WEBVTT - Prisons and Jails Are a Coronavirus Time Bomb 0:00:19.636 --> 0:00:23.196 From Pushkin Industries. This is Deep Background, the show where 0:00:23.196 --> 0:00:26.076 we explore the stories behind the stories in the news. 0:00:26.556 --> 0:00:30.156 I'm Noah Feldman. We're all in the process of doing 0:00:30.196 --> 0:00:34.836 our best to social distance to stop the spread of coronavirus. 0:00:34.876 --> 0:00:37.316 And for most of us, and probably it should be 0:00:37.316 --> 0:00:41.436 for all of us, that basically means self imposed isolation 0:00:41.596 --> 0:00:44.436 of a certain degree. But there are many people in 0:00:44.476 --> 0:00:48.756 the United States whose isolation is involuntary, and that is 0:00:48.916 --> 0:00:52.356 people who are incarcerated in jails, in prisons, or in 0:00:52.436 --> 0:00:57.356 immigration detention centers run by ICE. Prisoners have already tested 0:00:57.396 --> 0:01:00.516 positive for coronavirus in New York, in Georgia and other 0:01:00.596 --> 0:01:03.796 states as well. That's going to continue, and officials are 0:01:03.796 --> 0:01:07.516 scrambling to figure out how to stop the spread inside 0:01:07.756 --> 0:01:12.956 of institutions, prisons, in jails. To discuss this situation, I 0:01:13.036 --> 0:01:16.916 spoke to doctor Homer Vendors. Until recently he was the 0:01:16.996 --> 0:01:20.396 chief medical officer of the New York City Correctional Health Services. 0:01:20.996 --> 0:01:24.876 Now he's president of an organization called Community Oriented Correctional 0:01:24.916 --> 0:01:28.476 Health Services, which is a nonprofit that builds partnerships between 0:01:28.556 --> 0:01:31.756 jails and community healthcare providers. He has a new book 0:01:31.876 --> 0:01:34.996 called Life and death in Rikers Island, which is precisely 0:01:35.036 --> 0:01:38.276 about the health risks of incarceration. And he was involved 0:01:38.276 --> 0:01:41.316 in two thousand and nine in New York City's efforts 0:01:41.316 --> 0:01:43.676 to deal with the H one N one virus when 0:01:43.676 --> 0:01:47.836 it was spreading inside of Riker's Island. In short, doctor 0:01:47.916 --> 0:01:50.676 Vners is really the perfect person to speak to about 0:01:50.716 --> 0:01:55.676 this problem. We spoke on Monday morning, Homer. As of 0:01:55.716 --> 0:01:59.396 this morning, New York City Corrections, where you used to 0:01:59.516 --> 0:02:02.676 be the director of health for the entire system, is 0:02:02.716 --> 0:02:08.276 reporting thirty eight cases of corona among either inmates or 0:02:08.436 --> 0:02:12.076 prison staff. For jail staff, How worried should we be 0:02:12.116 --> 0:02:17.796 about that number? I think that that number should cause alarm. 0:02:18.036 --> 0:02:22.036 That should make us think about not just what's happening 0:02:22.036 --> 0:02:24.716 to people who are detained in the New York City 0:02:24.756 --> 0:02:27.956 jails and the people who work there, but every single 0:02:28.276 --> 0:02:31.596 one of the five thousand jails and prisons and ice 0:02:31.636 --> 0:02:33.716 detention centers across the country. I think this is a 0:02:34.516 --> 0:02:38.876 very small foreshadowing of things to come and implications for 0:02:38.916 --> 0:02:41.396 the survival. The welfare of the people who are in 0:02:41.436 --> 0:02:45.396 these places, who work in these places, is really in peril. 0:02:45.636 --> 0:02:47.836 And this is just the first of what I fear 0:02:47.876 --> 0:02:51.436 will be many many more headlines and reports like this 0:02:51.636 --> 0:02:54.436 around the country, many of the places, by the way, 0:02:54.556 --> 0:02:58.876 that have far fewer health resources, far less access from 0:02:58.916 --> 0:03:01.676 the press from outside eyes. So I think this is 0:03:01.716 --> 0:03:04.516 the beginning of what we've been worrying about is going 0:03:04.556 --> 0:03:08.116 to be a significant feature of this outbreak. A lot 0:03:08.156 --> 0:03:10.876 of us have a visual image of what it's actually 0:03:10.916 --> 0:03:14.316 like inside a jail or a prison only from television, 0:03:14.316 --> 0:03:18.196 and in fact, mostly from fictional television. Would you explain 0:03:18.236 --> 0:03:20.436 a little bit to us about how conditions, for example, 0:03:20.596 --> 0:03:24.836 in a big city jail like Rikers, are especially conducive 0:03:24.876 --> 0:03:28.116 to the transmission of infectious disease. Yeah. I think that 0:03:28.156 --> 0:03:31.996 there are some features of jails that we might generally 0:03:32.076 --> 0:03:35.796 understand that really contribute to the transmission of communicable diseases. 