What Prisons Could Still Do to Save Lives

By Deniz Ariturk

Six months after the first nationwide shutdown, US prisons and jails continue to be top COVID hot spots. Case numbers have continued to increase rapidly in prisons even as they plateaued nationwide in early summer, and new weekly cases peaked in August. By September 8, a total of 121,217 incarcerated people had tested positive, a five percent increase from the previous week. At least 1,017 people have died behind bars. Given that there are 1.4 million people confined in state and federal prisons, the COVID-19 mortality rate in prisons stands at approximately 72 per 100,000, much higher than the US rate of 59 per 100,000, which itself is one of the highest in the world.

The disparity between the incarcerated and general US population becomes even more disturbing once the general population mortality rate is adjusted for the sex, age, and race/ethnicity of people in prison. According to a recent reportby the National Commission on COVID-19 and Criminal Justice, the mortality rate in prison is twice the adjusted mortality rate of the general population. In five states—Arkansas, New Mexico, Kentucky, Ohio, and Delaware—the prison mortality rate is more than eight times higher than the adjusted state rate. In Arkansas, the reported prisoner mortality rate is nearly 20 times the adjusted state rate. In large prison systems like Ohio, Texas, and California, prison mortality rate is 11, 3, and 2 times the adjusted state rate, respectively.

This tragedy was neither unforeseeable nor inevitable. As early as March, advocates, physicians, and public health experts cautioned that, without mass releases, prisons and jails would become incubators for the virus. They called on states to drastically reduce their prison populations. Yet, those calls went almost entirely unheeded. By May, the typical US prison system had reduced its population by a mere five percent. By the end of July, that number had increased to only 13 percent. A significant portion of the more recent reductions has been due to the drop in new admissions from jails, which declined their populations significantly more, rather than the release of incarcerated people from prison.

Neither the size nor the speed of prison actions during the pandemic has been enough to protect the lives of incarcerated people. Prisons are, and have been for the past six months, in a direr state than anywhere else in the country. It is impossible to make up for the unnecessary deaths of hundreds in prison. Yet, it is not too late for things to change. The pandemic is not over. Drastic measures, if implemented rapidly and consistently, could still save many lives.

First, prisons must drastically, and urgently, reduce their population to prevent the further spread of the virus. Unless prisoners are released en masse, it will be impossible for those who remain behind bars to socially distance. In a typical prison cell, there is only 5x5 feet of free space. That is much smaller than the free space available in the typical nursing home or cruise ship, and leaves people next to no room to maneuver while staying six feet away from others.

Already, there are indicators that a small prison population with adequate room to social distance could save lives: Large prisons with more than 1,000 inmates account for 87 percent of all prison deaths, according to the National Commission report. Fourteen states report no prison deaths, and six report lower prison death rates than their adjusted state population. Being incarcerated during a pandemic need not become a death sentence.

There are many measures that governors, lawmakers, and prison administrators could take to reduce their prison populations:

Governors could use their commutation powers to release medically vulnerable people swiftly. In many states, governors have not granted any commutations during the pandemic, and those that have tended to grant less than a few dozen commutations. The governors of Kentucky, Oklahoma, and Washington stand out as exceptions, having granted approximately 800, 450, and 300 commutations, respectively. In North Carolina, Governor Cooper is on track to become the state’s first governor to not use his clemency powers in 40 years.

State corrections departments could expand their existing coronavirus early release policies. Currently, most states only allow the early release of individuals who are within a year of their scheduled release and who have been sentenced for nonviolent crimes. This leaves most prison inmates ineligible for release, many of whom are elderly or medically vulnerable. Research has repeatedly shown that people tend to age out of criminal behavior, and that older inmates with a violent offense on their record pose no significant risk of recidivism. Keeping them, or nonviolent offenders within a few years of release, ineligible for early release does not make sense from a public health or public safety perspective.

Lawmakers could pass legislation that directs corrections departments to release more people. New Jersey is the first and only state with such a bill currently moving through its legislature. The bill, S2519, would require credits to be awarded to certain (nonviolent) inmates during the public health emergency. Incarcerated individuals would receive a reduction of four months for every month served behind bars, with a maximum reduction of eight months. This bill, while the only one of its kind, is far from perfect: it would not ensure any immediate releases, or help those who have completed most of their sentences, but still have two or more years left to serve. Given that spending any time in a crowed prison during a pandemic is a substantial health risk, states that want to save lives would introduce bills that allow people to be released now, not in a month or two.

Governors and prison administrators could ensure that their release policies are actually implemented by supporting the rapid release of inmates who are eligible. So far, many inmates who meet the stringent criteria for early release have not been approved for release. In Louisiana, the state with the highest incarceration rate in the nation, the Department of Corrections suspended a furlough review panel created to consider up to 1,100 people for temporary medical release after reviewing fewer than 600 cases and approving only 63 people (about 0.2 percent of the state prison population) for release.

State and local governments could ensure that, once released, people have access to support programs during reentry, a challenging time made only more difficult by the social and economic hardships created by the pandemic.

Inside the prison, officials could implement changes to protect the physical and mental wellbeing of those who remain behind bars, a group that would ideally be a small fraction of what it currently is:

Prisons could provide proper healthcare and sanitation. Releasing large numbers of people would allow prison resources to be allocated to ensuring that the quality of care and level of staffing meets the needs of inmates, which has not been the case in prisons for decades. Releasing people would also allow prisons to provide a constant supply of PPE, soap, and water to incarcerated individuals. Many prisons have failed to implement even these basic sanitation measures during the pandemic. Such steps would protect not only the physical health, but also the mental wellbeing of those behind bars. Signaling to inmates that they are seen and cared for could help ease the fear and desperation that hundreds of thousands behind bars are feeling.

