Sheila’s 25-year-old son has been detained pretrial at Manhattan Detention Center (MDC) for almost three years. He hasn’t yet been convicted of any crime, but he’s losing hope that he’ll ever see home again. Two weeks ago, he told his mother that he’d lost his sense of taste and smell, two commonly known symptoms of COVID-19. Around the same time, he said, three of his peers were removed from the facility after fainting with fever.

While there has been extensive reporting on the threat that COVID-19 poses to incarcerated populations, Sheila said as the pandemic began to take the city, her son and other people incarcerated alongside him were told little. As panic rose due to the lack of information, antagonizing guards only contributed to the climate of fear.

“The guards would tell the inmates, ‘Prisoners don’t matter, I got my hand sanitizer,’” said Sheila. “The guards would wear their masks and their gloves and they would have their hand sanitizer and inmates had none of that. And they would say things like, ‘Yo, when shit hits the fan, we’re out of here.’”

Two weeks ago, MDC issued masks to those who were detained and Sheila says her son and others have been instructed not to take them off or else they will be subject to lockdown. But the efficacy of the face masks is declining by the day—the FDA describes them as single-use, but the facility has not provided any new ones since the first batch. The lack of meaningful preventative measures has left Sheila’s son doubtful that real change will come in time.

“My son’s like ‘Ma, there’s nothing you can do. Just accept that this probably is going to be my final resting place,’” said Sheila. “He said, ‘This city is just waiting for the virus to play its course out here and then they’re gonna empty out the building.’ So they’re expecting to die and that’s it. There is no other expectation. There is no hope for anything like, ‘Oh, we’ll be lucky enough that they’ll send testing or they’ll give us some treatments.’ There’s none of that kind of talk happening right now.”

Decarceration through a public health lens

Despite her son’s belief that there’s nothing left to be done, Sheila is continuing to fight on his behalf. She is a volunteer with Free Them All 4 Public Health, a New York City-based prison abolition group. The group has been striking a balance between drawing out the broader health implications of incarceration while primarily highlighting the experiences of those who are currently inside. The group has crafted broad demands for leaders in New York state that center on reducing criminalization, reducing the flow of new people into jails, and mass releasing those in prison, jail, and detention centers. The group also amplifies specific facility-based demands that are shared with them by people who are currently incarcerated. Every day, their website highlights a different state or city official for visitors to call or text with specific demands along with a script and talking points.  

Free Them All 4 Public Health seeks to walk the line. They focus on the needs of incarcerated people as human beings worthy of compassion and safety in their own right. There is also the growing push to frame the need for wide-scale decarceration in terms of public health to garner more support from the public and politicians who might otherwise be unsympathetic.

On March 27, a coalition of over 40 public health experts sent a letter to President Trump designed to do just that, calling the president’s attention to the impact that COVID-19 will have on federal prisons and immigration detention centers and echoing demands criminal justice reform advocates and abolitionist groups have been making since the onset of the pandemic. The letter outlines five concrete demands, including the commutation of sentences for all elderly people, those who are medically vulnerable, and people who have less than a year remaining on their sentence. It also calls for the release of all people detained in immigration facilities and the suspension of interior enforcement by ICE.

The co-authors include public health researchers, epidemiologists, infectious disease doctors, and medical school faculty. They draw the link between mass incarceration and the spread of disease, reframing what is often considered as solely a human rights or social justice issue into a national public health concern.  

Health care in American correctional facilities and immigration detention facilities is already abysmal. Incarcerated people, the letter explains, are “​housed cheek-by-jowl, in tightly-packed and poorly-ventilated dormitories; they share toilets, showers, and sinks; they wash their bedsheets and clothes infrequently; and often lack access to basic personal hygiene items.”

While the letter’s focus is on federal facilities, these same problems emerge at the state and local levels. At MDC, cleaning supplies are also not provided, so people are unable to sanitize shared surfaces such as the jail phone. Someone like Sheila’s son, who speaks to his mother twice a day, must instead use soap and rags to wipe the phone down—if he can afford the soap at all. It’s still not provided for free.

These conditions combined with the overall weaker health profile of incarcerated communities make COVID-19 a serious threat.

While the letter focuses on the risk that COVID-19 poses within correctional and detention institutions, it also broadens its lens to point out how these facilities are “​tinderboxes​, ready to explode and endanger our entire country.” While concern over those detained within these facilities ought to be enough, these public experts are asking Trump to consider how “they are not nearly the only people who stand to suffer if conditions are not changed: it is likely that an outbreak in a prison or detention center will spread beyond that facility.”

