Prison Systems Still Making COVID19-Era Mistakes

The last chapter of our book FESTER, which is already out from University of California Press, is called “The Next Plague.” We wrote it to warn everyone in prison administration, prison litigation, and politics, that if considerable reforms are not sought–chief among which is an aggressive 50% reduction in prison population, which we believe is feasible without a corresponding rise in crime rates–the next plague will provoke calamities in the same way this one has.

Two new pieces of information suggest that things are going the same way they had pre- and during COVID19. The first has to do with prison overcrowding and comes to me from the ever-attentive prison conditions activist Allison Villegas (thanks, Allison!) who diligently follows up the periodic population counts. Take a look at the latest:

Not only is the total number back up to 109,000–more than before COVID–but some prisons are so overcrowded that it looks as if Plata (which required population reductions to 137.5% capacity) never happened. Norco is at 171% capacity; Avenal is at 162% capacity. If Plata applied per individual prison, rather than system-wide (which would make more sense, as we explain in ch1 of FESTER), six prisons would currently be in violation of that standard. The entire system is at 117% capacity (design capacity is fewer than 79,000 people), Plata-compliant but not by much. This should never be the case if we are to maintain minimal healthcare standards and in many ways is the root of much of the evil we saw in Spring 2020.

The second piece of information comes from my colleague Dorit Rubinstein-Reiss. It is a Ninth Circuit decision regarding government accountability for the COVID vaccination fiasco in Oregon prisons, which you can read verbatim here. The lawsuit was brought by people incarcerated in Oregon, and claims that, during COVID-19, they were categorically assigned to a lower priority vaccination tier than correctional officers. In FESTER, we document a similar struggle in California, where the California Department of Public Health initially scheduled incarcerated people to receive the vaccine in tier A2, and then scratched that, to everyone’s amazement. At work, as we explain in the book, and as I explained in this op-ed, was a misguided zero-sum mentality that vaccines in prison somehow come at the expense of vaccines to other people–when, in fact, prisons and other congregated facility acted as incubators and loci of superspreader events. But here in California, the struggle was that, though prison guards were prioritized for the vaccine, they refused to take it, and their union was willing to go all the way to the Supreme Court to fight against it, with Gov. Newsom and AG Bonta’s support. We lost that fight, which is shameful, and this Oregon case is yet more proof of how and why the house always wins these kinds of lawsuits, no matter how meritorious they are: in this case, it turns out that Governor Allen and other state officials have immunity against the lawsuit that stems from the Public Readiness and Emergency Preparedness (“PREP”) Act.

Here’s how the parallel fight went down in Oregon:

The Oregon Health Authority then published guidance recommending phased allocation of the vaccines. In Phase 1A, healthcare personnel, residents in long-term care facilities, and corrections officers were eligible for vaccines. In Phase 1B, teachers, childcare workers, and persons age 65 or older were eligible. Neither phase categorically covered adults in custody (“AICs”), but AICs who met the eligibility criteria were prioritized for vaccination on the same terms as the general population. For example, all AICs who were 65 or older were eligible for vaccination in Phase 1B. The Governor’s initial rollout of the vaccines was consistent with OHA’s guidance.

In response, Plaintiffs amended their complaint to add class claims for injunctive relief and damages, alleging that the vaccine prioritization of corrections officers, but not all AICs, violated the Eighth Amendment’s prohibition against cruel and unusual punishment. On February 2, 2021, the district court certified a provisional class of all AICs who had not yet been offered a vaccine and granted Plaintiffs
preliminary injunctive relief, ordering the immediate prioritization of approximately 11,000 AICs for vaccination. Defendants complied with the court’s order.

In September 2021, when vaccines were no longer scarce, the district court dismissed as moot Plaintiffs’ claim for injunctive relief because all Oregonians (ages twelve and over) were eligible to receive a COVID-19 vaccine and vaccine supply in Oregon exceeded demand. Plaintiffs’ damages claims, however, remained.

Get it? After everyone got sick and died, then the vaccine was available, but by then, of course, the claim was moot. But even the revival of the case is of no avail, because the Ninth Circuit “conclude[s] that the vaccine
prioritization claim falls within the scope of covered claims because, under the PREP Act, “administration” of a covered countermeasure includes prioritization of that countermeasure when its supply is limited.”

