All posts by Dr. M Blatstein

7 BOP FEDERAL MEDICAL CENTERS – COVID19

Some were overwhelmed, even as we approach the second wave.

On June 2, 2020, BOP Director Michael D. Carvajal, and BOP Medical Director Dr. Jeffrey Allen testified before the Senate Judiciary Committee. They issued a written statement to the Committee addressing actions the BOP was taking to protect inmates and staff. While it may be true that BOP institutions have such supplies, prisoners dispute they receive them in sufficient quantities. “We were issued three of those motel-sized bars of soap each week,” said Lily. “While we could purchase limited commissary items while under virtually 24-hour a day lockdown, they were often out of products such as soaps. Naturally, exchanges were not permitted. So, if you ordered enough soap for yourself and commissary was out, you’d have to wait for the next three mini bars of soap.”[1]

“Within 24 hours of [the CDC’s change in the recommendation to wear masks], we had provided face coverings to most of our staff and inmates,” explained the directors. “Within 72 hours, all of our inmates and staff were provided face coverings.” “While the staff was provided with KN95 masks, we were initially issued two paper masks with elastic ear straps…[2]

“In prison, we are cut off from the outside world,” Lily said. “We are separated from our families and the social anchor points people rely on. And when the BOP stopped telling us anything about the risk or danger we were in, it resulted in a general sense of helplessness, agitation, and fear. Prison officials created an environment where safety was reduced, and mental health issues were exasperated.”[3]

FMC (FCC) Butner

8/2020, The Queen City Nerve reported that the Federal Medical Center-Butner in North Carolina is the deadliest site of coronavirus in the[4] country. What’s worst is that ‘Now incarcerated people are being thrown into solitary for speaking out’[5]

FMC Butner

Andre Williams was 78-years old and had undergone a quadruple-coronary bypass[6] while incarcerated at FCI Butner, NC. For months before COVID-19 hit the prisons, he sought compassionate release. Finally, on April 1, a court granted his petition. Relief came too late. Four days after the grant, he tested positive for COVID-19. On April 13, he died.

While these two men were granted compassionate release,[7] they did not escape the virus. Before being released the prison did not test either man (Later 79-year-old Alan Hurwitz and Juan Ramon 60) for COVID-19. Rather they have transported them to the airport, escorting them onto the planes, ‘without notifying the aircraft carriers’. Later within days, one was dead, but not counted as part of the total number at Butner, as they died at home.

Between March and April there were 8 deaths.[8]

4/7/2020, Butner prison in Butner, North Carolina, has 39 inmates who had tested positive. That is more than any other federal prison. No staff member there had tested positive.

 FMC Carswell (for women) in Fort Worth, Texas

8/5/2020; According to the Bureau of Prisons website, four inmates have died[i] from COVID-19 and 150 are currently positive. To date, 392 inmates have recovered[9]

7/21/20, 500 women tested positive for coronavirus[ii]

7/ 2020 Confirmed cases –confirmed cases in 1 week[10]:

  • 6/29/2020 according to the BOP, there were zero confirmed cases among prisoners.
  • 7/9/2020 there were 68 confirmed cases
  • 7/10/2020 there were 77 confirmed cases
  • 7/11/2020 The BOP reported 113 cases
  • 7/12/2020 The BOP reported 127 cases
  • If a prisoner tests positive at Carswell, they are put in solitary confinement (leading to psychiatric issues later on).
  • The use of solitary confinement in U.S. prisons has grown by 500 percent[11] during the pandemic.

FMC Devens, Mass

June 17, 2020; Massachusetts Lawmakers sent a Letter to Urge Federal BOP to Implement Widespread COVID-19 Testing: US Senator Elizabeth Warren (D-MA), Senator Edward J. Markey (D-MA) and Congresswoman Lori Trahan (D-MA),

FMC Ft Worth, TX

6/12/2020, 11th FMC Fort Worth Inmate Dies[16] After Contracting COVID-19 in Outbreak

FMC Lexington, Ky

July 2, 2020; It was the seventh coronavirus-related death[18] at the prison.

6/5/2020, 35 new COVID-19 cases and a 48-year-old inmate at Federal Medical Center dies[19]

  • There have been five total deaths at the Federal Medical Center, which currently houses 1,354 offenders.

5/18/2020, Stephen Cook sent a letter to the court in Tennessee, asking for compassionate release or to be sent to home confinement from the Federal Medical Center in Lexington, Kentucky. He suffered from sickle-cell and required monthly off-site treatment. The government opposed his release. Mr. Cook died on June 3, 2020.

FMC Rochester, Minn.

May 5, 2020; One staff member at the Federal Medical Center[20] has tested positive for the coronavirus.

MCFP/FMC Springfield, Missouri

Jun. 17, 2020; Federal Bureau of Prisons reports an active case of COVID-19 related to Springfield Fed Med[21] Center. Prison officials report 1,190 federal inmates and 170 staff have tested positive for COVID-19. There have been 85 federal inmate deaths and 1 prison staff member death attributed to COVID-19 disease.

