3rd April 2020
In an open letter to the Secretary of State for Justice, the Howard League for Penal Reform and the Prison Reform Trust have warned that failure to act immediately to reduce the prison population could lead to loss of life on an unprecedented scale.
The letter was published alongside a report by Professor Richard Coker, Emeritus Professor of Public Health at London School of Hygiene & Tropical Medicine, which sets out the most up-to-date evidence concerning the nature, spread and transmission of COVID-19 as it applies to prisons.
While the report refers to prisons in England and Wales, much of the commentary is applicable to prisons worldwide. Professor Coker’s report states “the risk of exposure of COVID-19 to prisoners and staff when new cases enter a prison is far, far greater than the risk to individuals in the wider community”, adding that social distancing and personal infection control measures are “almost impossible” in prisons.
Professor Coker notes that fatality rates around the world appear to be higher where there is a rapid spread and the breakdown of, or lack of access to, health care services. This is of concern, given the poor ratio of healthcare staff to the prison population. Accompanied by this, “overcrowding, unsanitary conditions, poor ventilation in a prison will likely increase the speed with which an epidemic unfolded”. The report states that once cases of COVID19 have entered a prison setting “[…] the identification of subsequent cases is almost impossible because of the asymptomatic nature of infection, the incubation period, and the different likely routes of transmission”.
The report finds that the risk of prisoners suffering from a severe case of COVID-19 is dependent upon the underlying risk factors such as age, sex and co-morbidities, and their timely access to appropriate health care facilities. This is concerning given that prison populations disproportionately experience complex, co-occurring health problems with higher levels of compromised health, ill-health and chronic conditions. In Irish prisons, 15% of people serving sentences are aged 50 or above.
Writing on the provision of prison healthcare, Professor Coker states that if treatment is to be provided within a prison setting then “the capacities, and timely access to facilities is critically important” because “the clinical status of patients with COVID-19 can, and often does, deteriorate rapidly”.
Coker writes that there is also a “wider public health imperative”, seeing as prisons act as ‘epidemiological pumps’ to the wider community. When prisoners and workers within the prison system develop the disease, “further exposure to others in the system is almost inevitable”.
Ultimately, in order to combat the realities of COVID-19 in prisons, the Expert Report recommends that authorities “should consider alternative options to incarceration where feasible”.
Professor Coker’s Expert Report is available here.