0:03:35.796 --> 0:03:37.636 So the fact that there are lots of people in 0:03:37.796 --> 0:03:41.316 very small spaces, and those people are jammed into housing 0:03:41.396 --> 0:03:44.556 areas that whether they're a dorm or comprised of cells, 0:03:44.556 --> 0:03:47.156 it's still lots of people in a small space, sharing 0:03:47.556 --> 0:03:52.116 congregate bathrooms and sinks. People to go from one part 0:03:52.116 --> 0:03:53.556 of the jail to the other have to go through 0:03:53.636 --> 0:03:56.476 hallways and go through these things called sally ports or 0:03:56.516 --> 0:03:59.036 control hubs, where they're all jammed in and you have 0:03:59.076 --> 0:04:01.436 a gate that closes behind you before a gate can 0:04:01.476 --> 0:04:04.796 open in front of you. There's intake areas where people 0:04:04.796 --> 0:04:06.956 come in, especially in county jails that have such a 0:04:07.036 --> 0:04:09.316 high churn. You know, half the people are gone by 0:04:09.356 --> 0:04:13.076 day ten or fifteen, so they're constantly filling up with 0:04:13.116 --> 0:04:16.636 newly arrested and detained people. Those folks are coming in 0:04:16.636 --> 0:04:20.876 through these intake pens that are very teeming with people, 0:04:20.956 --> 0:04:23.716 just scores of people in small spaces, nowhere to sit, 0:04:23.836 --> 0:04:26.516 laying on the floor, and that's all the physical plant. 0:04:26.516 --> 0:04:29.076 Then if you add in the fact that most of 0:04:29.076 --> 0:04:33.956 these places are filthy, they have incredibly bad sanitation. You 0:04:34.036 --> 0:04:38.276 have garbage, food trays, other types of trash built up 0:04:38.396 --> 0:04:41.836 all over the place. They really promote the spread of 0:04:41.876 --> 0:04:48.556 communicable diseases during normal times and during outbreak response. The 0:04:48.596 --> 0:04:52.436 way that they're built and designed and run promotes the 0:04:52.476 --> 0:04:55.556 spread of disease. One reaction that I had when first 0:04:55.556 --> 0:04:59.836 thinking about incarcerated population is that the lockdown, which is 0:04:59.876 --> 0:05:02.076 sometimes the word that we use colloquially to describe what's 0:05:02.076 --> 0:05:04.796 happening to everybody else. I mean, I know that Governor Quoma, 0:05:04.836 --> 0:05:07.556 New York wants to call it a pause. In California, 0:05:07.596 --> 0:05:09.396 they call it a stay in place where, or another 0:05:09.396 --> 0:05:11.516 sub called a shelter in place. But lockdown is still 0:05:11.836 --> 0:05:14.836 the vernacular phrase that comes from prison. I mean, that's 0:05:14.836 --> 0:05:18.876 a prison metaphor, and that might create the impression in 0:05:18.916 --> 0:05:20.996 somebody's mind. I think it did it. At my first 0:05:21.236 --> 0:05:23.516 uneducated thought before I started reading what you were writing 0:05:23.556 --> 0:05:26.676 about this that actually prisons might be manageable because you 0:05:26.716 --> 0:05:30.356 actually do have the capacity to control the movement of prisoners. 0:05:30.396 --> 0:05:32.556 But on closer examination of what you've been saying, that 0:05:32.556 --> 0:05:35.076 seems completely misguided. And I wonder if you would just 0:05:35.076 --> 0:05:36.596 say a word about that, because I think I might 0:05:36.596 --> 0:05:38.276 not be the only person who has that instinct. Yeah, 0:05:38.276 --> 0:05:41.396 I think that you know, prisons and jails are built 0:05:41.436 --> 0:05:46.076 for punishment and security control of people of humans. I 0:05:46.116 --> 0:05:48.676 think that we all have this desire to stop the 0:05:48.756 --> 0:05:51.036 movement of this virus through our society, and there's a 0:05:51.076 --> 0:05:54.396 lot of really important measures that we're all engaged in 