Why Decarceration Is Vital For Public Health Amid COVID-19

Across the United States, COVID-19 is running rampant in prisons, jails, and detention centers, putting millions of incarcerated people, families, and communities at risk.

The COVID-19 crisis in America’s prisons disproportionately affects Black, Indigenous, and Latinx communities due to decades of mass incarceration—a systemic injustice that is directly linked to the genocide, slavery, and structural racism that has marked the U.S. for centuries.

And COVID-19 outbreaks in prisons and jails put all communities at risk, not just those behind bars—an outbreak in Chicago’s Cook County Jail, for example, was later linked to nearly 16% of all statewide cases in Illinois.

In response, a growing list of health organizations, including the American Public Health Association, have called for decarceration as a necessary step to protect public health. Partners In Health is joining these calls with the publication of a white paper urging governments across the U.S. to release as many people as possible to stop the spread of COVID-19 and end the violation of human rights.

PIH’s paper, “Decarceration: Seeking Justice In The Era of COVID-19,” argues that decarceration is a public health imperative and provides practical recommendations for implementation.

“Basically, it lays out the argument for why nothing short of decarceration will actually mitigate the spread of COVID-19,” says Bram Wispelwey, a co-author of the paper and senior project lead with PIH’s U.S. Public Health Accompaniment Unit, which launched in May to provide technical advising and free resources to communities battling the COVID-19 pandemic.

While the paper focuses on the U.S., it comes as the latest chapter in PIH’s history of advocating for the health, human dignity, and rights of incarcerated people worldwide— from Lima, Peru to Tomsk, Russia.

Mass Incarceration: A Public Health Crisis

The U.S. leads the world in incarceration, imprisoning 2.2 million people—more than any of its peers. Over the last 40 years, the U.S. prison population increased by 500% due to changes in law and policy that sent an unprecedented number of people to prison.

Mass incarceration in the U.S. has disproportionately impacted Black, Indigenous, and Latinx communities due to centuries of systemic racism in the criminal justice system, which was developed when chattel slavery was legal.

“We incarcerate vastly more than any other country on earth,” Wispelwey says. “And there’s a direct legacy when you think about structural racism from slavery right up to the present, in terms of the injustice of the criminal justice system for Black and brown Americans.”

Years before COVID-19, the U.S. carceral system had all the makings of a public health crisis—including overcrowding, unsafe labor conditions, and a lack of quality health care. According to the Equal Justice Initiative, U.S. prisons have damaged incarcerated people’s physical and mental health by failing to protect them from violence, denying them access to mental health treatment, and tolerating abuse by correctional staff.

PIH knows from its experience working in prisons in Peru, Haiti, and Russia that incarcerated people routinely face risks to their health, without adequate care and support.

“Even under the best conditions, it would be hard to contain an airborne infection in a carceral setting,” says Justin Mendoza, PIH’s U.S. advocacy manager. “We know that from tuberculosis, which of course is a very, very different disease than COVID-19…but it’s the same set of issues.”

The Silent Pandemic: COVID-19 Behind Bars

During the pandemic, prison populations have been among the hardest hit. Cramped in tight quarters and unable to practice social distancing, incarcerated people face a high risk of exposure—with little to no institutional protection.

“Folks who are in prisons and jails have no freedom or ability to isolate or quarantine on their own. And then that makes it very, very hard to stop the chain of transmission for COVID-19,” Mendoza says.

Nationwide, at least 355,957 prisoners have tested positive for COVID-19 and 2,232 have died, according to The Marshall Project. Among people in prison, the incidence of the virus’ spread is 5.5 times higher than in the U.S. generally. Among those in U.S. Immigration and Customs Enforcement (ICE) detention facilities, that number is up to 13 times higher.

Although the Centers for Disease Control and Prevention (CDC) has released COVID-19 guidance for correctional and detention facilities, these rules cannot be followed due to overcrowding caused by mass incarceration in prisons and jails. Many prisons and jails don’t require correctional officers to wear masks. And many fail to provide incarcerated people with an adequate supply of masks, soap, and sanitizer to prevent infection.

