By Rick Lines, Naomi Burke-Shyne & Giada Girelli / Health and Human Rights Journal

“In every situation, where a number of people are crowded together, whether in ships, hospitals, or prisons, unless the strictest attention be paid to cleanliness, and to a free ventilation or circulation of air, a fever soon or later breaks out amongst them, of a very contagious nature, and attended with very fatal effects”.So begins the account of Dr James Carmichael Smyth of an outbreak of jail distemper (typhus) in Winchester prison in England in 1780. Over the course of three and half months, 268 Spanish prisoners of war died, with Smyth himself surviving two separate bouts of the disease while caring for the sick men.

The rapid spread of contagion and death among prisoners was not a new phenomenon. The first documented outbreak of ‘gaol fever’ in England took place in Newgate and Ludgate Prison in 1414, resulting in the deaths of 64 prisoners and gaolers. Almost 50 recorded outbreaks of fever in British prisons predate the Winchester events described by Dr Smyth, resulting in the deaths of thousands.

Nearly 250 years later, the prisons of the world are struggling to address a new ‘gaol fever’ that threatens to dwarf the impacts of previous historic contagions—COVID-19. With physical distancing core to the COVID-19 response—an impossibility in most places of detention—the health risks of congested prisons have again come to the fore. Poor and overcrowded conditions of detention, coupled with a detainee population that often suffers from multiple heath vulnerabilities, have long made prisons susceptible to rapid spread of disease and death. The highly contagious nature of the COVID-19, its global spread, and the worrying levels of mortality associated with it, have therefore raised widespread concern.

The relationship between prison health and public health is well established. In many of the historic cases of gaol fever the contagion spread beyond the prison walls into surrounding towns and villages.In more recent years, transmission of both HIV and TB has been documented in prisons, raising wider public health concerns about the role of incarceration in sustaining those epidemics. For this reason, protecting people in detention from the spread of COVID-19 must form an integral element of the global response to the virus.