0:05:54.436 --> 0:05:57.636 to try and do that. The problem in prisons and 0:05:57.796 --> 0:06:02.156 jails and in correctional spaces is that lockdown generally means 0:06:02.156 --> 0:06:07.516 putting people into locked cells. Often sometimes dorms, but often 0:06:07.596 --> 0:06:10.756 we use it. It's used of cells, locking people into 0:06:10.756 --> 0:06:13.436 cells and then keeping them there and then only bringing 0:06:13.436 --> 0:06:15.916 them out for certain circumstances. And the idea is that 0:06:16.156 --> 0:06:19.196 the problem will stay in the cell and so in 0:06:19.236 --> 0:06:22.756 this circumstance, and what I would say is inappropriate use 0:06:22.796 --> 0:06:26.676 of lockdowns as the primary response to coronavirus. The notion 0:06:26.756 --> 0:06:29.516 would be that if you lock everybody into cells, then 0:06:29.836 --> 0:06:31.716 the virus either won't get in or if it's in 0:06:31.756 --> 0:06:33.476 the cell, it won't get out and it won't move 0:06:33.516 --> 0:06:37.876 around the facility. That is erroneous for a number of reasons. 0:06:37.916 --> 0:06:41.236 First of all, people who are locked down are being punished. 0:06:41.516 --> 0:06:43.516 Whatever you say is the reason for it. When you 0:06:43.556 --> 0:06:46.036 go get locked into a cell, when you're going into solitary, 0:06:46.436 --> 0:06:48.876 it causes a lot of stress. People don't like it. 0:06:48.876 --> 0:06:51.636 It is associated with suicide and self harm, and so 0:06:51.676 --> 0:06:54.756 people don't want to go into those cells. Then to 0:06:54.956 --> 0:06:57.676 institute a lockdown that means that you'll, all a sudden, 0:06:57.716 --> 0:07:00.316 are going to ask your correctional staff to put their 0:07:00.316 --> 0:07:01.836 hands on a lot of people, to have a lot 0:07:01.876 --> 0:07:06.676 more physical contact with people. Sometimes us as a force 0:07:07.076 --> 0:07:09.436 that get them into these cells, and then every time 0:07:09.476 --> 0:07:12.236 they come out of those cells for a shower, if 0:07:12.276 --> 0:07:13.876 they come out to go to the medical unit, if 0:07:13.916 --> 0:07:16.116 they come out for any other reason, you're often then 0:07:16.156 --> 0:07:19.556 in this position of having to have two escort officers 0:07:19.716 --> 0:07:23.316 handcuff them, escort them physically. All of that is just 0:07:23.756 --> 0:07:27.276 really escalating the amount of physical contact between humans in 0:07:27.316 --> 0:07:30.636 these facilities. The other real core problem with this is 0:07:30.636 --> 0:07:33.196 that when people get sick, and we know they're getting sick, 0:07:33.756 --> 0:07:35.396 when they're locked in a cell, you don't see that. 0:07:35.596 --> 0:07:38.916 Correctional officers coming by every fifteen minutes or thirty minutes 0:07:39.436 --> 0:07:44.596 to peek through a dimly illuminated vision panel or window 0:07:44.636 --> 0:07:46.876 in a cell door is not the way that you 0:07:46.956 --> 0:07:48.756 keep an eye on people that you're worried about getting 0:07:48.796 --> 0:07:52.476 sick or dying. So the lockdown as a public health 0:07:52.476 --> 0:07:57.796 response is not appropriate as the primary measure, and in 0:07:57.836 --> 0:08:01.476 many ways it can actually increase the flow of the 0:08:01.556 --> 0:08:05.676 virus into and out of a facility. Obviously, the most 0:08:05.756 --> 0:08:08.756 immediate ethical worry that I think we all need to 0:08:08.796 --> 0:08:11.636 have with respect to incarcerated people is that it shouldn't 0:08:11.636 --> 0:08:13.516 be the case that if someone is being locked up. 0:08:13.556 --> 0:08:17.676 They're being essentially put in a situation like being put 0:08:17.676 --> 0:08:20.876 on a cruise ship, but involuntarily and with much worse conditions, 0:08:21.076 --> 0:08:24.196 which is likely to significantly increase their chance of getting 0:08:24.196 --> 0:08:27.476 sick and dying. But I assume there's also a concern 0:08:27.556 --> 0:08:32.396 for the general public associated with enabling a coronavirus to 0:08:32.396 --> 0:08:35.996 spread rapidly within jails and prisons, partly because corrections officers 0:08:35.996 --> 0:08:37.516 are coming and going and so it