Incarcerated and Infected: The Fragility of Our State Prison System During the COVID-19 Pandemic

In the face of the COVID-19 global pandemic crisis, policymakers were forced to answer hard-hitting ethical questions: how would resources including ventilation and vaccination doses be fairly allocated among citizens? Who would they prioritize, and how would they decide? Detailed as they were, allocation guidelines neglected to address and prioritize the needs of thousands who were especially unprotected from communicable diseases: those in the prison system, including prisoners, prison staff, and medical personnel. Despite the 1976 SCOTUS decision in Estelle v. Gamble, which ruled that inmates have the right to proper medical care, prisoners received the lowest quality care during the pandemic, if they received any at all. We must urge our state legislative bodies to improve conditions for prisoners by pushing for more media coverage and supporting organizations that champion prison reform.

Incarcerated populations were no strangers to systematic mistreatment when it comes to their health and well-being, even pre-pandemic. In 2019, inmates at the Metropolitan Detention Center endured NYC’s coldest weeks freezing in their cells, as heat and electricity were limited and unreliable. The situation was worse for those with acute-to-serious medical conditions, many of whom had difficulty accessing their prescription refills or medical attention. Others faced psychological distress, having no sense of what time of day it was. One inmate, Sean Daughtry, was denied antibiotics and Tylenol by prison staff, forcing him to self-treat a chronic infection; another inmate, with no access to medication, bled to death in his bed as a result of self-harm. These are only a few of the countless stories about the inhumane treatment prisoners face in America’s prison system.

Yet, even when compared to this low standard of care, the conditions of prison populations deteriorated further during the pandemic in completely predictable – and preventable – ways.

At the onset of the pandemic, with little to no governmental guidance, ethics committees, hospitals, and healthcare workers scrambled to make use of available personal protective equipment and life-saving machines, attempting to draft rough guidelines to ration their limited resources. Ethics committees considered different factors, including those with higher risks of infection and/or those who were immunocompromised. In the first weeks of vaccination distributions, many states, including New York and Pennsylvania, bumped healthcare workers to the top of the list, acknowledging their crucial role in treating affected persons; next on the list were critical populations, including persons with underlying medical conditions, essential workers, and first responders. Prisoners and their living situations and conditions were rarely discussed or addressed.

Imagine hundreds of people detained in one space with less-than-ideal ventilation or hygiene. Prison spaces make precautions such as social distancing a far-fetched idea. It is well established that prisoners are exposed to higher risks of viral infection and are more likely to suffer from complicated medical conditions, making vaccination that much more critical in detention centers. Consequently, following the outbreak of COVID-19, public health boards and medical institutions made multiple suggestions to mark “correctional staff and incarcerated people as high-priority populations for the vaccine” to “protect them and their communities from COVID-19 outbreaks.” However, only eleven states took this into account in their vaccine distribution plans during the initial statewide COVID plans. In the 2021 Annual Report issued by the Correctional Association of New York (CANY), 74 percent of respondents “reported that they had not received any information from DOCCS [the Department of Corrections and Community Supervision] on how to properly care for, use, or clean masks. Many incarcerated people were in possession of old, dirty, and unhygienic masks.”

Eventually, pharmaceutical companies such as Pzifer and Moderna streamlined the process of vaccine production, allowing state governments to secure a supply of vaccine doses that exceeded demand. However, once vaccines became available, a new issue arose: vaccine hesitancy among prisoners and prison staff. The CANY 2021 Annual Report mentioned above outlined the reasons and resolutions for vaccine hesitancy among inmates: the inaccessibility of healthcare in general, including poor quality of services for incarcerated people, the spread of “negative information about the vaccination at one point or another,” and lack of information about the vaccine. Many surveyed inmates “conveyed anxiety that the vaccine is yet another opportunity for prison officials to abuse, experiment on, and harm them.” They specifically cited the Tuskegee syphilis experiment (1932-1972), which misled hundreds of Black participants and their families to believe they were being treated for syphilis in exchange for health insurance and free meals. In reality, they were treated inhumanely – exploited, left untreated, and discarded after scientists were done with them. These unethical events laid the foundation for widespread mistrust of public healthcare initiatives and medicine such as the COVID-19 vaccines and boosters in prisons. To make the situation worse, “respondents… reported that overall DOCCS medical staff neglected to assist them during their reaction” to the vaccine in prison. To demonstrate the extent of distrust of healthcare services, respondents went as far as to claim “they would rather be infected with COVID-19, taking the risky chance to heal naturally in poor conditions, rather than accept the vaccine.”

