This week, the Cook County Sheriff’s Office issued a press release confirming one case of monkeypox at the Cook County Jail, whose population of incarcerated people is generally at least 5,000. The announcement takes pains to point out (1) that the individual “is believed to have contracted the virus in the community prior to being ordered into custody at the Jail;” and (2) “[d]ue to the vast experience gained in combatting the spread of COVID-19, many key protocols are already in place to combat monkeypox, including medical isolation, quarantine, screening, and testing.”
This appears to be the first confirmed monkeypox case in a correctional facility, but it will be far from the last. (In mid-July, someone in the Dallas County jail was tested for monkeypox, but the result was negative.) In response, the Cook County Sheriff’s Office announced that public health employees “will go to the jail on Tuesday to provide education, testing, and vaccinations for eligible people.”
Sheriffs and jailers – along with many other public officials — have been downplaying the severity of monkeypox, some commenting that it’s “like chickenpox.” And it is, if chickenpox required hospitalization for intra-anal, pus-filled lesions that can have life-threatening consequences.
It would appear that correctional authorities and sheriffs have not learned the lessons of the COVID-19 pandemic, in which incarcerated people died at much higher rates than those not in correctional facilities. As attorney Aaron Littman — an assistant professor at UCLA Law School and Acting Director of the UCLA Law COVID Behind Bars Project — tweeted, “Recent experience with COVID suggests that jails and prisons will struggle and largely fail to control the spread of monkeypox among the people they confine, who will likely suffer infection and illness at higher rates than in the surrounding communities.”
Because this outbreak of monkeypox has been closely associated with men who have sex with men — who already face stigma, marginalization, and criminalization — there is an additional risk of harm in correctional settings. LGBTQ+ people are more likely to be arrested and incarcerated and more likely to be sexually victimized, all worsening their health outcomes (in addition to being, you know, bad in their own right). Much as happened early in AIDS, even as monkeypox affects other than gay men, public health systems have responded particularly poorly, and correctional facilities much more so. The National Sheriff Association has not posted about monkeypox outbreaks or how to prevent them. Even the Cook County Sheriff’s Office, which issued a formal press release, has not posted information to its social media accounts on the outbreak as of the time this is published. Monkeypox does not yet have its Ryan White.
In part, this may be because of the federal government’s incompetent vaccine policy decisions that have helped lead to a lack of available vaccine doses. Despite quick production and rollout of the COVID-19 vaccine, for example, there has never been a consistent way in which people received it. In jails and prisons, the problems were compounded by administrative inefficiencies, a lack of data, and – quite frankly, if we are honest – a lack of interest or concern. New York and other cities have experienced both a shortage of monkeypox vaccines for distribution as well as problems with appointment scheduling and access. There have also been problems with diagnosis, testing, and treatment because of a lack of physician knowledge and longstanding inequities in health care.
Back when COVID-19 first appeared, it was clear it would become a massive pandemic in congregate settings, including correctional facilities. Many advocates called for the release of people from jails and prisons, focusing on those most at risk, like the elderly or those with other chronic conditions, as well as those in county jails being held pretrial. Even as the pandemic raged and continues to rage, a disproportionate number of incarcerated people have been infected with the virus.
While some jails and prisons did release people, many did not, and those reductions in population were short-lived. According to Vera, by 2021, jail and prison populations had rebounded to pre-pandemic levels or more.
The coronavirus pandemic should have taught us that jails are incubators for disease, impacting not just people who live and work there, but also the surrounding community. In many cases, guards were the ones spreading the disease, bringing it home to their families and loved ones. Jail “churn” – which means people cycling in and out of jail – is a particular danger because the population consists of people who are constantly going into the community and returning. According to the Prison Policy Initiative, “mass incarceration added more than a half million cases in just three months” during COVID. A study on the Cook County Jail, in particular, found that the facility was connected to almost 1 in 6 COVID-19 cases in Illinois
More than just the community health impact, however, it is important to value the people incarcerated inside jails and prisons as people deserving of health care. Most people in jails (around 60-85%) are incarcerated pretrial, meaning they have not yet been convicted. Many are also there for alleged violations of parole or probation, which often includes failing a mandatory drug test, traveling to a prohibited place, or possessing a firearm – acts that are not criminal for those without such formal restrictions. (Although why someone's pre- or post-trial status should matter when it comes to protection from a dangerous illness has no moral or ethical explanation.)
The failure to take action against monkeypox in jails and prisons trivializes the dangers of congregate living where resources are scant, cleanliness is not taken seriously, and officials ignore violence and a lack of preventative care. This can be a particular problem in jails, especially small ones, where health care is often determined by the sheriff – like the sheriff of Washington County, Arkansas, who hired a local doctor who gave incarcerated people ivermectin (without their consent). The sheriff hired him because he thought he was getting a good deal, a decision that went unquestioned by county officials until jokes about “dewormer” flooded the news. (“People are laughing at us,” one county official complained at the time.)
Even worse, sheriffs were often at the center of disinformation campaigns about COVID. They failed to implement health mandates among officers and in their counties, to distribute information to those incarcerated, and to provide clear and accurate data to governments and researchers — to say nothing of their unscientific pontifications to the public about vaccine efficacy. Right now, there is a lack of concern among sheriffs overall (they are more worried about non-existent election fraud), but one can quickly imagine how they will react – with negligence, disinformation, a lack of transparency, and a lack of empathy for incarcerated people and their families. One can only imagine how these responses will be all the worse for monkeypox not being an “innocent” disease in their eyes. Actually, we need not imagine. Jailers’ response to AIDS was a nightmare in the real world.
If we are moving into a new era of communicable diseases – diseases that may be much more deadly than coronavirus – that means we must also accept that mass incarceration, which came about in a historically anomalous era of low communicable disease rates, will mean mass suffering and eventually mass death. Decarceration is the only path forward. We can force millions of often already health-compromised fellow citizens through revolving doors into unsanitary, overcrowded, indifferent living conditions with effectively no access to healthcare. Or we can protect the broader community while ensuring the punishment for a dime bag is not death. We cannot do both.