Letter of Support from Public Health Workers

This is an open letter from health care providers, public health professionals, and community health advocates demanding that Governor Cuomo grant immediate clemency to incarcerated persons in New York State prisons, jails, and detentions for the sake of public health and health justice.

March 19, 2020

As health care providers, public health professionals, researchers, and community health advocates, we strongly urge Governor Cuomo to grant immediate clemency to all people incarcerated and detained in NYS in light of COVID-19. Under Article 18 and Article 4, Section 5 of the NYS Constitution,1 you have the power to immediately grant pardons and commutations to all people in NYS jails and prisons, and thus work to mitigate the spread of the virus. As people who care and advocate for patients with complex medical and mental health needs, many of whom have been incarcerated ourselves, we know that COVID-19 presents an extreme threat to the health and safety of incarcerated people, exacerbating the threat that prisons and jails already pose to public health.2–7  

Current prevention guidance, issued by the CDC as well as the State’s own Department of Health, indicate that the best ways to prevent exposure to the virus are by remaining 6 feet away from others, thoroughly cleaning one’s hands with soap or using hand sanitizer with at least 60% alcohol content, and disinfecting surfaces in the home daily with bleach or solutions that contain at least 70% alcohol.8,9 If exposed, the CDC recommends isolating, using separate bathrooms, and continually monitoring symptoms.10 

These prevention measures are simply impossible in prison. Prisons are densely populated settings with people contained consistently in large groups on the units, at work, and in programs. In over-crowded carceral settings, staying 6 feet away from fellow incarcerated people is infeasible. Additionally, in NYS, any product with alcohol is considered contraband,11 so while they’re expected to manufacture hand sanitizer for the rest of the State,10 incarcerated people don’t have access to appropriate sanitizer or cleaning solutions. Though washing with soap and water is preferred over using hand sanitizer, many prison sinks are unclean and broken and unfit for appropriate cleaning.12 Furthermore, cleaning products that are available to incarcerated people must be bought at the commissary, where items are expensive and not readily accessible. Given that Attica has already closed its commissary, there are reports of low stock in commissaries around the State, and package delivery is likely to become all the more challenging and dangerous in this current context, incarcerated people are unable to protect themselves from exposure to the virus in the same way those of us on the outside are.

We know that there are specific populations at higher risk for experiencing severe symptoms and outcomes of coronavirus, including older adults, people with chronic medical conditions, and immunocompromised people.9,13 Based on these categories, the incarcerated population is disproportionately vulnerable: incarcerated people are more likely than the general population to have a chronic disease including a respiratory condition and HIV,14,15 and are a rapidly aging population16–20 with significant health concerns18,21–25 exacerbated by their time in prison.26,27  

However, the current designation of vulnerability to COVID-19 is biased toward the general community, and does not account for the unique and compounding ways in which the incarcerated population is made vulnerable. Life within prison makes everyone particularly susceptible to poor health generally, and to severe COVID-19 outcomes specifically. Jails and prisons have always failed at providing healthcare to incarcerated people,28,29 and this failure is killing our communities,30 notably Valerie Gaiter,31,32 Judy Jean,33   Roland Perez,34 Jason Echeverria,35 Bradley Ballard,36 Layleen Polanco,37 Carlos Mercado,31,34 Jerome Murdoch,38 Jairo Polanco Munoz,39 Jose Rivera40 and Ronald Spear.41 We know that in China, the burden of COVID-19 within prisons was overwhelming;42 given that we have already begun to see cases within Rikers, we are incredibly concerned that its spread in Rikers and other carceral settings will mirror incidence in China.43

Speaking with the Brennan Center, the former chief medical officer of the NYC Correctional Health Services Dr. Homer Venters noted that incarcerated people already die of conditions like diabetes, trauma, and mental health issues that otherwise are manageable outside of prison.42 He explained, “I anticipate that people will die behind bars of coronavirus who would have survived if they were in the community. … I think our lack of evidence-based systems in these places may also drive jail-attributable deaths from coronavirus.”42 

In part, this vulnerability is attributable to the lack of agency incarcerated people have over their health or access to care.43 The presence of police and custodial officers46 discourages health care utilization,44 in particular by those who are immigrants45 or are undocumented,46 have substance use disorders47 and/or have mental illnesses.48 Moreover, jails in hospitals (as well as correctional health in general) can lead to compromised medical ethics49 in which obligations to care for patients ceded50 to “security needs,”43 and medical professionals face intimidation and violence when they challenge the DOC. The inadequacy of medical care in prisons would likely require incarcerated people infected with the virus to receive treatment outside of the prison. Epidemiologic projections demonstrate that NYS may not have the hospital bed capacity to care for the predicted number of severe cases expected.56 Failing to protect incarcerated people from the virus now will likely cause an influx of additional patients on the already strained system, meaning our State’s incarcerated citizens might not receive the quality of medical treatment they deserve.  

We only need to consider the well-documented and researched issue of high Tuberculosis

incidence and transmission in prisons and jails across the State51 and country52 to anticipate the ways COVID-19 could spread throughout prisons. In fact, it was a catastrophic spread of multidrug resistant TB in NYS prisons and jails in 1989-1991 that provided the impetus for dedicated public health attention to TB in carceral settings.53–55 Poor ventilation, overcrowding, prolonged contact, and inevitable congregation are common structural risk factors for TB transmission in prisons that would rapidly facilitate the spread of COVID-19 as well.55,57–59 Similar to COVID-19, those most impacted by TB are those who having ongoing chronic conditions, respiratory conditions, and HIV, as many incarcerated people in NYS do. Furthermore, the structural and ethical challenges of healthcare provision in prisons previously addressed, as well as sufficient equipment and supply of medications, a poor continuity between civilian and prison services, and the de-prioritization of medical care in prisons have facilitated the transmission of TB in prisons, and are likely to do so for COVID-19 as well.60 

Public health work is grounded in the elimination of disparities in health outcomes. We are all too well aware of the racism, classism, and homophobia that drives the incarceration rate in NYS and beyond. As the prison and jail population is disproportionately poor, black and brown, immigrant, and queer or transgender, the community of people at most extreme risk of severe health outcomes from COVID-19 are disproportionately marginalized and oppressed. This is unconscionable, and as public health professionals, we urge you, Governor Cuomo, to grant clemency and allow for the release of all incarcerated people immediately to mitigate this devastating public health crisis.

Signed,

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