Planning for Respiratory Pathogens in Prisons
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This is CNA Talks, the flagship podcast of CNA, a Washington, D.C.-based nonprofit analysis organization. In March 2020, Americans were instructed to practice social distancing to prevent the spread of COVID-19. However, for our correctional institutions, this posed a particular challenge.

In this episode, we examine how jails and prisons adapted to mitigate the spread of COVID-19 and identify the best practices that emerged from this experience. Welcome to CNA Talks. I'm John Stimson. On today's episode, we are going to cover how correctional facilities can increase their resilience against respiratory viruses. And I'm excited to welcome three new guests to the show to discuss this topic.

Nunak Pham works on public health and emergency management projects via CNA's Center for Public Health Preparedness and Resilience. Nunak, thanks so much for being here today. Thank you for having me. Jim Alexander works on our justice projects via the Center for Justice Research and Innovation. Both of these centers reside in CNA's Institute for Public Research. Jim, thanks for being here. Thank you for having me.

And finally, Darren Segar is the Director of Administration for the Broward County Sheriff's Office and has helped correctional facilities implement steps to mitigate respiratory viruses. Darren, thanks for being here. Thank you, John. Happy to be here. Absolutely. The project we're going to be discussing today was kicked off when the Bureau of Justice Assistance asked CNA to stand up the COVID-19 Detection and Mitigation in Correctional Facilities Training and Technical Assistance Center.

which assisted state, local, and territorial health departments and correctional authorities in their COVID-19 response efforts, including how best to utilize federal funding, collaboration between health departments and state and local facilities, and implementing strategies informed by CDC guidelines, criminal justice standards and practices, and innovations in the field. CNA was the training and technical assistance provider on this project, but our team worked with many stakeholders in the field.

This project provided resources, training, and technical assistance to those responsible for monitoring and detecting COVID-19 in confinement facilities. It also focused on building field knowledge and capacity and maximizing the reach and impact of resources for correctional agencies. This work resulted in the publication of Planning for Respiratory Pathogen Pandemics, a Guidebook for Corrections, Systems, and Confinement Facilities, which can be found in the show notes of this episode.

As a note at the top of the show, we'll be using the acronym TTA for Training and Technical Assistance Center and BJA for the Bureau of Justice Assistance. Jim, I'm going to start with you. What are some unique challenges that were faced by correctional facilities during these public health emergencies? Thanks, John, for the question. And I just want to say thank you to all the stakeholders who participated in this discussion.

Endeavor, BJA, all the organizations that we worked with. Again, this is important work relative to our confinement facilities. So big shout out to everybody who helped us with this work. As we think about confinement facilities, obviously, one of the things I used to notice is you take people for tours of facilities and folks would walk out of there and they'd say, well, these are like little cities, right? And they really are. So they're self-contained facilities. They hold vulnerable individuals. When we think about other

other types of settings where we have congregate groups. It's a 24-7 operation traditionally. And so everything is confined there. And so by virtue of it being self-contained, it's a confined environment, right? And so there's high population densities. And so in a lot of situations, people are very close to each other.

There, you know, there's open air, in particular, as we talk about respiratory illness. That's a particularly unique challenge that we found certainly during the COVID-19 pandemic. And so within the confinement facilities, those are some of the unique things. And so we also think about it from the perspective of while we are self-contained,

we also have collaborative environments, right? And so as a correctional institution, we may need to rely on our other public health agencies. We may need to rely on hospitals. We may rely on other governmental agencies. And so as part of this particular project, we looked at not only the nature of what is confinement facilities, what is corrections, jails relative to the pandemic, but also what's the relationship like with other agencies. And so when you think about

you know, the nuances that happen in jails and prisons. Some, you know, prisons tend to be longer term facilities. Jails tend to have the, you know, the ins and outs. So they're bringing people in actively from the community. So that created another dimension of circumstances that we needed to consider. It's all of those kinds of interventions

interesting and meaningful and important characteristics relative to having confinement facilities where there's a really high population density that we initially started to take a look at and develop our standards for. You know, Jim brought up the point in a similar to prisons, obviously jails are cities as well. So some of the differences that jails may have experienced in

is that we don't control who comes in the front door and who goes out the back door. We can't shut our door. And in some cases during the pandemic, state prison facilities were not accepting inmates. So we have to continue accepting inmates. So I'm gonna get a little more granular in the experience that many jails had.

