Thinking critically about the coronavirus (COVID19) means thinking about the exercise of power and social divisions. While it has been reported that the rich have been jetting off to private islands, and while celebrities have been paying for testing and then unashamedly proclaiming to the world that they are not infected, as ever it is the economically and socially vulnerable who are being harmed by this pulverising virus. The brutal imposition of free market capitalism, and the retrenchment of social democratic states from policing the economic and harmful activities of the powerful, lie at the root of the crisis. It is these processes, and the systemic indifference to their human costs, which are now proving to be the gravediggers of the powerless.

The coronavirus is of greatest danger to the most vulnerable people in society, especially those with underlying health problems and/or living in inadequate social conditions. The incubation and spread of the virus is hastened by dirty, overcrowded and unhygienic environments with poor ventilation and sanitation. Close physical contacts in restricted spaces results in what epidemiologists are calling “cluster amplification”. Whilst the virus presents an existential threat to many around the world on the downside of capitalist exploitation, especially those in slums, ghettoes, refugee camps, or among the homeless, the focus of this article is on risks associated with prisons. Indeed, at the time of writing, the coronavirus already has a presence in a number of prisons England and Wales, with a significant number of prisoners and prison staff developing symptoms and subsequently placing themselves in isolation. The first prisoner death was reported at HMP Littlehey on 26th March. At the time of writing, a new birfucated approach appears to be in the making, with the government apparently on the verge of both introducing mass lockdowns across the penal estate, enforcing 23 hour bang-up for most prisoners, whilst at the same time seriously considering whether pregnant women and remand prisoners could be transferred to bail hostels.

In this article particular attention is given to the position of prisoners. What about their health and safety? How will they be protected physically and psychologically from the ravages of the virus? What about different groups of prisoners? What should a radical response be to this life and death issue for prisoners? This article considers these questions in relation to England and Wales.

Minimising Disruption or Minimising Harm?

In a remarkably candid account on BBC Radio 4’s Today programme, the current president of the Prison Governors Association, Andrea Albutt, warned that the transmission and death rate of the coronavirus was likely to be much higher in prisons than the general community. Despite further warnings from leading epidemiologists that up to 60% of the prison population (approximately 50,000 prisoners) could be infected resulting in a death rate perhaps as high as 2.3%, the government response thus far has been one of containment and situational control. The prisons minister, Lucy Frazer, in her statement on preparedness to deal with the virus in prisons on 12th March 2020, focused on reassurance and minimising disruption to the existing penal regimes:

Prisons have existing, well-developed policies and procedures in place to manage outbreaks of infectious diseases. This means prisons are well prepared to take immediate action whenever cases or suspected cases are identified, including isolating individuals where necessary.

Basic hygiene is a key part of tackling the virus and good practice is being promoted on posters throughout the estate. Handwashing facilities are available to all prisoners – not just in cells but other shared areas such as education blocks and kitchens. Staff and visitors also have access to handwashing facilities and we have worked closely with suppliers to ensure adequate supply of soap and cleaning materials.

Prison officers are to adopt prophylactic measures (like wearing disposable gloves; fluid repellent face masks; plastic aprons; and disposable face visors or goggles), minimise non-essential contact and try to keep less than 2 metres distance from prisoners. Alongside this emphasis on ‘protective isolation’, and the payment of prison officer bonuses to cover extra shifts, the the government is also considering a strategy of ‘cohorting prisoners’ (which is grouping people together who have symptoms of COVID19 should there be insufficient isolation).

Should the numbers of cases in an establishment increase, isolation resources could be under pressure. Cohorting is a strategy which can be effective in the care of large numbers of people who are ill by gathering all those who are suspected confirmed cases into one area (or a limited number of areas where it is necessary to keep some prisoners or detainees separate).

However, these policies have severe limitation, an issue to which we now turn.

The Limitations of the State’s Response

Given that the negative health implications of COVID19 are much more severe for those with multiple exposure to the disease (as evidenced by the deaths of health care workers) the proposed last-ditch strategy of “cohorting” is deeply concerning. Indeed, this policy, if introduced in the coming weeks, could prove disastrous. Prisoners with COVID19 housed together will be subjected to multiple infections of the disease and, especially for those with underlying health problems, this could escalate the seriousness of the illness. Indeed, the consequences of the cohorting policy may become tantamount to ‘social murder’ – cohorting COVID19 positive prisoners is a political decision that almost certainly will result in social arrangements that are unsafe, harmful and result in premature and otherwise avoidable deaths. But this is not the only limitation of the current policy. The emphasis on social isolation and social distancing, designed to curb the virus, continue to dominate the state’s response are problematic for different groups both inside and outside prisons. For example, outside prison, they fail to consider those in domestically abusive relationships. How can these policies protect them and minimise harm?.

