On March 11, 2020, I spent a morning walking from dorm to dorm in one of the jails on Rikers Island, talking to the people who lived there about COVID-19. I was a physician at Correctional Health Services, the independent public agency that provides health care in the New York City jail system. The majority of the patients I worked with were in pretrial detention at the North Infirmary Command, a converted bus depot where you can feel the wind blow through the walls. My patients were all either older, seriously or terminally ill, or significantly disabled. They lived in barracks of around forty beds spaced three feet apart, and shared bathrooms where toilets were separated by low dividers instead of walls. They seldom went outside to spend their allotted hours in the yard, which is a fenced-in concrete square with nowhere to sit.
People in jail have access to television and the newspaper. Our patients knew that a novel virus was killing people in China and Italy, and that cases had already been detected in New York City. They were angry and scared; they’d started hearing rumors—unfounded, but spreading quickly—that people were dropping dead in other jails. At that time, we didn’t yet have the capacity to test people in the jail system for SARS-CoV-2. We also didn’t know that the virus was airborne, or that it could cause asymptomatic infection in people who could then pass it on. Had we known those things, we would have been more worried than we were. Still, we already had plenty to worry about.
The Diamond Princess, a cruise ship with more than three thousand people on it, had been the site of a SARS-CoV-2 outbreak a month earlier. By the end of the ship’s quarantine period, almost twenty per cent of the people on board had contracted the virus, and an estimated fourteen passengers had died. My colleagues and I joked grimly that Rikers Island was like the worst cruise ship in the world: our patients were held in close proximity, in violent, unsanitary conditions, without freedom of movement, in a setting that required an excess of human contact because detainees were permitted to do so few things for themselves. If we could expect fallout similar to what we had seen on the Diamond Princess, we would be looking at the possibility of more than a thousand cases, and dozens of deaths, in a period of weeks. Those numbers were unfathomable to us. In 2019, we’d had three deaths in custody, total.
Frightened by the oncoming crisis, some friends and I anonymously authored an open letter to Mayor Bill de Blasio with urgent recommendations for the city’s pandemic response, including interventions aimed at reducing the number of people in jail. The Mayor had only just been convinced to cancel the St. Patrick’s Day parade; despite declaring a state of emergency, he was reluctant to meaningfully alter city operations or discourage people from their usual routines. When asked by a reporter about our recommendations that the N.Y.P.D. minimize arrests for low-level violations and that the city encourage the release of people older than sixty from jail detention, de Blasio was dismissive, and said that “criminals” wouldn’t take a “time-out” because of the pandemic. He seemed to forget that the “criminals” he spoke of were also his constituents, and just as vulnerable to infection as everyone else.
The first COVID case on Rikers Island was reported on the evening of March 17th. Our first hospitalization followed soon afterward: a middle-aged man had been found sitting on the floor of his housing unit, dazed, with an oxygen saturation at seventy per cent of normal. By mid-March, New York’s hospitals were filling up, and Rikers Island was at the epicenter of the pandemic. Ambulances were constantly crossing the bridge to and from the island, and my colleagues and I were diagnosing cases inside at a rate that far outpaced that of the non-incarcerated community. Each morning, I would review the charts of all our hospitalized patients and send an e-mail to my bosses with updates: who had improved overnight, who was now intubated. We all kept a change of clothes in our cars that we’d wear into the jails to see patients, and we’d change out of them before going home to our families.
My colleagues and I were panicked, but also emboldened by that panic: we spoke publicly about what we saw coming, even if it meant risking our jobs. (Although we did not work for the Department of Correction, our agency was ultimately under the jurisdiction of City Hall, just as the D.O.C. was.) Our chief medical officer, Ross MacDonald, pleaded with judges and prosecutors to “please let out as many people as you can” in a Twitter thread that went viral. Soon afterward, the Mayor said that his administration was prepared to facilitate the release of ill and elderly people from the jails, but his spokeswoman clarified that “for everyone’s safety, this decision cannot be rushed.”
Despite City Hall’s cautious rhetoric, the dynamics of the criminal-justice system were shifting quickly in New York. The Mayor’s Office for Criminal Justice started unprecedented conversations between my bosses and the District Attorneys from each borough. We needed to make the case directly that jail, always a dangerous place, was now potentially deadly in a new way. This was the moment when tragedy met possibility: the crowded jail system was generally acknowledged to be an unsafe premise in the midst of a pandemic, not only to the people detained but to the surrounding communities where officers and staff returned home every night. Public health was prioritized over a punishment-heavy approach to public safety. Using their various avenues to release people, city and state officials began letting our patients go.