[1] https://www.prisonlegalnews.org/news/2020/aug/1/coronavirus-prison-cruel-reality/

[2] https://www.prisonlegalnews.org/news/2020/aug/1/coronavirus-prison-cruel-reality/

[3] https://www.prisonlegalnews.org/news/2020/aug/1/coronavirus-prison-cruel-reality/

[4] https://solitarywatch.org/2020/08/12/seven-days-in-solitary-81020/

[5] https://qcnerve.com/fmc-butner-is-host-to-countrys-deadliest-covid-19-prison-outbreak/

[6] https://www.fd.org/sites/default/files/covid19/bop_jail_policies_and_information/2020_07_30_covid_19_in_federal_detention_src_fact_sheet_v2.pdf

[7] https://www.newsobserver.com/news/coronavirus/article244131227.html

[8] https://www.news-leader.com/story/news/local/ozarks/2020/04/08/coronavirus-missouri-cases-springfield-fedmed-prison-inmates-covid-19/2963161001/

[9] https://www.nbcdfw.com/news/local/inmate-at-fmc-carswell-in-fort-worth-dies-from-covid-19/2420454/

[10] https://shadowproof.com/2020/07/14/carswell-covid-19-infections-reality-winner-whistleblower-release/

[11] https://shadowproof.com/2020/07/14/carswell-covid-19-infections-reality-winner-whistleblower-release/

[12] https://medium.com/@SenWarren/congress-must-move-to-rapidly-increase-our-coronavirus-testing-capacity-8c5abd71b6f1

[13] https://www.warren.senate.gov/newsroom/press-releases/warren-markey-in-letter-to-president-trump-sound-alarm-over-lack-of-federal-support-for-massachusetts-amid-coronavirus-pandemic

[14] https://www.warren.senate.gov/oversight/letters/warren-demands-answers-from-fema-on-plans-to-ensure-massachusetts-receives-essential-medical-equipment

[15] https://www.warren.senate.gov/imo/media/doc/PRESSLEY%20WARREN_Letter%20to%20Trump_COVID%20Incarcerated%20Persons%20SIGNED.docx2.pdf

[16] https://www.nbcdfw.com/news/local/11th-fmc-fort-worth-inmate-dies-after-contracting-covid-19-in-outbreak/2387878/

[17] https://www.nbcdfw.com/news/coronavirus/more-than-600-inmates-test-positive-for-covid-19-at-federal-prison-in-fort-worth/2367644/

[18] https://www.wtvq.com/2020/07/02/federal-medical-has-first-coronavirus-death-in-weeks/

[19] https://www.lex18.com/news/coronavirus/48-year-old-inmate-at-federal-medical-center-in-lexington-dies-from-covid-19

[20] https://www.kimt.com/content/news/Positive-test-for-coronavirus-at-Federal-Medical-Center-in-Rochester-570211051.html

[21] https://www.ky3.com/content/news/Federal-Bureau-of-Prisons-reports-a-case-of-COVID-19-related-to-Springfield-Fed-Med-571329251.html

[i] https://www.nbcdfw.com/news/local/inmate-at-fmc-carswell-in-fort-worth-dies-from-covid-19/2420454/

[ii] https://www.brownsvilleherald.com/2020/07/21/500-women-fort-worth-federal-prison-test-positive-coronavirus/

Facing The BOP With: Intellectual Disabilities, Neurological Impairments, Social Deficiencies Or Autism

CorrectionalOfficer.org © 2020 – Screen Shot[i]

 

The Skills Program[i] 

Do you have clients facing incarceration in the BOP, and who are being treated for intellectual disabilities, neurological impairments, social deficiencies, or autism? If yes; which of the BOP’s ‘2’ available prison facilities are best suited for their placement? That’s right, there are only 2 locations.

I ask this is because the concept of prison officials engaging individuals with autism (for example), has its own brand of procedural issues. For those with a documented history, this could be critical for the safety of all parties; the inmate, correction officers, and the facility general population.

Increasingly, media outlets are reporting instances whereby police officers are confronting subjects on the streets and encountering behaviors of some as “resisting verbal commands” and “obstructing justice,” among others. Eventually, the presence of autism or a different disability is discovered after these police/civilian engagements. Thus, a BOP facility who at a minimum, provides this type of care at a couple of facilities, should be made part of the BOP placement request through the PSR.

Inmates with significant functional impairment due to intellectual disabilities, neurological deficits, and/or remarkable social skills deficits are considered for the program. Participants must be appropriate for housing in a low or medium security institution. Inmates must volunteer for the program.[i] While this program is conducted over 12-18 months, inmates may continue with the program at additional times.

Autism spectrum disorder

Autism spectrum disorder (ASD[ii]) occurs in all ages, racial, ethnic, and socioeconomic groups, according to the Centers for Disease Control (CDC)[iii]. Autism is generally characterized by social and communication difficulties and repetitive behaviors. Signs of autism[iv] occur in three main areas:

  • Social interactions
  • Verbal and nonverbal communication
  • Repetitive or ritualistic behaviors

A particular focus on autism-affected inmates, classified by BOP under the umbrella category as “Intellectual Disabilities, Autism Spectrum Disorders” and “Major Neurocognitive Disorders,” seeks to treat affected inmates with a multidisciplinary modality, albeit only available at two BOP locations nationwide. The Federal Bureau of Prisons amended and published (May 2014)[v] its agenda to handle/treat mentally unstable inmates while incarcerated.

Intellectual disabilities are classified by severity, [i]

  • Mild to Moderate
    • Mild
      • slower in all areas of conceptual development and social and daily living skills
      • can learn practical life skills, which allows them to function in ordinary life with minimal levels of support.
    • Moderate
      • care of themselves,
      • travel to familiar places in their community, and
      • learn basic skills related to safety and health.
      • Their self-care requires moderate support.
    • Severe
      • has the ability to understand speech but otherwise has limited communication skills ()[ii].
    • Profound (MH CARE LEVEL III [iii])
      • cannot live independently, and
      • they require close supervision and
      • help with self-care activities.
      • limited ability to communicate and often have physical limitations.

Social Deficiency[iv]; reasons why a person may have a social skills deficit.

    • inability to acquire new skills,
    • because of a competency deficit,
    • they may struggle to perform because of limited practice or inadequate feedback, or
    • external factors
      • anxiety or
      • chaotic surroundings.

Basic Communication

  • inability to listen,
  • follow directions and/or
  • refrain from speaking.

Empathy and Rapport

Interpersonal Skills

  • Those who have a social skill deficit may struggle with asking accurate and concise questions.
    • appear disinterested and even
    • anti-social,
    • they may struggle to understand proper manners in different social contexts and settings.