This was unprecedented. So we were not well prepared. There's different buckets of preparedness in terms of your staffing, the impact on the inmate population, your vendors that provide services. And because you have a duty to care for those in our custody, we own everything. However, we were dealing with

really heavy at all levels, at all sides of those buckets. And ensuring that we maintain public safety, how do we go about ensuring that those that are most vulnerable, that are sick, are separated from those who are sick? And operating housing units that are in quarantine, we weren't prepared with PPE gear

the way that we should have been. But we learned quickly, so that was a good thing. One of the things that we did is we respond well. So unfortunately, our playbook was not as strong as it should have been, but jails rapidly adapted to getting with their public health experts in the community

some of their emergency management folks and that offered us resources, testing materials, vaccinations for staff and for the inmate population. It was a very challenging time. It was an amazing learning experience

So I wanted to, I want to hit on something you just said about like the amount of different staff that goes into running a correctional facility. And I think that people's assumptions are probably that the people inside of

correctional facilities are incarcerated people and correctional officers. But you kind of hinted at the fact that there are food service workers involved. So can you talk a little bit about the larger ecosystem of support staff that's necessary to run one of these facilities and what these kind of protections do to keep them safe as well?

So, John, that's a great point. As Jim and I both alluded to, we're running cities, so it takes a lot of support services beyond the security staff to successfully operate and serve your populations. That includes healthcare workers that are in the facility. We have medical personnel.

We have facilities management, or sometimes known as maintenance workers, that help keep the facility up and running. And we have program staff that are in the facilities. So there's a whole multitude of support services that help make the facilities run efficiently, effectively, and safely. If I could add to that, too, not only are there other programs

entities that are involved with the operation of a correctional facility, but there's also other underlying living conditions that we have to consider too in the midst of a public health emergency. So for example, in prison population, the crowded living space is something to consider,

But also there's a high amount of what we call high risk population. For example, people with underlying medical condition that may make them more susceptible for a respiratory infection. So there's also that layer impact where not only does the confined space a contributing factor for increased risk, but also characteristics

of those that are in the facility, both the incarcerated population and the staff workers and their underlying medical condition that could further contribute to higher risk of infection as they're operating in this mini city, as Jim and Darren had called it.

To NUNOC's point, there are some very difficult populations that we serve that made it even more challenging to provide services and care for during the pandemic. A lot of people in the community may not realize that there's a very high acuity level of illness

in the jail and there's also a high acuity of mental illness in the jail. So those folks were more susceptible to COVID and it being more lethal as well as the mental health population

It's just much more challenging to get them to comply with the procedures that we put in place to help protect them. - Neenak, let's go to you next. What were some successful approaches that you discovered for mitigating airborne viruses through this program?

So we capture a lot of lessons learned and best practices through working with our TTA recipients. We capture things like improvement in HVAC system, upgrading them, as well as putting in new air filtration system that is more HEPA filtered related or things like using UV light for sanitation. And what we saw was that there were a lot of innovation and innovative ways to approach the different problems during the pandemic.

More so, we also saw vaccination campaign being done within the facility to help increase vaccination rates, as well as education campaign that really promoted coughing etiquette, mask wearing, and the importance of ventilation, risk communication that's really tailored towards this demographic. So for example, during Darren's conversation,

conversation, he mentioned the population is really dynamic. You have a lot of movement in and out of jails. There's also a high population at higher risk, whether it's pre-existing conditions that makes one more susceptible to infections or not. So we saw targeted communication campaign that talks about those things and how these individuals could better utilize the resources that are provided by correctional staff in order to mitigate their risk.

So one thing that was unique about this project is it's not strictly an issue for corrections, but intersects with a larger emergency management and public health efforts.

