rest of the prison. This depends on whether a prison has space to do so.

Family visits

Family visits have been suspended since March 12 at most prisons in Missouri. At a handful prisons where all staff and prisoners tested negative for COVID-19 during mass testing, visits have resumed with some limitations.

Visitors — up to two per prisoner — must schedule appointments for two hour time slots, and minors are not allowed to visit. Visitors will be screened and their temperatures will be checked before the visit. The visiting rooms can only be 30% full, and there will be 45-minute breaks between scheduled visits to sanitize surfaces. The prison system encourages visitors to get tested for the virus seven days before a planned visit. A full list of the restrictions in place can be found here.

Spaulding and Dolovich were both pleased with Missouri’s efforts to reinstate family visits.

“In the short term, people are so anxious and worried and feeling isolated that I think anything that can allow family members to come together will be to the benefit of everybody,” Dolovich said. “So I really think that that is a great move.”

She said it seems like the state put a lot of thought into the restrictions, but she said that allowing visitors does become a potential vector for infection.

“So they probably, unfortunately, would need to impose rules in the visiting room which require people to socially distance, even from their visitors,” Dolovich said. “It’s just like people in the free world are having visits with friends and family where they don’t get to hug and they have to stay 7 feet apart.” 

Spaulding said people in prison should be able to participate in family visits in a virtual way.

“It would also be good to be able to reduce the price of telephone calls, video conference calls, email and so on just to maximize the use of other modalities for visitation,” Spaulding said.

Since March 23, prisoners have been given two free 10-minute phone calls each week. Since April 7, prisoners have been given an additional free email each week. Family video conferencing is not available in Missouri prisons.

Screening

Anyone entering a Missouri prison is verbally screened and their temperature checked before they are allowed inside.

“I think the screening and temperature checks would be effective in curbing 50% of the exposure,” Spaulding said. “But it would miss people who are asymptomatic.”

Spaulding also said many prisons don’t ask about all of the most common symptoms of COVID-19.

“There’s a longer list of symptoms that people need to be screened for than were in the original guidelines and people should keep an eye on the CDC website,” she said.

Dolovich said screening is not a silver-bullet. 

“It’s better than nothing,” she said. “It at least allows you to identify the people who have an active fever and require them to go away. But we know that it doesn’t begin to come close to being protective because many people will be carriers who won’t be feeling it.”

Limits on interactions

Missouri prisons have restricted prisoners’ movements and how many people can gather in groups. The strategy limits the number of people who staff and residents have contact with, because residents only interact with members of their own housing units throughout the day, according to the department spokesperson.

“That totally makes sense and is in-line with the CDC guidelines,” Spaulding said.

Dolovich also said the measure is good as long as the “bubbles” created by this policy actually remain separate.

“I think staff sometimes can feel themselves immune, so it would not surprise me if in some facilities staff decide they can take it upon themselves to go between bubbles, and a prison administrator has to make absolutely sure that doesn’t happen,” Dolovich said.

Each prison also has cells, wings and units that can be used for isolation if needed. Dolovich said this measure makes sense. Spaulding agreed, as long as it doesn’t cause overcrowding in other places as prisons try to keep those areas free for isolation.

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