What should I do in a small jail with no negative airflow room?

If there is a clinical need to isolate and the jail does not have capability, the jail medical authority will need to identify another facility to meet this need. Presumably this is a hospital or perhaps a neighboring correctional facility. In the absence of full negative pressure facilities, some degree of isolation and related precautions is better than none—a room with a closed door rather than an open cell, for example. Please consult local authorities and the CDC for the latest information.


In my jail, there are questions of whether or not we should put all new arrestees into an intake dorm for 14 days as a form of quarantine for COVID-19. We are unsure if any known exposure/travel history occurred and there have been instances of community spread, so we may not know if an arrestee has been exposed.

Every jail is very different and we cannot recommend a one-size-fits-all approach. One approach is to screen all patients at intake (current screening is based on history and symptoms) and then hold patients in a transition cell for as much as a week. Anyone who develops symptoms is immediately isolated and the rest remain in quarantine.


Are any sheriffs setting up holding cells or tent cities for new arrivals who are possibly infected with the virus?

We are not aware of sheriffs taking this approach, but it may be occurring. We do know that some jails are setting up holding cells to quarantine new intakes until they are proven symptom free and / or have a low exposure risk. People with symptoms should certainly be isolated. Other inmates quarantined with an ill person need to enter a fresh period of quarantine until everyone is symptom free. People are using the period of two weeks of no symptoms to be considered not infected. You could potentially do this process anywhere. Keep in mind the social distancing guidelines for groups.


If the correctional facility experiences widespread infection, what is the plan if hospital capacity is exceeded and we must provide on-site care to a large number of patients? Any suggestions for temporary housing for patients who are ill or PUI beyond our usual capacity to isolate?

This is a difficult situation. If you must provide care at your facility, you must have a contingency plan for doing so. Check your space, supplies, staffing, procedures, etc., to manage such a disaster. Be ready to triage. Keep strong and clear communications with inmates and staff and build a sense of community response as much as possible without compromising safety and security. Build off and customize your existing disaster and mass-casualty plans for this pandemic. Consider developing a rotation of doctors from outside to care for the very ill. Ventilator and ICU capacity is a concern in every community worldwide, so speak with your local hospital about local capacity and how to care for the most seriously ill. Plan worst-case scenarios and be prepared. Be sure local hospitals are aware of you and a potential surge of patients. Don’t panic. Be calm and rationale and provide leadership. Everyone is looking to medical during these times.