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Association of Jail Decarceration and Anticontagion Policies With COVID-19 Case Growth Rates in US Counties

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Question  Were jail decarceration and government implementation of anticontagion policies associated with the spread of SARS-CoV-2 in US counties?

Findings  In this cohort study of 1605 counties in panel regression models, an estimated 80% reduction in US jail populations would have been associated with a 2% reduction in daily COVID-19 case growth rates, with considerably greater COVID-19 reductions in counties with above-median population density and above-median proportion of Black residents. In analyses of anticontagion policies, nursing home visitation bans were associated with a 7.3% reduction in COVID-19 growth rates, followed by school closures (4.3%), mask mandates (2.5%), and prison visitation bans (1.2%).

Meaning  The findings of this study suggest that anticontagion policies, including jail decarceration to minimize carceral outbreaks and their spillover to surrounding communities, appear to be necessary for epidemic control, public health, and mitigation of racial health disparities.


Importance  Mass incarceration is known to foster infectious disease outbreaks, amplification of infectious diseases in surrounding communities, and exacerbation of health disparities in disproportionately policed communities. To date, however, policy interventions intended to achieve epidemic mitigation in US communities have neglected to account for decarceration as a possible means of protecting public health and safety.

Objective  To evaluate the association of jail decarceration and government anticontagion policies with reductions in the spread of SARS-CoV-2.

Design, Setting, and Participants  This cohort study used county-level data from January to November 2020 to analyze COVID-19 cases, jail populations, and anticontagion policies in a panel regression model to estimate the association of jail decarceration and anticontagion policies with COVID-19 growth rates. A total of 1605 counties with data available on both jail population and COVID-19 cases were included in the analysis. This sample represents approximately 51% of US counties, 72% of the US population, and 60% of the US jail population.

Exposures  Changes to jail populations and implementation of 10 anticontagion policies: nursing home visitation bans, school closures, mask mandates, prison visitation bans, stay-at-home orders, and closure of nonessential businesses, gyms, bars, movie theaters, and restaurants.

Main Outcomes and Measures  Daily COVID-19 case growth rates.

Results  In the 1605 counties included in this study, the mean (SD) jail population was 283.38 (657.78) individuals, and the mean (SD) population was 315.24 (2151.01) persons per square mile. An estimated 80% reduction in US jail populations, achievable through noncarceral management of nonviolent alleged offenses and in line with average international incarceration rates, would have been associated with a 2.0% (95% CI, 0.8%-3.1%) reduction in daily COVID-19 case growth rates. Jail decarceration was associated with 8 times larger reductions in COVID-19 growth rates in counties with above-median population density (4.6%; 95% CI, 2.2%- 7.1%) relative to those below this median (0.5%; 95% CI, 0.1%-0.9%). Nursing home visitation bans were associated with a 7.3% (95% CI, 5.8%-8.9%) reduction in COVID-19 case growth rates, followed by school closures (4.3%; 95% CI, 2.0%-6.6%), mask mandates (2.5%; 95% CI, 1.7%-3.3%), prison visitation bans (1.2%; 95% CI, 0.2%-2.2%), and stay-at-home orders (0.8%; 95% CI, 0.1%-1.6%).

Conclusions and Relevance  Although many studies have documented that high incarceration rates are associated with communitywide health harms, this study is, to date, the first to show that decarceration is associated with population-level public health benefits. Its findings suggest that, among other anticontagion interventions, large-scale decarceration and changes to pretrial detention policies are likely to be important for improving US public health, biosecurity, and pandemic preparedness.

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Article Information

Accepted for Publication: June 27, 2021.

Published: September 2, 2021. doi:10.1001/jamanetworkopen.2021.23405

Correction: This article was corrected on September 27, 2021, to fix incorrect wording in the Abstract and Results.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Reinhart E et al. JAMA Network Open.

Corresponding Author: Eric Reinhart, MD, Department of Anthropology, Harvard University, 21 Divinity Ave, Tozzer Anthropology Bldg, Cambridge, MA 02138 (

Author Contributions: Drs Reinhart and Chen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Reinhart.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Both authors.

Obtained funding: Both authors.

Administrative, technical, or material support: Both authors.

Supervision: Both authors.

Conflict of Interest Disclosures: None reported.

Funding/Support: Funding for this research was received from The Bucksbaum Institute for Clinical Excellence at The University of Chicago and The Radcliffe Institute for Advanced Study at Harvard University. The only role of these funding sources pertained to publication fees.

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Viknesh Nagarathinam, MSc (Data and Evidence for Justice Reform, The World Bank), provided research assistance with no compensation outside of salary.

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