The mistreatment of prisoners is a deep-rooted issue that has existed for decades. Simply addressing concerns in reports won’t scratch the surface of grievances, especially as the responsibility to meet the medical needs of prisoners isn’t properly enforced or explicitly cited in the federal or states’ constitutions. Only recently has constitutional law been extended to offer any sort of protection for prisoners from cruel forms of punishment. In Estelle v. Gamble (1976), the US Supreme Court ruled that inmates have the constitutional right to healthcare under the Eighth Amendment as a protection against cruel and unusual punishment. While working in the textile mills at the Huntington Unit of the Texas prison system in the 1970s, J. W. Gamble was badly injured and sent to the prison hospital where he received substandard medical care. After being dismissed by his doctors and disciplined when he refused to continue working at the mill, he brought the case to court where they decided he had the right to medical care, but that the prison had not violated the constitution, and did not provide a clear mechanism for enforcement.

Due to the US government’s ineffective prison policies, we fail to protect prisoners from corruption, denial of care, and inhumane treatment, but the problem is bigger than government policy. We as a society are guilty of continuing to believe that they deserve to be punished and deprived of basic necessities because of their social status. This is reflected in our judicial system, in the inhumane forms of punishment for inmates, in the lack of care for prisoners, and in the broader inability to cooperatively reform our criminal justice system.

We are at the end of 2022, and prisoners still face vulnerabilities relating to the pandemic, from lack of medical attention to legal underrepresentation. Threats of COVID-19 variants, such as Omicron and Delta, still exist in jail cells; inmates are still kept in close proximity to one another and under unhygienic conditions, making the infection rate that much faster; and infected inmates don’t speak up, afraid that they will be put in isolation which will worsen their mental health. There have been some improvements made, such as the expanded availability of COVID testing kits and grants of early release or parole for prisoners who meet specific criteria. Current widespread efforts to vaccinate those in the prison system are underway and have become a major health priority for cities to tackle. These measures lessen the strain on limited space in detention centers, slowing down the rate of infection. Still, there are many prisoners at risk of infection, literally trapped in these conditions without effective relief from the community and government. There is much more to be done to raise awareness of these issues.

We as individuals need to encourage open and mindful dialogues to foster a deeper understanding of prisoners in order to advance their rights to adequate treatment. Prisoners’ rights are not addressed or prioritized in policies because of our lousy efforts to advocate for them. This failure to penalize the mistreatment of prisoners was prominently exemplified during the peak of the COVID-19 pandemic. Women in prisons reported increased verbal and physical abuse by staff, and an overall more “‘aggressive environment’ due to COVID-19.” What’s more, we need efforts to oversee and enforce the proper treatment of prisoners, including prison system-based and legislative resolutions. Examples of managerial solutions include the implementation of electronic medical records to document requests and responses, patient-centered care, routine screenings, education, and outreach. In the future, our legislators must ensure the assessment of healthcare quality and accessibility in prisons and address complaints “related to incarcerated persons’ health, safety, welfare, and rights.”

Our ignorance of the state of the US prison system is compounded by lackluster news coverage and a lack of publicly available data. Prison reform activists can reach a bigger audience with real-time statistics and accurate reports. It cannot be stressed enough how important data-reporting nonprofits, such as the Covid Prison Project, Prison Policy, and The Marshall Project, have been in providing transparent and accessible COVID data concerning reported cases, testing efforts, and deaths in prisons. Our efforts shouldn’t be undermined because our government representatives do not want to pursue solutions and effective policies for prison systems. Our incarcerated populations need our help as human beings with indisputable rights to healthcare and humane treatment.

Featured image caption: (Courtesy Jobs for Felons Hub)

Elaine Li

Elaine Li is a student at Macaulay Honors College studying Public Health with concentrations in Research and Policy and Urban Studies. She’s on an accelerated track to earn her Masters in Public Health with an Epidemiology and Biostatistics concentration. She is currently working as a research assistant in the field of Urban and Environmental History.

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