Study: Higher COVID rates seen in Missouri counties housing large prison populations

Since the Delta variant of the coronavirus took hold at the beginning of June, almost a quarter million Missourians have tested positive for COVID-19.

In Missouri’s 22 prisons, the Delta surge had very different impacts, depending on whether the facility receives new inmates directly from county jails. Four do, and saw additional cases in numbers that mirrored the state as a whole, with more than 1,000 prisoners testing positive since June 1.

Eighteen don’t, and saw only a fraction of the cases — only 200 infections among prisoners over the same period.

That difference highlights the need for uniform standards for controlling infectious diseases in correctional facilities, whether state-run prisons or county jails, according to a new analysis on the impact of incarceration on community COVID-19 spread. 

The study, based on 2020 data, found that counties with more incarcerated people had higher infection rates. While COVID-19 enters a jail or prison from the community, the close living conditions can cause it to spread rapidly and infect staff and visitors who take it home.

“The way we handle COVID in jails and prisons impacts the whole state, not just the people who work and live there,” said Liza Weiss, executive director of Missouri Appleseed, the St. Louis-based not-for-profit that commissioned the study.

The authors are six academics from the fields of law, health and sociology from St. Louis University, Washington University and the University of Georgia.

Conditions in jails and prisons, such as close quarters and group dining, can speed the spread of a disease, said Savannah Larimore, postdoctoral research associate in the Department of Sociology at Washington University. 

New inmates, staff shift changes and visitors all can carry infection into the facility, she said.

“Having some kind of mandates or requirements on folks who are coming in and out of those locations, that’s going to be beneficial to the community, as well as people who are incarcerated,” she said. “Just so we’re making sure that we’re limiting those opportunities for spread across locations.”

The recommendations of the Missouri Appleseed report include:

• Reduce jail and prison populations by diverting non-violent offenders and releasing medically vulnerable inmates, with a target of housing 85 percent of the rated capacity.
• Protect inmates and staff with testing, vaccination, education about COVID-19, protective equipment and social distancing.
• Provide raises and hazard pay to corrections employees to compensate them for the extra risk of working during a pandemic.

“Prisons and jails cannot guarantee safety, regular recreation, prompt trips to medical services, or even on-time meals to the people incarcerated during a pandemic unless the facilities are adequately staffed,” the report states.

The corrections department was provided a copy of the report and, reviewing its recommendations and protocols, believes that it has already implemented many of the ideas, said Karen Pojmann, spokeswoman for the department.

The list of ideas “reads more like a report of the best practices we’ve implemented than a collection of suggestions for improvement,” she said.

The average daily census of the department facilities is about 23,000, but that number changes daily as men and women are received and released. The long-term population is relatively stable but many prisoners are eligible for parole in six to 12 months and many others are released after 120-day treatment programs.

In all, Pojmann said, the prison system houses about 40,000 people over the course of a year. That is just one example of the number of people who enter and leave every day, a list that includes all staff and visitors, she said.

The four prisons that process new inmates sent by the courts – in Bonne Terre, Fulton, St. Joseph and Vandalia – have recorded 1,144 coronavirus infections since June 1. The department is focused on making sure infection does not reach the prisons where those new inmates will serve long-term commitments, she said.

“City and county jails are not consistent with their protocols,” Pojmann said. “We take whoever comes to us, quarantine them, test them and isolate them if they are positive and try to keep the virus from spreading.”

About 75 percent of prisoners in state custody are vaccinated, she said.

Incarceration and COVID-19

The data on cases among incarcerated individuals in Missouri is spotty. 

The Department of Corrections began reporting cases among staff and inmates by facility in June 2020. The latest report shows 7,031 infections among the 22 facilities listed. 

The department reported 51 inmate deaths from COVID-19, but does not list deaths by facility.

For county jails, where tens of thousands of Missourians spend anything from a few hours to several months in custody each year, information is almost all anecdotal.

The study points to the St. Louis County Jail as a standard for infection control. But events have shown many jails do not meet that standard. 

In early December, the Howard County Jail in central Missouri was emptied of prisoners because many inmates and almost all employees of the Howard County Sheriff’s Department, including the sheriff, were ill or in quarantine. 

There were also large outbreaks of COVID-19 during 2020 in several of the state’s largest jails, including Greene County, which closed its jail kitchen amid an outbreak in September 2020, and late November 2020, when 122 cases were found at the Jackson County Jail.

Using data as of Dec. 31, the analysis found that infection rates in counties hosting prisons was higher than in those that do not. 
More prisoners is associated with more cases, the study found. 

The data indicated counties without incarcerated people would have 63 infections per 100,000 residents. With five per square mile, the rate increases to 77 per 100,000 and “a county with 12 incarcerated people per square mile (the maximum observed in the data) would have 96 infections per 100,000 residents.”

The report does not conclude that a prison magnifies infection rates, said Finola Trendergast, director of research for Missouri Appleseed. 

“What it shows is a correlation between the presence of a prison in the community and higher community COVID case rates,” she said. “What the report suggests is that counties with prisons generally have higher community case rates. It would be difficult to definitively prove a causal relationship.”

The department considers its record on COVID-19 control to be a good one, Pojmann said. 

Nationally, average COVID rates in state prisons were 3.7 times higher than the COVID rates in their states, Pojmann said. The prison infection rate for Missouri was only 1.8 times higher than the infection rate in the rest of the state, “placing the Missouri DOC among the nation’s best-performing state prison systems for successful COVID management.”

The department’s inmate industry made more than 700,000 high-quality face covers and 14,000 protective gowns in the sewing factory. The chemical factory filled 16,000 gallons of hand sanitizer and 18,000 four-ounce bottles.

The department has used extra space from a reduction in daily prison populations from a peak of about 33,000 in 2017 to create isolation wings and social distancing, Pojmann said.

But the department has no control over when to release inmates, she added. And releasing a person unprepared for life outside could be more dangerous to them than keeping them in prison.

“It doesn’t protect them from getting COVID and it doesn’t help them succeed when they are released,” she said.

The people who most frequently enter and leave jails and prisons are staff. In more than half of Missouri’s state prisons, the first case reported by the corrections department was a staff case. In all, about 2,700 facility employees have tested positive for COVID-19.

While the department set rules for screening staff on their way to work, and at times required masks, enforcement was spotty in 2020, said Lori Curry, director of Missouri Prison Reform.

Curry uses a network of inmates and staff to obtain information about conditions in state prisons.

“The biggest thing I was hearing is that staff members were not wearing masks, at all,” Curry said. “That was frustrating to the incarcerated because they were potentially bringing in infection. The staff go out into the community, and were not doing anything to protect themselves. That is something the incarcerated were extremely frustrated with.”

That exposure in the community has been seen in the department’s reports during the Delta variant wave. While very few inmates in non-intake prisons became infected, there was little difference in the additional cases among staff at the four intake prisons compared to facilities with a more stable population.

New infections in that period increased the total about 23 percent for both groups.

That was, however, lower than the state as a whole, which has seen a 41 percent increase in cumulative cases since June 1.

The number of infections originating in local jails is unknown. That lack of data is just one issue that shows that the health of incarcerated people needs attention, Weiss said.

“The overall issue is there really is no oversight for the jails and no enforceable standards and no transparency,” Weiss said. “It is hard to just even know what the policies are. It is hard to analyze the situation.”