Covid-19, prison crowding, and release policiesBMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1551 (Published 20 April 2020) Cite this as: BMJ 2020;369:m1551
All rapid responses
The statement “prisons as incubators of infectious diseases” (1) is not a statement to be taken lightly. P Simpson and T Butler aptly present the longevity of this belief in their reference to the 16th century typhus outbreak in English prisons (2). In this time of great uncertainty within a far reaching pandemic, it is with merit that the question is asked of the potential safe release of prisoners into community based alternatives.
Measures have already been taken to lessen the spread of COVID-19 infection within prisons, including but not limited to suspending visits, social distancing as in the community and the early temporary release of prisoners within two months of their release date after a risk assessment (3). However, in order to meet the requirement of solitary isolation for those individuals who meet the criteria in symptoms or in diagnosis, the issue of lack of physical space does come into play. Overcrowding in prisons may indeed increase the risk of transmission of infectious diseases such as COVID-19 (4) and it will be interesting to observe how the UK government furthers their measures on this matter in an attempt to contain the spread of infection within prisons.
P Simpson and T Butler mentioned in their editorial (1), the prospect of releasing a “sizable proportion” of prisoners back into the community , as advised by the UN (5), may be advantageous. However, whilst there is a line of thought that this may indeed improve public health, it may also in the process compromise public safety. This is why a thorough risk assessment is necessary, with complete transparency to the public, in order to maintain their trust. As the UN recommendations state, vulnerability to COVID-19 and risk to the community of each individual need to be assessed, but whilst the metaphor of prisons as incubators may ignite a sense of urgency in fast-tracking certain prisoner release, there must be no complacency on the risk assessment front.
In my opinion, three further questions must also be asked alongside assessing whether a “sizable proportion” of prisoners should be released:
1. If indeed certain prisoners were released, how would individuals be selected and would the wider community of prisoners begin to feel a large sense of resentment?
2. If the mass release of prisoners was to take place in light of the COVID-19 pandemic, would it not set a precedent for the likes of psychiatric hospitals to open their doors?
3. How can prisoners be reconciled back into the community under the current restrictions that COVID-19 imposes?
There will of course be many more questions surrounding what is a potentially contentious issue and a balance must be struck between public health management and community risk management. For now, it seems the Ministry of Justice is focused on improving progress on releasing prisoners within two months of the end of their sentence, but it will be interesting to see how they tackle this wider issue if COVID-19 cases in prisons continue to rise.
1. Simpson Paul L, Butler Tony G. Covid-19, prison crowding, and release policies BMJ 2020; 369 :m1551 doi: https://doi.org/10.1136/bmj.m1551
2. Howard J. Prisons and Lazarettos. The state of the prisons in England and Wales. (First published 1777).Patterson Smith, 1973
3. Public Health England. Coronavirus (COVID-19) and prisons. 2020. Available from https://www.gov.uk/guidance/coronavirus-covid-19-and-prisons
4. Simpson PL, Simpson M, Adily A, Grant L, Butler T. Prison cell spatial density and infectious and communicable diseases: a systematic review. BMJ Open2019;9:e026806. doi:10.1136/bmjopen-2018-026806 pmid:31340959
5. UNODC. Handbook on strategies to reduce overcrowding in prisons. United Nations Office on Drugs and Crime, 2010.
Competing interests: No competing interests