will spread into 0:08:37.556 --> 0:08:41.476 the general population. Partly because of resource allocation issues, because 0:08:41.476 --> 0:08:44.036 if you get a big outbreak, a lot of resources 0:08:44.076 --> 0:08:46.316 are inevitably going to be called on, even if they 0:08:46.316 --> 0:08:49.796 were not distributed in a fair way. What do you 0:08:49.836 --> 0:08:52.876 see as the main concern for the general public here? 0:08:52.916 --> 0:08:55.516 I mean putting aside the very pressing ethical concern that 0:08:55.556 --> 0:08:57.996 we shouldn't be arresting people from minor offenses and then 0:08:58.036 --> 0:08:59.716 putting them into place where they have a better chance 0:08:59.756 --> 0:09:02.676 of catching a disease and dying. Yeah, I think the 0:09:02.756 --> 0:09:06.236 simplest way I could put it is that correctional settings, prisons, jails, 0:09:06.236 --> 0:09:09.436 and ice decession centers are going to drive this piademic 0:09:09.516 --> 0:09:12.876 curve straight up. So we hear about trying to flatten 0:09:12.876 --> 0:09:15.996 that curve about trying to relieve the strain and stress 0:09:16.036 --> 0:09:19.316 on our health system by social distancing and taking all 0:09:19.356 --> 0:09:22.396 these other measures and really extreme important measures that are 0:09:22.396 --> 0:09:26.556 being implemented today. What happens behind bars is going to 0:09:26.636 --> 0:09:29.476 drive that epidemic curve in exactly the opposite direction of 0:09:29.516 --> 0:09:33.396 what we're working towards, and so they will quickly become reservoirs. 0:09:33.396 --> 0:09:37.756 And they probably are already, but certainly as we make 0:09:37.796 --> 0:09:40.516 gains in the rest of the community, these places will 0:09:40.556 --> 0:09:43.996 become critical reservoirs for infection. They're going to continue to 0:09:44.076 --> 0:09:47.716 cycle infection out of these places in and out as 0:09:47.716 --> 0:09:49.916 staff go in and out, and to some extent the 0:09:49.996 --> 0:09:51.956 people who are held there. But you know, there's many 0:09:51.956 --> 0:09:54.836 more people coming and going every day who are staff 0:09:54.876 --> 0:09:58.716 members than there are arriving as newly arrived people in 0:09:58.756 --> 0:10:02.356 a prisoner jail. So these places, as reservoirs of infection, 0:10:02.596 --> 0:10:06.476 as congregate settings where the spread of the infection cannot 0:10:06.476 --> 0:10:12.196 really be controlled, stand to dramatically escalate the epidemic curve 0:10:12.236 --> 0:10:14.836 that we're working so hard to bring down. Homer, you 0:10:14.876 --> 0:10:19.836 mentioned crucially that prisons and jails are probably already at 0:10:19.916 --> 0:10:24.676 least in New York City becoming reservoirs of coronavirus. That 0:10:24.756 --> 0:10:27.796 leads us to the really pressing question of what we 0:10:27.836 --> 0:10:30.036 should be doing and how we should be doing it 0:10:30.116 --> 0:10:33.356 with respect to releasing people. And I want to start 0:10:33.396 --> 0:10:35.676 with just asking a question of you when you wear 0:10:35.716 --> 0:10:39.276 your epidemiologist hat. And that is given that we know 0:10:39.396 --> 0:10:43.596 now that there are presumably lots of cases, including asymptomatic cases, 0:10:44.236 --> 0:10:48.116 in jails and prisons, if we open those doors, is 0:10:48.116 --> 0:10:50.676 that going to be adding a new vector of rapid 0:10:50.756 --> 0:10:53.876 spread to the general population. And if so, is that 0:10:53.996 --> 0:10:55.756 nevertheless the right thing to do in terms of the 0:10:55.796 --> 0:10:59.036 overall cost benefit of fighting the disease. Well, I think 0:10:59.076 --> 0:11:03.516 where we're at now is that when coronavirus arrives in 0:11:03.556 --> 0:11:06.796 a community, it's part of the community is the jail 0:11:06.916 --> 0:11:09.156 or prison or is attention center, and it's going to 0:11:09.276 --> 0:11:14.596 arrive there. So places where we likely have a significant 0:11:14.676 --> 0:11:17.636 number of people who are asymptomatic, who are kind of 0:11:17.636 --> 0:11:21.236 brewing early infections. It's no different inside the jail than 0:11:21.276 --> 0:11:23.476 