Wizdom Powell, Ph.D., is an associate professor of psychiatry and the director of the Health Disparities Institute at UConn Health, part of the University of Connecticut in Farmington. In this article, she discusses the impact of COVID-19 on those who are or have recently been incarcerated.

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The number of justice-involved people with COVID-19 may be much higher than some statistics indicate.

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COVID-19 has claimed the lives of more than 900 people housed in state and federal prisons in the United States. The Marshall Project indicates that more than 100,000 people in carceral settings have received a diagnosis of COVID-19.

However, epidemiologists (people who study the outbreaks of diseases) warn that data collection gaps and inconsistencies contribute to a gross underestimation of the impact that COVID-19 has on justice-involved individuals, especially those housed in our nation’s jails.

In fact, the American Civil Liberties Union (ACLU) projects a more significant increase in COVID-19 fatalities in jailed populations than previously calculated by federal officials.

The projected and preventable loss of life from COVID-19 in carceral settings will also be compounded by other deaths of despair among justice-involved citizens who often enter them with complex traumas, substance abuse diagnoses, histories of suicidality, and other behavioral health challenges.

Such challenges are notably deepened by daily dehumanizing experiences with corrections staff and inmates, as well as the seemingly now commonplace use of solitary confinement to slow COVID-19 spread.

We rely on carceral settings to provide a range of behavioral healthcare, which was woefully inadequate even without the additional demands produced by COVID-19.

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Carceral settings are dark and foreboding spaces akin to the basement described in Ursula K. Le Guin’s haunting philosophical essay, The Ones Who Walk Away from Omelas.

They result from the bargains society makes in return for a largely illusory sense of happiness and pubic safety. To be clear, people have drawn analogies between Le Guin’s essay and justice system failures before. My first introduction to the essay came during my stint as a 2016 Aspen Health Innovator Fellow.

The essay opens with a vivid celebratory scene of Omelas’ summer festival. As the story unfolds, we learn about the citizens of Omelas and their preoccupation with carnal pleasures. The city appears idyllic. Yet, we soon discover that Omelas has an open secret residing in the basement of one of its public buildings — an abandoned and abused child.

Most of Omelas’ citizens appear to accept this child’s abuse as a prerequisite for their utopian existence. However, some walk away for undisclosed reasons.

Each time I revisit this prose, I glean something more from the side by side realities of those joyously participating in the festival, the child in the excrement-filled basement whose circumstances are well known to the city’s residents, and those who chose to walk away.

Our neglect of justice-involved populations during the COVID-19 pandemic reminds me that, like Omelas, we are a nation disturbingly accustomed to looking away from the abominable miseries faced by the largely Black, Indigenous, and People of Color (BIPoC) confined in our carceral basements.

We seemingly bury them alive in the mistaken belief that we are maintaining law and order — even in the midst of a pandemic when some are raging against a parallel sense of curtailed individual freedoms.

While COVID-19 spurs compassionate release and other decarceration efforts, it is unclear how many BIPoC are benefiting, and whether those released receive adequate transition supports, especially for behavioral health and trauma.

Even more alarming are data compiled by the Prison Policy Initiative, citing increases in 71% of the jail populations they are tracking across the U.S.

Returning citizens who manage to secure early release are re-entering communities hardest hit medically and socioeconomically by COVID-19. They are also returning to a world fundamentally altered by time lost to incarceration, new and different rules of physical and social engagement, extreme political polarization, and heightened racial unrest.

Alone, these factors should remind us that a perfect storm of widening health disparities is brewing among justice-involved populations and the communities they are returning to. However, it is the lack of coordinated behavioral and trauma recovery supports for justice-involved citizens admitted into carceral settings and returning to our communities that should keep us up at night.

Nighttime is when I find myself increasingly reflecting on Kalief Browder’s carceral experience. As a trauma psychologist, I have had the privilege of bearing witness to harrowing stories about trauma exposure, response, and resilience, often from our nation’s bravest service members and veterans. And yet, none of the stories I’ve heard have haunted me more than Kalief’s.

Kalief Browder is the 16-year-old Black male arrested in 2010 for allegedly stealing a backpack. He refused a plea agreement and was subsequently released without conviction following a torturous roughly 3-year period of incarceration at New York City’s Rikers Island.

On June 6, 2015, Kalief Browder committed suicide. We can see Kalief as a representation of the child in Omela’s basement.

Most people are aware of the tragic circumstances surrounding Kalief’s unsubstantiated arrest and prolonged period in solitary confinement at Rikers Island. Some may also be aware of his fearless leap into justice reform advocacy almost immediately after being released without being charged or convicted.

However, few people know about what happened to Kalief when he returned home to a community lacking the kinds of therapeutic resources he so desperately needed. Many other triumphs and tragedies befell Kalief during his transition from Rikers Island.

For example, he enrolled at Bronx Community College and went on a media tour in an effort to expose conditions in carceral settings. The moving Netflix documentary Time also chronicles his mental health decline and attempts to secure mental health treatment.

We would be wise to revisit Kalief’s whole story and the many lessons it reveals about the traumatizing impacts of solitary confinement, limited access to carceral mental health care, and the lack of coordinated supports for community re-entry.

We failed Kalief and are repeating these failures as we stumble our way towards plans to address the myriad COVID-19 fallouts in carceral settings.

Now would be the time to advocate for the justice reforms that Kalief fought during his short life. We could honor his memory by increasing and coordinating investments in clinical community integration programs. These schemes encourage tailoring clinical services to fit an individual’s unique experiences and tackling their unmet social needs. Such programs could play an essential role in connecting returning citizens to integrated behavioral and primary care services.

States that have not expanded Medicaid could consider doing so, especially since the Affordable Care Act created enhanced provisions allowing individuals in carceral settings to enroll and extend coverage upon release under specific conditions. These policy levers are readily available as are the commonsense reforms suggested by the Prison Policy Initiative, which include granting parole to a wider net of eligible or near-eligible individuals.

There are also opportunities to improve the daily living conditions and restore dignity to the countless incarcerated men, women, and children who are paying their societal debts. For instance, David McQuire, Executive Director of Connecticut’s American Civil Liberties Union (ACLU), reached a settlement with the Department of Corrections that require them to provide regular access to showers with running water, antiseptic cleaning supplies, soap, and functional masks.

The moral and ethical dilemmas of this moment are daunting but familiar. I am unsure if it is any better to be among those who walked away or those who were content living in Omelas amidst such marked dehumanization.

However, I believe that we will evolve into a more merciful and just nation when we are willing to confront our reckless disregard of the many Kalief Browders whose names we will never say.

We need to do more than simply reject the argument presented to us in LeGuin’s thought experiment, which essentially suggests that some lives are dispensable to preserve the perceived greater good, such as those housed in carceral settings.

Perhaps in this time of justice awakening and deepened empathy, reimagined political will might also emerge along with an acceptance that the specific links between structural racism and COVID-19 are confining us all to the very basements that some of us would much rather walk away from.