How does this interplay between the three of these affect the project or not? I'm glad that you asked that question because through this project, we were able to sort of build out a better understanding between these three entities. For example, at times, correctional facilities are doing things that public health entities and emergency management entities did not know about. And so this opportunity allowed for all three different facilities

key stakeholder to come together, discuss about their unique challenges, and think of different ways to approach it and problem solve so that it's coming from different perspectives, both on the emergency management side, how do we approach mitigation of the problem? From the public health side, how do we prevent infections? And how do we continue surveillance so that we can maintain low infection rates? And as well as how can we apply all

these different recommendations from the emergency management side, from the public health side, and how can we implement it through the lens of correctional facility, they know best which one will work, which one will not. And they were able to tell us this is not going to work in our circumstances because of X, Y, and Z. So again, I really think

This project was an opportunity for all three to sit down to come to the table and discuss ways to target this unique situation that we found ourselves in in the peak of the COVID-19 pandemic. And I kind of want to follow up on that a bit because I think that it's easy to see jails and prisons as sort of isolated, but

As we've kind of been discussing, that's not really true. There's a lot of people who are coming and going. There's a lot of staff who are coming and going. And so what happens in a prison does affect the larger community and does affect everyone who lives nearby and then the community around it. So this idea of this as intersecting with other public health issues and how we can use tools that we've learned in one place to benefit another, I think there's a lot of value in that.

Right. And you're absolutely right in that because we also factor in staff workers who are working, you know, in these mini cities, for lack of a better word, but they have to go home to their family member at the end of the day. So they are bringing home an elevated risk to

outside community. So we talked about ways to mitigate maybe potentially bringing an infection home outside, or if they go home, they go to the grocery store, they go to a church or something like that, they have to take proper mitigation strategies and protocol to decrease the risk if they were infected unknowingly and bring it out to the larger community. Nunak, you bring up some great points. The jails are

Though we, as I mentioned earlier, though we pivot well, we found that our relationships with some of those emergency management services and our public health partners really needed to be strengthened to address the pandemic. We're in a much better position now moving forward because of that experience. We have much better relationships with

with those individuals. And that includes beyond just the traditional public health and emergency management services that you would think. We're talking also about the county leadership, leadership within hospitals, the Department of Health within the community. So though we had relationships from routine operations, they're much more strengthened now for our playbook moving forward.

And John, if I could add to that, as we think about best practices and things that we saw on the field during our process here, we had the pleasure really of

interacting and engaging with the state of Alaska. And I say that because that group up there had some incredible best practices. And one of them is exactly what we're talking about, which is this interrelatedness between agencies. And so they had established some really great relationships. So in other words, think of the state epidemiologist, think of the communities, state, local. And so we use that as one of our best practices because we knew it was important

And it wasn't just a theoretical thing. They legitimately

legitimately had those relationships in place and they had them in place before this. And so when we think about best practices, one of the things obviously that we're recommending is that these kinds of things, to Darren's point, be established and be in place so that we're not trying to put that together in the middle of a crisis or a pandemic or any other public health emergency. And so, yeah, it was one of the things that we really were impressed by was the fact that there was like literally those folks were on calls with them on a daily basis.

And they were literally like measuring the community spread and talking about what's the level here. And so how does that impact our operation? And so, again, clearly a best practice, clearly something we'd highly encourage. And I'm glad we brought it up at this juncture. So thank you.

Right. And you see a lot of coordination within the facilities, but also outside externally to, you know, with with entities that one might not think about on a daily operation. Like, how do you work with epidemiologists and how do you work with the local public health department to do surveillance data so that you can have all of the evidence based recommendation from them of how one would implement out a vaccination campaign within the facility?

Yeah, absolutely. And I think this is a good chance to talk about any other insights that you all gained from your respective TTA centers while you were working on where you're working on implementing this project, building on the Alaska example.

I think the notion of coordination and relationship building. So when we think about this external piece, that's incredibly important. But also internally, if you have large operations, you can sometimes get silos, right? You can sometimes have like the medical staff do what they do and the education staff do what they do and the maintenance. Well, best practices that we saw was this huge collaboration here. So particularly what we saw was a

great collaboration between medical staff and custody staff, right? Because in this particular confinement facility, when we find prisons and jails, those two entities in this kind of a circumstance really needed a good relationship. And so, again, it wasn't a theoretical thing where someone sat down and said, oh, yeah, we talked with medical. They literally sat on calls on a daily basis with everyone involved.

enjoying together and talking about the critical issues that we're facing them. And again, you know, like Darren talked about when we deal with external agencies at times where we have to transport people, we found a very, very comprehensive transportation outline and transportation guidance. And then there's

this notion of, you know, what's the command structure? What's the way by which, you know, if we get to a certain level, how are we going to engage activities? How are activities going to change? And relative to that, what's the communication plan internally? And so,

One of the things that we saw that was really good was that they had a great internal communications plan. People understood what was going to happen. And again, it really feeds back to this notion of everyone was on the call. Like the key stakeholders were on the call and there was a great communication plan to the staff. So it started with the administrators and the leadership, but it really funneled into all of the staff so that everybody understood, here's what the current situation is.

