by Carlos Franco-Paredes, MD, MPH; Michael Aaron Vrolijk MA, MS, and Eniola Ogundipe
Mr. H, who was incarcerated in a county jail in the United States during a recent outbreak of COVID-19, asked one of the authors, “Is dying from Covid-19 part of the pretrial incarceration punishment?” after his cellmate, a young Black man died from COVID-19. To understand the events that led to Mr. H’s cellmate death caused by COVID-19, it is crucial to assess the social environment that led to his incarceration in the first place.
The twenty-first century carceral apparatus in the US is the product of deeply institutionalized social and political forms of racial oppression implemented by dominant groups to control the life and death of minority groups. Imprisonment as a form of controlling the Other has deeper roots; according to Michel Foucault, the origin of prisons as an instrument of social confinement and punishment of members of society can be traced to the stigma and fear of leprosy in the middle Ages. The era of European exploration and colonization carried the carceral system to North America with an important subsequent expansion occurring during the Civil War. The most salient prison example is the Confederate Prison (Camp Sumter) in Andersonville Georgia that over a 14-month period (1864-1865) confined more than 45,000 Union soldiers with more than 13,000 dying during imprisonment. Yet, the most significant modern growth of the penal system took place in the 1960s due to criminal justice legislation that propelled the US down a more punitive path by pursuing harsher laws. Benefitting from this imprisonment boom were both the politicians (who sought to win votes through a “law-and-order” rhetoric) and the for-profit corporations that owned many of these facilities. Mass incarceration is also the product of residential racial segregation, the war on drugs, unemployment, and police brutality. Working in concert with harsh sentences and racial oppression, mass incarceration also contributed to build the framework for the contemporary validation of the death penalty.
The geographic overlap of the US States where lynchings took place between the period of 1883 and 1950 corresponds to the same locations within States where most executions of prisoners in death row have been carried out. The Civil War and the emancipation did not alter the desires of white Southerners to maintain a racial caste system, which eventually led to the establishment of the Jim Crow laws and the widespread use of lynchings as a substitutive punishment to slavery. Indeed, the main justification of the use of the death penalty was to reduce the number of lynchings. Prior to the Furman vs. Georgia case, the death penalty was exclusively implemented on the most disfavored members of society: the black, the mentally ill, and the poor. After 1976, while many white and Latino men have received the death penalty, the capital punishment remains disproportionately sought and imposed against individuals accused of murdering White victims.
The COVID-19 pandemic has unveiled the existence of present-day expressions of historically entrenched social injustices and health inequities affecting many people in the US. Black Americans, Latinos, and Native American groups are shouldering a disproportionate burden of COVID-19 resulting from deeply rooted structural vulnerabilities stemming from inequitable access to opportunities, power, and resources These groups are at a high risk of exposure to COVID-19 by having to work in the service industry or as day laborers without benefits protection. They are also at risk because of housing and food insecurity, neighborhood disadvantage, high prevalence of chronic medical conditions, discrimination and fear to reach the healthcare system, and lack of medical insurance. The disproportionate impact of COVID-19 is not limited to the underserved inner-city neighborhoods across the nation. Among incarcerated individuals in the US, most of them people of color, more than 150,000 confirmed cases of COVID-19 cases with 1122 deaths have been identified. Compared to the general population, the case rates of COVID-19 have been higher and augmenting rapidly in State and Federal prisons.
The rapid dissemination of the SARS-CoV-2 coronavirus in the conglomerate environment of jails and prisons is the result of poorly ventilated facilities and unsanitary conditions where detainees are unable to shield themselves from the pandemic; once becoming ill, they are unable to receive adequate and timely medical care. In essence, these deaths would have been prevented if jails and prisons were not overcrowded with pretrial detainees or prisoners with unjust long sentences; and if those incarcerated were able to protect themselves from the pandemic by achieving some degree of physical separation, by having access to protective masks and sufficient disinfectant and soap. This pandemic has been responsible for as many deaths among incarcerated individuals in the US over a nine-month period as the total number of individuals executed by the death penalty over a 44-year period (1526 executions since 1976). To end the life of a prisoner by execution is different from a prisoner dying of COVID-19 during incarceration. However, the structural forces that led to both types of deaths are unequivocally rooted in structural racism.
Mr. H’s cellmate died while being on the COVID-19 death row because he was a young Black man that grew up in a low-income inner-city neighborhood and began selling drugs as the only economic engine available to him. He also suffered from uncontrolled hypertension and congestive heart failure. He became infected and died from COVID-19 during his recent reincarceration after a parole violation. He was arrested the same day after he missed his parole officer because, that day, he was desperately searching for a job to pay for his rent and to have money for food.
The uncontrolled number of cases and deaths caused by COVD-19 in correctional facilities enforce the pervasive racial divide that has defined the history of the US. Many incarcerated individuals who are at an increased risk of dying from COVID-19 remain largely unprotected inside the walls of correctional facilities across the nation living on the COVID-19 epidemiologic death row.
Carlos Franco-Paredes is an Associate Professor of Medicine, Division of Infectious Diseases at the University of Colorado who currently works in decarceration efforts along with civil right attorneys and advocacy groups.
Michael Aaron Vrolijk is a fourth-year medical student at the University of Colorado, School of Medicine who is a community-based activist focused on improving access to healthcare to minorities; and health equity and social justice interventions. He will continue these activities as an Emergency Medicine Resident.
Eniola Ogundipe is a fourth-year medical student at the University of Colorado, School of Medicine who is a community-based activist focused on health equity and social justice among marginalized communities. She will continue her work as a Urology Resident.