Between March and May, my colleagues and I wrote more than fourteen hundred letters of attestation on behalf of patients who we thought were at risk for serious COVID-19 outcomes. Our agency also worked with public defenders around the city to support bail applications to free as many clients as possible. In a period of weeks, the jail system was decanted. Fifteen hundred people returned to their communities, and the jail system hit its lowest census since the nineteen-forties. And, contrary to what de Blasio had predicted, crime rates, including gun violence, dropped in New York City throughout the spring. I had never felt more purposeful or effective, and I had never felt so terrified.
Correctional facilities have long served as “epidemiologic pumps,” concentrating pathogenic transmission within their walls and then spreading it to the surrounding community. The Rikers experience bore this out and previewed what would happen when the virus hit elsewhere: in 2020 and 2021, the rate of known COVID-19 infections among incarcerated Americans was more than three times higher than the rate for the rest of the community. National public-health experts argued in expert-consensus statements and medical journals that the most important intervention to minimize pandemic-related morbidity and mortality was aggressively depopulating jails and prisons.
It initially seemed possible that the pandemic might lead to a wave of decarceration around the country. In May of 2020, for example, the Federal Bureau of Prisons released more than twenty-four thousand people, under the CARES Act, to serve the remainder of their sentences at home. That same month, this magazine published reporting from Louisiana, the state with the highest incarceration rate in the world, with the headline “Will the Coronavirus Make Us Rethink Incarceration?” My clinical work in the jails had always been premised on a conviction that incarceration was at odds with health, and that all doctoring inside was an effort at harm reduction. My friends and I often said to one another that what we wanted most was to be put out of a job altogether. Suddenly, the momentum seemed to be with us.
But, even when city officials were most receptive to the possibility of emptying the jails, getting our patients out wasn’t easy. The question of who ought to be released became a point of extreme consternation. Prior to the pandemic, I had already worked on well over a hundred compassionate-release cases—efforts to free people before they died of terminal illness. The premise of those petitions had been that the detainee was already seriously sick, and we were trying to prevent a likely death in custody. Here, the situation was different. We were advocating for relatively healthy people’s release in anticipation of potential illness. The first deputy mayor’s chief of staff made repeated demands for lists from our agency of who, in our estimation, was most deserving of immediate release. Who was going to get sick and die? Which of the people with serious charges were really at risk? Could I rank the detainees with chronic illness and violent felony charges in terms of who I thought was most urgent, who ought to be sent home to their families?
I couldn’t; the assignment was absurd, time-consuming, and impossible to complete. I didn’t have a crystal ball and couldn’t provide City Hall with the definitive assessments they wanted. This is often the problem with decarceration efforts on a wide scale: progressive mayors, governors, and district attorneys might theoretically support scaling back mass incarceration, but when it comes time to look at a list of names and grant the requests, they hesitate.
We made it through that first wave of the pandemic with only three COVID deaths in custody—a tragedy and a relief at once. By May, my colleagues and I felt that the worst was behind us. I was exhausted after what we’d just been through, but also strangely hopeful that the city could progress toward the smaller, fairer jail system that it had promised.
But the summer brought a sharp reversal of momentum. Civil unrest after George Floyd’s murder provoked new anxiety about crime, and increased tensions between the community and the police. Gun violence and homicides were rising across the country. Prison-release efforts slowed, and jails started to fill back up. This inflow of detainees around the country was met with diminished jail outflow: throughout the pandemic, courts have operated at severely reduced capacity, meaning that people stay in jail longer. Our patients, many of whom lost loved ones to the virus, were traumatized, restless, and despondent as their cases dragged on without being resolved.
When New York City’s second COVID wave arrived, in late 2020, there was no concomitant wave of decarceration. The District Attorneys’ offices seemed tired of being told that they couldn’t send people to jail. My colleagues and I continued to submit letters attesting to our patients’ risk of getting sick from the virus, but we were told by public defenders and prosecutors alike that no one was taking our pleas seriously anymore.
I was going on maternity leave in December. The week after Thanksgiving, I walked around the infirmary again to say goodbye to my favorite patients. I told them all I hoped that they wouldn’t be there when I returned in six months. “I’ll be here,” one man whom I loved said ruefully; we’d petitioned for his release several times without success, despite the fact that he was paralyzed, bed-bound, and had three children at home waiting for him. Another patient had recently returned to Rikers after a stint in an ICE detention facility upstate. “It was so much worse there,” he said. “They wanted to let us die.”
Through the first half of 2021, COVID rates in New York’s jails remained on par with or lower than community rates, likely owing to some combination of high natural-immunity rates and strong infection-control measures. The impact of the virus was primarily felt through secondary effects. Correctional systems around the country, including ours, had halted in-person visits to facilities. Programming had also been severely curtailed, and in-person appearances to court were cancelled. On Rikers Island, intakes had all been rerouted through a single jail facility, which created a bottleneck in the system.