In prisons, safe quarantine measures are effectively impossible to implement. For decades, the appalling conditions inside, compounded by gross and needless overcrowding, particularly in male, local prisons, have been highlighted by critical academics, prisoners’ rights organisations and by official bodies such as the Prisons Inspectorate. Since the beginning of 2018, the Inspectorate has produced a number of withering reports which have pointed to the abject and soul-crunching conditions in which many prisoners exist. The Inspectorate’s report on Birmingham prison, published in August 2018, was scathing about the conditions inside:

Communal areas in most wings were filthy. Rubbish had accumulated and had not been removed. There were widespread problems with insects, including cockroaches, as well as rats and other vermin. We saw evidence of bodily fluids left unattended, including blood and vomit. I saw a shower area where there was bloodstained clothing and a pool of blood that apparently had been there for two days next to numerous rat droppings. Many cells were cramped, poorly equipped and had damaged flooring or plasterwork. Most toilets were poorly screened, many were leaking and we saw cells with exposed electrics.

The National Audit Office, looking more broadly at the prison estate, also recently found that prisons were infested with vermin, damp, wet, and cold. This evidence of dilapidated prison building seems to stand in stark contrast to the claims of the prison minister about prison hygiene. Given such conditions, the point made by Richard Coker is crucial. As he notes “[p]risons and centres of detention are well-recognised ‘epidemiological pumps’. They can spread disease outwards into the community if the internal dynamics of disease transmission are not confronted. This happened in the USA, and the former Soviet Union, when HIV and multidrug resistant tuberculosis infected those beyond the walls. Therefore, reducing ‘unnecessary close contact in closed environments may help prevent large case clusters and superspreading events that seed beyond those confined’. Whilst such ‘bridgehead’ arguments about the spread of diseases alone are not sufficient (they erase the human dignity of prisoners), they do highlight the importance of getting the policies on containing the virus in prison right.

In his annual report published in July 2019, the Chief Inspector of Prisons was blunt: ‘far too many prisoners still endure very poor and overcrowded living conditions’. The physical and spatial restrictions of the prison place also mean that there is more handling and touching of goods and physical objects and there are numerous concerns regarding the spread of contamination through the physical limitations imposed by security measures on preparations for food and drinks. Given current living conditions, security restraints, and the overcrowding which means that many prisoners are sharing cells and ironically are often isolated and locked down in these cells because of the lack of purposeful activity, how can prisoners feasibly be kept safe and harm minimised by the limited policy suggestions of the government in recent days?

These issues were further highlighted in a report published by Parliament’s Health and Social Care Committee into prison health care in November 2018. The two paragraphs below provide a clear indication of the state of health care inside:

Even the most basic needs of people detained, such as their diet and living conditions, continue to be compromised in some English prisons. HMIP’s most recent annual report noted that inspections over the last year have identified poor, and even squalid, conditions in several prisons. Prison establishments frequently struggle, according to the inspectorate, to provide meals of sufficient quantity and quality on £2 per day per prisoner.

Short-staffed, overcrowded prisons severely limit access to healthcare and the ability of prisoners to lead healthy lives. Prisoners spend the vast majority of their time in their cells, limiting their opportunity to move and engage in adequate levels of physical activity, and their access to healthcare, inside and outside prison, is restricted. Only 16% of prisoners report being unlocked for the recommended minimum of 10 hours per day. A third of people detained in local prisons and almost 40% of people held in young adult prisons report spending less than 2 hours out of their cell a day. Low staffing levels, excessive waiting times for some services and inadequate management of prisoners with chronic conditions are three recurrent concerns HMIP and CQC have about the delivery of healthcare in prisons, based on the findings of their joint inspections over the last year (emphasis in the original).

The report also noted that 15% of prisoners have respiratory problems – a condition associated with virus-induced deaths – compared with 8% of the general population.