Problem Solving: involves asking for help, apologizing to others, deciding what to do, and accepting consequences;

  • morbidly shy or
  • clinically introverted.

Accountability, fear of being criticized in public;

  • struggle with accepting blame for problems or
  • dealing with constructive feedback.

Other neurological impairments[vi] (e.g. traumatic brain injury, Spina Bifida, Prader-Willi syndrome, Alcohol-Related Neurodevelopmental Disorders or FASD)

As a Police Officer, Cheri Maples, stated earlier, “…wisdom is being able to discern when gentle compassion is called for and when fierce compassion is called for.” That, my friends, rather sums it up.[ix]

Criminal Justice Advocacy – Screen Shot[i]

 ‘The responsibility for a client’s mental and physical health should be safeguarded to protect them from themselves and others, providing a safe environment for the duration of their incarceration.’

This is the responsibility of the legal defense team, court, and BOP.

The Skills Program[ii] is available at these two facilities:
FCI Coleman, FL-Medium

FCI Danbury, CT-Low

 

[i] https://www.arcnj.org/programs/criminal-justice-advocacy-program/

[ii] https://pprsus.com/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[i] https://www.ncbi.nlm.nih.gov/books/NBK332877/#:~:text=Historically%2C%20intellectual%20disability%20(previously%20termed,100%20in%20the%20population)%E2%80%94and

[ii] https://www.ncbi.nlm.nih.gov/books/NBK332877/#

[iii] https://pprsus.com/programs/bop-mental-healthcare/

[iv] https://www.masters-in-special-education.com/lists/5-types-of-social-skills-deficit/

[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350917/

[vi] https://www.ninds.nih.gov/Disorders/Support-Resources

[vii] https://www.cerebralpalsyguide.com/cerebral-palsy/

[viii] https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy

[ix] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://pprsus.com/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

[ii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/

[iii] https://www.additudemag.com/autism-spectrum-disorder-in-adults/#footnote1

[iv] https://www.additudemag.com/signs-of-autism-in-adults/

[v] https://www.bop.gov/policy/progstat/5310_16.pdf

[i] https://www.correctionalofficer.org/overseeing-inmates-with-autism

[i] https://pprsus.com/bop-psychology-treatment-the-federal-presentence-report-sentencing-and-prison-placement-preparation/skills-program/

COVID-19 Ever Increasing Long-Term Complications

Post COVID-19 Complications; the world’s medical and scientific communities are now facing an ever-increasing list of symptoms.

With the pandemic just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will spur the onset of chronic diseases. Screenshot 8/19/2020
The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain. Screenshot 8/19/2020

8/12/2020, Long after the fire of a Covid-19 infection, mental and neurological effects can still smolder[1]

As many as 1 in 3 patients recovering from Covid-19 could experience neurological or psychological after-effects of their infections, experts told STAT, reflecting a growing consensus that the disease can have a lasting impact on the brain. Beyond the fatigue, neuropsychological problems range from headache, dizziness, and lingering loss of smell or taste to mood disorders and deeper cognitive impairment.

Doctors have concerns that patients may also suffer lasting damage to their heart, kidneys, and liver from the inflammation and blood clotting the disease causes. Additionally, between 30% and 50% of people with an infection that has clinical manifestations are going to have some form of mental health issues,” said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine.

So far the virus appears to cause its damage to the brain and nervous system not as much through direct infection as through the indirect effects of inflammation, said Victoria Pelak, professor of neurology and ophthalmology at the University of Colorado School of Medicine.

“Strokes are larger, potentially more damaging with this disorder. Once inflammation or blood vessel problems occur within the nervous system itself, those people will have a lot longer road to recovery or may die from those illnesses,” Colorado’s Pelak said.

Doctors are also watching for a syndrome called demyelination, as in the autoimmune disease multiple sclerosis, this can cause weakness, numbness, and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations. “We’re just not sure if this virus causes it more commonly than other viruses,” Pelak said.

The COVID-19 infection might also act as a “priming event” for problems to resurface in the future said Teodor Postolache. Psychological stress could reactivate behavioral and emotional problems that were initially triggered by the immune system responding to the virus. “What we call psychological versus biological may actually be quite biological,” he said.

Ely of Vanderbilt suggests three things to do now.

  1. “We can open the hospitals back up to the families. That’s important,” he said.
  2. “We can be aware of these problems and tell the families about them so that the families will know that this is coming. [And]
  3. we can do counseling and psychological help on the back end.”

8/12/2020, MIT Technology Review:[2] Covid-19 “long haulers” are organizing online to study themselves.

Slack groups and social media are connecting people who have never fully recovered from coronavirus to collect data on their condition.

Gina Assaf was running in Washington, DC, on March 19 when she suddenly couldn’t take another step. “I was so out of breath I had to stop,” she says. Five days earlier, she’d hung out with a friend; within days, that friend and their partner had started showing three classic signs of COVID-19: fever, cough, and shortness of breath.

Assaf had those symptoms too, but a full month after falling ill, she attempted to go to grocery shopping and ended up in bed for days. In those first few months, Assaf found a legion of people in situations similar to her own in a Slack support group for COVID-19 patients, including hundreds who self-identified as “long-haulers,” the term most commonly used to describe those who remain sick long after being infected.

It wasn’t until late July that the US Centers for Disease Control published paper recognizing that as many as one-third of coronavirus patients not sick enough to be admitted to the hospital don’t fully recover. So Assaf, a technology design consultant, launched  Patient-Led Research for Covid-19[ii], released its first report[iii].

The Body Politic COVID-19 Support Group[iv]

8/12/2020, Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center who studies delirium during intensive care (watch video)[22] stays. “The problem for these people (when coming off ventilators), is not over when they leave the hospital.”

Long term effects are health issues that are caused by an illness, disease, or treatment that lasts for several months or years after infection. Long-term effects can be physical, mental, or emotional and can occur even if the initial illness or disease is no longer present in the body.[23].

