A view of the hospital and flower garden at San Quentin State Prison, circa 1915, a short time before the onslaught of the 1918 Spanish Flu pandemic. This image is from a family album of a San Quentin guard, Richard M. Smith, and his wife Genevieve Smith, who was the San Quentin matron. Both men and women were housed at San Quentin at the time. Dr. Leo Stanley Collection, Marin County Free Library

Old Prisons

As people and governments around the world began to deal with the grim reality that COVID-19, also known as coronavirus, had become a pandemic, many comparisons were made to the Spanish Flu of 1918.

And mixed in with modern news reports and history articles is the fact that incarcerated people and those who work at prisons and jails are at increased risk of attack by the virus if it is introduced into the facility. As in the larger community, the elderly and those with underlying health problems or compromised immune systems are most vulnerable.

An 84-year-old inmate in the UK may have been the first prisoner to die from coronavirus. He was incarcerated at HMP Littlehey in Cambridgeshire and died on March 22, 2020. His infection was not detected until after his death. On March 25, authorities in the UK said 19 inmates in 10 prisons had tested positive for coronavirus. The number was expected to rise.

In Georgia, a 49-year-old inmate at Lee State Prison told his mother he felt sick on March 10. His death on March 26 was attributed to coronavirus.

Prison challenges

A “Pandemic Influenza Plan” prepared by the U.S. Federal Bureau of Prisons in October 2012, suggests that a pandemic similar to the 1918-19 flu pandemic would result in a death rate in prisons nearly twice that of the larger community.

The report used the Department of Health and Human Services estimates that “for a severe pandemic flu … the death rate in the general community would be six deaths per 1000 persons who become ill, compared to 10 deaths per thousand prison inmates, because of factors including close contact of inmates.

On March 28, the Bureau of Prisons announced the first death from coronavirus and soon after it was learned that testing at the federal facility in Oakdale, Louisiana, had ceased because of the “presumption” that many sick inmates had the virus. The entire federal system began a 14-day lockdown was on modified operations by April 1.

Mother Jones magazine reported on March 4, 2020, that California’s prison system had nearly 800 cases and three deaths during the 2009 swine flu pandemic. Although coronavirus is not the flu, it is a pandemic with similar infection risk in close quarters. In China, as of early March, there were said to have been more than 500 coronavirus cases in five prisons and in Iran, more than 50,000 “low-level” inmates were released to combat the spread of the disease in that country. The South China Morning Post reported that prison officials were fired for failing to prevent the virus from entering prisons in China.

No ‘social distancing’

From the tiniest of old jails to the largest modern prisons, the concept of “social distancing” that is asked of people in towns and cities all over the world is just not possible for incarcerated people, especially in overcrowded institutions. The United States, the UK, and more than 100 other countries around the world have prison populations greater than design capacity.

Also, some of the products that many free people are encouraged to use — such as hand sanitizers — are against the rules for prisoners to use in many jurisdictions.

These are among the reasons that the American Civil Liberties Union and others have called for the release of prisoners to reduce the number of people locked up together. By late March 2020, some jurisdictions were releasing jail inmates and some states, including California, had agreed to early release to reduce the population.

‘Fire here is invisible’

Chief U.S. District Judge Kimberly Mueller deals with many prison health matters coming before the federal court in the Eastern District of California, and on March 20, 2020, ordered the creation of a task force to examine issues related to the coronavirus and California’s prisons.

The Golden State’s governor, Gavin Newsom, vowed not to release any “violent criminals.” He also pointed to the importance of properly preparing inmates for release.

“If we start to release prisoners that are not prepared with their parole plans they may end up out on the streets and sidewalks in a homeless shelter,” the governor said. “If we don’t prepare people to get back on their feet they may end up in the emergency rooms clogging the system that we were trying to address in the first place. We have to be very thoughtful about this.”

Judge Mueller reportedly was satisfied that the task force — which included prison and state hospital officials as well as attorneys for the state and inmate attorneys — was working to address the crisis, but emphasized the urgency of the situation.

“I am satisfied that no one is fiddling while Rome burns,” the judge said. “The other observation I would make is that the fire here is invisible, at least in its early stages.”

On March 31, California told the court it will provide early release for 3,500 inmates.

The 1918 flu experience

Sadly, California has experience dealing with a pandemic and the outcome for inmates at the state’s oldest prison — San Quentin — is well documented.

Don Chaddock, who writes articles about the history of California’s prisons, noted that the 1918 flu broke out a  decade before antibiotics were discovered and 20 years before an effective vaccine was developed.

California had two prisons at the time. San Quentin opened in 1852 and Folsom, opened in 1880. Dr. Leo Stanley began working at San Quentin in 1913. He detailed California’s experience with the 1918 flu pandemic.

“The California State Prison at San Quentin was visited in 1918 by three, distinct epidemics of influenza,” Dr. Stanley wrote. “The first in April, the second in October, and the third in November. These. epidemics were similar to the widespread visitations of the respiratory disease which has attacked the inhabitants of almost every part of the world during the year.”

