Given the COVID-19 pandemic’s ongoing course, it is important to prioritize offering our still limited vaccine supply to individuals with the highest risk of exposure to, and negative outcomes from infection with the virus. While each state is allocating their initial vaccines somewhat differently, for the most part, staff working in hospitals and nursing homes have been given priority. Hopefully, with few exceptions, the initial doses have gone to those who are clearly at higher risk due to their line of work and/or age.

The New York State Health Department declared that those eligible to receive the vaccine would now also include:

• high-risk hospital and Federally Qualified Health Center (FQHC) staff, including the Office of Mental Health (OMH) psychiatric centers
• emergency medical services (EMS) personnel
• medical examiners and coroners
• funeral workers who have direct contact with infectious material and bodily fluids
• agency staff and residents in congregate living situations run by the Office for People with Developmental Disabilities (OPWDD), OMH, and the Office of Addiction Services and Supports (OASAS)
• urgent care providers
• staff administering the COVID-19 vaccine

Starting January 4, this list will be expanded to include:

• all outpatient/ambulatory front line, high-risk health care providers who provide direct in-person patient care or other staff of any age in a position where they have direct contact with patients, such as receptionists. This will include but is not limited to hospital and community based ambulatory care, primary care, outpatient behavioral health services, phlebotomists, physical and occupational therapists, and specialty clinics, including dialysis centers
• all front line, high-risk public health workers who have direct contact with patients
• health care workers at testing sites

Despite the seemingly broad “will include but is not limited to …” language describing the groups that can receive the vaccine starting January 4, I believe there is a glaring omission as a forensic psychiatrist.  The list does not include a subset of facilities (and of our population) that is easily and often overlooked. I am referring specifically to correctional facilities.

I have worked providing psychiatric treatment and evaluations in correctional facilities for 15 years. Jails and prisons, like many settings already prioritized, are congregate environments. They house large numbers of people, often in close proximity, and freedom of movement is quite restricted. It is not always easy to “socially distance.” Despite hand washing, sanitizing, masking, and temperature checks, inmates and staff are still at risk of exposing others in the facility to COVID 19. Cleaning products, hand sanitizer, and high-quality masks are not always available. Ventilation is limited, and open windows are simply not a thing. Even with the facilities’ best efforts to have quarantine measures, there will always be a heightened risk for disease spread.  In close (and closed) quarters, this can, and does, quickly become catastrophic.  This is evidenced by the findings in the December 6, 2020 report by the National Commission on COVID-19 and Criminal Justice. That report found that COVID infection rates in prisons are almost three times higher than those in the general population, and that “as of November 13, 2020, state and federal prisons reported 1,412 COVID-19 deaths among incarcerated individuals. That is 721 deaths (51 percent) in excess of the number expected given mortality rates for individuals of a similar age, gender, and race/ethnicity outside prison.”

The Niagara County jail, located in western New York, had had no inmates test positive for COVID since the pandemic.  However, I walked into work today to discover that we now have a COVID outbreak.

Just south of us, Erie County jails (the second-largest jail system in the state, after the New York City area) have already had at least 52 inmate cases, including an outbreak involving 27 inmates at one facility earlier this month.

East of us, the Monroe County Jail in Rochester, New York, is struggling to contain dozens of cases (the media has recently reported 125 active inmate COVID cases, although actual numbers may actually be much higher).

In addition to the isolation brought about by being confined, inmates are experiencing the less obvious consequences of this pandemic:

• In-person visits with family and friends are restricted or completely suspended. Just today, New York has suspended in-person visits in all prison facilities.
• Visits and communication with attorneys have become more difficult for those with pending charges.
• Hearings have been delayed, and trials have been postponed for months- we’ll be lucky if jury trials can resume in Western New York by Summer 2021.
• Transfers of mentally ill inmates to state hospitals have also been challenging, delaying treatment for those who need care in an inpatient setting.

Having the COVID vaccine available now would help our correctional facilities decrease the demonstrated high risk of catastrophic outbreaks and allow our systems to begin returning to safer and more “normal” operations within our walls, despite the ongoing pandemic “on the outside.”

We didn’t ask to be first in line for COVID vaccines. But to those making the decisions at a state and local level, I submit a request that correctional medical and support staff, corrections officers, and inmates be next in line. We are at equal or greater risk of contracting and spreading COVID as those living and working in other prioritized settings.  Therefore, we should be provided equal, timely access to COVID vaccines without any further delay.

Ana Natasha Cervantes is a forensic psychiatrist.

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