This applies to post COVID-19 patients (Long-Haulers), as physicians and scientists from around the globe begin to study these patients post-hospitalization.

The long haul | Science science.sciencemag.org Screenshot

Also found in my LinkedIn: Compassionate Relief – COVID-19 Emerging Long-Term Complications 

[1] https://www.statnews.com/2020/08/12/after-covid19-mental-neurological-effects-smolder/

[2] https://www.technologyreview.com/2020/08/12/1006602/covid-19-long-haulers-are-organizing-online-to-study-themselves/

[3] https://docs.google.com/forms/d/e/1FAIpQLScM2EeJhgisTUdo5Op6euyx1PYu8O-aNeDVYhXuPFa_Gs9PnQ/viewform

[4] https://patientresearchcovid19.com/

[5] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[6] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[7] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[9] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[10] https://www.medpagetoday.com/neurology/dementia/87543

[11] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[12] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[13] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[14] https://www.ptsd.va.gov/covid/COVID_effects_ptsd.asp#:~:text=PTSD%20Symptoms%20Can%20Be%20Affected,things%20most%20people%20consider%20safe.

[15] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[16] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain#:~:text=A%3A%20Cases%20around%20the%20world,Seizures

[17] https://www.frontiersin.org/research-topics/14627/impact-of-the-coronavirus-pandemic-covid-19-on-mood-disorders-and-suicide#:~:text=During%20the%20coronavirus%20COVID%2D19,problems%20and%20perceived%20social%20isolation.

[18] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[19] https://www.healthline.com/health-news/the-covid-19-symptoms-most-people-could-miss

[20] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[21] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[22] https://www.icudelirium.org/

[23] https://www.talktomira.com/post/what-are-the-long-term-side-effects-of-coronavirus-covid-19

[i] https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html?deliveryName=USCDC_2067-DM35559

[ii] https://patientresearchcovid19.com/

[iii] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[2] https://www.technologyreview.com/2020/08/12/1006602/covid-19-long-haulers-are-organizing-online-to-study-themselves/

[3] https://docs.google.com/forms/d/e/1FAIpQLScM2EeJhgisTUdo5Op6euyx1PYu8O-aNeDVYhXuPFa_Gs9PnQ/viewform

[4] https://patientresearchcovid19.com/

[5] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[6] https://docs.google.com/document/d/1KmLkOArlJem-PArnBMbSp-S_E3OozD47UzvRG4qM5Yk/edit

[7] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[8] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[9] https://www.medpagetoday.com/neurology/dementia/87543

[10] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[11] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[12] https://health.ucdavis.edu/health-news/newsroom/covid-fatigue-is-hitting-hard-fighting-it-is-hard-too-says-uc-davis-health-psychologist/2020/07

[13] https://www.ptsd.va.gov/covid/COVID_effects_ptsd.asp#:~:text=PTSD%20Symptoms%20Can%20Be%20Affected,things%20most%20people%20consider%20safe.

[14] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[15] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain#:~:text=A%3A%20Cases%20around%20the%20world,Seizures

[16] https://www.frontiersin.org/research-topics/14627/impact-of-the-coronavirus-pandemic-covid-19-on-mood-disorders-and-suicide#:~:text=During%20the%20coronavirus%20COVID%2D19,problems%20and%20perceived%20social%20isolation.

[17] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[18] https://www.healthline.com/health-news/the-covid-19-symptoms-most-people-could-miss

[19] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[20] https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/how-does-coronavirus-affect-the-brain

[21] https://www.icudelirium.org/

[22] https://www.talktomira.com/post/what-are-the-long-term-side-effects-of-coronavirus-covid-19

[i] https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html?deliveryName=USCDC_2067-DM35559



Entering the BOP, ease your client’s medication fears

To someone entering prison for the first time, they assume that they will still get medical care. The assumption may be that they will also get the same medications that they got on the outside, which is likely not the case.

  • Medication availability (~ 3000 different drugs), falling into 3 categories.
    • 1st) On Formulary -Available: These medications are available for BOP healthcare providers for inmate’s use.
    • 2nd) Non-Formulary -These require a lengthy Preauthorization Process-: These medications while they are stocked, they are not immediately available for your use. The prescribing BOP Physician or other healthcare provider needs to go through a lengthy Pre-authorization process to get permission to provide this to you.
    • 3rd) Similar equivalents- When there are no other options, here similar or equivalent substitutions are used. Should the need for a required drug be used where there is no equivalent substitute; this medical problem should be brought up before the sentencing hearing, and hopefully get the backing of the US Attorney, and finally the court.
  • Examples of medication confusion;
    • Cholesterol Control: PCSK9 Inhibitors vs. Statins. Statins are a popular treatment that has been available since the 1980s. PCSK9 inhibitors, on the other hand, are a new type of cholesterol drug. They were approved by the Food and Drug Administration in 2015.
      • But these Cholesterol generics look very different, and may not look like what the defendant has been taking – adding to their stress level.

        Cholesterol Generics:(multiple colors and shapes, while having similar ingredients)

        Generics

        • These are the drug of choice for the BOP as they are cheaper than brand name medications.
        • It may be beneficial to inform your client ahead of time that, while they’ll be taking a generic medication since there are many manufacturers who each produce similar generic drugs that may differ in color and shape; they should be appropriate.
        • Nobody likes surprises, especially if they are entering prison for the first time.
        • Examples of Lipitor (the generic name is atorvastatin)
        •     Generic Lipitor-Dr Reddy’

 

 

 

 

                                                              Generic Lipitor Good Rx

 

New Female ‘PTSD’ Integrated Treatment (FIT) Program; Available at FCI Danbury

The FIT Program is an evidence-based approach designed to ensure that each participant has an individually tailored treatment plan and receives a full-range of services to address their needs. The program will combine three psychology treatment programs, including the Residential Drug Abuse Program, for those who are eligible.