Regulations regarding COVID-19 testing within facilities are highly variable and inadequate, varying vastly with each state’s guidelines. In October, PIH endorsed legislation introduced by Senator Elizabeth Warren (D-Mass.) and Senator Cory Booker (D-N.J.) that would require weekly COVID-19 testing, data collection, and prevention standards in federal prisons across the U.S., but this has yet to be enacted.

When an incarcerated person becomes infected with COVID-19 and must isolate, as required by CDC guidelines, prisons often put them in solitary confinement—a cruel and inhumane practice that has been condemned by human rights organizations and that essentially punishes them for becoming sick.

The Case for Decarceration

PIH’s white paper makes two key recommendations: reduce the number of arrests and release as many incarcerated people as possible.

“The first step, the most important step, both from a public health perspective and from a justice perspective, is decarceration,” says Wispelwey, who developed the paper as part of PIH’s internal Anti-Detention Working Group. “To divert people away from jails and prisons, who would otherwise be on their way there, and to release as many people as possible.”

The paper calls attention to the tens of thousands of people imprisoned on technicalities. Nationwide, 45% of state prison admissions last year were due to violations of probation or parole, and technical violations alone accounted for 25% of prison admissions. Also behind bars are nearly half a million people detained pre-trial—meaning, they are legally innocent and incarcerated simply because they can’t afford to post bail. In just one example across the nation, a team of researchers at the University of Texas at Austin found  that 80% of those who died of COVID-19 in that state’s county jails were never convicted of a crime.

To divert people away from prisons, the paper proposes a series of measures, including imposing a moratorium on incarceration for nonviolent crimes, reducing or eliminating cash bail, suspending all immigration detention except in extraordinary circumstances, and calling on judges and prosecutors to recommend against pretrial detention.

For the millions of people currently imprisoned, the paper calls for the release of as many people as possible – with priority given to those at high risk for COVID-19.

To implement this, the paper recommends establishing transparent and racially equitable release programs and revising policies to allow for sentence reductions and early release, among other measures.

Once people are released and re-enter society, the paper says, it is crucial that they receive social support and medical care, including routine COVID-19 testing, housing support, and access to public benefits typically denied to formerly incarcerated people.

Protecting Public Health

For decarceration to be an effective strategy, the paper argues, it is critical for as many people as possible to be released. Prisons and jails are hotbeds for COVID-19 outbreaks, and these outbreaks put all communities at risk.

Community spread from infections in jails could contribute to between 99,000 and 188,000 deaths in the U.S. population, according to a study from the American Civil Liberties Union.

Further, the authors note, it is crucial that incarcerated people are prioritized for a vaccine option—a policy that the American Medical Association and other health organizations have backed as a necessary measure to stop the spread of COVID-19 and protect public health.

The paper notes that decarceration has already been put into practice in several states. Oregon and Kentucky revised their furlough commutation practices to reduce their prison populations. And New Jersey passed a bill that reduced sentences and released more than 2,000 prisoners to slow the spread of COVID-19.

According to the Prison Policy Initiative, large-scale releases have been common throughout U.S. history, and the places where these releases happened did not become hotbeds of crime—in fact, the opposite often occurred. The American Civil Liberties Union (ACLU) found in a study that crime was lower in nearly every location where decarceration measures took place between February and April 2020. The study found no evidence of any spikes in crime in the 29 locations examined.

For years, PIH has advocated against the social forces and policies that result in the incarceration of the poor and marginalized—from Russia to Peru to the United States. Care, support, rehabilitation, and decarceration are needed, says Dr. Joia Mukherjee, PIH’s chief medical officer, to repair harms caused by unnecessary and overbroad incarceration.

“In the U.S., home to the largest number of incarcerated people in the world, we know that the legacy of enslavement of Black people, genocide of Native peoples, and denigrating migrants is embodied in who we imprison as a society,” Mukherjee says. “COVID-19 has only added to deplorable conditions in American prisons, jails, and detention centers. Decarceration and reparations are central to our pursuit of justice and equity in the U.S."

For Wispelwey, advocacy around decarceration taps into the heart of PIH’s mission: providing a preferential option for the poor, vulnerable, and oppressed.

“This is a justice issue and it’s a health issue,” he says. “At PIH, we have a special lens and an opportunity, hopefully, to make an impact.”