outside the jail. Now, in the coming weeks, we will 0:11:23.556 --> 0:11:27.756 have spread inside those facilities that you may be more 0:11:27.796 --> 0:11:32.596 accelerated than outside. But one of My primary concerns is 0:11:32.636 --> 0:11:35.036 that unlike the community, where we're going to have some 0:11:35.436 --> 0:11:38.956 family or ability some other we have capacity to see 0:11:38.996 --> 0:11:41.996 who's getting sick and who needs hospital level care. We're 0:11:41.996 --> 0:11:44.876 going to miss that behind bars. When H one N 0:11:44.916 --> 0:11:48.036 one hit, everybody who was symptomatic was tested in the 0:11:48.076 --> 0:11:52.196 New York City jails, and so sometimes the press and 0:11:52.276 --> 0:11:55.396 people on the outside would erroneously think that this was 0:11:55.436 --> 0:11:58.116 a riker's outbreak of H one N one. But we 0:11:58.316 --> 0:12:01.276 everybody who was symptomatic was in a housing area, and 0:12:01.316 --> 0:12:03.476 these weren't cells, they were dorms, but they were in 0:12:03.516 --> 0:12:05.676 housing areas where they couldn't move in and out. But 0:12:05.716 --> 0:12:07.756 also we would give them a test and then if 0:12:07.756 --> 0:12:10.236 they were symptoms attic, they'd go to the same place 0:12:10.276 --> 0:12:13.156 that the coronavirus patients are going today, the West Facility 0:12:13.156 --> 0:12:17.036 of Communicable Disease Unit. But people thought, because I think 0:12:17.076 --> 0:12:18.956 it was like two and a half percent of the 0:12:18.996 --> 0:12:21.196 people coming into the who it came into the jails 0:12:21.236 --> 0:12:23.996 during that time tested positive, they thought, boy, this is 0:12:24.036 --> 0:12:26.676 a riker's problem. It wasn't. It's a community problem. We 0:12:26.796 --> 0:12:29.196 just happened to be very aggressive about testing because we 0:12:29.196 --> 0:12:32.156 did not want to miss a single case. I think 0:12:32.196 --> 0:12:35.516 that the way to characterize what's happening behind bars is 0:12:35.996 --> 0:12:38.836 if it's in the community, it's part of the community's 0:12:38.836 --> 0:12:43.196 the jail or prison, and so I don't believe that, 0:12:43.636 --> 0:12:48.596 at least today, there's an epidemiologic reason to say releasing 0:12:48.636 --> 0:12:51.356 people is going to contribute to the infection. And I 0:12:51.396 --> 0:12:54.276 think that right now we've turned a corner in this country, 0:12:54.276 --> 0:12:58.996 which is our primary focus is on preventing death, and 0:12:59.076 --> 0:13:00.636 to do that, we have to get people out of 0:13:00.636 --> 0:13:13.716 these places. We'll be back in just a moment. There 0:13:13.716 --> 0:13:19.796 are voices, including yours, increasingly calling for release of certainly 0:13:19.916 --> 0:13:23.756 people who are jailed awaiting trial, and even of inmates 0:13:23.796 --> 0:13:27.356 who've already been convicted or guilty to crimes. Do you 0:13:27.396 --> 0:13:29.196 have a view about how that should be done, how 0:13:29.236 --> 0:13:32.556 should that be triage. I think that we'll need different 0:13:32.556 --> 0:13:36.156 strategies for county jails, for state and federal prisons, and 0:13:36.196 --> 0:13:39.836 for ice detention centers. Some of these places, like ice detention, 0:13:40.196 --> 0:13:43.596 there's not really nobody is even making a public safety 0:13:43.636 --> 0:13:45.876 argument for why people should be detained, and so you 0:13:45.916 --> 0:13:49.276 could categorically just administratively, it seems to let people out 0:13:49.756 --> 0:13:54.076 county jails have one set of pathways, which involved looking 0:13:54.076 --> 0:13:56.276 at people in the nature of their charges and figuring 0:13:56.276 --> 0:13:59.676 out how they can get people out certainly before there 0:13:59.756 --> 0:14:01.716 so they can just show up to trial. And that's 0:14:02.196 --> 0:14:04.596 and that's different than you know, when I've talked to 0:14:04.636 --> 0:14:08.476 state prison administrators in the last couple of weeks, that's 0:14:08.476 --> 0:14:11.796 a very tough off road. There are people who are 0:14:11.796 --> 0:14:14.436 on the pathway to prison release, and so those pathways 0:14:14.436 --> 0:14:18.356 can be accelerated. There are in most states prison furlough 0:14:18.636 --> 0:14:23.156 processes that can be enacted, But the state prisons I'm 0:14:23.316 --> 0:14:26.836 terribly worried about because you have just huge numbers of people. 