Prisons could implement mass testing of all inmates and staff members. Only some states have implemented mass testing so far, and many of those states did not start to do so until months into the pandemic. Mass testing revealed mass outbreaks in prisons in Ohio, Michigan, Tennessee, Texas, and more. Many of those outbreaks and resulting deaths could have been prevented if mass testing had begun before the virus spread through the prison facilities.

Prisons could waive all co-pays to make sure nobody is financially unable to seek healthcare during a public health emergency, whether they be suffering from COVID symptoms or something else. Given that most prisoners make less than $1 a day working full time, the $2-8 co-pay is often prohibitively expensive and puts inmates’ health at risk. Eleven states and the District of Columbia had already stopped charging co-pays prior to March, and 11 others suspended all co-pays during the pandemic, according to the Prison Policy Initiative. Twenty-seven states only suspended co-pays for respiratory, flu-related, or COVID-19 symptoms. Nevada has not made any changes to its co-pay policy. States that are concerned with the long-term health of the people in their prisons could stop charging them medical co-pays during the pandemic and beyond.

Prisons could make sure that medical isolation does not turn into solitary confinement, as it has for at least 300,00 peoplesince the beginning of the pandemic. Prolonged solitary confinement has been locally and internationally condemned as an inhumane practice tantamount to torture. Not only does solitary confinement cause great physical and psychological harm, but it is also likely to increase, rather than curb, the spread of the virus. During the pandemic, incarcerated people have reported “hiding” their COVID symptoms to avoid solitary confinement, highlighting the policy’s counterproductive effects. In order to contain COVID-19, prisons could use more humane and effective methods, such as drastically reducing the prison population, implementing universal testing, separating COVID-positive and non-positive inmates and staff, and providing PPE to all who live and work in prisons.

Prisons could offer unlimited free video calls. This would provide much needed respite to incarcerated people who have not seen their loved ones since prison visits were suspended in March. The social isolation of the past six months has been challenging for everyone. But those of us outside of prison have had the opportunity to regularly call loved ones and even spend some socially distant time with them. Recognizing their privileged position, prison officials could put extra care into ensuring that incarcerated individuals have access to electronic contact with the outside world, as well as other coping tools like virtual learning materials, their hobbies, and the outdoors during this extraordinary time.

State lawmakers and prison administrators across the country could implement any and all of these measures. Yet, they likely would have implemented them months ago, if they wanted to. These are not novel suggestions. Recognizing their necessity does not require fresh data or analysis, but rather a fundamental shift in our collective attitude towards prisons, and the people confined in them – we cannot save prisoners’ lives without first believing that they are worth saving.

What is happening in prisons is disturbing, heart-breaking, and infuriating, yet not surprising. It is not the result of poorly-designed policies or individual choices of governors or prison administrators. Rather, it is emblematic of a long-standing, collective dismissal of the human dignity and potential of incarcerated people. This dismissal has been apparent in the way we place people in cages for minor crimes, deny them proper healthcare, make them fight fires and deny them firefighting jobs upon release, place them in solitary confinement for having mental health problems, and disenfranchiseand discriminate against them even after they have served their time. It is not surprising that during a global pandemic, prisoners are once again bearing the biggest burden among us.

In the midst of this frustration and endless stream of bad news, I have been thinking about this article, written by Michelle Alexander back in May. In it, Alexander shares a letter from a man in Marion Correctional Institution in Ohio, where more than 80 percent of the incarcerated had already been infected with COVID-19. In it, the man describes how he became the nurse for his friend battling COVID-19. He explains that “unqualified inmates” have done more for this friend than prison staff, who would have him “thrown into a cell and left to his own devices.” He talks about yet another friend who almost died but for whom prison nurses did not show up even as he was unable to breathe. He describes a nurse, “one of the good ones,” who explains to him that they “should be grateful we are receiving any care at all.” He wonders if he should really be grateful for “deficient medical care and two-month lapses between access to vital necessities, hygiene products, and sanitations services.” He imagines that the prison nurse would not feel that her own daughter ought to feel lucky for receiving this kind of “care.” He ends the letter with this paragraph:

“She just feels this way about prisoners. The social category of prisoner qualifies one as undeserving of a decent civilized life. Herein lies the cause of the profound spread of the virus throughout the institution: the collective sense of the undeservingness of prisoners. A vaccination would be nice. Proper P.P.E. would help. But the real cure for our woes is an affirmation of the inalienable entitlement to life for people in prisons and jails.”

When a person dies behind bars, some corrections departments do not even release their name. They report that “an inmate” has died, and sometimes include the crime they were convicted of, and the length of their sentence. Obscured behind such anonymous news briefings and an ever-rising death toll are human lives cut too short, families and communities left in mourning. Mourning Our Losses is a memorial to those lives, with already over 100 obituaries honoring the people who died of COVID behind bars. Reading their names and their stories might make those of us who have been comfortable with our prisons’ response to coronavirus feel less so. It might make us begin to recognize the dignity and deservingness of all people, even those who have done bad things. Only then can we hope to save their lives.

– Deniz Ariturk, 24, is a Duke Master's Graduate who has been working with the Wilson Center for Science and Justice.