by Gregory Dober

In 1918, countries worldwide were hit with one of the worst influenza outbreaks in modern time. Experts believe that the pandemic of the Spanish flu originated and spread through overcrowded WWI army camps, then was transported into surrounding civilian communities. That allowed the disease to rapidly spread and, more importantly, to mutate into a more virulent killer strain. It is estimated that 20 to 50 million people died, including around 675,000 in the United States. What was unusual about this strain of the flu was that it afflicted and killed many healthy adults between the ages of 19 and 49.

Fast-forward a century to 2018 and there is a similar situation brewing in U.S. prisons and jails, just not with the same scope or severity – yet. The demographics of incarceration indicate that most prisoners are between the ages of 19 and 49, and are being held in overcrowded conditions with inadequate medical care.

The 2017-2018 flu season was particularly bad, with a virulent influenza strain. Up to 4,000 people died each week in the U.S. due to the flu. “The levels of influenza-like illnesses being reported now are as high as the peak of the swine flu epidemic in 2009...,” Fortune.com reported on February 10, 2018.

Despite the increased risk of a pandemic, state Departments of Corrections and local jails are not adhering to the standard of care for flu vaccinations established by the Centers for Disease Control and Prevention (CDC).

In 2010, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended expanding the population of annual flu vaccines to include all people age six months and older, not just the elderly and those with chronic conditions that are more susceptible to the flu. That recommendation came on the heels of the 2009 H1N1 swine flu pandemic which hit the 19 to 49 age group especially hard, resulting in a higher than usual mortality rate.

Despite the CDC noting that the new standard of care is for everyone to be vaccinated, many corrections officials have ignored that advisory.

In January 2018, a prisoner at Oregon’s Coffee Creek Correctional Facility, Tina Ferri, 53, died from complications of the flu. Ferri developed a staph infection and pneumonia which killed her due to organ failure. She had been sick for nearly two weeks, and was taken to a hospital three days after she reported coughing up blood.

At Coffee Creek, only 18 percent of the prison’s population was vaccinated for the flu – the Oregon Department of Corrections (ODOC) had purchased approximately 519 vaccines for nearly 1,645 prisoners at the facility. Only about 300 vaccines were actually administered; 43 prisoners ended up contracting the flu at Coffee Creek. Some prisoners accused the ODOC of not properly notifying them of the availability of the vaccine shots, and a prison spokesperson noted that was an “oversight.”

Coffee Creek was not the only Oregon prison with inadequate vaccinations. Despite the CDC’s recommended standard of care and the ODOC classifying immunizations as Level 2 care, the department bought vaccines for only one-third of its total prisoner population. Level 2 care in Oregon facilities is defined as “presently medically necessary care and treatment” and “treatment without which an inmate could not be maintained without significant risk of either further serious deterioration of the condition or significant reduction in the chance of possible repair after release or without significant pain or discomfort.”

The ODOC purchased about 4,650 vaccine doses for around 14,000 prisoners, and prison officials reported that approximately 4,500 prisoners statewide were inoculated for the flu. However, the number of prisoners who received vaccine shots at Coffee Creek and in other state prisons was inadequate to prevent a potential epidemic in the close confines of correctional facilities.

Experts recommend that effective vaccination rates must provide coverage for 70 to 80 percent of a population to prevent a localized epidemic or pandemic. It was reported that ODOC officials paid $7 per vaccine dose, which is relatively inexpensive compared to the cost of ER and ICU visits, staff overtime, prescriptions and over-the-counter medications to relieve flu symptoms.

The ODOC was not the only corrections system that had inadequate vaccinations. At the Montgomery County Jail in Texas, two prisoners died during the 2017-2018 flu season. Despite being offered, usually at no cost, vaccines were not mandatory for prisoners or jail staff. Not requiring staff members to be vaccinated increased the likelihood of an epidemic at the facility, as well as the spread of the disease to the local community.

Rashod Develt Aldridge, 29, incarcerated at a state prison in Iowa, died from the flu on February 1, 2018. Although he had a history of chronic health problems, he had not been vaccinated. He was serving a 10-year sentence.

And at the Henderson County Detention Center in Kentucky, one prisoner infected 14 others with the flu. The already-sick prisoner, who was transferred to the jail from a state prison, exposed other detainees, guards and staff to the virus. Fortunately, the jail had about 300 vaccine doses available that had been donated by a local hospital.

It’s likely that many prisons and jails are adhering to the pre-2010 CDC standard of limiting vaccinations to the elderly and those afflicted with chronic illnesses affected by the flu. With more virulent strains of the influenza virus mutating, however, a limited vaccine approach should be cause for alarm. Not only are prisoners at risk, but also guards, administrators, visitors and surrounding communities. Often, state prisons are sited in rural areas to provide revenue and jobs – but those same communities frequently lack a robust health care system, and would become overwhelmed if confronted with a flu pandemic involving thousands of prisoners.

With low vaccination rates in jails and prisons, it is only a matter of time before an influenza outbreak causes a public health disaster, echoing the pandemic that occurred in 1918. In the words of philosopher and essayist George Santayana, “Those who cannot remember the past are condemned to repeat it.”  

Sources: www.cdc.gov, www.oregon.gov, Willamette Week, The Bulletin, Houston Chronicle, Des Moines Register, The Gleaner, www.fortune.com, www.history.com

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