0:14:27.396 --> 0:14:29.756 I was talking with somebody from a state prison system 0:14:29.836 --> 0:14:33.516 yesterday where the overall capacity of the state prison is 0:14:33.556 --> 0:14:35.996 at one hundred and seventy five percent of what they 0:14:36.036 --> 0:14:40.436 should have, and so incredibly densely populated places where there's 0:14:40.476 --> 0:14:43.956 really very little prospect of getting people out. And so 0:14:44.476 --> 0:14:47.276 as I think about what we need to do to 0:14:47.356 --> 0:14:50.956 react besides release, part of it is it will contemplate 0:14:50.996 --> 0:14:54.476 strategies that are different for these different types of settings. 0:14:55.316 --> 0:14:57.996 That seems very sensible, but I just you know, there 0:14:58.076 --> 0:14:59.916 is a substantial risk I think that none of that 0:14:59.956 --> 0:15:02.516 could happen fast enough. I mean, so, for example, I 0:15:02.556 --> 0:15:06.796 know some DA's offices around the city, including Brooklyn, have 0:15:06.916 --> 0:15:11.476 called for applications from lawyers for people who are detained 0:15:11.516 --> 0:15:13.836 to say, hey, explain to us why we should go 0:15:13.876 --> 0:15:15.956 to the court and move to have your or agree 0:15:15.956 --> 0:15:19.076 to your emotion to have your client release under these 0:15:19.076 --> 0:15:21.876 conditions and circumstances. I think that's a great response. I 0:15:21.996 --> 0:15:24.516 worry that it can't work at scale. It's not just 0:15:24.596 --> 0:15:28.396 that courts are moving more slowly because of their own 0:15:28.436 --> 0:15:32.636 concerns about Corona's that even under the best of circumstances, 0:15:32.676 --> 0:15:35.036 that's a very individuated way of doing it. And of 0:15:35.036 --> 0:15:37.316 course it seems sensible. Let's make sure, let's weigh, let's 0:15:37.356 --> 0:15:39.556 make a judgment about each person. That's what courts are 0:15:39.596 --> 0:15:43.196 good at. But it's not a crisis response approach. Do 0:15:43.236 --> 0:15:45.676 you think there's a plausible argument to say, for example, 0:15:45.716 --> 0:15:50.636 that all non violent offenders being held in rikers, or 0:15:50.676 --> 0:15:53.236 all non violent offenders over the age of fifty, or 0:15:53.476 --> 0:15:55.916 you know, something of that sort just ought to be 0:15:56.236 --> 0:15:58.076 straight up released. And the reason I ask this is 0:15:58.076 --> 0:16:00.556 not just about getting things right in New York city 0:16:00.676 --> 0:16:03.436 or in the jail slash prison that you know very well. 0:16:03.676 --> 0:16:05.516 It's also that this is going to become a paradigm 0:16:05.556 --> 0:16:09.396 set a presumably for other places in the country, if 0:16:09.436 --> 0:16:14.356 in most likely when we see the same scenario repeated elsewhere. Yeah, 0:16:14.436 --> 0:16:18.276 I think that's an important point that deliberative and piecemeal 0:16:18.516 --> 0:16:22.156 approaches are not always the ones we want to turn 0:16:22.196 --> 0:16:24.876 to in really die our emergencies. I reminded of a 0:16:24.876 --> 0:16:27.356 colleague who once told me that after Katrina in New Orleans, 0:16:28.156 --> 0:16:32.396 what they got was a plan that was developed by 0:16:32.436 --> 0:16:34.636 an Internet And I can say this as an Internet, 0:16:34.676 --> 0:16:36.476 but what they needed was a plan developed by an 0:16:36.476 --> 0:16:39.716 emergency medicine doc. And I don't mean that just for 0:16:39.756 --> 0:16:41.796 the medical part, and so I think that's right. I 0:16:41.796 --> 0:16:44.836 think one of the things I'm calling for in terms 0:16:44.836 --> 0:16:48.116 of what we should do besides release with keeping releases, 0:16:48.156 --> 0:16:52.836 the number one objective is every state must appoint or 0:16:52.916 --> 0:16:56.556 identify a correctional health coordinator who can manage this process, 0:16:56.716 --> 0:16:59.596 and the