A second podcast featuring Dr. Nina Harawa, PhD, MPH, a professor-in-residence at the UCLA School of Medicine. Today she breaks down for us why incarcerated people are experiencing such devastating coronavirus outbreaks. How do the day-to-day realities of life in prisons and jails make it nearly impossible to avoid exposure, and what needs to be done about it?
Stigma, Incarceration and Coronavirus – A Triple Threat
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Welcome to Code WACK!, your podcast on America’s broken healthcare system and how Medicare for All could help. I’m your host, Brenda Gazzar.
How are incarcerated populations faring during the coronavirus pandemic — and what more can be done to protect them? I recently spoke to Dr. Nina Harawa, a professor-in-residence at UCLA’s David Geffen School of Medicine, to find out. Her opinions are her own.
Welcome to Code WACK! Dr. Harawa.
You’ve worked with incarcerated populations, who have been hard-hit by COVID. Can you talk about the susceptibility of incarcerated people to COVID-19.
Harawa: It’s been an absolute travesty how it is that incarcerated populations have been affected. Their rates of mortality from COVID are about three times that of the general population when adjusted for age. We’ve had these terrible outbreaks in specific facilities, including San Quentin where multiple people died within a few months.
Incarcerated populations are extremely vulnerable primarily because they can’t social distance. Right? They are in either dormitories or cells, generally with other people that don’t allow for social distancing. Even if you have protective equipment. I would doubt that people are going to sleep with masks on. I don’t even know if that would be advised, and so people are living 24-7 in a setting in which there’s that risk.
There definitely needs to be more research on this but my conclusions has been based on the way airflow and ventilation works in different settings, even people in isolated cells seem to be at risk because there were several death row inmates in San Quentin who contracted COVID-19 and died, and they are, you know, in total solitary situations but they still contracted it. So either that was a ventilation issue or when there is some movement or contact with staff, that that could have occurred, but we know that these populations are very much at risk primarily for that reason, but we also know that there’s been a lot of mishandling on the part of various prison systems.
I’ve provided expert testimony related to some lawsuits addressing this and I was actually really astounded by the level of what seemed to be sheer neglect and incompetence in some of the specific jurisdictions that I read about. For example, a bunch of people being pulled out of their cells, placed close like shoulder to shoulder while their cells were searched and then being searched by a deputy who wasn’t wearing gloves, wasn’t wearing a mask, or was wearing the same set of gloves to search multiple — actually, no, they were wearing gloves but the same set of gloves to search multiple inmates.
I read about a women’s jail where they reduced the number of people in the dorm, but then they said they all had to sleep on the bottom bunk. So you know you could like put one on the bottom, one on the top and you can create some distance but they were all told they had to sleep on the bottom, so even by reducing the (number of people in the) dorm, you still put people close to one another.
There were a lot of reports of deputies who didn’t wear face masks, people being moved close to each other, even though they had symptoms.
There are people you can find on Twitter who have smuggled cell phones and the stories that they tell about cell mates who are sick and are not getting medical attention are just heartbreaking.
Another example was individuals in immigrant detention who were moved to like eight different facilities in a matter of months during the coronavirus pandemic. You can have a facility where there’s no COVID-19 and you mishandle these transfers and now you have an outbreak, right, and so both the close quarters and then movement without real careful planning and mitigation efforts can be deadly, unfortunately.
Q: There have been some studies indicating that those with certain levels of Vitamin D may fare better if they contract the novel coronavirus. Do you think there should be an effort to ensure incarcerated people have enough Vitamin D in their system?
Harawa: I would definitely support better nutrition for prisoners period and there’s research showing that it leads to both better health outcomes but also better management, you know, fewer issues with violence and other management issues within custody. So I think it has benefits that go beyond just health. I’ve read some of this research that you talked about, not maybe enough to necessarily say I can support it, but I think it’s definitely worth considering.
But I feel like one of the biggest priorities right now is that prisoners need to be vaccinated and that we need to have in that setting — I should be careful in how I say this — prisoners need to have the option to be vaccinated because we’re talking about a setting where people often don’t have options. There is a great potential for people to either be coerced or feel coerced into getting vaccinated. But I think we can use the same principles in that setting as we do in other settings to encourage vaccination and hopefully get to high levels of uptake.
