Doctors for decarceration

IMAGINE YOU ARE TRAPPED in a room with 20 other people. You share one sink. You have limited access to soap and hand sanitizer. You can’t leave. Then, someone starts coughing. This is the reality for the nearly 15,000 individuals who are incarcerated in crowded Massachusetts prisons during the COVID-19 pandemic.

As physicians working at the forefront of the COVID-19 pandemic in Boston, we see the devastating effects of the virus on our patients, colleagues, and communities. We are disturbed by the rapid rise of cases in our state’s prisons and the inevitable spread outward. This is a public health crisis that affects us all. With high rates of chronic disease, the incarcerated population is particularly vulnerable to complications and death from COVID-19. Decarceration is urgently needed to achieve social distancing, our strongest tool to mitigate infectious spread. We call for legislators to support House Bill 4652, which demands the decarceration of individuals who pose no immediate public threat and are at high risk for life-threatening complications of COVID-19.

As of April 20, more than 200 persons in prison and 150 correctional staff across the state have tested positive for COVID-19, and seven incarcerated individuals have died. Five deaths occurred in just one facility, the Massachusetts Treatment Center in Bridgewater. Prisons are perfect incubators for the highly transmissible coronavirus because people are unable to achieve the physical distancing required to reduce its spread. Despite extreme economic and social costs, our society has shut down with schools and businesses closed for more than six weeks because of the importance of social distancing. On the contrary, almost 15,000 people in Massachusetts prisons and jails remain trapped in shared cells and dormitories, unable to avoid person-to-person contact that puts them at risk for this deadly disease. According to Carol Mici, the Commissioner of the Department of Correction, only 42 percent of prisoners are housed in single cells while the rest have roommates or sleep in dormitories with bunks only three feet apart. Persons known to have COVID-19 share bathrooms and showers with non-infected individuals. These conditions violate CDC recommendations for infection control in congregate settings, which are being readily implemented statewide in other communal facilities like nursing homes and shelters.

Overcrowding fuels outbreaks that easily spill into the general population as correctional staff bring the virus home to their families and neighborhoods. The resulting spread of COVID-19 threatens to further overburden our hospitals, leading to a scarcity of ventilators and other life-saving treatments. One model from the American Civil Liberties Union estimates that infection in correctional facilities could increase the projected number of total US deaths by an additional 100,000 due to constant movement between facilities and surrounding communities.

Decongestion of prisons is vital to protect the health of both incarcerated individuals and the community at large. Recognizing the urgency of this problem, other states and cities including New Jersey, Illinois, San Francisco, Los Angeles, Seattle, and Detroit have already implemented decarceration initiatives with success.

Furthermore, many people in prison are among the most vulnerable to severe COVID-19 infection. Twenty-nine percent of the Massachusetts prison population is over 50 years old, one of the oldest cohorts of any state in the country. Incarceration leads to “accelerated aging” in which prison shortens life expectancy and exacerbates chronic health problems. This effect is independent of underlying health disparities already present among incarcerated populations, including higher rates of chronic illnesses like heart disease, diabetes, and liver disease that predispose to complications of COVID-19 infection. Chronic disease treatment in many prisons has halted due to decreased medical personnel during the pandemic, further increasing the likelihood that chronically ill individuals will suffer poor outcomes if infected with COVID-19.

Incarcerated individuals are also more likely to belong to racial and ethnic minority groups, which have already been inequitably burdened by COVID-19 infection and death. Continued spread of the virus in correctional facilities will only widen these disparities.

Decarceration can be achieved safely, even for the most vulnerable. Many incarcerated individuals have families who are eager to bring them home. For others, the Department of Public Health and shelter providers have created new solutions to safely house people experiencing homelessness in converted college dormitories and other vacant facilities. Social work, medical care, and mental health support before and after release will be essential to ensure safe transitions for individuals who are released. Recommending a period of quarantine after release may mitigate the risk of transmission into the general population, similar to what many hospitals implement for patients with COVID-19 upon discharge.

The COVID-19 pandemic poses a tremendous threat to incarcerated individuals and surrounding communities. The incarcerated population includes many at-risk elderly and chronically ill individuals who were convicted of non-violent crimes or parole violations and pose minimal public safety risk. As physicians and public health advocates, we urge Massachusetts legislators to align with other states and cities by facilitating safe and urgent decarceration. Through the passage of bill H.4652, we can prevent unnecessary deaths among incarcerated individuals and prevent future outbreaks of this devastating disease in our communities.

The authors, all physicians, include Emily Lupez, Sebastian Suarez, Emily K. Jones, Nika Sulakvelidze, Linda Paniszyn, Hannan Braun, Samantha Siskind, Rachel Stovall, Jordana Laks, Jenny Siegel, Catherine Rich, and Ricardo Cruz.