This is exactly the point we make in FESTER. What with prevarications, immunities, and continuances, courts adjudicating prison health matters as such are the worst place to seek justice in a timely manner. And since politicians know that protecting incarcerated people, particularly those who are old and infirm, is never an electorally wise move, and that shortchanging and sandbagging the prison population can happen with immunity, how is there ever going to be motivation to vaccinate and decarcerate, the two things that must happen the next time a big one comes along?

The Zero-Sum Game of Epidemiology

One of the problems of siloed reporting is that, in times of serious conflict, each side can remain isolated from news of suffering and horror on the other side. It’s understandable that parties to the horrific war in the Middle East can’t muster the attention, let alone the compassion, to read news from the “other side,” which explains why a San Francisco man telling of the slaughter of five family members by Hamas was met with jeers, horns, and pig noises, and why Matt Dorsey’s request that the sexual violence against Israeli women be similarly denounced yielded yells “liar” from my fellow San Franciscans. In my very institution, an educated, erudite, well-dressed man, a former colleague of many years, stood before an audience of 200 and ascribed facts of the massacre to “disinformation.”

But the problem goes both ways, and the Israeli press is not reporting on the humanitarian crisis in Gaza (nor is it easy for international orgs to do so). The Israeli’s public’s attention and capacity to feel for Gazans is pretty low. And, as Itamar Mann explains, if there’s anything good about the Hague tribunal taking place as I write, it is that it airs some of these realities, which we ignore at everyone’s peril.

There’s one particular aspect to this disaster that we cannot and should not ignore, regardless of where one stand politically: the war is unearthing a serious public health crisis, including diseases. And as Chad Goerzen and I explain in our forthcoming book Fester, seeing disease through a siloed zero-sum game framework is a horrific mistake. Here’s NPR covering the WHO report about this public health crisis:

MARTÍNEZ: All right, wow, so really bad. How have things gotten so bad?

DANIEL: Well, Gaza’s health infrastructure has really crumbled amidst Israel’s bombardment and ground offensive. The WHO says more than half of Gaza’s hospitals are no longer functioning. And that’s because Israel has accused Hamas of harboring fighters and weapons in and around those hospitals and under them in tunnels, putting them in the line of fire [H.A.: this wording implies the accusations were not true; they were, of course]. Plus, the conditions inside Gaza are a perfect storm for the spread of infectious disease. There is intense overcrowding, colder winter weather and a lack of clean water, sanitation and proper nutrition, which are services that are difficult to secure under Israel’s near-total siege of Gaza. Here’s Amber Alayyan, deputy program manager for Doctors Without Borders in the Palestinian territories.

AMBER ALAYYAN: It’s just sort of a cauldron of possibility of infectious disease. This really just is an infectious disaster in waiting.

MARTÍNEZ: And that brings us back, I suppose, to the World Health Organization’s prediction that disease could endanger more lives than military action.

DANIEL: Exactly. And it’s why global health groups are racing to ramp up disease surveillance efforts.

Anyone getting sick and dying from a preventable disease in the shadow of conflict is a tragedy. There are heartbreaking reports of Gazan children suffering from horrendous diarrhea and infections. But when one is overwhelmed with grief and rage it’s hard to see that. What should not be hard to see, though, is that viruses and epidemics don’t take sides.

I’ve had plenty of opportunity to see the zero-sum game mentality in action. In Chapter 4 of Fester we recount the public debate about vaccination priority. You’ll be able to notice the same thinking error problem right away:

Advocates were trying to combat disturbing news: kowtowing to public pressure not to prioritize prisoners, CDPH removed prison populations from tier 1B of vaccination. This misguided zero-sum thinking—based, of course, on the myth of prison impermeability—reflected similarly worrisome developments nationwide. In Colorado, for example, the first draft of the vaccine distribution plan prioritized the prison population, but the governor later backtracked, “sa[ying] during a media briefing that prisoners would not get the vaccine before ‘free people.’” His response caused public uproar and was reported in national media outlets.

Similarly, in Wisconsin, parroting the old law-and-order playbook, assemblymember Mark Born tweeted, “The committee that advises @GovEvers and his department tasked with leading during this pandemic is recommend- ing allowing prisoners to receive the vaccine before 65 year old grandma?”