CDC needs to also, and so does HHS. 0:16:59.676 --> 0:17:02.436 We need state level and federal level people who have 0:17:02.516 --> 0:17:07.956 been identified to coordinate what's happening with the health aspects 0:17:07.996 --> 0:17:11.036 of corrections and to tend spaces around the country because 0:17:11.036 --> 0:17:13.116 we have five thousand of these places. If you sit 0:17:13.716 --> 0:17:16.036 as a commissioner of health or the person who's running 0:17:16.076 --> 0:17:20.596 your state's COVID emergency response, you look across this array 0:17:20.676 --> 0:17:23.076 of places you probably don't even know much about. You 0:17:23.116 --> 0:17:26.276 have county jails in all your counties, mostly, you have 0:17:26.316 --> 0:17:29.076 state prisons, and then you have ice detension centers, some 0:17:29.116 --> 0:17:31.956 of which are run by for profit companies. And so 0:17:32.756 --> 0:17:35.556 we need just like we're taking seriously what's happening in 0:17:35.596 --> 0:17:39.436 long term care facilities, assisted living, in nursing home settings, 0:17:39.676 --> 0:17:42.116 we need to identify one person in every state that's 0:17:42.156 --> 0:17:43.876 going to take on this task because we don't even 0:17:43.876 --> 0:17:47.196 have data today. Nobody could tell you how many patients 0:17:47.476 --> 0:17:50.716 inside county jails, state and federal prisons, and ice detention 0:17:50.876 --> 0:17:54.316 centers have symptoms today, how many are needing a test. 0:17:54.916 --> 0:17:57.676 And one of the critical concerns I have is we 0:17:57.756 --> 0:18:00.476 do not have pathways to hospital level care for most 0:18:00.516 --> 0:18:03.076 of these patients. Most of these patients who get sick, 0:18:03.676 --> 0:18:05.956 the traditional method of getting them into a hospital is 0:18:05.996 --> 0:18:09.156 to send them with two armed correctional officers to go 0:18:09.196 --> 0:18:12.036 to a local hospital. It's a process that for people 0:18:12.076 --> 0:18:14.676 who have seen it, like everybody who works in emergency 0:18:14.756 --> 0:18:17.516 rooms and people who work in corrections know this. It 0:18:17.596 --> 0:18:21.076 takes a ton of resources because you're sending two officers 0:18:21.196 --> 0:18:22.996 who are going to stay with this person twenty four 0:18:22.996 --> 0:18:25.076 to seven. They take up a ton of space in 0:18:25.116 --> 0:18:28.676 an emergency room. Emergency rooms that are incredibly over stretch 0:18:28.756 --> 0:18:31.356 right now in terms of their staffing and their space. 0:18:31.916 --> 0:18:35.036 And so if we get five or ten or fifteen 0:18:35.116 --> 0:18:38.956 people from one facility going to the hospital, there just 0:18:38.996 --> 0:18:41.956 won't be CEOs correctional officers to go with them. They're 0:18:41.996 --> 0:18:44.596 going to have fewer staff because they'll be sick. We 0:18:44.676 --> 0:18:47.316 won't have a magical new resource for them to go 0:18:47.396 --> 0:18:51.316 to to get this care. And my experience in investigating 0:18:51.316 --> 0:18:54.356 deaths all over the country is that these patients are 0:18:54.396 --> 0:18:56.716 patients who are behind bars today, are the ones that 0:18:56.756 --> 0:18:58.196 go to the back of the line when it comes 0:18:58.196 --> 0:19:01.556 to access to hospital level care. And so part of 0:19:01.556 --> 0:19:06.036 the priority has to be we create explicit passways for 0:19:06.316 --> 0:19:09.756 access to hospital level care when we had toify patients 0:19:09.756 --> 0:19:13.356 that need it in the real world. I don't think 0:19:13.556 --> 0:19:15.836 you'll see that happening. I mean, I think it's maybe 0:19:15.876 --> 0:19:18.916 ten or fifteen patients. You could conceive of a system saying, well, 0:19:18.916 --> 0:19:21.356 we're going to send two correctional officers, but at some point, 0:19:21.396 --> 0:19:22.876 either they're going to have to stop doing that and 0:19:22.956 --> 0:19:27.836 shoulder the risk of escape, or alternatively, simply not send 0:19:27.876 --> 0:19:32.956 people who are incarcerated to hospitals. And if that happens, 0:19:33.796 --> 0:19:37.236 what will happen within the jails and the prisons. Well, 0:19:37.276 --> 0:19:39.556 if those are the only two options, then yes, people 0:19:39.596 --> 0:19:42.476 will die preventable death because people will be held in 0:19:42.516 --> 0:19:45.156 correctional facilities where staff will to try and take care 0:19:45.156 --> 0:19:47.716 of them for too long. They'll get well passed their 0:19:47.796 --> 0:19:52.276 level of clinical competence and equipment and infection control capacity. 