It is important to recognise that prisoners are not a homogenous group. The population is diverse with complicated health care needs. Elderly prisoners, one of the fastest rising groups in the prison population and of course, the group most vulnerable to the virus on the outside, are confronted by a prison system which even if there was no crisis, does not deal with their needs. There are more than 1,800 prisoners over the age of 70 (219 people in prison are over the age of 80) and more than 60% of prisoners over the age of 50 have disability. According to the Health and Social Care Committee’s report, older prisoners ‘are frequently held in prisons which, even with reasonable adjustments, are unfit for their needs….’.

Other prisoners have specific health issues. For example, what about women in prison who are pregnant? What about the specific health care needs of black and minority ethnic groups?

It is also important to recognise two other issues which have not been addressed so far. First, it is not just a question of protecting the physical health of prisoners. There is also the issue of their psychological health. Being detained in a prison cell waiting for the virus, or simply waiting to hear details about the spread of the virus, and, unlike those on the outside, having very little, if any autonomy, to address negative thoughts about the virus, is likely to have a detrimental impact on the confined. Therefore, it is important to address the particular situation confronting prisoners with respect to the psychology of the virus. The prison makes all prisoners not only physically vulnerable but also psychologically vulnerable. This may also be intensified for those prisoners in segregation. Second, there is the issue of prisoners’ families and the stress that they are likely to experience in not knowing about the physical and psychological health of their relatives. Like prisoners, their families are also often treated as less than human and as less eligible subjects as the often-desperately negative experience of the families of prisoners who die in custody indicate.

The organisation of prisons makes even the most practical policies difficult to implement. Whilst the UK government claims there are appropriate handwashing facilities in prisons in England and Wales, hand sanitisers, for example are often considered contraband in prison because they can contain alcohol. Handcuffed or otherwise restrained people cannot cover their mouths when they cough or sneeze, sinks often lack soap. According to a recent account by a prison doctor, there is also the issue of getting prisoners to hospital who are ill given the combination of security and staff shortages. In dealing with one prisoner in Wormwood Scrubs she pointed out ‘I knew as always, that I would have a battle on my hands to arrange for his admission to hospital’ (emphasis added). At Wandsworth, in 2017, two hospital appointment a week were missed on average because there were no officers available to escort prisoners. For Chris Atkins, who served part of this sentence in Wandsworth, ‘[p]rison health care is straight out of the Middle Ages. It wouldn’t have been out of place if they had started dispensing leeches’.

Radical Alternatives

What is the way forward in England and Wales? There are two dimensions to developing radical alternatives to the state’s policies. First, the state should abandon the fallacy that more prisons and prisoners equal less crime. This is palpably untrue, yet has (mis)informed the law and order policies of successive governments for the last two centuries. Instead, the present government could learn lessons from around the world where prisoners are being released in a number of countries such as Turkey, Spain and Iran where 85,000 prisoners have been released. Different states and cities in America - New York, Los Angeles, Ohio - have followed a similar decarceration path. Ross MacDonald, the chief medical officer for Correctional Health Services in New York, has called on prosecutors and judges to enable prisoners to be released from the state’s jails in response to the outbreak. These countries have therefore begun to think beyond the traditional punitive responses to crime - locking people up in increasing numbers and leaving them to fester in often-deplorable conditions - and have begun to follow the least coercive, dehumanising and intrusive and restrictive policy possible of releasing prisoners.

This policy challenges the physical and psychological harm that prisons engender and which will only be intensified and magnified if the virus takes hold inside. Of course, how long this decarceration policy will last is a matter of conjecture, but at least there has been some movement away from the blind alley of state coercion and control. It is also important to note that in countries where no such action has been taken, such as Italy, there have been, at the time of writing 27 disturbances resulting in 9 deaths. And not all countries are pursuing these policies. For example, prison labour is being used to shore up supplies of face masks and hand gels in Hong Kong Lo Wu women’s prison where 100 prisoners are working six days a week, in shifts of six to 10 hours, including night shifts. Retired or off-duty prison officers – 1200 of them - are also working to produce the masks. The governor of New York announced the state will also be using prison labour to produce 100,000 gallons of hand sanitiser for schools, prisons, transportation systems and other government agencies.

However, it is important to recognise that even if such decarceration policies were implemented, there is still the question of the quality of community support prisoners would receive given the decimation of community support networks due to the ‘violence of austerity’. Prisons cost £4 billion annually, within a criminal justice budget of £16 billion. The expenditure pattern is skewed towards security, control, public order policing and the militarization of the state. Therefore, there needs to be a radical redirection of expenditure towards well-funded community alternatives, staffed by well-trained, fully committed staff. Even in pre-virus times this has not been the case. Allied to this is the fact that the number of ex-prisoners dying in the community is already disproportionately high. An influx of new prisoners into the community will only be detrimental unless radical policies are put in place to respond humanely, urgently and empathically to them.