And, in Tennessee, health officials placed the state’s prison population last in line, because a state advisory panel tasked with vaccine prioritization, which acknowledged that prison populations were high-risk, concluded that prioritizing them could be a “public relations nightmare.” Documents reported that the panel understood the problem: “If we get hit hard in jails it affects the whole community. Disease leaves corrections facilities and reenters general society as inmates cycle out of their sentencing,” the document read, adding that when inmates get the disease, “it is the taxpayers that have to absorb the bill for treatment.” But while corrections workers were bumped up to one of the earliest slots, incarcerated people—including those who met the state’s age qualifications for earlier vaccinations—were relegated to the last eligible group.

I knew this was public health idiocy even as it was happening, and wrote an op-ed about that for the Chron. In addition to the heightened mortality and supbpar healthcare in prisons, there was another important consideration that should have led everyone, bleeding-heart liberals and hard-line law-and-order folks alike, to clamor for prison vaccines:

Second, prisons must be prioritized because vaccinating behind bars protects everyone in the state. It is imperative to understand the role that prison outbreaks play in the overall COVID picture of the state. As of today, all but two CDCR facilities have COVID-19 outbreaks, and numerous prisons have suffered serious outbreaks with hundreds of cases. Months of analysis I have conducted, superimposing the CDCR infection rates onto the infection in California counties at large, show correlations between pandemic spikes in prison and in the surrounding and neighboring counties. Vaccinating people behind bars protects not only them, but also you and yours.

The result was disastrous but predictable. In Chapter 5 of Fester we show how prison outbreaks impacted the overall COVID-19 picture in California. Our epidemiological analysis, which relies on the Bradford Hill criteria, included a counterfactual model in which the outbreaks in prison were controlled. The results were striking:

Together, these show that due to the extraordinarily high prevalence of COVID-19 cases inside CDCR facilities, particularly during the year 2020, these facilities had a large influence on their regions, far more than their rela- tively small population and isolation would suggest. Note the difference between the total casualties in Marin County with and without the counter- factual—58 deaths, 22 percent of the COVID-19 deaths in Marin for this period—and the difference between the total casualties in California with- out CDCR facilities—11,974 deaths, or 18.5 percent of the COVID-19 deaths in California for this period. Furthermore, the outbreaks in San Quentin and CDCR occurred before vaccinations were publicly available and before effective treatments for COVID-19 were developed, making them particularly high impact on mortality.

That’s close to 12,000 preventable deaths in the state of California–outside prisons–that are causally attributable to the outbreaks in prisons. We point this out because even people who can’t find compassion for their fellow Californians behind bars should wake up to the fact that, if the incarcerated population ails, all of us are put at risk.

Israeli newspaper coverage does not feature the dire epidemiological threat, because people’s attention is focused on the more direct existential risk from the war (especially with the possibility of a northern front becoming more and more real every day.) In the overall noise of political partisanship we could forget how densely populated the Middle East is, and how soldiers go in and out of Gaza. We also forget how easily epidemics travel the world and could quickly spread beyond the Middle East. I realize I’m speaking to a wall of partisanship, rage, and fear. I worry that the halt in the process of releasing hostages and prisoners is going to make this as much of a quickening sand situation as Lebanon was, and that eventually the public health outcomes will decide this conflict, to the detriment of everyone.

News! FESTER Available for Preorder

Fester Book Cover

We’re live! FESTER, my book with Chad Goerzen about the COVID-19 catastrophe in California prisons and jails, is available for preorder on the UC Press website and on Amazon. The official publication date is March 2024.

From the back jacket:

The mismanagement of the COVID-19 pandemic in California’s prisons stands out as the state’s worst-ever medical catastrophe in a carceral setting. In Fester, socio-legal scholar Hadar Aviram and data scientist Chad Goerzen offer a cultural history of the COVID-19 correctional disaster through hundreds of first-person accounts, months of courtroom observations, years of carefully collected quantitative data, and a wealth of policy documents. Bearing witness to the immense suffering wrought on people behind bars through dehumanization, fear, and ignorance, Fester explains how the carceral system’s cruelty threatens the health and well-being not only of those caught in its grasp, but all Californians—and stands as a monument to the brave coalition of incarcerated and formerly incarcerated people, family members and loved ones, advocates and activists, doctors, journalists, and lawyers who fought to shed light on one of the Golden State’s correctional system’s darkest times.

If you’d like us to come to your campus or bookstore in Spring 2024 and beyond, please contact us and we’ll make it happen.