I returned from leave just in time for the Delta wave that summer. By this point, vaccines had been available for some time, but uptake among detainees was spotty. I walked around one of the tougher buildings with my favorite nurse and physician’s assistant as they reassured, cajoled, and sparred with guys who were reluctant to take the shot. “You ever been offered cash for getting medical care from the government before?” said one man, who was suspicious of the financial incentive that the city was offering to people who got vaccinated. Another said that he’d consider taking the vaccine in exchange for his release. “You go back out there and tell them: Pfizer for Pfreedom,” he said to me.
But none of the people who had the power to make our patients free were particularly interested in doing so any more. The N.Y.P.D. commissioner, Dermot Shea, consistently blamed decreased use of pretrial detention for rising crime, even as the data proved otherwise, and the Mayor did not contradict him. Progressive politicians found themselves in the position of defending previous criminal-justice reforms against an onslaught of misplaced criticism toward bail-reform and release policies established during the first wave of the pandemic.
Meanwhile, the Department of Correction was hitting an all-time low in terms of morale and performance, and officers stopped showing up to work. The jails were plagued by violence, increased rates of self-harm and suicide, chaotic operational issues, and increased numbers of drug overdoses. A federal monitor appointed by the Department of Justice noted “deterioration of basic security protocols and denial of basic services and protections.” In late summer, 2021, COVID rates on the island rose again, fuelled by a crisis in the crowded intake area, where hundreds of men were being held for days in close quarters without receiving medical care.
I toured intake one morning with one of my team’s social workers, Justin Butler, and was shocked by what we saw: cages of hundreds of men, most of them Black, standing in urine and feces, their arms through the bars, yelling for help. A nurse showed us a shower stall that had been turned into a makeshift segregation cell, where a twenty-five year old named Brandon Rodriguez had died by suicide the week before. Then she pulled us out of the area, just as a fight broke out: the officers were about to use pepper spray to disperse the crowd and regain temporary control of the tight, unventilated space.
De Blasio had avoided visiting Rikers for the entirety of his second term, and through August and September of 2021 he avoided doing so, even as the crisis escalated and the deaths piled up. He also declined to use 6-A—the state law that gives a New York City mayor the power to release people being detained for misdemeanor violations, which de Blasio had used earlier in the pandemic. He seemed spooked by aggressive coverage in the New York Post about his use of the policy during the first months of the pandemic; the paper quoted anonymous law-enforcement sources as accusing him of trying to “release as many prisoners as he can,” despite evidence to the contrary. It became clear that the Mayor who had once promised to close Rikers had lost his appetite for reform.
Fifteen people died in Rikers custody in 2021. By year’s end, I would go to work and spend most of the day talking to my colleagues and patients about whether the prior day’s news coverage of the Rikers crisis had been accurate or not. During the pandemic, New York City’s embattled jail system has received the most attention of any correctional system in the country, but its implosion is part of a national trend: even as the fundamental problems with excessive incarceration have been exposed everywhere, old and flawed ideas about law and order are being repeated with new confidence, and nothing much has changed.
I began working in the jail system in 2016, inspired, in part, by the “Close Rikers” campaign. During my first three years in the job, crime in New York City was at a historic low and the jail census dropped day over day. Our agency was able to implement a host of effective, radical interventions, like expansion of methadone and Suboxone therapy for people who use drugs, and these measures made our patients safer. In a strange way, the apex of my job satisfaction coincided with the first wave of the pandemic: the alchemic mixture of fear and purpose made those weeks in March, 2020, exceptionally vivid. I thought that things couldn’t get worse, so they’d simply have to get better.
Two years later, however, we’ve made few of the major changes necessary to prepare us for the next existential threat. We let the punishment system decay under stress without dismantling it: during the week marking the two-year anniversary of the first COVID case in New York City’s jails, two detainees died within twenty-four hours of one another, and the federal monitor issued another report that remarked on the system’s “entrenched culture of dysfunction” and exceptional levels of violence. Universal health care, a universal basic income, a sustained child tax credit, paid sick leave, publicly funded child care, greener and cleaner buildings—we gestured toward some of these investments in an initial moment of panic, and then we pulled away, doubling down on systems that crack under pressure and let people fall through the floor.
In jails and prisons, every conflict has the potential to escalate into violence. The atmosphere is perennially tense, and it takes enormous work to overcome the mutual mistrust between staff and people who are incarcerated. For me, doctoring in a broken place required a sustaining belief that the place would become less broken as a result of my efforts. After what I had seen with Justin in intake that morning, I couldn’t sustain that belief any longer. The tenor of the work had changed; I was too upset to take good care of my patients. I was avoiding going into the jails altogether, and felt overwhelming relief whenever I would exit and hear the door clang and lock behind me.
I finally left the job in January of this year. I had none of that strange alchemy left in me; my adrenaline was gone, and so was my clarity and sense of purpose. I felt guilty saying goodbye to my patients, and even guiltier saying goodbye to my courageous and talented colleagues. But I didn’t feel any ambivalence driving off the island one last time. I was done.