“There’s somehow this idea that a virus respects any man-made boundary”

The letter situates the coronavirus within a long line of past epidemics and outbreaks in jails and prisons, from the flu to tuberculosis that have ultimately expanded outward to infect the larger community. This often-unconsidered consequence of mass incarceration is the subject of a recent study conducted by Dr. Seth Prins, assistant professor of epidemiology and sociomedical sciences at Columbia University’s ​Mailman School of Public Health, who also signed on to the March 27 letter.

The study reveals how infectious diseases permeate beyond jails and prisons and raise the contagion rate for the broader communities that these facilities are located in. Prins’ study analyzed data from 1,670 counties over the 30 years between 1987 and 2017 and found that rises in a county jail’s incarceration rate correlated to increases in the county’s mortality rate. Much of this was attributed to deaths from HIV, however, a 25% increase in the county jail population did increase the county’s death rate from non-HIV infectious diseases by 4%.  

Prins says that while jails and prisons are often considered to be contained and separate from the rest of the community, the issues that impact and infect those inside are the same ones that will impact the public. In the case of COVID-19, a highly contagious virus, continued neglect of the incarcerated will “prolong and exacerbate the pandemic.”

The ability of viruses and infections to spread so quickly from incarcerated areas to those outside results from the constant movement of individuals in and out of these facilities. For one, jails are highly transient places that see over 10 million admissions a year. Secondly, not everyone who spends time in facilities is held captive to them. Correctional staff, visitors, and legal counsel enter and exit facilities every day, raising the likelihood that they will have contact with those who are infected inside and then return home to bring the virus to their families and communities.

Dr. Morgan Philbin, an assistant professor of Sociomedical Sciences at Columbia University Mailman School of Public Health and another signee to the March 27 letter, has seen this in her own research around HIV and AIDS.

“I think in the American imaginary—and this came up a lot with COVID—there’s somehow this idea that a virus respects any sort of man-made boundary, which of course is ludicrous,” said Philbin. “The prison walls don’t stop anything because people move. People who are incarcerated move, guards move, prison staff moves.”

In New York City, 9,000 new people were admitted to facilities within the city’s Department of Corrections in 2017 alone. Roughly 76% of them were pretrial detainees like Sheila’s son, many of whom would have relatively short stays inside.

Redefining public safety

The detrimental impact of continued incarceration in this moment tears down one of the core arguments by critics of decarceration: that keeping people in cages ensures public safety. While research has already debunked the idea that decarceration compromises public safety, this pandemic exposes that myth even further. If safety is tied to community health and well-being, decarceration and mass release may be our best option for ensuring it.

Philbin explains that the efficacy of framing this current need for decarceration around public health is due in part to the public’s inclination to only take action once they understand the immediate ways that a problem may impact their lives.

“I think there is not going to be as much compassion as we might want for people who are incarcerated, and so instead [it may be more persuasive] to say, this is not just about their health, but because a lot of these spaces are [for] pretrial incarceration, people are not going to be there for a long time and so they’re going back out into the communities and obviously the staff are going in and out on a daily basis,” said Philbin. “If it explodes inside, it will also be outside.”

However, while the public health concerns are real, focusing the need for decarceration solely on that aspect is not without its problems. Prins is careful to note that there must be a balance, and that wholly defining mass incarceration as a public health issue can create the adverse effect of only tackling incarceration using public health solutions.  

“It’s like being in a burning building”

Of the many things that society has awakened to as a result of this pandemic is the collective responsibility for public health. Social distancing forces deeper consideration of the way individual actions and movements can compromise the health of those whom we may not ever even meet. In much the same way, governmental neglect of over 2 million people within correctional confinement will only stymie our ability to flatten the curve and sentence those inside—like Sheila’s son—to death.

As the pandemic continues to rage, uncertainty and fear are spreading inside jails and prisons. At MDC, Sheila’s son told her, those who suspect they may be sick are reluctant to reveal their condition because of a lack of clear protocol of where they will be sent and what will happen to them.

“When you’re an inmate you’re already unaccounted for,” said Sheila. “So if you get sick and they whisk you away, nobody is gonna know where they take you. And when you die, nobody’s gonna know what becomes of your body.”

The potential for not just contracting the virus while incarcerated but also being reprimanded and neglected for having it is just one of the many realities that heightens the dangers of this pandemic in ways the rest of the public rarely experiences or considers.

“Not only are they dealing with what we’re dealing with outside, [but] there’s no wiggle room inside,” said Sheila. “It’s like being in a burning building and there’s no way to get out, and we from the outside are watching the building burn and doing nothing about it.”