Women are twice as likely as men to experience PTSD, according to the World Health Organization. A woman’s chances of experiencing trauma are higher — 10% of women will experience PTSD versus 4% for men. “It’s tough to say there are sure symptoms of PTSD, since no two people will have the same experience,” Pereau says.

DSM-V Revisions to Signs and Symptoms of PTSD

In the most recent publication of the DSM, the DSM-V, PTSD symptoms are grouped into five different clusters. One or more symptoms are required from each of these clusters in order for a patient to receive a full diagnosis.

Those clusters include:

  1. Stressor– (one required) The person was exposed to injury or severe illness that was life-threatening, which includes actual or threatened injury or violence. This may include at least one of the following:
    • Direct exposure to the trauma
    • Witnessing a trauma
    • Exposure to trauma by being a first responder, such as police, firefighter, medic, or crisis counselor
    • Learning that someone close to you experienced the trauma
  2. Intrusion Symptoms(one required) – The person who was exposed to a trauma then re-experiences the trauma in one or more ways, including:
    • Flashbacks
    • Nightmares
    • Distressing and intense memories
    • Distress or physical reactions after being exposed to reminders, known as “triggers”
  3. Unpleasant Changes to Mood or Thoughts(two required) –
    • Blaming self or others for the trauma
    • Decreased interest in things that were once enjoyable
    • Negative feelings about self and the world
    • Inability to remember the trauma clearly
    • Difficulty feeling positive
    • Feelings of isolation
    • Negative affect, and difficulty feeling positive
  4. Avoidance(one required) – This occurs when a person tries to avoid all reminders of the trauma, including:
    • Avoiding external reminders of what happened
    • Avoiding trauma-related thoughts or emotions, sometimes through the use of drugs or alcohol
  5. Changes in Reactivity(two required) – This occurs when a person becomes more easily startled and reacts to frightful experiences more fully, including symptoms of:
    • Aggression or irritability
    • Hypervigilance and hyper-awareness
    • Difficulty concentrating
    • Difficulty sleeping
    • Heightened startle response
    • Engaging in destructive or risky behavior
    • Difficulty sleeping or staying asleep

All of these symptoms must have persisted at least one month, and they must be causing distress or functional impairment of some kind. These symptoms must not be related to any substance use, illness, or medications.

Also seen: https://www.linkedin.com/pulse/women-facing-federal-incarceration-bop-have-ptsd-dr-m-blatstein/?published=t

Guilty and Facing Prison, Now What? Critical 1st steps that will determine your future…

Critical 1st steps that will determine your future are in the PSR.

To support your attorney’s efforts, please contact me, Dr. M. Blatstein: info@PPRSUS.com, or call 240.888.7778 (leaving a brief message).

While I cover preparing for BOP placement, medical issues could apply to both state and federal agencies.

  1. Having attorney representation is critical, and if expenses are an issue there are Federal Public Defenders 2020.
  2. Before the sentencing hearing, if your attorney identifies medical (or mental healthcare) issues, now is when a professional consult is recommended.
  3. If you have a history with any medical specialty or drug clinic etc.; getting your records is especially important.
  4. Religious Diet – Accommodation Form (BP A700.53).
  5. First Time Offenders (NACDL)– Alternatives to Incarceration
  6. Do any of these mental health issues apply to the defendant? Federal prison placement includes Medical and Mental Healthcare needs to be implemented through the BOP CARE LEVELS I-IV along with there Structured Psychological Treatment Programs.
    • I) Brave Program A first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more
    • II) Challenge Program A male inmate facing a high-security penitentiary with a current diagnosis of either: Mood, Anxiety, Schizophrenia, Delusion and/or a Substance-induced Psychotic Disorders
    • III) Mental Health Step Down A male or female who lacks the skills to function in a general population prison setting and is willing to work with Psychiatry Services.
    • IV) Resolve: A male or female with a current diagnosis of a mental illness related to physical, mental and/or intimate domestic violence or traumatic PTSD
    • V) Skills A significant functional impairment due to intellectual disabilities, neurological and/or remarkable social skills deficits such as Autism Spectrum Disorder, Obsessive Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s or Traumatic Brain Injuries (TBIs) to mention just a few.
    •  VI) Stages  A male inmate with a serious mental illness and a primary diagnostic of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment.
    • VIIa) Sex Offender Non-Residential Single Sex Crime, or first time Internet Sex Offense
    • VIIb) Sex Offender Residential Multiple sex crimes.
    • VIIc) Butner’s Commitment and Treatment Program for Sexually Dangerous Persons, Page 12Is considered for sexually dangerous persons with the possibility of criminal recidivism
    • VIII) Female Integrated Treatment Is a female with substance abuse (RDAP Eligibility Possible), trauma-related disorders, and other mental illnesses. (FIT) Program
  7.  COVID-19:

Unfortunately, prisons and jails are perfect petri dishes for contagions to spread into their communities via the corrections staff and inmates. Masks along with 6’ of separation are unlikely and problematic to implement.

COVID-19: BOP News

Focus: 6′ of Separation (Unlikely), Overall testing and contact tracing is not yet available for either the general public or those incarcerated as of this post update 5/9/2020.

COVID-19 in Prisons (Federal, State) and  Jails, like Cruise Ships, unfortunately, act as perfect breeding grounds for any kind of virus and especially one that currently has no treatment protocols.
7/9/2020 (6 South Florida)

South Florida Federal Corrections Officers Warn of Potential Coronavirus Crisis Brewing

6/30/2020 (Reason)

These Women Received a Death Sentence for Being Sick In Prison – alleged medical neglect at FCI Aliceville, a federal women’s prison.

6/28/2020 (Forbes)

Otisville Federal Prison Camp Is More Like A Higher Security Prison In Fight Against Covid-19

6/11/2020 (Fort Worth Star)

11th inmate from a federal medical prison in Fort Worth died from coronavirus. This is discouraging as Fort Worth is a BOP Federal Medical Center.

