The rapid spread of new variants of the coronavirus, some of which appear to be more contagious than older versions, is leading experts in the US to call for stricter social distancing and better masking to avoid another large spike in new Covid-19 cases and deaths.
Health advocates and epidemiologists are particularly concerned about what will happen when the new variants get into prisons, prisons and immigration detention centers.
In the United States, at least one in five people incarcerated is already infected with Covid-19, and a disproportionate number of them have died. One study found that the 2.3 million Americans who live behind bars are twice as likely to die from Covid-19 than a similar person who isn’t.
Jaimie Meyer is an Associate Professor at the Yale School of Medicine and a researcher and clinician who specializes in the spread of infectious diseases behind bars. The pandemic has subsided [and] has exposed the problems related to detention conditions, ”she told Vox, including the difficulty or inability to truly protect those held behind bars. In its quest to survive, Covid-19 will “find all the holes [in our public health strategy] … all weaknesses and pressure tests, ”she added. “If institutions haven’t done anything to keep people safe, higher transmittable pollution will spread like wildfire.”
An epidemiological nightmare
Prisoners are at increased risk for Covid-19 for one simple reason: how the virus spreads. Scientists now know that the disease is mostly transmitted from person to person through respiratory droplets and sometimes air, which is why it is so risky to be in constant proximity to others – and why overcrowded prisons and prisons are particularly dangerous. Contagion also often occurs before someone has symptoms, making it impossible to know who to isolate without frequent, quick, and near universal testing.
“Congregation in general, and prisons in particular, are places where physical distancing is impossible,” Meyer said. In addition, people in prisons are more likely to have certain medical conditions, including obesity and diabetes, which put them at higher risk for infectious diseases.
The epidemiological realities of Covid-19 have been exacerbated by the failure of elected officials and institutions whose job it is to protect those detained. Chris Beyrer, Professor of Public Health and Human Rights at Johns Hopkins, has been a vocal critic of Maryland’s approach to dealing with the crisis. In December, cases of the virus in state prisons more than doubled.
“The most important thing you have to do to deal with Covid in prison is: [reduce] crowded, ”he said to Vox. “We failed.” Although the number of prisoners and inmates declined at the start of the pandemic – mainly because fewer people entered the system due to virus concerns rather than being released early – these populations are now on the rise again.
Second, most important is implementing measures that can contain the spread of the disease, including social distancing and the provision of masks for prisoners and staff, as well as other essential relief supplies. “That too was slow, inadequate and inadequate,” said Beyrer. The Maryland Department of Corrections, he told Vox, doesn’t provide free, unlimited bars of soap to people incarcerated in the state, leaving prisoners unable to do anything as basic as washing hands.
And worries don’t stop there. In facilities across the country, detainees have reported a number of serious security issues during the pandemic: correctional officers refusing or not being required to wear masks; insufficient or failed efforts to test staff and detainees; and creating new outbreaks by moving Covid-positive prisoners to new facilities.
In most prisons and prisons in the country, vaccination has not even started, while those in other communities – including nursing homes and homeless shelters – were among the first to receive the shot.
“We live by failure of the basics of Covid prevention,” Beyrer said.
With all of these systemic deficiencies, many prisons are extremely concerned, and prisons will be even harder hit as more contagious loads break their walls. Early research has shown that people infected with the new strain may carry higher viral loads, meaning that the same behavior – longer periods of time indoors without distancing – poses an even greater risk for the virus to spread than before. For the prisoners, this means that the worst outbreaks may still be ahead.
“A more contagious virus will only infect more people,” Beyrer said. “If more people get infected, more people will die.”
“Fear of hell”
With so few resources to protect themselves and no vaccine in sight in most places, many prisoners worry about the future. Jabriel Lewis is incarcerated in Allenwood Federal Prison, Pennsylvania. “This new breed scared everyone here as hell,” he said. “[I]If it gets into federal institutions, it could potentially result in a death sentence. “
For Michelle Angelina, a woman incarcerated at New Jersey’s Edna Mann facility, the threat posed by the new variants is not limited to the virus. The steps the prison system has taken to protect prisoners – stopping all visits, ending the academic and drug abuse program, and canceling worship – are only strengthening. “It burdens us all immensely.”
Her concern was confirmed by Shebri Dillon, a woman detained at the Fluvanna Correctional Center in Virginia. She described the difficulty of “spending hours and hours in a concrete cage without seeing or hugging our children and family.”
“This new variant is an extension of everything that hurts us,” Dillon told Vox. “It’s not about whether it gets in, but when.”
A question of justice and public health
However, there are fundamental ways to protect this large, vulnerable segment of the population – and the rest of the public at the same time.
For epidemiologists, lawyers, and inmates, the answer is to implement the guidelines they recommend. “The implications of a faster-spreading variant of Covid-19 in prisons are clear,” said Robert Cohen, a doctor who previously worked on Rikers Island and now serves on the Board of Corrections that oversees prisons in New York City. In addition to better access to basic PPE, disinfection of consumables and tests, as many people as possible need to be released from prisons, prisons and other detention facilities, Cohen stressed, and all remaining detainees and employees need to be vaccinated against the virus sooner rather than later .
In a handful of states, including Massachusetts and California, vaccinations of prisoners have already started – but in many places, including New York, they are not being prioritized for vaccine.
Officials have begun administering Covid-19 vaccine to correctional facilities across Massachusetts. David L. Ryan / The Boston Globe via Getty Images
Proponents say this reality is just another example of the unequal impact of the virus on poor and colored people, as black and Latin American individuals are incarcerated at many times the rate of their white counterparts. “Despite the demand for equity in the distribution of vaccines [New York’s] Governor Cuomo has neglected incarcerated people, even as he introduced vaccines to other communities, ”said Katie Schaffer, director of advocacy and organization at the Center for Community Alternatives, which does program and policy work to reduce incarceration across New York state.
While many incarcerated individuals seek to be vaccinated, a hesitant vaccine persists in prisons and jails, not least due to the long history of medical experimentation in these facilities. Some agencies are offering incentives to encourage prisoners to participate, including video visits with family members and slightly reduced sentences, while outside initiatives have attempted to educate prisoners about the vaccine and its safety. With the two coronavirus vaccines currently only having emergency FDA approval in the US, it is likely illegal for law enforcement agencies to allow prisoners or staff to receive the shot.
Releasing more prisoners and accelerating the vaccination of those left inside is not just a human rights issue, say public health officials, but a necessary step in protecting the public.
There is evidence that widespread infection within these types of facilities can easily spread to the community and beyond. One study found that the spring outbreak at Cook County Jail in Chicago contributed to about one in seven cases in the state overall in the following months. Prisons have also incubated particularly deadly varieties of other diseases, including strains of multidrug-resistant tuberculosis.
“This is part of our public health,” said Meyer. “We should all want people who are in a community to have the best chance of preventing exposure and infection” – for their own health and safety and that of everyone else in the country.
Aviva Stahl is an award-winning investigative reporter who writes on how health policy and scientific debates play out in the prison context. She has written for a variety of outlets including Vox, The Guardian, and the New York Times and can be followed at @stahlidarity.
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