We know for HIV, for example, in settings in prisons and jails where they do kind of universal opt-in or opt-out testing for HIV that’s voluntary, they actually get high levels of uptake even when you make it voluntary. (With) the flu vaccine, they don’t necessarily get the highest levels of uptake, but we work with a provider in L.A. County who said their vaccine uptake for the flu this year was higher than prior years and so she’s feeling optimistic that her patients will actually be more likely to take the vaccine.
Q: So where is this population in terms of vaccination priorities?
Harawa: I don’t know. There is a resource somewhere and I’m sorry I don’t have it in front of me. California has included — not in the first priority and I’m sorry I don’t remember exactly which, I want to say it was (Tier) 1B but if you look at the L.A. County priority guidelines, people in custody are not mentioned specifically at all like in any priority listing so I’m a little bit confused by that.
In talking to my colleague again in the (L.A. County) sheriff’s department, she said the providers have been vaccinated, some of the correctional officers have been vaccinated but not all of them yet but the prisoners haven’t had the option to be vaccinated yet and she doesn’t know when.
Q: So how do you feel about that?
Harawa: I think they should have been prioritized by now or at least there should be a plan. I mean I certainly support that healthcare workers needed to be prioritized first and it seems like some healthcare workers are still getting vaccinated or still were getting vaccinated this week. But I feel like prisoners need to be close behind given what we’ve seen already and given that they have limited options to protect themselves.
Some other priority groups are also very important but have more options to protect themselves, but what we often see for people in custody is that they don’t have those same kinds of options.
They might wear a mask, the person in the cell with them may not, the correctional officer may or may not and so ethically, it seems unconscionable to me that we would not prioritize them, but I know that we also have a lot of stigma around incarceration within our society and that may be part of what has moved them down further on the list.
Q: Got it. And I imagine that this population has more chronic health conditions than the average population. Is that right?
Harawa: Yes, there’s also in prison medicine, there’s often this practice of thinking of prisoners as older than they really are. They are older than their biological age because both incarceration and the kind of lifestyles that often lead to incarceration have a weathering effect on individuals so I know doctors who work with patients who are incarcerated who start looking for age-associated conditions earlier because they seem to be more prevalent earlier in their populations.
Q: So obviously getting vaccinated is vital. What other policies can you recommend that might help them avoid infection right now?
Harawa: The one that people have called for the most is reducing the number of people in custody, so that it’s possible for those who remain to socially distance. Some jurisdictions have done that. L.A. has reduced its custody population at least at one time by about 30 percent, maybe a little bit more than that — and that was through a combination of different efforts to reduce the numbers of people in custody. The protective equipment is really key, access to cleaning supplies. Especially earlier in the pandemic, many reports and prisoners were saying that they did not have good access to soap, to cleaning supplies, etc.
In one of the things I wrote, I even pointed out it’s difficult, if you look at the way even most prison sinks are like that people have, it’s hard to even properly wash your hands because there are those little push-button sinks, where you need to like hold one button there. And then you have these little bars of soap and how do you adequately wash your hands for 30 seconds in that kind of environment?
So there are many, many things that can be done. You know ensuring that people have masks, really requiring that correctional officers are using them, ensuring that correctional officers are staying home if they are sick and that they are able to stay home if they are sick, properly cohorting individuals as they come into a facility and testing them so that they don’t inadvertently bring COVID-19 into a new facility, limiting movement between facilities, cohorting staff as well, so you don’t have one staff member who goes to multiple areas, say, of a custody facility, kind of ensuring that people sort of continue working in one area with one population so you limit that sort of mixing.
Thank you, Dr. Harawa.
Find more Code WACK! episodes on ProgressiveVoices.com and on the PV app. You can also subscribe to Code WACK! wherever you find your podcasts. This podcast is powered by HEAL California, uplifting the voices of those fighting for healthcare reform around the country. I’m Brenda Gazzar.
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