5/28/2020 (Lexington Herald Leader)

Federal Medical Center prison helps drive a single-day spike in Lexington (FMC) COVID-19 cases.

5/28/2020 (LA Times)

Inmate labeled as ‘recovered’ from coronavirus dies at Terminal Island

 

5/28/2020 (Morning Journal)

Forest City Low-FCI prison in Arkansas currently has more federal prison coronavirus cases, according to the BOP website.

 

5/27/2020 (The Crime Report)
A task force led by current and former justice officials has proposed a 15-point platform to improve the federal criminal justice system.
5/27/2020 (Salon)

Even as the Justice Department announced that federal prisons would release vulnerable, nonviolent inmates to home confinement to avoid the spread of COVID-19, the agency was quietly adopting a policy that makes it harder for inmates to qualify for release, not easier.

5/27/2020 (AP)

TERRE HAUTE – An inmate at the federal prison complex in Terre Haute who had COVID-19 has died, and three others there also have tested positive for the disease, the Bureau of Prison said Tuesday.

 

5/26/2020 (Government Executive)

…a secret BOP policy has kept all but 1.8% of federal inmates behind bars where the virus rages.

May 22, 2020 (KSAT.com)

A Federal Bureau of Federal Prisons truck drives past barbed wire fences at the Federal Medical Center prison in Fort Worth, Texas, Saturday, May 16, 2020. Hundreds of inmates inside the facility have tested positive for COVID-19 and several inmates have died with numbers expected to rise. (AP Photo/LM Otero) (Copyright 2020 The Associated Press. All rights reserved.)

Federal prison system to begin moving nearly 7K inmates to one of three designated quarantine sites — FCC Yazoo City in Mississippi, FCC Victorville in California, and FTC Oklahoma City — or to a Bureau of Prisons detention center.

May 16, 2020 (The Review)

Of the 399 accumulated COVID-19 cases in Columbiana County, the health department reports nearly 25 percent, 94 of the cases, have been inmates from FCI-Elkton, totaling 118 for inmates and 12 corrections staff.

May 11, 2020

Inmates, families fear worst for Fort Worth Federal Medical Center – as the prison is ‘consumed’ by coronavirus where 636 inmates — 43% of the total population — had tested positive, and five have died.

May 10, 2020 (CBS DFW)

Tarrant County Public Health (TCPH) reported 485 new cases of the coronavirus Sunday, of which 423 were caused by the Texas Fort Worth Federal Medical Center prison outbreak. So far, the county has seen 3,695 positive cases and 780 recoveries.

May 9, 2020 (FCI Lompoc):

But covid-19 at FCI Lompoc is straining the relationship with LOMPOC, Calif. residents, part of this central California agricultural community.

70% of inmates test positive for coronavirus at Lompoc federal prison.

May 8, 2020 (KTLA5):

As of Friday 5/8/2020, 823 inmates tested positive in FCI Lompoc (2 have died), and another 644 at FCI Terminal Island (6 have died at the San Pedro facility).

May 8, 2020 (The Appeal):

FCI Hazelton is one of 11 federal prisons designated quarantine facilities. When new people are convicted or otherwise brought into the federal system, they will be sent to one of the facilities for a two-week quarantine period, BOP spokesperson Justin Long told The Appeal.

May 5-6, 2020 (Lex 18):

70 inmates test positive at the Lexington Federal Medical Center (FMC) in Lexington, Kentucky, however “communication with [FMC Lexington] has been sporadic, and sometimes it’s non-existent,” Lexington Health Department Spokesman Kevin Hall

May 5-6, 2020 (Lex 18):

LEXINGTON Federal Medical Center is quickly emerging as a hot spot for Coronavirus in Kentucky, without providing the needed communication with Lexington Fayette County Health Department.

May 1, 2020 (Penn Live Patriot-News):

LEWISBURG – Lewisburg Federal Penitentiary will transition into a medium-security facility is complete (and every unit will have multiple rooms with televisions, computer stations, and telephones).

May 1, 2020 (The Marshall Project):

COVID-19 continues to spread through Ohio prisons, with the FCI Marion and Pickaway correctional institutions combining for nearly 2,500 confirmed cases of the coronavirus. That is an estimated 80 percent of the inmates in those two prisons.

 

April 30, 2020 (The Marshall Project):

Texas prison system failed for years to equip employees with personal protective equipment…

Over 70 percent of tested inmates in the federal prison system have COVID-19. AP

COVID-19 outbreak at FCI Terminal Island is now the largest within the Bureau of Prisons system…

 

April 28, 2020 (ABC, WQAD8)

Thomson USP is one of 11 facilities designated as a “quarantine location,” now concerns over-testing.

April 23, 2020

…a federal judge dismissed a class-action lawsuit that was aimed at getting medically vulnerable prisoners released from the federal prison in Oakdale, Louisiana.

 

April 22, 2020 (Forbes):

Bureau Of Prisons Removes Webpage FAQ Home Confinement On COVID-19. BOP Website Displays…..

 

April 20, 2020 (Government Executive):
Union Files National Grievance Over Alleged Safety Violations at Federal Prisons During Coronavirus Pandemic. Forced leave, lack of protective gear, and privacy breaches are among the allegations.
April 18, 2020 (NYT):

‘Something Is Going to Explode’: When Coronavirus Strikes a Prison. An oral history of the first fatal outbreak in the federal prison system, in Oakdale, La.

 

Friday, April 17, 2020 (ABC):

Butner ( a BOP Federal Medical Center) has more COVID-19 cases than any other prison in the federal system: 66 inmates and 25 staff members have tested positive for COVID-19 at Butner; four inmates have died

 

April 15, 2020 (Forbes):

COVID-19 Positive Tests in Bureau of Prisons Institutions (April 14, 2020) W PAVLO

Federal Bureau Of Prisons Institutions Not Showing Any Signs Of “Flattening Curve”, By Walter Pavlo

The continued inaction of the BOP to swiftly reduce the population of inmates, particularly the elderly and those with underlying health conditions, is an unfolding story with tragic consequences.

