“Medical isolation” and “quarantine” procedures are substantively different from “solitary confinement” (Table 1). However, critical misperceptions persist inside and outside correctional facilities about what these procedures should be and how they affect the people living and working in prisons and jails.
Table 1 Comparing Solitary Confinement, Medical Isolation, and Quarantine The only commonality that solitary confinement should share with quarantine and medical isolation is a physical separation from other people. In fact, those in medical isolation may be housed together with others who also have COVID-19. This means that people in quarantine or medical isolation should have enhanced access to resources that can make their separation psychologically bearable—for example, television, tablets, radio, reading materials, and means of communicating with loved ones—since they are enduring isolation for the greater good, not for punishment. They should have easy access to medical and mental health professionals, and daily updates from healthcare staff as to why separation is necessary and how long they can expect it to last. Corrections officials should make additional efforts to communicate with and show compassion for people in their custody who are scared and feeling unwell in quarantine or medical isolation.13 Some simple ideas include distributing cell phones, tablets, televisions, gaming consoles, and other equipment that people in medical isolation, quarantine, or sheltering-in place in the community may be using to cope with the anxiety of isolation. Healthcare providers working outside corrections could offer telehealth consultations with patients via tablets and other HIPAA-compliant digital platforms. If corrections systems lack these resources, public health agencies, non-profit organizations, advocates, faith-based entities, and philanthropies should mobilize to assist in providing them.
In many correctional facilities, the only available spaces for implementing quarantine or medical isolation are those typically used for punishing people with solitary confinement. This is because these units have single cells with solid cell doors and are removed from communal living areas. Repurposing solitary confinement units for medical purposes, however, runs the risk of corrections officials falling back on policies that subject people to living conditions known to harm their health. It is imperative that if these units are used to contain the COVID-19 epidemic, there must be accompanying communication from medical and correctional staff to the wider population and clear examples of how housing in these units will differ from “run of the mill” solitary confinement. Similarly, any housing used as part of a medical response must be medically appropriate with, for example, proper ventilation and adequate sanitation. Given the high rates of comorbid conditions in correctional settings, corrections and public health officials should ensure that people undergoing quarantine do so in reasonable proximity to urgent care.
Additionally, solitary confinement is often used for extended or even indeterminate periods of time, with release back to general population housing at the discretion of correctional officers. In stark contrast, quarantine and medical isolation are temporary procedures that should be overseen by medical professionals. CDC guidelines for discontinuing quarantine and medical isolation should govern decisions in jails and prisons, just as they do in the community.14 Community standard length of time for quarantine and medical isolation, on average about 14 days, aligns closely with (and do not exceed) the United Nation’s Standard Minimum Rules for the Treatment of Prisoners (the “Nelson Mandela Rules”) that define punitive use of solitary confinement for longer than 15 days as “torture”15 (Table 2).
Table 2 Characteristics of Solitary Confinement and Medical Isolation