It was on April 13, he wrote, that the flu was introduced to the prison by an inmate transferred from the Los Angeles county jail.

“This man himself had been sick before he came here, having had pains over his body accompanied by fever. On his entrance to this prison he mingled with the 1,900 men who were congregated in the yard on Sunday, April 14, ate in the general mess with them, and at night was locked in the receiving room with about 20 other newcomers,” the doctor wrote.

“His illness returned the following day or at least was aggravated, for he was admitted to the hospital with a temperature of 101, chills, and an aching sensation in the back and bones. From this time on until May 26, there was an epidemic of unusual severity, with 101 patients admitted to the hospital, of whom 7 developed broncho-pneumonia and 3 died.”

Height of the epidemic

Dr. Stanley reported that there were 1,900 men at the prison (women were in a separate area at the time and not affected), and that on April 23 and 24, about half of them were ill as the first wave of the epidemic reached its peak.

Prison records showed that typically 150 to 200 inmates would report to San Quentin’s hospital on a given day, but at the height of the epidemic there were 700 and 750 needing medical attention, the doctor wrote.

“They should have been placed in the hospital,” he wrote, “but it was impossible to put them there on account of lack of facilities. They were allowed to stay in the open air and were not permitted to go to their cells until evening, because it was believed that this unusual disease might be increased by confinement in stuffy rooms during the day.”

‘Moving-picture shows’ blamed

The San Quentin doctor noted that the disease “reached its height on Tuesdays and Wednesdays of the second and third weeks,” and he suggested that this may have been because the flu had an incubation period of 36 to 60 hours, which coincided with the congregation of inmates in a crowded auditorium at the prison. (Dr. Stanley eventually concluded that the flu had a 48-hour incubation period, much shorter than today’s coronavirus).

“On every Sunday morning two moving-picture shows are held,” Dr. Stanley wrote, “one at 8 and the other at 10 o’clock. The room in which these shows are given is partly underground, poorly ventilated, artificially lighted, and at both shows tremendously crowded.” He wrote that almost all of the prison’s 1,900 inmates attended one or the other of the showings. 

“Before the morning is over the room is moist, warm, and foul with smoke and human odors,” he wrote. “Fans have been installed, but they are not efficient. Between the shows little time is allowed for refreshing the atmosphere, one body of prisoners entering as soon as the other leaves. Some prisoners remain for both shows, while others complain of acquiring headaches while there and refrain from attending.”

If the respiratory infection attacked inmates at the shows on Sunday, that could explain the sudden illness on the following Tuesday or Wednesday, he suggested. 

The Oakland Municipal Band at San Quentin State Prison for a concert in 1921; a similar event in 1918 is believed to have precipitated a second outbreak of the Spanish Flu at the prison. Oakland Public Library, Oakland History Room and Maps Division

Second wave of infection

Spring passed, then summer, but on October 3, 2020, a second wave of the Spanish Flu epidemic broke out at San Quentin — again attributed to the arrival of an inmate from the county jail in Los Angeles.

Dr. Stanley wrote that although the man was admitted to the hospital, he first spent one night in the prison’s receiving room with 10 other men and had eaten in the dining hall with 1,900 other prisoners and spoke with many who were anxious to get news from the outside.

By October 21, there were 69 cases of flu and two deaths.

Although there had been no Sunday movies, there was an open-air band concert by the Oakland Municipal Band.

“This concert was held in the open yard, but the prisoners crowded around the band, and were loud in their cheers,” Dr. Stanley wrote. “The day following this concert there was an increase in hospital admissions.”

In an effort to prevent further spread of the virus, San Quentin provided masks for inmates as well as prison staff and their families living nearby.

On October 22 masks were provided for all the men as well as for the officials and their families. “These masks were made of washed flour sacking, one-ply, sewed in the shape of a bag which fitted over the nose and cheeks and up under the chin, and were fastened at the two corners by tape and elastic bands which went behind the head,” Dr. Stanley wrote. “They resembled the shape of the nose bag used for feeding horses. Air, of course, could go through the cloth, and there was considerable air space in the bag, for in no way did the material touch the external nares or the mouth.”

Although the inmates used the masks for several days, the doctor said it was doubtful if they helped, largely because they were worn inconsistently.

There were many efforts to develop vaccines during the 1918 pandemic, including one created by Timothy Leary, a professor of bacteriology and pathology at Tufts Medical School in Boston.

Dr. Stanley provided Leary’s vaccine to 30 or more San Quentin inmates, but reported that “the efficacy of the vaccine was indeterminable.”

‘Picture shows’ return

Fewer inmates were affected by the October outbreak, in part because so many had the flu the previous April. By Sunday, November 24, life at the prison was believed to have returned to normal and films were again shown, after not being available for six weeks.