April 14, 2020 (Marshall Project):

Nearly 600 prisoners and staff members are infected with COVID-19 in the federal system. Thirteen prisoners have died. Bureau of Prisons

 

April 8, 2020 (The Appeal):

Don’t Look to the DOJ to Keep Federal Prisons and Their Surrounding Communities Safe During the COVID-19 Pandemic. By  Shon Hopwood/Felon turned Georgetown Law Professor, Apr 08, 2020

April 8, 2020 (NYT):

…1,324 confirmed coronavirus cases are tied to prisons and jails across

Prisoners hung signs pleading for help in a window of the Cook County jail on Tuesday.Credit…Jim Vondruska/Reuters

the United States

 

April 7, 2020 (News Observer):

The Federal Correctional Complex at Butner is moving to the top of the list of prisons for early release 

April 6, 2020 (NPR):

Inmates, Staff On Edge As COVID-19 Spreads Through Federal Prisons  The Federal Bureau of Prisons says 138 inmates and 59 employees have tested positive and at least seven inmates have died.

April 4, 2020 (FEDweek):

 

Brooklyn, NY - Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Brooklyn, NY – Feb 2019: Protest over inmate conditions in front of the Brooklyn Metropolitan Detention Center which partially lost power and heat, resulting in a lockdown.

Bureau of Prisons Implements Partial Lockdown to Halt Spread; The challenge is that prisons and jails are not built to provide 6′ of separation to inmates and correction staff.  I have to assume that PPE, cleaning materials and testing for all parties are not diligently implemented.

April 2, 2020:

Marshall ProjectCoronavirus Tracker By State: How Justice Systems Are Responding in Each State; Coronavirus Published 03.17.2020 Updated 2:03 P.M. 03.25.2020

April 1, 2020 (Gov Exec Daily):

Federal Prison System Goes Into ‘Modified Lockdown’.

The Metropolitan Detention Center in Brooklyn, N.Y., had the first known case of coronavirus in the federal prison system. The facility is shown here in February 2019. KATHY WILLENS / AP

New procedures due to coronavirus concerns will last 14 days, after which the agency will re-evaluate. By COURTNEY BUBLÉ

Mar 31, 2020 (The Appeal, MedPage):

BOP Halfway House Residents Describe ‘A Scary Situation’ As Coronavirus Sweeps The U.S. By Lauren Gill. These halfway houses appear ill-prepared for the influx of those who may have (or haven’t yet contracted), COVID-19.

 

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

Could Wearing a Face Mask Be a COVID-19 Game Changer?— Augmenting protection during a global pandemic. by Rossi A. Hassad Ph.D., MPH

An easy and cheap option for all inmates and correction staff, in either Jail, Halfway House, State, Federal or Private facility. We can argue the efficacy benefit later.

Mar 30, 2020 (Vice News, NYT):

Inside the Federal Prison, That’s ‘Ground Zero’ For the Coronavirus Outbreak, By Keegan Hamilton

Mar 27, 2020 (The Marshall Project):

156-beds-in-Elm-Hall-a-minimum-security-dormitory-at-the-California-Institution-for-Men

No such thing as social distancing in prison. From THE MARSHALL PROJECT

PUBLIC HEALTH DOCTOR AND HEAD OF CORRECTIONS AGREE: WE

MUST IMMEDIATELY RELEASE PEOPLE FROM JAILS AND PRISONS; By Brie Williams, Leann Bertsch

Mar 26, 2020 (The Hill):

COVID-19 gives us an urgent argument for compassionate release

Mar 24, 2020 (wbur):
A medical exam room in the Worcester County jail in West Boylston

A medical exam room in the Worcester County jail in West Boylston

Pain And Profits: Sheriffs Hand Off Inmate Care To Private Health Companies; By Christine Willmsen  and Beth Healy

Prisons and Jails are unprepared; COVID-19

COVID- 19 in Prisons and Jails are unprepared and may now be forced to recommend, in some cases alternative diversion sentences and/or home confinement.
I can only believe that the PSR could play a significant roll in this process.

Six feet apart, unlikely

6' apart, unlikely

COVID-19 in Prisons (Federal, State) and  Jails, like Cruise Ships, unfortunately, act as perfect breeding grounds for any kind of virus and especially one that currently has no treatment protocols.
John Hopkins has a Live Interactive Dashboard
Provides Current Reported Cases of COVID-19. Use our interactive web-based map to track cases of the virus around the world

UpToDate/Coronavirus disease 2019 (COVID-19)

_____________________________

Recent Press Releases:
September 2020

Visitation beginning to restart.

June 3, 2020 (Marshall Project)

How Prisons in Each State Are Restricting Visits Due to Coronavirus

 

June 3, 2020 (Marshall Project)

Jails Are Coronavirus Hotbeds. How Many People Should Be Released To Slow The Spread?