FESTER Blurb from UCI’s Keramet Reiter

Fester Book Cover

Another great endorsement for FESTER comes from Prof. Keramet Reiter of UC Irvine, one of the nation’s most respected and productive scholars of extreme punishment and incarceration and the author of 23/7: Pelican Bay Prison and the Rise of Long-Term Solitary Confinement. Keramet is the director of UCI LIFTED, a phenomenal higher education program granting incarcerated people access to, and degrees from, UC Irvine, and also spearheaded the Prison Pandemic project, which collected first-hand accounts of COVID-19 in prisons and was one of our best primary sources.

Here is Keramet’s endorsement for FESTER:

Aviram, with Goerzen, has produced another tour de force unpacking a new legitimation crisis in California’s punishment infrastructure. Marshalling evidence from litigation, first-person narratives, administrative data compilations, and their own advocacy work, Aviram and Goerzen meticulously analyze how COVID-19 outbreaks in California prisons and jails cruelly terrorized incarcerated people and also exacerbated health risks in the surrounding communities. Impressively, the book reads like a true crime thriller – about the horrors wrought not by the people inside prisons but by the people running and overseeing those prisons. Poignant details of everyday life in prisons in crisis make vivid the book’s pointed policy critiques: information gaps about criminal legal system practices, in combination with dangerously inaccurate assumptions about the impermeability of prisons and jails, produce dangerous incarceration conditions. And dangerous incarceration conditions put us all at risk.

FESTER Blurb from the Chronicle’s Jason Fagone

Fester Book Cover

I’m very pleased to share the first book blurb for FESTER, from star journalist and author Jason Fagone. As a reminder, Jason was part of the San Francisco Chronicle team that broke the story of the San Quentin outbreak. He is also the author of a terrific nonfiction book, The Woman Who Smashed Codes: A True Story of Love, Spies, and the Unlikely Heroine Who Outwitted America’s Enemies.

Here is what Jason has to say about FESTER:

Myths can kill, and FESTER dissects a vicious one: the idea that prisons are worlds apart, isolated from their surrounding communities. With passion, rigor, and a flair for storytelling, Aviram and Goerzen show how California’s fealty to this myth placed whole cities at risk during the coronavirus pandemic, transforming the state’s overcrowded prisons into virus bombs that exploded outward. An indictment of a failed system and the politicians and judges who prop it up, this stunning book is also a call to action, laying out reforms that could save lives the next time a deadly virus proves that we’re all connected.

First Peek at the Cover Art for FESTER

Fester Book Cover

Last night we were ecstatic to receive the cover art for FESTER. UC Press has always done right by me–we had a back-and-forth about Yesterday’s Monsters that was very productive, and to this day people remember Cheap on Crime as “the one with the stripes”–but I think this is the best cover they’ve designed for me so far. I like it for three main reasons:

(1) The color. THE COLOR! I love it! Sickness green. You can’t avoid it. You can’t ignore it. It’s so sick. It’s so sickening. It’s the color of miasma and nausea. It evokes with such visceral precision the story we tell in the book. And, people will remember “that green one.”

(2) The map. This was my proposal to the press, and I’m really glad they took me up on it; the execution, of course, is much nicer and cleaner than anything I could’ve possibly produced. You’ll notice it is a map of California, with coronaviruses indicating the locations of CDCR prisons. Inside the book, in Chapter 5, you’ll see another version of this map, which overlays the prison locations on the entire state’s COVID-19 map, which we think drives home the point we make there, and throughout the book: when and where people get sick behind bars, everything around them is sick, because prison is not isolated from its surroundings, but rather along a continuum. I love that this spatial idea, according to which we are not safer when our fellow Californians age and ail behind bars, made it to the cover in such a neat, communicative way.

(3) The font and the way the word breaks down the middle. They could’ve written it on the diagonal, or in smaller print, but they wanted it to be HUGE.And it *should* be huge. We’ve been spelling FESTER in all-caps for a reason, and I’m so glad they kept it that way for the cover. It is only now, presented with the cover art, that friends of mine are finally “getting” the title: it’s not just the disease that is festering. It’s the massive neglect and dehumanization that festered there for decades. The outbreak is nothing more than a trigger that activated existing vulnerabilities. And don’t forget how the coronavirus permeates not only the state map, but also the letters. Everything about this cover is overlaid and permeable.

We are told that FESTER copies will be at the warehouse in January and available in bookstores, brick-and-mortar and online, in March. I will keep you all posted as to developments and as to the book party and tour.