When a college or university closes because of a public health concern they can send students home or transition classes online, but what happens when an institution's residents are permanent? County jails and houses of correction are facing that question as the possibility of the rapidly spreading COVID-19 entering inmate populations increases.

County sheriffs across the state are taking extra precautions as cases of the virus in the state increased to 108 on Thursday, up 13 from Wednesday. Middlesex County has the greatest number of presumptive cases, 49, followed by 24 in Norfolk County, 22 in Suffolk County, nine in Berkshire County, two each in Essex, and one in Worcester County.

In interviews with the News Service, sheriffs from Middlesex, Norfolk, Essex, and Worcester detailed measures they are taking in response to the novel Coronavirus that was first discovered in Wuhan, China and migrated across the globe. From ordering extra cleaning to suspending inmate and detainee visitation, departments are reacting to the nearly 120,000 cases of the virus reported worldwide.

In the two counties with the most confirmed and presumptive cases, the sheriffs are emphasizing cleanliness and inmate screening either upon or prior to arrival.

Middlesex County Sheriff Peter Koutoujian deals with 800 to 900 incarcerated individuals a day in his county facility. As the former chair of the Legislature's Joint Committee on Health Care and Joint Committee on Public Health, he says he comes at the COVID-19 situation with a different lens.

During his tenure on Public Health, he dealt with the bird flu and worked on prevention and mitigation. Koutoujian, who also serves as president of the Massachusetts Sheriffs Association and Major County Sheriffs of America, is also in contact with correction officials on the state and national level.

At the Middlesex facilities, he said inmates are subject to medical screening questions that ask about travel, family travel, and fever, among others. Visits are limited to non-contact, where inmates and their visitors communicate between glass via a phone. Koutoujian said he deals with about 250 to 300 visits a week.

Following a visitation session, which could run two hours, officials at the facility wipe down the glass, phones, and table. Regular cleaning of the facility also occurs.

"It's crucial that we maintain those visits in some fashion," he said in an interview Wednesday.

Norfolk County Sheriff Jerry McDermott said he convened his medical and security staff two and a half weeks ago to discuss preventative procedures and emergency management plans. The county manages a jail in Dedham with nearly 490 inmates.

In an attempt to combat any potential germs, the department is using sanitizer guns that shoot bleach pellets to disinfect surfaces. The guns cost $2,400 each and shoot out a special pellet filled with cleaning chemicals that stick directly to surfaces. The sheriff said he ordered staff to "triple that effort."

"What we decided to do is just take as preventative measures steps to increase the cleaning of all the housing units so that the inmates in our care and custody wouldn't come down with anything," he told the News Service.

McDermott said he benefits from having a nurse in his family, and cited that as one reason he started planning early. Through conversations with his sister Mary, a nurse who serves on the Dedham Board of Health, McDermott thought about the number of daily interactions officers and staff have with inmates.

As a result, the department is instituting inmate screenings for COVID-19 at trial courts.

If there is an inmate in a holding cell at Quincy District Court who is going to be sent to the house of corrections in Dedham, they will be screened before they are transported. If the inmate is showing signs of any potential sickness, officers would call an ambulance to take them to the nearest medical facility.

The Suffolk County Sheriff's Department suspended all inmate and detainee visits excluding for attorneys and restricted access for volunteers, outside program staff, and activities, according to a statement released Wednesday. Separately, the Bristol County Sheriff's office, which has no confirmed or presumptive cases, suspended inmate and detainee visitation at all Bristol County correctional facilities for two weeks starting March 15, according to a statement released Friday.

In Central Massachusetts, Worcester County Sheriff’s Office Superintendent David Tuttle said officials started discussing their approach to the issue three or four weeks ago. The department has spent $10,000 to $12,000 on additional cleaning supplies including equipment to spray down the jail in West Boylston.

Officers are planning to sanitize their vans several times a day with chlorine-based chemicals and are screening new arrivals before they enter the main jail. Staff are not attending conferences and officials are starting to cancel meetings.

"We like to stay ahead of things and you could kind of see what was happening and it was slowly starting to spread. We're not panicking about it," Tuttle said in an interview on Wednesday. "We might as well implement changes now while we have the opportunity to modify or change them."

Unlike many of the colleges that moved classes online or asked students to move out of on-campus dorms, Tuttle said the situation at a jail or house of correction is much different.

"If this continues to spread we can't close," he said "We have an emergency management plan for that. We may have to reduce a lot of the services we are providing and just focus on the basic care, custody, control."

Back in Norfolk, McDermott said he designated a specific housing unit as a quarantine area in the case that an inmate exhibited signs of COVID-19. The unit could handle a couple hundred cases if the situation required such an action.

"But I feel confident that the measures we've taken, we have insulated the house of corrections in Dedham from COVID-19," he said.

Koutoujian said if someone needs to be quarantined it would take place on an individual level. If an incarcerated person needs medical attention that his facility could not provide they would be transported to an outside medical facility.

At the Middlesex Jail and House of Correction in Billerica, the health unit consists of two wards with eight cells that can handle up to 21 people at one time. A pandemic at the Middlesex facility is a different issue, Koutoujian said.

"I don't believe that we will ever get to the point where we need large-scale quarantine units," he said.

Essex County Sheriff Kevin Coppinger said for the past 10 to 14 days his staff has been cleaning the facilities under his command. He said he is concerned about the older inmate populations with health issues that are located in Essex County facilities. Coppinger said he has placed orders for additional cleaning supplies.

The sheriff also sent emails out to local judges asking for their corporation and to prioritize video conferencing over transporting inmates. The department also contacted its medical provider, Wellpath, to take advantage of national resources.

"What should we do? What are we looking at? How is this transmitted?" he said in regards to questions he posed to Wellpath.

Like McDermott, Coppinger also designated a gymnasium as a potential quarantine area should the need arise.

"Our goal is we're just trying to make practical common sense decisions," he told the News Service Wednesday afternoon. "We're tapping every resource we can."