(CNN)”Spit socks” are under a spotlight after the death of Daniel Prude in March while in police custody in Rochester, New York.

After fielding various calls about Prude, including one saying he might be suicidal, police found him naked in the street. An officer then handcuffed him, and Prude yelled that he had the coronavirus and spat in their direction, police said. Video shows an officer putting a spit sock, a mesh head covering also called a spit hood, over his head.Daniel Prude, 41, in an undated photoDaniel Prude, 41, in an undated photoDaniel Prude, 41, in an undated photoPolice sometime later held him — handcuffed and on the ground — in a prone position. He spat and appeared to have vomited, police say, and he eventually stopped breathing and died a week later at a hospital. New York Attorney General Letitia James said she is investigating the case, and seven officers have been suspended.READ: What medical examiner’s report says about the causes of Prude’s deathHere is a look at what spit hoods are, why and when law enforcement officers may use them, and some controversies surrounding their use.Read MoreWhat is a spit hood?Spit hoods are items that some corrections officers, police officers and paramedics could place on a detainee’s head in certain circumstances to make it harder for that person to spit at, or bite, those officers or others — potentially keeping at bay any communicable disease the wearer might have.Some are basically just a mesh sack, with a ring of elastic at the opening. Others add a layer of another material — sometimes fabric like that used in a medical mask — on the bottom half where one’s mouth would be.The mesh is meant to let the wearer continue to breathe and see, while containing any spittle. They’re made and sold, including online, by companies that cater to first responders.”They’re an effective tool,” said Chet Epperson, a former Rockford, Illinois, police chief who as a sergeant developed a policy for his department on the hoods’ use in the late 1990s. “You can spit all day,” and the spit generally isn’t going to project out.”Officers are concerned about contracting a disease through struggles with suspects — and the coronavirus pandemic only increases that sense of vulnerability, said Maria Haberfeld, professor of political science and a police training expert at New York’s John Jay College of Criminal Justice.This year, federal prosecutors brought a court case against a Florida man after he allegedly coughed and spit on a police officer who was helping to arrest him. The detainee falsely claimed to have the coronavirus, and police eventually put a spit hood on him after he spit, a criminal complaint says. Law enforcement called his crime a “biological weapons hoax,” according to court documents.A police officer in Heilbronn, Germany, demonstrates the use of a spit hood on a dummy in April 2019.A police officer in Heilbronn, Germany, demonstrates the use of a spit hood on a dummy in April 2019.A police officer in Heilbronn, Germany, demonstrates the use of a spit hood on a dummy in April 2019.When can police use a spit hood?There is no national standard for use of a spit hood or training for it. If a department allows officers to use them, that department will decide its own policy, procedures and training, said Epperson, co-owner of the AGR Police Practice Group, which in part advises police departments on policies and practices.Generally, though, departments may allow them in at least two situations: When a detainee is spitting or biting, or when a subject verbally threatens to do so, Epperson said.That likely would satisfy the US Supreme Court’s demand, from the 1989 Graham v. Connor case, that use of force must be objectively reasonable, he said.Seattle police, for example, have a policy allowing officers to use a spit hood “if the detainee is actively spitting on officers, or the officers have a reasonable belief that the detainee will spit on them.”Training, including that dealing with detainee safety, varies, Haberfeld said. Vomiting with a hood on may present a choking risk, so some policies “will specifically spell out that (the hood) should be … removed if somebody is vomiting,” she said.Because pepper spray could hinder someone from breathing properly, some departments prohibit the hoods’ use for someone who has been sprayed, she said.The lack of national policy and training standards is one reason why Amnesty International USA says it has concerns about spit hoods.”There needs to be national guidance on the use, … and we need to have proper training and monitoring of the use,” said Justin Mazzola, the organization’s deputy director of research. “It’s usually up to each police department or corrections office. They tend to copy each other,” and that could lead to numerous insufficient policies, he said.National guidelines, he said, should come from the US Department of Justice and its research arm, the National Institute of Justice. He also calls for nationwide studies on “how often they’re used, what manner they’re used, and when.”Much of Amnesty International’s concern about policy stems from its apprehension about other health risks to detainees.What are some of the risks to the wearer?Beyond the collection of fluid such as vomit that could lead to choking, the hoods also pose significant risk to someone already in a mental health crisis or in other agitated states, such as those brought on by drug use, Mazzola said. “Use of drugs and already at an elevated heart rate — this can actually further restrict their breathing and lead to either further distress or an increased agitated state” that can lead to death, Mazzola said.Being restrained in other ways, like being held down and handcuffed, while also wearing a hood, will increase the agitation, and therefore the danger, he said. To