Why COVID-19 runs rampant among the US prison population

DC Report’s Dr. Bandy X. Lee was interviewed by the Rev. Jean-Fritz Guerrier, Coordinator of Community Life for the All School Conference at Yale Divinity School, on the state of the U.S. prison system in this time of COVID-19.

Question: What are the main characteristics of the U.S. prison system?  What makes it different from systems adopted by countries of similar size or economic development?

Answer: Most economically advanced countries use prisons for containing danger or for rehabilitation.  In the U.S., we use them largely for punishment and oppression.  Since punishment is not effective in helping society but only increases criminality and violence as a rule, it is a very self-defeating system.

The United States has less than 5% percent of the world’s population, but 25% of the world’s prison population.  Now, again, we have less than 5% of the world’s population, but over 25% of the world’s coronavirus cases.  These numbers can have uncanny parallels because they are barometers for societal mental health.  More so than a problem of resources, knowledge, or capability, it is a problem of America’s soul.

Much like crowded institutions were breeding grounds for tuberculosis in an earlier era, prisons are now ideal breeding grounds for COVID-19.

It’s fair to say that the prison system in this country was strained before this pandemic.  Could you now talk to us about how it has been affected by COVID-19?  I am asking this question partly because we recently learned that 1 out of 4 inmates contracted the coronavirus in a specific prison in California.

Much like crowded institutions were breeding grounds for tuberculosis in an earlier era, prisons are now ideal breeding grounds for COVID-19.  It affects not just those in prisons but all of us.  The close confinement, unsanitary conditions, limited personal protective equipment, and greater likelihood of cardiac and respiratory compromise cause this.  The age-adjusted death rate is about 3.0 times higher in federal and state prisons than in the general population.  But the rates are escalating: while the mean daily case growth rate is 3.4% per day in the U.S. population but 8.3% per day in prisons.

You played an important role in initiating reforms at a correctional facility in New York which was known for its high levels of violence.  So, based on your research and experience, what are a few things that can be done right now to address the biggest challenges in our prison system during this pandemic?

As in many systems of inequality and oppression, small groups with concentrated power will not be motivated to act urgently for the benefit of all, since they can protect themselves and even profit from the crisis, while large segments of the disadvantaged population are left helpless.  I have called this structural violence.  Hence, some of the immediate measures that would go a long way are to invest in protecting vulnerable populations.  Many public health officials have advocated for releasing the prisoners—literally, setting the captives free—to reduce the conditions that breed infectious disease.  The vast majority of prisoners are not violent and not a menace to society, and this will improve the most urgent situation for all.

You are an expert in violence and violence prevention.  You even wrote one of the most important books on this topic.  In writing this book, what were the most striking things you learned about the causes and consequences of violence?  Would you also give us some details about the cures you proposed to address them? 

The most striking thing I learned was that the different forms of violence are interrelated.  In other words, suicides, homicides, collective violence, and even violence that is done through the means of managing or mismanaging the coronavirus pandemic are all connected.  Structural violence is the deadliest form of violence as well as the most potent stimulant of all other forms of violence.  If we eliminated structural violence, or the extreme levels of inequality, we would go a long way in not being so self-destructive as a society.  Because these are policy-level changes, it costs very little to have a very large effect.

You’ve been outspoken about the current president’s mental condition since 2016.  You even published with the contribution of other mental health experts a book of essays about it.  We also know that surveys show that most people are not satisfied with his performance in managing this pandemic.  How do you think the President’s mental state affects his ability to help us deal effectively with our biggest crisis since World War II?

I have said since the beginning that the eventual death toll of this pandemic would depend more on the president’s mental state than on the virus.  We are confronted with perhaps the most critical emergency in U.S. history, and it is not the pandemic but the fact that the presidential powers lie in the hands of a dangerous, mentally unstable individual.  Now, the pressures from this pandemic could bring on worse national and international crises that have the potential to compound or overshadow the pandemic.

As a prison psychiatrist, I have treated about a thousand individuals with a similar presentation as Donald Trump.  The standard procedure for dealing with such individuals is to contain them, to evaluate them to decide what the least restrictive means of management would be, and above all to remove them from access to weapons.  Instead of managing the president according to the medical standard of care, as we are supposed to even the First Citizen, we have coddled him and enabled his pathologies.  A culture that uses prisons for punishing people of minority and lower socioeconomic status but not for those who commit serious structural violence that causes over 150,000 deaths per year, is also a culture that condones a presidency that will soon cost 150,000 lives.  Learning to correct oppression is not just good for public health, but is much needed for our collective soul.

Featured image: California's San Quentin prison is experiencing a serious COVID-19 outbreak.