And based on circumstances and here are what the circumstances are, here's how things are going to change and here's what we're going to need to do to adapt to that. So I think not only this notion of like coordination externally, but also this great coordination internally was some great best practices that we saw. Jim, you were absolutely right when you talk about planning. I think planning was one of the key words that stood out to me from what you just shared because we also saw that people

Having a plan and having some type of protocol or guidance on how do you carry things in and out throughout the day or on a daily basis was really important. And some facilities that we work with have that already in place and they were just sort of boosting it along the way. Again, I'm trying to highlight the fact that you're absolutely right. Having a plan and having protocols written down was really important for the success of some correctional facility and efficiently managing, um,

pandemic situation at their facility? So I had the privilege to visit the Milwaukee County Community Reintegration Center and some of the best practices that we observed there, similar to what you mentioned earlier regarding reworking the air evac system, we observed at this facility where they

had such a fantastic support services unit. They retrofitted their air handler system to also include the fluorescent lighting that also kills those germs and the viruses that were airborne

So we witnessed that. They also worked very closely in the early stages of the pandemic with the Army Corps of Engineers, and they had the benefit of having an empty housing unit that they converted into a somewhat of a hospital-type environment for the ability to manage people

very acute cases of COVID without having to send them out to hospitals that were already maxed out in their capacity. And they did that through their partnerships that they had made. And that ties back to communication. And I would be remiss if I didn't say, as Jim mentioned, having daily communication internally and externally is

was so important to being able to manage because the conditions were changing so rapidly and on a daily basis. And then also being able to communicate externally to get the resources that we required to maintain that healthy environment across the county. And as Nunak mentioned, even up to the state level to get those resources, it really required

Very creative and at times angular ways to bring resources back to your home base, which is what we did.

One of the things that we heard among a lot of our TTA recipient is that one of the skills that had to be sort of learned or practiced frequently is the ability to be nimble and dynamic to different challenges. We saw during the pandemic, the peak of the pandemic, is that things were changing almost every other day. So a process or a protocol that's been established for the week prior may not work for this week based on the situation, the different characteristics in a facility. So a lot of

correctional staff members and leaders that we talked to, they really stressed the importance of having members be nimble to changes and think of different ideas and ways to pivot. So for example, we saw in Milwaukee, they use a face that were not typically used to house the incarcerated individual, but then they reconfigured it and used it. So a lot of other facility kind of did the

Same thing, using spaces they typically would not use to house individuals, they did. Using spaces they typically would use for storage, they used it to handle other processes like learning or video chat and things like that. So again, the point is not only...

I think I mentioned before having a plan is great, but also having the ability and being able to make those critical decision on the fly really quickly and being nimble. So that change as changes are occurring, actions and practices could change to fit the circumstances in a dynamic situation like an infectious disease spread within a pandemic scenario.

All right. Well, this has all been really interesting and you guys have given us a lot to think about. But we are just about out of time for today. But I do want to thank all three of you for coming on. I've learned a lot. Thank you for having me, John. Thank you, John. Thank you for having us. This is great and appreciate the opportunity to share our experiences and the work that we've done through this TTA project that CNA played a major part in.

Absolutely. For our listeners, there'll be a link in the show notes to the Planning for Respiratory Pathogen Pandemics Guidebook for Correctional Systems and Confinement Facilities. If you're interested in learning more about this, that's a great resource and has a pretty extensive approach to has a set of toolkits. But I want to thank you all so much for listening. And we'll see you next time on CNA Talks.

The views expressed are those of the commentators and do not necessarily reflect those of CNA or any of its sponsors. CNA Talks is produced, edited, and mixed by John Stimson. Our theme music is by Edward Granga. If you enjoy our show, we'd love it if you could give us a five-star review on Apple Podcasts and tell your friends about us. Thanks again for listening, and we'll see you in two weeks.