Medical Isolation and Solitary Confinement: Balancing Health and Humanity in US Jails and Prisons During COVID-19
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Division of Geriatrics, Department of Medicine, School of Medicine, University of California, San Francisco San Francisco, CA, USA; 2Division of Infectious Diseases, Department of Medicine, School of Medicine, University of California, San FranciscoSan Francisco, CA, USA.
In the face of the continually worsening COVID-19 pandemic, jails and prisons have become the greatest vectors of community transmission and are a point of heightened crisis and fear within the global crisis. Critical public health tools to mitigate the spread of COVID-19 are medical isolation and quarantine, but use of these tools is complicated in prisons and jails where decades of overuse of punitive solitary confinement is the norm. This has resulted in advocates denouncing the use of any form of isolation and attorneys litigating to end its use. It is essential to clarify the critical differences between punitive solitary confinement and the ethical use of medical isolation and quarantine during a pandemic. By doing so, then all those invested in stopping the spread of COVID-19 in prisons can work together to integrate medically sound, humane forms of medical isolation and quarantine that follow community standards of care rather than punitive forms of solitary confinement to manage COVID-19. J Gen Intern Med DOI: 10.1007/s11606-020-05968-y © The Author(s) 2020
poor preparation and slow response to the T herisksnation’s posed by COVID-19 have been compounded in jails and prisons, many of which are now reporting high numbers of infections among incarcerated people and staff. Evidence so far indicates that correctional facilities, including jails in New York City and Chicago and prisons in Ohio, have the highest rates of confirmed cases of COVID-19 of any setting.1 As the COVID-19 pandemic sweeps through an alarming number of US jails and prisons, guidance from the medical community on the ethical and humane use of medical isolation and quarantine in these settings is urgently needed. While social distancing is critical to slowing the spread of disease, it is exceedingly challenging in the unique settings of prisons and jails. Consequently, some correctional systems are employing isolation in ways that are haphazard or inhumane Received April 28, 2020 Accepted June 5, 2020
and will, in turn, undermine their public health intentions. Recently, some prison reform advocates and litigators working on behalf of incarcerated people have called for a prohibition against the use of isolation to combat COVID-19, out of concern that recent strides made toward ending solitary confinement in the USA are being put in jeopardy.2, 3 This tension, left unresolved, could rapidly result in a health and humanitarian crisis affecting the residents, employees, and surrounding communities of our nation’s over 5000 places of detention.
RESPONDING TO COVID-19 IN CORRECTIONS: UNIQUE CHALLENGES TO MEDICAL ISOLATION AND QUARANTINE
From a public health perspective, the concerns of both correctional systems and prison reform advocates are valid. Solitary confinement i
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