Intended for healthcare professionals

Letters Healthcare in prisons

Fighting covid-19 outbreaks in prisons

BMJ 2020; 369 doi: (Published 02 April 2020) Cite this as: BMJ 2020;369:m1362
  1. Hong Yang, lecturer1,
  2. Julian R Thompson, professor2
  1. 1University of Reading, Reading RG6 6AB, UK
  2. 2UCL University College London, London, UK
  1. h.yang4{at}

Poor prison healthcare has been reported by Armstrong.1 Improving prison health services is critical for fighting epidemics such as covid-19.

On 20 February 2020, over 500 new covid-19 cases in five prisons ended 16 days of continuous decline in new cases in China (excluding Hubei province).2 Over half were in Hubei, including 230 at Wuhan Women’s Prison and 41 at Shayang Hanjin Prison. A total of 207 cases, including seven guards, were at Rencheng Prison (Shandong), and a further 34 at Shilifen Prison (Zhejiang).

Prisoners are at much higher risk of infectious diseases than communities outside.3 Highly infectious prison environments are fuelled by overcrowding, poor health services, high risk behaviours, security versus public health concerns, and lack of empathy for prisoners.4

Over 10 million people are incarcerated worldwide.5 The UN Basic Principles for the Treatment of Prisoners states that prisoners “shall have access to the health services available in the country without discrimination on the grounds of their legal situation.”6 But burgeoning prison populations and epidemics mean that healthcare services are increasingly strained. In China, there were 1.65 million prisoners in 2018, compared with only about 16 000 health workers in prisons.7 Infectious diseases account for around 17.5% of prison deaths. The tuberculosis infection rate in prisons of about 1250 cases per 100 000 is 3.4 times China’s national average.

Eruption of covid-19 in Chinese prisons emphasises the need to improve prison healthcare.3 Although attention has been focused on hepatitis C, HIV, and tuberculosis, urgent research is required on emerging infectious diseases. Health education for inmates and prison staff must be intensified, and better treatment and prevention measures require increased funding. More non-custodial sentences would decongest prisons, reducing the potential for the outbreaks seen in China. Links between prison and national health services should be strengthened.