The coronavirus disease 2019 (Covid-19) pandemic has uniquely affected prisons and jails across the country. The incidence of Covid-19 among incarcerated persons is nearly six times that among nonincarcerated community members. The Centers for Disease Control and Prevention, the National Academy of Medicine, and the American Medical Association have recommended prioritization of prison and jail populations for deployment of Covid-19 vaccines, but vaccine rollout has varied across these settings, and few studies have been conducted on the effectiveness of vaccination efforts in congregate housing. Most of such studies have been performed in skilled nursing facilities, where vaccine effectiveness has been measured at 63 to 64%.

Carceral settings in the United States have been the source of many single site COVID-19 outbreaks. Quarantine is a strategy used to mitigate the spread of COVID-19 in correctional settings, and specific quarantine practices differ state to state. To better understand how states are using quarantine in prisons, we reviewed each state's definition of quarantine and compared each state's definition to the Centers for Disease Control's (CDC) definition and recommendations for quarantine in jails and prisons. Most prison systems, 45 of 53, define quarantine, but definitions vary widely. No state published definitions of quarantine that align with all CDC recommendations, and only 9 states provide quarantine data. In these states, the highest recorded quarantine rate occurred in Ohio in May 2020 at 843 per 1,000. It is necessary for prison systems to standardize their definitions of quarantine and to utilize quarantine practices in accordance with CDC recommendations. In addition, data transparency is needed to better understand the use of quarantine and its effectiveness at mitigating COVID-19 outbreaks in carceral settings.

This cohort study describes the burden of coronavirus disease 2019 among people detained by US Immigration and Customs Enforcement compared with the US population.

As of February 15, 2021, there were more than 464 000 COVID-19 infections and at least 2400 deaths among incarcerated persons and staff members in prisons, jails, and detention centers across the United States. Efforts to prevent and contain outbreaks in correctional facilities have been stymied by entrenched, hyperpunitive attitudes toward people who are incarcerated—held by politicians and members of the public alike—and by prevailing misconceptions that correctional facilities are self-contained. Although prisons and jails appear to be detached from our communities by fences, walls, and bars, their populations are dynamic. Their walls are permeable. Each day, thousands of persons are admitted and released, and staff return home to their families. As a result, disease outbreaks that occur in prisons and jails rarely stay there. In April 2020, nearly 16% of all COVID-19 cases in Illinois were traced back to Chicago’s Cook County Jail. Despite these risks to the lives of incarcerated persons, staff members, and the communities to which they all return, monetary resources, protocols to control and contain outbreaks, and other mitigation activities in correctional facilities have been woefully insufficient. In this issue of AJPH, Tompkins et al. (p. 907) document the point prevalence of COVID-19 among incarcerated persons (30.5%) and staff members (2.3%) in a correctional facility in Arkansas. The authors found that among incarcerated persons who tested positive and responded to a questionnaire about symptoms, 81% were asymptomatic. The findings from this research reinforce the urgent need for widespread implementation of three essential strategies to reduce COVID-19 spread in correctional settings: mass testing, prioritized vaccination, and, critically, decarceration.

Background: Fentanyl and related compounds have recently saturated the illicit drug supply in the United States, leading to unprecedented rates of fatal overdose. Individuals who are incarcerated are particularly vulnerable, as the burden of opioid use disorder is disproportionately higher in this population, and tolerance generally decreases during incarceration. Methods: We conduct a systematic search for publications about fentanyl overdoses during incarceration in PubMed and PsycINFO, as well as lay press articles in Google, from January 1, 2013 through March 30th, 2021. Results: Not a single fentanyl overdose was identified in the medical literature, but 90 overdose events, comprising of 76 fatal and 103 nonfatal fentanyl overdoses, were identified in the lay press. Among the 179 overdoses, 138 occurred in jails and 41 occurred in prisons, across the country. Conclusions: Fentanyl-related overdoses are occurring in correctional facilities with unknown but likely increasing frequency. In addition to the need for improved detection and reporting, immediate efforts to 1) increase understanding of the risks of fentanyl and how to prevent and treat overdose among correctional staff and residents, 2) ensure widespread prompt availability of naloxone and 3) expand the availability of medications to treat opioid use disorder for people who are incarcerated will save lives.