“Of course, there was a large attendance at both the 8 and 10 o’clock shows,” Dr. Stanley wrote. “After this, the epidemic broke out very suddenly, and from Tuesday noon, November 26, to Wednesday noon, November 27, there were 24 well-defined cases admitted to the hospital.”

Ultimately, from this outbreak, there were 59 cases, but no pneumonia and no deaths.

The introduction of the virus was attributed to the arrival of an inmate from Colusa County on November 21.

On Thanksgiving Day (November 28), a traditional field meet was held, with about 200 inmates participating and 1,600 crowding the sidelines. This congregation of inmates was believed to result in another 22 hospital admissions.

Dr. Leo Stanley, San Quentin prison doctor, circa 1915. Dr. Leo Stanley Collection, Marin County Free Library

Preventive measures

As a result of his review of statistics kept during the three outbreaks, Dr. Stanley and prison officials instituted preventive measures following the November outbreak, including quarantine of sick inmates, and putting all new arrivals in isolation for four days. Prisoners were required to wear masks during visits and visitors were required to sit at a table to provide distance from the inmate.

Dr. Stanley considered these measures to be a success, and also noted that none of the hospital force at San Quentin, including staff, nurses, and attendants, became ill during the three outbreaks of the flu.

“Probably as a result of these precautions there was no return of the epidemic,” he wrote, “although surrounding cities had many cases after December.

“On Sunday, December 20, after a lapse of one month following the last outbreak,” he wrote, “the picture shows were allowed to open again. At these shows, it was arranged to have one-half of the men wear six-ply gauze masks and the others to act as controls without this protection. No influenza developed in either group. On Wednesday, December 25, the same experiment was tried with a like result. Several other subsequent shows were, in this way, tried out with no developments.”

Folsom Prison

Despite the preventive measures at San Quentin, an inmate there who was transferred to Folsom State Prison on December 23 is believed to have carried the virus to that prison, Dr. Stanley wrote.

The inmate had been in quarantine at San Quentin for four days and his temperature was normal and he had no symptoms when he left for Folsom.

Unfortunately, when he arrived at Folsom, his temperature was 102.6 F and he had unmistakeable flu symptoms.

“Two days afterward,” Dr. Stanley wrote, “one of the guards who accompanied this prisoner to Folsom became ill, and within two weeks there were over 100 cases there, including the resident physician, the pharmacist, and three nurses.”

Raikeswood Camp deaths

California’s San Quentin wasn’t the only facility hit hard by the 1918 Spanish Flu.

Raikeswood Camp, built in 1915 as a military training camp in the Craven District of North Yorkshire, England, town of Skipton, was used as a prisoner-of-war camp for German officers beginning in January 1918.

Britain was hard-hit by the flu, with a quarter of the population infected and a death toll of around 228,000.

According to the Skipton World War I Camp website, “a small number of British guards died from the illness” in July and August 1918.

The second wave of infection hit the camp on February 12, 1919, when five prisoners became sick. Soon the camp hospital was filled and the sick had to remain in their barracks, although the most serious cases were transferred to a nearby hospital.

Eventually, of the 683 prisoners held at Raikeswood, 371 became ill and 47 died.

Jails and workhouses

Although the impact of the pandemic at San Quentin and Raikeswood Camp are among the best documented, the 1918 pandemic affected prisons, jails, workhouses, and similar facilities across the United States and around the world.

In West Virginia, a man was arrested for forgery and put in a cell with another man who was infected with the flu. According to this report and others, James Horvatt was sick by the time he went to court. Although Horvatt’s eventual fate is unknown, three attorneys in the courtroom that day caught the flu and died. Another attorney, the court clerk, and the judge also got sick and nearly died.

And the man in the cell with Horvatt, Robert Smith, ended up dying on a train somewhere between Martinsburg and Wheeling, West Virginia, becoming that state’s first casualty of the 1918 pandemic.

In October 2018, according to this research, there were 30 cases of the flu in the District of Columbia jail. 

Ironically, the jail in Belfast, Ireland, may have been one of the safest places at the time. According to this report, more than 100 members of the Irish political party, Sinn Féin, were being held at the Belfast Jail when they contracted the virus. Responding to political complaints, extra doctors were assigned to the prison and the Sinn Féin prisoners received a special diet with the result that there were no fatalities among the group.

But there were many deaths in other places and according to an article on History.com, the mass mortality of the 1918 pandemic led to macabre scenes. There weren’t enough gravediggers to handle the volume and in New Brunswick, New Jersey,15 Middlesex County workhouse inmates had to lend a hand, wielding picks and spades to dig graves, under supervision by jail guards.


Certainly history provides a playbook for prison and jail officials dealing with coronavirus. Of prime importance is keeping the virus outside of prisons and jails. Although halting visits was the first step of many institutions, the fact remains that staff come and go from the community to their jobs, and by March 30, 2020, hundreds of inmates and employees at various facilities were known to have contracted the virus.

The effectiveness of measures taken to prevent the spread of the virus at other facilities — including potential prisoner releases to reduce the population — remains to be seen.