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Covid-19: control measures must be equitable and inclusive

BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1141 (Published 20 March 2020) Cite this as: BMJ 2020;368:m1141

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Italian policies to mitigate COVID-19 pandemic risk across the penitentiary system

Dear Editor

Strategic and unprecedented measures - for the first time in the European Union - have been taken by Italy to face the COVID-19 outbreak. On March 11 2020, the Italian Government passed the Prime Minister’s Decree, known as “Stay at home - Resto a casa”, which established a lockdown in the entire national territory, including penitentiaries and custodial settings. Hence, family and lawyer visits to prisoners have been suspended, as well as the possibility for detainees to get probation and special permits to leave facilities [1].
Inmates reacted to the directive staging violent protests at 49 different sites across the Country, leading to 12 deaths among prisoners, 19 offenders escaped and 40 injured guards. Authorities estimate the correctional facilities damage at around €35 million [2].
According to the Ministry of Justice, a total of 191 penitentiaries are housing 61.230 inmates, with the prison system operating, on average, at 129% of its capacity. Despite legal dispositions, one person cells may de facto host up to three prisoners, giving less than four square-metres of personal space each one [3].
The overcrowding of Italian detention centres as well as their limited access to medical care may represent an immediate risk to the spread of the COVID-19 pandemic. Yet, 4 COVID-19 cases have been registered amongst prisoners.
On March 17 2020, the Cabinet issued the “Cura Italia - Care Italy” Decree, to offset the economic impact of the COVID-19 on the general welfare of the Country, including, among others, the justice sector. The latest directive allows for early supervised release of detainees with less than 18 months left to serve on their sentence, in order to protect the health of inmates and guards as well as alleviate overcrowding in its penitentiary system [4]. The measure should affect approximately 4.000 prisoners which will spend their unspent conviction under house arrest until 30 June 2020. Detainees are required to carry a personal identification device, a house arrest monitoring system that automatically verifies the presence or absence of prisoners at the prescribed location [5].
There are critical lessons learned from the current COVID-19 pandemic: i) the systematic problem of overcrowding of Italian prisons proves to be a limit to principles of humanity and human rights safeguard (including health); ii) Nearly 16.000 people incarcerated in Italian correctional facilities were 50 or older in 2019. Almost 70% of the penitentiary population suffer from at least one disease, posing them at higher COVID-19 vulnerability [6]; iii) adequate penitentiary financing is required to address the needs of detainees excluded from the temporary release ordinance; this includes appropriate technology equipment to re-establish contacts with their families; iv) interventions to strengthening prisons and custodial settings emergency preparedness must be in place to prevent the outbreak; among others, the distribution of protective masks for the prisoners and the guards is essential.
Consistent policies to screen, monitor, and treat people suspected of having COVID-19 are needed to ensure marginalized group of patients the same level of care of the general population.

REFERENCES

1. Ministry of Health of Italy. Covid-19, in Gazzetta ufficiale Serie Generale, n. 64 del 11 marzo 2020). Available at: http://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=73643
2. Coronavirus, s'infiamma la protesta nelle carceri: morti tre detenuti a Modena, sequestrati due agenti a Pavia – Repubblica. Available at: https://www.repubblica.it/cronaca/2020/03/08/news/paura_per_il_coronavir...
3. Statistiche, Ministero della Giustizia. Available at: https://www.giustizia.it/giustizia/it/mg_1_14.page [last accessed on 28 March 2020]
4. DECRETO-LEGGE 17 marzo 2020, n. 18. Misure di potenziamento del Servizio sanitario nazionale e di sostegno economico per famiglie, lavoratori e imprese connesse all'emergenza epidemiologica da COVID-19. In Gazzatta Ufficiale serie generale n.70 del 17 marzo 2020.
5. Tremila braccialetti elettronici saranno installati entro tre mesi. Agenzia Italia. Available at: Available at: https://www.agi.it/cronaca/news/2020-03-18/carceri-braccialetti-elettron...
6. Voller, F., Silvestri, C., Martino, G. et al. Health conditions of inmates in Italy. BMC Public Health 16, 1162 (2016).

Competing interests: No competing interests

28 March 2020
Silvia Logar
MD, PharmD, MPH, PhDc
Maggie Leese
School of Social Sciences, Humanities & Law, Teesside University (UK)
Southfield Rd, Middlesbrough TS1 3BX, United Kingdom