On March 25th it was reported in the media that one possible option under consideration by the government was the release of some sentenced prisoners (50 pregnant women prisoners), release of a small number of other prisoners on licence and the possible rehousing of remand prisoners in bail hostels. Whilst these policies are to be welcomed (and are certainly much more humane than the lockdown of prisoners) they do not go far enough. Commentators such as Eric Alisson and the charity INQUEST have suggested more radical alternatives to the current situation. INQUEST’s proposals include:

a) An immediate release of all those held in immigration detention centres, in line with recommendations made in the British Medical Journal by key health professionals in the field.
b) Relieving the pressures within prison system by closing child prisons (Secure Training Centres and other facilities holding children) as soon as practicable.
c) Prompt release into the community and relevant support services for women in prison, alongside increased funding for women’s centres and other specialist support services as a priority.
d) Dramatic reduction of the population across the rest of the prison estate, with consideration of options to release all those who safely and reasonably can be. This should be done with input from (and funding provided to) community and voluntary sector services providing support for people on release. Nobody should be released into destitution or poverty or faced with a lack of health and welfare support.

Second, there needs to be a radical transformation in how prisoners are regarded, not just in relation to the current coronavirus crisis but when the crisis has abated. For the last two centuries, they have been regarded as less than human, as less eligible subjects who were undeserving of, or entitled to, decent health care services. There was, in effect, no ethics of care. In practice, this has meant that prison regimes have always been inherently unhealthy and demonstrably unsafe for prisoners which, in turn, has had an often devastating impact on the physical and psychological health of prisoners who have remained outside of the social democratic orbit of care, compassion and protection which those on the outside the prison’s walls have as a right, at least in theory. In areas such as deaths in custody, this has led to prisoners being blamed for their own deaths either because they have allegedly had some kind of abnormal characteristics which have propelled them into self-inflicted death or they have died ‘naturally’.

However, as INQUEST has pointed out: ‘no death in prison is natural’ as the ‘failure to treat prisoners with decency, humanity and compassion is a “consistent feature” of deaths inside’. In their evidence to the Health and Social Care committee in relation to ‘natural’ deaths in prison INQUEST pointed to ‘serious lapses in the delivery of, and access to, healthcare’. They included, ‘failures to make urgent referrals where it is suspected that prisoners might have cancer or a failure to “review and treat abnormal blood test results.” The Committee went on to note that it had

…….received similar complaints in response to our call in Inside Time. For example, one prisoner informed us of the death of his friend who complained repeatedly to healthcare services within the prison about pain he was experiencing. When healthcare services finally did help “it was too late, he had cancer and only had weeks to live.” (ibid)

This is a key point not only for critiquing the statistics around deaths in prison but more broadly in the present coronavirus crisis. Health statistics, like all social statistics, are social constructions. Therefore, while deaths may well be put down to the underlying condition of the individual in fact, such deaths may well be caused by institutional structure of power. In short, such deaths are preventable. As an example, on March 17th in an interview in The Guardian, a consultant cardiologist pointed out that in the previous week, a 79-year old woman was admitted ‘for an elective, non-urgent procedure. She was then diagnosed with Covid-19, which, he says, “she almost certainly acquired on our wards”. She was put on a ventilator but died on Monday night. “I’m sure she will go down as an elderly patient with underlying conditions, but she should have lived to 90,” he said’.

Therefore, there needs to be a political, cultural and social shift away from the criminal (in)justice model that current prevails and which has abjectly failed to protect prisoners and indeed the wider society both from conventional crime and also the rampant criminality of the state and the powerful who enjoy a culture of immunity and impunity not afforded to the powerless. This means developing structures of democratic accountability based not on criminal (in) justice but social justice for all. At the same time, the prison system should be be abolished in its present form, the prison building programme should be stopped and the radical alternatives discussed above should be implemented. Coupled with a less hypocritical understanding of what crime is and who the ‘real’ criminals are, and the removal of the rabid social divisions and gross inequalities in wealth and power that scar the social landscape and destroy lives, these radical alternatives will ensure the health, safety and protection of the whole society, including prisoners and their families.