The COVID-19 pandemic is devastating the health of hundreds of thousands of people who live and work in U.S. jails and prisons. Due to dozens of large outbreaks in correctional facilities, tens of thousands of seriously ill incarcerated people are receiving medical care in the community hospital setting. Yet community clinicians often have little knowledge of the basic rights and ethical principles governing care of seriously ill incarcerated patients. Such patients are legally entitled to make their own medical decisions just like non-incarcerated patients, and retain rights to appoint surrogate decision makers and make advance care plans. Wardens, correctional officers, and prison health care professionals should not make medical decisions for incarcerated patients and should not be asked to do so. Dying incarcerated patients should be offered goodbye visits with their loved ones, and patients from federal prisons are legally entitled to them. Community health care professionals may need to advocate for this medically vulnerable hospitalized patient population to receive ethically appropriate, humane care when under their care in community hospitals. If ethical care is being obstructed, community health care professionals should contact the prison's warden and medical director to explain their concerns and ask questions. If necessary, community clinicians should involve a hospital's ethics committee, leadership, and legal counsel. Correctional medicine experts and legal advocates for incarcerated people can also help community clinicians safeguard the rights of incarcerated patients.

This study describes physical and mental health of incarcerated males aged ≥50 years who spent at least 20 consecutive years in prison, comparing those with life sentences ("lifers") with those expected to be released/paroled. Data included demographics, chronic medical conditions, self-reported and objective disabilities, depressive symptoms, suicidal ideation (SI), and social support. The 65 participants (M_age = 56.9, SD = 6.6) were racially diverse (40% White, 51% Black, 9% Hispanic/Other), incarcerated for M = 26.6 (SD = 4.5) years, and 34 (52%) were lifers. Among the 39 (60%) of participants with visitors, lifers had lower social support scores (p = .005). After controlling for age, race, and chronic conditions, lifers reported disability in a higher number of activities (p < .001), and had higher depressive symptoms (p = .08) and SI scores (p = .04). Health-related differences between lifers and those expected to be released have implications for prison systems including staff training, advance care planning, and need for expanding prison-based hospice programs.

COVID-19 is ravaging US prisons. Prison residents and staff must be prioritized for vaccination, but a rapidly mutating virus and high rates of continued spread require an urgent, coordinated public health response.Based on knowledge accumulated from the pandemic thus far, we have identified 10 pressing public health priorities for responding to COVID-19 in prisons: (1) accelerate population reduction coupled with community reentry support, (2) improve prison ventilation systems, (3) ensure appropriate mask use, (4) limit transfers between facilities, (5) strengthen partnerships between public health departments and prison leadership, (6) introduce or maintain effective occupational health programs, (7) ensure access to advance care planning processes for incarcerated patients and delineation of patient health care rights, (8) strengthen partnerships between prison leadership and incarcerated people, (9) provide emergency mental health support for prison residents and staff, and (10) commit to public accountability and transparency.Dedicated prison leaders cannot accomplish these public health priorities alone. We must mobilize prison leaders, staff, and residents; public health departments; community advocates; and policymakers to work together to address the pandemic's outsized impact in US prisons.