Gatsi/iStock(NEW YORK) — As much of the nation adjusts this week to sudden and indefinite home confinement, prison and jail wardens across the U.S. are scrambling to forestall an outbreak of COVID-19 inside a crowded U.S. correctional facility.With the highest incarceration rate of any nation in the world, the U.S. faces unique challenges among its roughly 2.3 million inmates as the coronavirus surges silently through all 50 states.As projected staff shortages and fears of thinning medical resources cascade through the nation’s patchwork of federal, state, county and private prisons and jails — where even rudimentary protective measures like alcohol-based hand sanitizers are considered contraband in many facilities — officials told ABC News are preparing for the worst.“I think the threat level is at 10 now,” said Scott Kernan, a former secretary of the California Department of Corrections and Rehabilitation. “The [nation’s] corrections leaders are struggling to figure out what the national response will be.”Burdened by often crowded and at times unsanitary conditions, a generation of aging inmates, and a large portion of its population suffering underlying chronic health issues, the tinderbox conditions inside at least some of the nation’s more than 6,000 incarceration facilities have corrections officials and organizations stockpiling supplies and hustling out medical guidance through webinars.“People refer to cruise ships as petri dishes, but nobody has invented a more effective vector for transmitting disease than a city jail,” said Martin Horn, a former New York City corrections commissioner.Earlier this week, Los Angeles officials began releasing hundreds of inmates incarcerated for low-level offenses in order to guard against infection, and on Wednesday, New York City Mayor Bill de Blasio said his city was considering similar measures. Calls are growing nationwide for the release of lower-level inmates to stem the spread of the virus.On Tuesday, Brooklyn District Attorney Eric Gonzalez said his office would immediately cease prosecuting low-level offenses and consider freeing jailed suspects “vulnerable to infection,” part of a harm-reduction strategy among U.S. law enforcement — unthinkable just months ago — that’s also beginning to take hold across the U.S.Only a handful of corrections officers nationwide have so far tested positive – one died earlier this week — but if that number climbs, experts say the calls for wider inmate releases could, too.There’s also a fear of staff shortages if the COVID-19 crisis deepens.“Some staff are thinking, ‘Gimme a break. Time to call in sick. Time to think of my family first,’” said Robert Hood, a former warden of Colorado’s “Supermax” federal penitentiary.The nation’s incarcerated population includes about 1.3 million in state prisons, another quarter million in federal prisons, and about three-quarters of a million in local jails, according to the non-profit Prison Policy Initiative.Corrections experts who spoke to ABC News said the success or failure of a response to a COVID-19 outbreak could depend to some extent on the size and location of the facility.“These are the forgotten people,” said Hood. “There’s a lot of good people in prison. There’s not probably a lot of sympathy out there for them now, but I have to be candid with you — there’s a crisis going on.”Visitation, transfers suspendedInside prisons and jails from Washington state to southern Florida, wardens and sheriffs are facing the challenge of not just containing an unprecedented health crisis, but the potential ripple effects of riots and violence if inmates learn the highly contagious virus is sweeping through their facility.Those natural fears would be exacerbated by growing inmate isolation as family visits dry up and virtually all rehabilitation programs cease — and millions of Americans face the encroaching uncertainty of life with the coronavirus alone, from inside a cell.Earlier this week, the federal Bureau of Prisons (BOP) issued an order suspending inmate visits and transfers for 30 days, and issued fresh guidance for protecting against an outbreak. Yet on Thursday, corrections sources at a federal facility in the southern U.S. told ABC News that inmate transfers were still being accepted at their facility.At Manhattan’s federal Metropolitan Correctional Center in New York, local corrections union president Tyrone Covington told ABC News on Thursday that the staff there was already running short of hand sanitizer, gloves and N-95 masks.Tim Lloyd, a former associate warden and 20-year veteran of the federal Bureau of Prisons told ABC News that while the bureau has plans in place, it would be a disaster if an inmate or staff member were to contract the coronavirus.If inmates feel that they aren’t getting proper treatment, there is “definitely” the possibility of a riot, he said.“That could get ugly pretty quick,” he explained.‘Who’s coughing?’Hood told ABC News that the coronavirus threat has turned the whole U.S. corrections system “upside down.”“All of the sudden the guys that are the best inmates, the 50 to 60% who are in for drug-related, non-violent offenses, the guys in the dormitories — not the lockdown guys — all of the sudden they’re at the most risk. What would I do if I was an inmate in a dormitory? I’d go smack someone in the head — and I mean that. I’d want to go on lockdown, because then I’d be a little better off.”“But then I’d realize I’m still on the same ventilation system. I’m still breathing the same air. Think about it this way: if a [corrections] officer didn’t care about you on a good day, are they going to be overly-concerned about germs on my [cell] table on a bad day?”Hood said that even fear factors inside the nation’s prisons have been turned inside out.