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TV Shows and the Reality of COVID in Prison

Lauren Brinkley-Rubinstein considers the 11 million who cycle through jails and prisons in a year: “We have to start thinking of public safety and public health as working in concert.” (Contributed photo)

Growing up in small-town Tennessee, Lauren Brinkley-Rubinstein watched a lot of Law & Order. She didn’t know much about college, but figured criminal justice might lead to an interesting career.

“I thought I might want to be an FBI agent,” she recalled. “So it’s been kind of a twisted path to where I am now.”

Instead of chasing down criminals in an FBI windbreaker, Brinkley-Rubinstein works to give them a better shot at health and recovery. Now an assistant professor of social medicine at Carolina, she has become one of the country’s leading voices for the well-being of incarcerated people, melding her background in sociology, criminal justice and public health to change the way we think about public safety.

“Eleven million people in this country cycle through jails and prisons in any given year,” she said. “And the environment of jails and prisons sets them up to be ripe for disease transmission. We have to start thinking of public safety and public health as working in concert.”

Nationally, as of Jan. 29, 2021, there have been:

372,569

COVID-19 cases among incarcerated people

2,296

deaths due to COVID-19 of incarcerated people

89,524

COVID-19 cases among staff working in prisons

142

deaths due to COVID-19 of staff working in prisons

That perspective gained new prominence over the past year as prisons across the country became pandemic hotspots. In December, the Marshall Project released data showing that one in five prisoners in the U.S. has contracted COVID-19, a rate four times higher than the general population. Prison staff also have been badly affected.

“As soon as COVID hit, we knew this was going to be disastrous for people in prison and jail settings,” Brinkley-Rubinstein said. “It’s a lot of people in small spaces with no ability to engage in social distancing, and most prisons are already over capacity.” Plus, most incarcerated people have at least one chronic health condition such as diabetes or heart disease, heightening the risk for severe complications from COVID.

Working with colleagues at Tufts and the University of Miami, Brinkley-Rubinstein helped launch the COVID Prison Project to keep track of emerging outbreaks and tally cases and deaths among prisoners and staff; it also pushes authorities to include prisons in vaccination plans. She co-authored a policy brief calling for states to include incarcerated people early in their vaccine rollout, pointing out that prisons share many of the same risk factors as nursing homes.

“Prisons and jails are not places apart from the community,” the policy paper argued. “Outbreaks in correctional facilities spill over to the community and further burden healthcare systems that are overtaxed, especially in rural communities with local jails.” Initial recommendations from the Centers for Disease Control and Prevention included no guidance on where to include prisons in the vaccine rollout, underscoring the politically fraught nature of any effort to improve conditions for incarcerated people.

“It’s really an ethical question,” she said. “COVID has shined an interesting spotlight on things we’ve already known but chosen not to address. We view these people as less deserving, as criminals who shouldn’t get the same consideration as others in our society. And we’ve seen that play out in real time.”

Brinkley-Rubinstein has made a career of trying to spotlight things we should already know but don’t want to reckon with. She got into health policy in the first place because she thought it would be a productive angle for reforming the criminal justice system, a way of reminding policymakers and voters that incarcerated people are not permanently separated from society.

“We tend to think of prisons and jails as a place apart, so that what happens inside doesn’t affect the rest of the community. And that’s just not true. Most people are released, and the illnesses and experiences they have inside are brought right back into the community with them.”

Before COVID, much of her work focused on HIV prevention in prison settings and the nascent movement to improve opioid treatment for incarcerated people. Despite the massive increase in opioid addiction and overdose deaths across the country, few prisons or jails are equipped to provide treatment.

“You see people who have been arrested for what is essentially a disease. They’re in severe withdrawal, and what they get is some Pedialyte. That’s kind of the norm across North Carolina.”

She wants to see more programs like one in Durham County, which provides some methadone treatment in its jail. Brinkley-Rubinstein has been studying Durham’s approach and thinks it will prove effective in reducing drug relapses when people are released. But winning support for health initiatives is a challenge when correctional facilities are focused on their core mission.

“Departments of correction need reform,” she said. “But in a lot of ways, they’re just doing the job that’s been given to them. They’re told to incarcerate people, and that’s what they do. They’re a public safety agency, so providing treatment is not their specialty.”

Change will have to come from the legislative level, from lawmakers taking a broader look at how to spend resources on public welfare. “We need to stop incarcerating people for what are really public health issues. When we create opportunities for people to be well, to be healthy, we’re actually creating public safety.”

All of those crime shows she used to watch as a kid aren’t helping the case. The popular image of criminals as monstrous, violent, antisocial people doesn’t reflect the more mundane reality of the men and women who actually populate our jails and prisons.

“Look, I love a good crime drama. But it’s a fantasy. It’s a way to create distance between us and this atrocious system we’ve created. When we watch a television show full of scary monsters, we don’t have to reckon with the fact that we’ve created a hellscape where we send people who are actually a lot like us.”

She has some hope that the heightened attention to prison-related public health through the pandemic might lead to broader reforms. There aren’t many people who study the intersection of health and criminal justice, Brinkley-Rubinstein said, and she’d love to have more company in academia.

“We now have this very tangible, very prominent example of why this matters to the broader world,” she said. “I hope it can actually move the field forward.”

— Eric Johnson ’08


 

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