This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

As COVID-19 has raged through Wayne County, the Wayne County Sheriff's Department and Wayne County Jail have experienced a heavy toll. COVID-19 took the life of Wayne County Sheriff's Office Commander Donafay Collins last March. The next month, two physicians serving inmates in the jail system, Dr. Angelo Patsalis and Dr. Richard Miles, died from the disease. By June 2020, more than 200 staff members and nearly 100 inmates had contracted the virus. And Sheriff Benny Napoleon contracted COVID-19 in November, then died in December.

This somber introduction to the pandemic prompted a collaboration between the Wayne County Jail, Wayne State University (WSU) School of Medicine, and the WSU Center for Behavioral Health and Justice (CBHJ) with the goal of making Michigan's jails safer from COVID-19. WSU researcher and CBHJ project coordinator Tyler Logan explains that while national efforts focused on prisons and long-term care facilities, county jails were left to their own devices.
Tyler Logan.
"The individuals in the jail are part of our communities," Logan says. "As they enter and exit, they impact the community. Making sure they are also receiving resources that are important for their public health ultimately benefits the overall community."

National data found that jails and prisons had five times the number of COVID-19 cases and deaths as their surrounding communities — and accounted for 80% of the largest COVID-19 outbreaks, more than nursing homes or food processing plants. Unlike a prison population, county jail inmates may be booked in and then released on bail within hours, or serve short sentences that send them back out to vulnerable family, friends, and coworkers. Developing best practices for mitigating COVID-19 within jails not only keeps inmates and jail staff safe, but also provides a strategy with huge ripple effects for containing the virus.
Brad Ray.
"If the jail has an increase in COVID-19 cases, it's likely that the community will, as well. Most of those people who are booked in bond out or are released the following week," says Brad Ray, CBHJ director. "We saw the big need. There was also deep concern in the community. We pulled the right people into weekly calls [to discuss] how this or that could work in a jail setting."

With additional input from leadership at Wayne County Health, Human, and Veterans Services, Wayne County Public Health, and Michigan's Third Circuit Court, Logan, Ray, and their team of CBHJ researchers stepped up to develop a Toolkit and Community of Practice webinar series to help mitigate COVID-19's impact on jails. Both the Toolkit and webinar series provide recommendations on how jails can best implement COVID-19 testing, contact tracing, and discharge planning in order to slow the virus. Wayne County Jail was quick to adopt measures recommended in the Toolkit, which was made available in September 2020. By February 2021, its jail population reported a positive COVID-19 test rate that was lower than the surrounding county.

Another concern of the Toolkit is how COVID-19 impacts marginalized populations — Black, Indigenous, Latinx, and other people of color who are disproportionately represented in the criminal justice system.

"From a large, macro level, we can't escape that jails are a known touchpoint for exacerbating inequalities in our society," Ray says. "The people that are ending up there are more likely to have pre-existing conditions and are more likely to have risk factors from their experiences in the community."

According to the Toolkit, the first step jails need to tackle is mass testing. With emergency funding from the Michigan Justice Fund, the WSU School of Medicine organized and administered mass testing of all Wayne County Jail inmates, quarantining those who tested positive. Like many counties, Wayne County outsourced medical care to privatized providers who maintained COVID-19 testing and vaccination were outside their purview. To overcome this barrier, the Wayne County Health Department was enlisted to help.

"The success in Wayne County has been the work of the county public health department getting involved in this matter," Ray says. "We talk to inmates and ask, 'Why are you agreeing to getting tested?' It's because it's public health asking them to get tested — not the corrections officer, not the jail staff in uniform. It's a matter of getting the right people in there to inform detainees, have a conversation about testing, and explain the safety of the vaccine."
Jordan Hrynik, a disease intervention specialist with the Jail Health division of Wayne County’s Department of Health, Human, and Veterans Services, conducts COVID-19 contact tracing and testing for an individual booked into a Wayne County Jail.
While jails across the state had taken steps to reduce COVID-19 transmission by releasing inmates and implementing social distancing measures, few had put testing in place before the Toolkit was developed. The Toolkit recommends inmates be tested at the time of booking, be kept separate from others until test results come back, and quarantined for 14 days if the results are positive or the inmate declines being tested. With positive test results, recommendations for contact tracing include tracing people the inmate interacted with in the 48 hours prior to booking. The Toolkit also includes practical recommendations for inmates who are released before test results come back. 

The Toolkit also includes guidance for discharge planning, recommending additional testing for inmates prior to release, with results provided before release or as soon as possible afterwards. For inmates living with behavioral health issues, recommendations include providing referrals to the county's community mental health agency for further triage and support services. Jails are encouraged to contact inmates' families to make sure they have a place to live. If they don't, they should be connected to housing facilities, including safe, temporary housing for those testing positive for COVID-19. 

The Community of Practice webinar series, which Logan put together, further explains these strategies in a session on decarceration as a strategy to mitigate the spread of COVID-19. Other webinars supporting the toolkit's tactics include sessions on addressing the COVID-19 "infodemic," addressing behavioral health and COVID-19, COVID-19 vaccines, and more.

The webinars have been popular not only throughout Michigan, but across the country and the world — with viewers as far away as Oxford, England. After attending one of the webinars, Anna Gonzales, CDC Foundation senior advisor, emailed Logan and Ray to say the session was "absolutely fantastic." 

"A colleague texted me that this was the best webinar during this pandemic that she has been on, except maybe one that had [Dr. Anthony] Fauci on it," Gonzales wrote.

Vaccine hesitancy on both sides of the law

Although the Toolkit and webinars offer valuable resources, many pandemic-related challenges remain for jails in Michigan and beyond. Now that vaccines are available, refusing vaccination has become another barrier to preventing COVID-19 within Michigan's county jails. Vaccine hesitancy is found not only among the incarcerated, but also among correctional staff. Logan says staff's hesitancy arises from "a wide spectrum of beliefs." Some may believe in conspiracy theories about the vaccine, but others' hesitancy may originate from a historical context of distrust in the health care system.

"There are different elements of vaccine hesitancy going on, and that's another area that researchers will have to pay attention to, to see not only why individuals are being hesitant to get the vaccine within the criminal legal system — especially staff — but also what are the solutions to that," Logan says.

The Toolkit and links to the Community of Practice webinar series have been sent to every county jail and health department in Michigan. Updated versions of the Toolkit will be sent out this September.

"If you're a jail person, we want you to immediately start thinking to yourself, 'Who do I know in the county health department that could collaborate with me?' and, if you're in the county health department, our hope is that you think, 'What's going on in my jail? Where can I help out?'" Ray says. "It has really been about bringing those two together."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Antonio Cleveland and Jordan Hrynik photos courtesy of Wayne County. All other photos courtesy of the subjects.