May 15, 2020 (Marshall Project)

For Mentally Ill Defendants, Coronavirus Means Few Safe Options

While their mental health deteriorates, some are stuck in jail as hospitals are decreasing admissions to prevent the spread of infections

April 17, 2020                                                                                           

Inadequate access to medical care poses a severe threat to a population that is already more vulnerable to coronavirus: there are about 10,000 people over 60 in federal custody, and about a third have pre-existing conditions. Photograph: Jonny Weeks/The Guardian

In prisons and jails across the deep south, coronavirus threatens to overwhelm

chronically underfunded, understaffed and overpopulated facilities

Mar 21, 2020;

Forbes; Can US Prisons React Fast Enough To COVID-19? By Walter Pavlo

 

March 22, 2020; 

Assistant U.S. Attorney Tanya Hajjar –  – wrote that no inmates at the Metropolitan Detention Center (MDC) in Brooklyn, NY or any other federal facility had tested positive for the coronavirus. What she failed to mention is that the BOP was not doing any testing of prisoners. ByJ.J. O’Hara

 

3-23-2020;

At least 38 people in New York City jails have contracted the virus. Associated Press

First federal prisoner, in Brooklyn, tests positive for COVID-19. Associated Press

3-20-2020
Florida beaches covered with 1000’s on spring break, 2020.
All of this while COVID-19 is spreading across our country and the world. As a growing number of state governors urged all of us to Shelter in Place, in Florida, their beaches were covered with 1000’s on spring break.
You ask why and I have no idea. But these revelers are now on their way home to spread the virus throughout their families, friends and fellow workers’ personal space. Yet another vector.
The spread of COVID-19 from these beaches will ultimately whether direct or indirectly impact our society and prison system.
The Marshall Project, 3-19-2020

‘Those 55 and older are a growing share of the people in prisons. They’re also the most at risk as coronavirus spreads.’ By WEIHUA LI and NICOLE LEWIS

Couple this with the unprecedented delay of the federal government to act in any manner to assist state governors since January 2020, COVID-19 has exploded across the country exponentially! These same prisons and jails are already overcrowded, resulting in a healthcare disaster ready to get out of control.

Marshall Project: Jails are perfect incubators for COVID-19.” By Cary Aspinwall, Keri Blakinger, Abbie VanSickle and Christie Thompson

3-19-2020
ICE Now could be another vector waiting to explode, impacting immigrants and ICE officers alike. While ICE claims to “have a plan”, the horse has already left the barn.

_____________________________

#covid19 #Covid19Prison #covidBOP

Federal Sentencing, COVID-19 and Compassionate Release

(1) Federal Sentencing in the age of COVID-19; for drug crimes from the U.S. National Library of Medicine – Evidenced Based Diversion Sentencing (a step by step process clearly explained).

  • This is critical as prisons are perfect petri dish incubators for contagions to multiply as in the cruise ship; e.g., Diamond Princess.
  • With ~600K inmates released each year with no current treatments available;
(2) Compassionate Release  /COVID19; while to my understanding it’s been difficult-impossible to get in past years, with COVID19, these examples just appear cruel:
  • People with severe obesity (body mass index [BMI] of 40 or higher).
  • People with diabetes.
  • People with chronic kidney disease undergoing dialysis.
  • People with liver disease.
  • I recommend the website UpToDate, an excellent resource tool for clinicians, hospitals, and hospital systems.

(3) 5-15-2020; Halfway House photos show no 6′ social distancing or masks being used.

 

BOP/ COVID-19 / Hydroxychloroquine / The Science

4-7-2020 (Marshall Project)

BOP buys $60,000 worth of hydroxychloroquine, the un

White House economic adviser Peter Navarro reportedly clashed with the National Institute of Infectious Diseases director Dr. Anthony Fauci over the efficacy of hydroxychloroquine as a coronavirus treatment.

proven COVID-19 treatment drug;

Many Trump-friendly pundits, however, are convinced of the drug’s effectiveness, most notably those on Fox News shows from which the president is known to take policy cues.

INDICATIONS:

Malaria (not recommended for the treatment of complicated malaria.)

Lupus Erythematosus

Rheumatoid Arthritis: the treatment of acute and chronic RA  in adults.

Common side effects of Hydroxychloroquine include:

________________________

Clinical Effectiveness COVID-19 Resources Available to All

UpToDate (Medical Experts for Physicians)

Clinical Effectiveness COVID-19 Resources

DrugsCOVID-19

Coronavirus disease 2019 (COVID-19): Management in adults

 

I) Hydroxychloroquine/chloroquine— 

There are insufficient data thus far to know whether hydroxychloroquine or chloroquine has a role in the treatment of COVID-19. For this reason, we strongly recommend that patients should be referred to a clinical trial whenever possible.

If hydroxychloroquine or chloroquine is used outside of a clinical trial, the potential for adverse effects should be carefully assessed. (See “Coronavirus disease 2019 (COVID-19): Arrhythmias and conduction system disease”, section on ‘Monitoring for QT prolongation’.)

 

Ia) Azithromycin and hydroxychloroquine –

We do not routinely use azithromycin in combination with hydroxychloroquine for treating COVID-19. Although one study suggested the use of azithromycin in combination with hydroxychloroquine was associated with more rapid resolution of virus detection than hydroxychloroquine alone [62], this result should be interpreted with caution…

 

II) Remdesivir (Testing canceled,, not because the drug wasn’t working, but because it proved too difficult to enroll the required number of patients. (Endpoints News))

…is a novel nucleotide analogue that has activity against SARS-CoV-2 in vitro [43] and related coronaviruses (including SARS and MERS-CoV) both in vitro and in animal studies [44]. Several randomized trials are underway to evaluate the efficacy of remdesivir for moderate or severe COVID-19 [45].

IIa) The WHO is launching a trial to further evaluate:

…remdesivirhydroxychloroquine/chloroquine, and lopinavir-ritonavir with and without interferon beta [76]. Various other antiviral and immunomodulating agents are in various stages of evaluation for COVID-19. A registry of international clinical trials can be found on the WHO website and at clinicaltrials.gov.

 

III) Convalescent plasma — 

In the United States, the Food and Drug Administration (FDA) is accepting investigational new drug applications for use of convalescent plasma for patients with severe or life-threatening COVID-19 [50]; pathways for use through these applications include clinical trials, expanded access programs, and emergency individual use.

 

IV) Tocilizumab

…is an interleukin (IL)-6 receptor inhibitor used for rheumatic diseases and cytokine release syndrome. Elevated IL-6 levels have been described in patients with severe COVID-19, and case reports have described good outcomes with tocilizumab [66-69].