0:19:53.116 --> 0:19:55.636 Some of the data indicate thirty or forty percent of 0:19:55.636 --> 0:19:57.716 the people who need kind of a middle level of 0:19:57.796 --> 0:20:00.956 inpatient treatment but not yet I see you treatment. About 0:20:00.996 --> 0:20:02.876 thirty or forty percent of them will need a higher 0:20:02.956 --> 0:20:05.276 level of care. Well, if you're trying to manage the 0:20:05.476 --> 0:20:09.796 middle level inpatient folks in your jail or prison or 0:20:09.996 --> 0:20:13.116 detention center, than when they need that higher level of 0:20:13.116 --> 0:20:15.756 care because they deteriorate, you're not rolling them down the 0:20:15.756 --> 0:20:17.996 hall to the ICU. You're going through a two hour 0:20:18.036 --> 0:20:21.356 transfer process, so they're going to die. There is another option. 0:20:21.796 --> 0:20:25.636 We did this after Sandy to set up secure treatment 0:20:25.716 --> 0:20:30.356 units as part of what's going to be the surge 0:20:30.436 --> 0:20:34.956 in capacity at hospital. So hospitals that are currently building 0:20:35.796 --> 0:20:39.796 sometimes tense, sometimes new opening up wings that have been mothballed, 0:20:39.956 --> 0:20:44.676 setting up new space to handle this incoming flux of 0:20:44.996 --> 0:20:48.476 COVID patients. In that the states that are planning this 0:20:48.676 --> 0:20:52.356 with their hospital partners, they need to explicitly detail and 0:20:52.476 --> 0:20:56.836 plan for care for incarcerated patients. And so sometimes what 0:20:56.916 --> 0:20:59.156 you can do is you can as we did after Sandy, 0:20:59.156 --> 0:21:01.556 We've set up a new unit. We had patients go 0:21:01.596 --> 0:21:06.036 to a couple of dedicated places but when Bell was evacuated. 0:21:06.076 --> 0:21:08.356 But one of the things you need is the capacity 0:21:08.356 --> 0:21:10.836 to set up are units. So you're not relying on 0:21:11.436 --> 0:21:15.596 two correctional officers for every patient. But you can figure 0:21:15.636 --> 0:21:19.116 out how to get a better ratio of correctional officers 0:21:19.116 --> 0:21:22.476 to patients in a unit that's somewhat secured, that meets 0:21:22.516 --> 0:21:26.156 the custodial requirements of the securing authorities. And it may 0:21:26.196 --> 0:21:28.996 be that in some states and some regions you actually 0:21:28.996 --> 0:21:33.236 have multiple correctional administrations, like different sheriffs or sheriffs and 0:21:33.236 --> 0:21:36.556 state prisons cooperating to figure out how can they staff 0:21:36.636 --> 0:21:39.916 up and design these units quickly with the hospitals that 0:21:39.996 --> 0:21:44.156 are surging their capacity. Because these units and this response 0:21:44.196 --> 0:21:47.836 has to involve hospital level care by hospital staff, it's 0:21:47.876 --> 0:21:50.356 not going to work if you're keeping patients out in 0:21:50.396 --> 0:21:54.556 these correctional settings. They're just not going to survive. What's 0:21:54.596 --> 0:21:57.316 the sort of best case scenario you can picture. We've 0:21:57.316 --> 0:21:59.436 spent a lot of time in this pandemic situation talking 0:21:59.476 --> 0:22:01.356 about worst case scenarios, and you've made it pretty clear 0:22:01.356 --> 0:22:03.796 that the worst case scenario is significant number of people 0:22:03.916 --> 0:22:08.356 dying unnecessarily and prisons and jails really contributing to the 0:22:08.476 --> 0:22:11.156 rapid rise of the curve. But what's the best case 0:22:11.156 --> 0:22:15.356 scenario that you can realistically foresee if good recommendations are 0:22:15.396 --> 0:22:19.436 followed well. I think that one of the things that 0:22:19.556 --> 0:22:22.876 could happen relatively quickly is that as states in the 0:22:22.956 --> 0:22:26.796