elaborate, Mazzola hesitantly mentioned excited delirium, a controversial diagnosis used by some medical examiners. Amnesty International generally doesn’t agree with its use in autopsies, he said, because the organization believes it could incorrectly exclude other causes of death.”It tends to be commonly used by medical examiners to explain sudden deaths in custody of individuals, usually if they’re under agitated states — like under the influence of drugs or other forms of psychosis. (The detainees) suffer a surge of adrenaline,” and their systems collapse, he said.In Prude’s case, a medical examiner’s report ruled the death a homicide. It listed his cause of death as “complications of asphyxia in the setting of physical restraint, due to excited delirium, due to acute phencyclidine (PCP) intoxication.” The report does not mention the spit hood. It does, when elaborating on physical restraint, cite police reports’ mentions of physical restraint “in a prone position.”In this image taken from police body camera video provided by Roth and Roth LLP, a Rochester police officer puts a hood over the head of Daniel Prude, on March 23, 2020, in Rochester, New York.In this image taken from police body camera video provided by Roth and Roth LLP, a Rochester police officer puts a hood over the head of Daniel Prude, on March 23, 2020, in Rochester, New York.In this image taken from police body camera video provided by Roth and Roth LLP, a Rochester police officer puts a hood over the head of Daniel Prude, on March 23, 2020, in Rochester, New York.Haberfeld stressed that police officers need to protect themselves, and restraining devices — she counts spit hoods among them — are an important tool to safeguard themselves and those around them.Mazzola acknowledges spit hoods could protect officers from diseases delivered by saliva and says their use would be OK in certain circumstances.”But (whether to use them) needs to be seriously considered for people” in certain states of mental or physical health, Mazzola said.That goes to his call for national studies and guidelines, he said. Amnesty International USA issued a wider statement in which Mazzola addressed Prude’s case as a whole, calling for wide-ranging reform of policing practices and a thorough investigation into Prude’s death. How many police departments use them?Experts say it’s not clear how many departments use spit hoods. But not all do.The New York Police Department does not issue spit hoods to patrol officers, though it has recently given them to emergency service officers — those responding to incidents like people being stuck on elevators — because of the coronavirus pandemic, The New York Times reported.Officers generally won’t equip with spit hoods without their department’s approval, Epperson said. Departments are responsible for knowing what’s in their officers’ service belts, and for everything in those belts, there should be a policy, he said. The device’s prevalence should be one of the subjects that should be studied, Mazzola said.Experts to whom CNN spoke also weren’t sure how long police departments have used spit hoods. European and American police forces have used them for years, Haberfeld said. Epperson became familiar with their use by police officers around the time he wrote the Rockford department’s policy in the late 1990s, he said. What have been some controversial uses?Spit hoods have been featured in a few wrongful death lawsuits in recent years, or otherwise attracted criticism even in nonlethal cases. Some examples: • Midland County, Michigan: A 51-year-old man died days after losing consciousness and suffering cardiac pulmonary arrest following a struggle against county jail officers in 2015, the Midland Daily News reported. Officers had put a spit hood on him after he spat on them during the fight, and he passed out after saying he couldn’t breathe, Detroit TV station WJBK reported. His widow sued the county, alleging the hood caused him to asphyxiate and suffer a “severe anoxic brain injury,” The Guardian reported. A judge ruled the officers used reasonable force and threw out the case. But after the widow appealed, the case was settled in 2017 for $500,000, the Midland paper reported.• Nashville: In 2015, the unified government of Nashville and Davidson County agreed to pay $150,000 to settle a wrongful death lawsuit filed by the sister of a man who died after a correctional officer placed a spit hood on him, the Tennessean reported.”While it is unclear whether the use of the spit hood actually caused or contributed to his death, the failure to follow (sheriff’s office) procedures and continuously supervise” the detainee “certainly supports the plaintiff’s argument,” a city-county attorney wrote in a legal analysis before the settlement approval.• Sacramento, California: After police placed a spit hood on a 12-year-old boy who allegedly spit at an officer last year, his family sued the city police department this year, alleging he was the victim of excessive force, the Sacramento Bee reported.Video of the incident went viral after being posted on a Sacramento Black Lives Matter Facebook page. The police department backed the officers, saying they acted appropriately to protect themselves, the Bee reported.• Cleveland: In 2014, the DOJ in a report on excessive force used by Cleveland police, criticized part of an incident where police used a spit sock on a mentally ill suspect who had been spitting.The report didn’t take issue with the spit sock itself. Instead, it called out an officer for using pepper spray over the hood while the suspect was handcuffed in a car, after the suspect kicked a window and tried to spit again. Spraying through the spit sock was “cruel and amounts to unnecessary punishment,” the report reads.

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