“Instead of worrying, ‘Who’s carrying the shanks?’” he said, “It’s ‘Who’s coughing?’”Kernan now runs a tech firm called LEO Technologies, which uses artificial intelligence to mass-monitor millions of inmate phone calls annually from jails and prisons in five states.A tenth of all inmate phone calls the firm monitors touch on the spreading virus.“It’s on the forefront of their minds,” said James Sexton, an executive at Kernan’s firm. “We’re seeing 10% of calls in some form or fashion talking about the coronavirus, whether it’s the [call] recipient or inmate.”‘An isolating place’Prisoners are literally trapped inside cells as the virus spreads all around them, experts say.“Jail is already an isolating place — you’re already ostracized from society,” said Sexton, a former California law enforcement official who also served time in prison.“In a situation like this, where things are already beyond your control — and they become beyond the institution’s control? It’s an immense amount of anxiety when you’re locked down like that and you know that you don’t have control over your own destiny,” he said.As one inmate incarcerated less than 20 miles from the Washington state nursing home considered ground zero for the virus in the U.S. wrote in a story published jointly on Wednesday by the non-profit Marshall Project and BuzzFeed News: “When I walk through the unit now, I cannot help but linger on the faces of the elderly prisoners, some of them who have been like father figures to us younger men, and think about how they are unlikely to survive this.”Kernan said he’s worried about the ability of most prisons or jails to treat or contain an outbreak within their facility.“The point should be made that prison and jails across the country use the local hospital to take care of the inmate population,” he said. “Every day, thousands of inmates are taken to hospitals for care. If those are not available, it could be a really big deal.”“We’re going to see a dramatic drop in [medical] services to inmates in a second or third [wave] that’s going to play out in May or June,” Kernan predicted. “There’s going to be a drawdown on the people that can be found to treat our inmate populations.”‘First responders’Yet other corrections industry leaders and organizations told ABC News that they are prepared for anything.“There’s no question that the jails and the prisons are going to face challenges, but they are as prepared — or perhaps more prepared — than society at large because they’ve always planned for contagious disease outbreaks,” said Horn.“I think there’s a distinction between a large sophisticated system like the state of New York or the state of Pennsylvania’s corrections system and a small jail in Podunk, Mississippi, but measles, chickenpox — these things happen all the time and most large correctional agencies have plans to deal with them,” Horn said.“Having said that,” he added, “I don’t think anybody was prepared for something like this, and we’re still not even sure what ‘this’ even is.”Other industry leaders were optimistic in interviews this week.“Correctional professionals are first responders,” said Elizabeth Gondels of the American Correctional Association, the oldest and largest corrections industry accrediting body in the world. “And in my heart of hearts? Our prison systems are on this. They talk. They’ve got great networks. Our jails are doing a lot of outreach.”Gondels said that she isn’t worried about shortages of medical supplies.“We’ve always done a lot with less,” she said. “They’re a phenomenal group of people, of first responders, and we’re going to get the job done. I don’t even know of an inmate that’s gotten it yet.”Some leaders in U.S. corrections health care told ABC News that fears of outbreaks may be overblown.“In terms of like this sort of seething, ready-to-blow prison environment that people maybe think about? I just don’t think it’s the reality,” said Dr. Brent Gibson, chief medical officer for the National Commission on Correctional Health Care (NCCHC), an organization that creates health care corrections stands and offers voluntary accreditation. About 500 facilities nationwide are accredited by NCCHC, Gibson said.“I hear stuff like, ‘There’s no soap and water,’ ‘It’s just a festering cesspool.’ That’s just not true. If they’re doing a good job, they have excellent hygiene, sinks and soaps.”“It’s in their DNA, it’s part of their contingency [plan] to plan for emergencies,” Gibson said. “It is day-to-day operations to be prepared for weather emergency, a fire — so in a sense the tempo of operations, whatever happens, I think they’ll be able to handle.”“For sure there are shortages of things like masks, and people come to us wondering, ‘Where can we get a supply of respirators?’ and those kind of potential supply chain disruption [questions],” he said. “But I can’t — literally three days in a row — can’t find any toilet paper [anywhere] in Chicago. So I don’t think supply chain disruptions are unique to corrections industry.”Gibson also pointed out that inmate populations have dropped significantly in the past decade or more. Between 2007 and 2016, the total inmate population of both jails and prisons in the U.S. dropped by 18%, according to the Bureau of Justice Statistics.“Every place is different, and I’m not saying there’s not overcrowding facilities, but we have firsthand experience with jails that are far less at capacity than where they were even a couple years ago,” he said.Despite the challenges, many veteran corrections leaders said they are confident that sick inmates would get the medical treatment they need.“The only group in American society which has an absolute, Constitutional right to health care is prisoners,” said Horn, the former New York City corrections commissioner. Copyright © 2020, ABC Audio. All rights reserved.